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Healthy Aging Habits

Healthy aging month banner

Whether we like it or not, aging is a natural and essential part of life. Many people resent the aging process because of the simple fact that our bodies begin to change and even break down a bit as we age. However, the unfortunate effects of aging can be slowed down by practicing healthy aging habits in our younger years. Although it’s better to start earlier, there are still benefits no matter when you start practicing these habits. 


The month of September is Healthy Aging Month whose purpose is to provide inspiration and practical ways to improve your physical, mental, social, and financial health. Although this awareness is aimed at adults over the age of 45, most of these habits can prove beneficial to younger ages as well. 


Healthy Aging Month’s founder, Carolyn Worthington who is editor-in-chief of Healthy Aging® Magazine and executive director of Healthy Aging®, purposely picked the month of September for raising awareness. She notes that she hopes to use the “back to school” mentality to help individuals take stock of their lives and set new goals moving forward. 


At Overlake Internal Medicine Associates, we are devoted to your health, as well as helping you set and reach health-related goals. As such, we have composed a list of healthy aging habits that you can implement in your daily life for happier living and healthier aging: 


Pay Attention to Your Diet: 

Fruits and vegetables

What you eat, as well as how much you eat, are extremely important when considering your overall health and how your body will age. Foods that are high in sugars, carbs, and fats can accelerate the aging process, making you feel older than you actually are. When combined with overeating, as many of us are all guilty of at one time or another, these foods can cause cardiovascular disease, type 2 diabetes, high blood pressure, and a shorter lifespan. 


Instead, it is recommended to eat lean protein, whole grains, and fruits and vegetables that are low on the glycemic index. Foods that are high in omega-3 fatty acids are also recommended. In addition to eating food that is better for you, you also need to watch how much you are eating. It is recommended that you eat a balanced diet consisting of about 2.5 cups of vegetables, 1.5-2 cups of fruit, six ounces of grains, three cups of dairy, and five ounces of protein daily. 



In addition to diet, staying active is another key factor is staying healthy. Unfortunately, a natural part of aging is the loss of muscle tissue. To combat muscle loss, resistance workouts can help you build and maintain your muscle mass despite your age. It has also been said that as little as 5 minutes of vigorous exercise a day offers benefits. 


The key with exercise is to stay somewhat consistent. You should be moving everyday or almost everyday. To stay active, it is important to practice proper stretching and to not over exert yourself or injure yourself during your workout. Additionally, if you are exercising with arthritis or other conditions you will need to learn how to manage that condition while exercising. 



Sleep is important for many reasons such as having enough energy during the daytime, improving memory, and even hormone regulation. Consequently, a lack of sleep can cause serious issues including obesity, heart disease, diabetes, and accelerated aging of the brain. To make sure you are getting the most benefits from sleep, it is recommended by the National Sleep Foundation that you get 7-9 hours of sleep every night. 


Stay Connected: 

Maintaining with relationships with family and friends is highly important to your health. Establishing and maintaining a support system with people you can trust helps you to better deal with stress. This, in turn, decreases the amount of cortisol (stress hormone) in your body and slows the aging process. Social relationships are so powerful, in fact, that a study published in the journal PLoS Medicine found that those with strong social relationships are 50% more likely to live longer than those who are not as social. 


Protect Yourself from the Sun: 

Woman's back with a sun made out of sunscreen

As wonderful as the sun is, overexposure can pose a threat to your health. While UV radiation does help your body produce vitamin D, after a few unprotected minutes in the sun it starts to do more harm than good. Too much sun can cause your skin to age prematurely and develop wrinkles. Additionally, too much sun can also result in skin cancer and cataracts. To avoid this, be sure to wear sunscreen to protect your skin and sunglasses to protect your eyes. 


Take Advantage of Preventative Services: 

While no one is excited about their yearly physical or the various medical tests that come with it, these services are highly important to preventing or identifying possible medical issues early on. With most health conditions, the sooner they are diagnosed, the sooner they can be treated and the better the treatment outcome. 


Practice Positivity: 

Your attitude regarding aging can affect all other areas of your health. According to the Journal of the American Medical Association, senior with a positive attitude towards aging are 40% more likely to bounce back from a disability than those who express a negative attitude. Additionally, practicing daily positivity and surrounding yourself with positive people will increase your overall level of happiness and satisfaction. 


Take Care of Your Teeth: Woman brushing her teeth

Smiling regularly can improve your mood, however many people avoid smiling because they have decayed or missing teeth. The American Dental Association recommends you visit your dentist at least once every six months for regular dental checkups and professional teeth cleanings. This will help to keep your teeth in the best shape possible and preserve your natural smile. Modern dentistry even has a variety of options for restoring decayed or missing teeth so that you can continue to smile, eat, and speak properly. 


Maintain Your Brain: 

Just as your body needs physical exercise to maintain muscle structure and be healthy, your brain requires mental exercise. Anything that strains your brain or forces you to learn something new is a great way to exercise your brain. Some examples of brain exercise include: games, puzzles, learning a new skill, doing math in your head, or memory games. 


Are you up to date on preventative medical services? Do you want to learn more about healthy aging habits? Schedule a consultation with one of internal medicine specialists at Overlake Internal Medicine Associates today!




How to Prevent Hearing Loss

Close up of a man putting his hand to his ear with a circle around the ear canal indicating hearing loss

Hearing loss is one of the most common medical conditions around the world. In the United States alone, about one third of adults ages 65-75 and about one half of adults over the age of 75 suffer from some form of hearing loss. 


To understand more about hearing loss and why it occurs, we must first take a look at the human ear and how it functions. The human ear is broken up into three main parts: outer, middle, and inner. The outer ear is the part of your ear that is visible on either side of your face, which is known as the pinna. The ear canal is also considered to be part of your outer ear. The main function of the outer ear is to gather sound waves and funnel them into the ear. 

Anatomy diagram of the ear

The middle ear is an air-filled sac that sits just behind your eardrum. Within your middle ear are the hammer, anvil, and stirrup bones that are named according to their shape. These are some of the smallest bones in the human body and they vibrate along with the eardrum to process sound waves. The middle ear is also connected to the back of your nose and throat by the Eustachian, or auditory, tube. This tube plays an important role because it helps to equalize the pressure and drain fluids as needed. 


Finally, the inner ear is made up of fluid-filled chambers called the semicircular canals and cochlea. Sound waves travel through the stirrup bone to the fluids of the cochlea where they travel through the semicircular canals and are converted into electrical impulses. Once they have been converted, the electrical impulses are transmitted to the brain via the auditory nerve. 


Because the ear is composed of three key regions, there are three different types of hearing loss that can occur depending on the region of the ear that is affected. Namely these are conductive, sensorineural, and mixed. Conductive hearing loss describes hearing loss that affects the outer or middle ear, sensorineural hearing loss affects the inner ear, and mixed hearing loss is a combination of the two. 


Hearing loss can occur for a variety of reasons including damage to the inner ear from aging or exposure to loud noise, a buildup of wax, ear infections, ear growths or tumors, or a ruptured eardrum. In fact, exposure to loud noises is a common cause of hearing loss. Over time, loud noises can cause more wear and tear on inner ear structures, such as the cochlea. When sound waves are not transmitted into electrical signals effectively, then hearing loss can occur. 

Woman having an ear exam

Certain types of hearing loss can also be caused by certain things. For example, conductive hearing loss is usually the result of ear infections, ear wax, ear trauma, or any other disease or damage that affects the outer or middle ear. Depending on the cause and severity of the issue, conductive hearing loss can usually be restored over time. Sensorineural hearing loss, on the other hand, is generally caused by damage to the nerves that convert and carry sound signals to the brain. Because the nerves are damaged, there is no way to restore sensorineural hearing loss and a hearing aid is often suggested. Sadly enough, when you are exposed to loud noises and you can feel your ears buzzing or ringing, that often means some of your nerve cells may have died. 


Now that we have a better idea of the ear’s anatomy, its function, and what causes hearing loss, let’s take a look at some ways that we can prevent hearing loss. 


  • Minimize exposure to loud noises: hearing loss due to constant exposure to loud noises is completely preventable. Loud noise is defined as anything over 85 decibels. To give you a reference, a normal conversation is about 45 decibels, heavy traffic is about 85 decibels, and a firecracker is about 120 decibels. You can also minimize loud sounds by reducing the amount of time you are exposed to them. 
  • Watch your music volume: while it is tempting to listen to your music loudly, doing so causes excess wear and tear on your ears. If you find yourself needing to speak louder to talk to someone, your music is likely too loud. Even though headphones may seem innocent enough, if the decibel is over 85, you are constantly exposing your ears to “loud noises”. 

Man at work wearing heavy duty earmuffs

  • Use protective ear wear: If you intend on participating in activities with loud noises, you should come prepared with ear plugs or earmuffs to minimize the damage done to your ears. Ear plugs are made of foam or rubber and are tiny enough to fit comfortably inside your ear canal. Once inside, ear plugs can reduce sounds by 15-30 decibels. This means that you will still be able to hear things around you, but the sound will be muted so that it does not damage your ears. Earmuffs have the same principle, however they are worn over your ears instead of inside them.


  • Don’t smoke: smoking in general is detrimental to your health, however new studies are finding that those who smoke may be more likely to eventually lose their hearing. 
  • Clean your ears: ear wax is natural, however excess ear wax can lead to hearing problems and be uncomfortable. To keep your ear canals clean, it is recommended to use an at-home irrigation kit to soften and flush out wax. Although many people use cotton swabs, this is not recommended because it can damage your eardrum or simply push the wax farther back without actually removing it.  
  • Double check your medications: did you know that about 200 different types of antibiotics and cancer-fighting drugs can actually damage your hearing? Theses drugs are known as ototoxic drugs and they can cause the following symptoms: tinnitus, pressure in the ears, loss of balance, or dizziness and vertigo that can lead to nausea. The easiest way to find out if you are taking a medication that can harm your hearing is to speak with your doctor regarding the medication. 


If you are worried about losing your hearing or have other hearing loss concerns, we encourage you to Schedule a consultation with one of our internal medicine specialists at Overlake Internal Medicine Associates so we can conduct a baseline hearing test. 


Daily Habits That Can Lower Cholesterol

Chalkboard with "Cholesterol" written on it surrounded by a stethoscope


We all know that lowering our cholesterol is important to prevent heart attack or stroke. In fact, it is so important that our cholesterol levels are regularly checked at our yearly physicals. Although some levels of cholesterol are essential for proper body function, the trouble occurs when these levels become too high. Because cholesterol is a waxy substance, excess cholesterol can cause fatty deposits to develop in your blood vessels that can restrict blood flow or form a clot with the potential to cause a heart attack or stroke. 


There are two different types of cholesterol that are found in the blood, and both of these are tested during your routine cholesterol panel. When cholesterol connects to protein in the bloodstream, it is known as lipoprotein. Thus, the two types of cholesterol are low-density lipoprotein (LDL) and high-density lipoprotein (HDL). 


LDL is responsible for the transport of cholesterol through the body. It is also the type of cholesterol that ultimately sticks to the inside of your blood vessels and arteries. For this reason, it is often referred to as “bad cholesterol”. HDL, on the other hand, is responsible for transporting excess cholesterol to the liver. Because of this, HDL is known as “good cholesterol”. 


Your total cholesterol is a combination of these two types. Most people have higher LDL levels than HDL levels, but in some cases certain individuals can have high HDL levels that causes their overall cholesterol to be high. In general, however, most high cholesterol medications and advice is centered around reducing LDL cholesterol levels. 


Luckily, there are a number of steps you can take to reduce your LDL cholesterol and even boost your HDL cholesterol. Ultimately if you are serious about lowering your cholesterol, you will probably need to make a variety of lifestyle changes. While this may seem daunting at first, making a few changes at a time will help ease the transition. Also, the changes you make to lower your cholesterol will also have other health benefits as well and will improve your overall quality of life. Here are some lifestyle changes we suggest:



Close up of feet walking on a treadmill

Ugh, you had to know this one would be on the list, right? Well don’t panic, you don’t need to exercise to the point of complete exhaustion. In fact, you only need as little as 2.5 hours of brisk walking or about an hour of jogging a week to lower your cholesterol levels. 

Exercise is also beneficial because it can help you lose weight. Losing weight can help you reduce your cholesterol and has a range of other health benefits. In fact, losing only 5-10 lbs has been found to decrease your total cholesterol, LDL cholesterol, and triglyceride levels. 



Eat More Good Fats and Fiber: 

Unsaturated fats, also known as good fats, will not raise your cholesterol levels. These include: nuts, fish, avocados, and oils such as vegetable, olive, canola, and sunflower. Nuts are especially good to snack on because they leave you feeling more full and satisfied than traditional snack foods and are much healthier. 

There are two types of fiber found in plant foods: soluble and insoluble. Soluble fiber, in particular, helps to decrease your cholesterol levels by effectively reducing its ability to be absorbed into the bloodstream. Foods containing soluble fiber include: whole grains, beans, peas, fruits, and vegetables. 

Foods high in good cholesterol

Eat Less Bad Fats and Trans Fats: 

Saturated fats, also known as bad fats, are those that appear solid at room temperature. These include: red meat, pork and chicken products, and dairy products. The American Heart Association suggests that saturated fats should make up only 5-6% of your daily caloric intake, meaning that you should have less than 13 grams of saturated fat for every 2,000 calories you eat a day. 

Trans fats are artificial fats that are often found in baked goods, snack foods, frozen pizza, margarine, coffee creamer, vegetable shortenings, and refrigerated dough. Any ingredient that begins with the phrase “partially hydrogenated” indicates the presence of trans fat. Not only does trans fat increase your LDL levels, but it also actively decreases your HDL levels. 


Manage Alcohol Intake: 

Some studies have found that a moderate amount of alcohol can actually raise levels of HDL cholesterol, however this claim is still up for debate. A moderate amount of alcohol is about one daily drink for women and two daily drinks for men. Not only is excess alcohol intake bad for your cholesterol, but it can cause a range of other health problems including high blood pressure, heart failure, strokes, and liver problems. 


Quit Smoking: 

Smoking causes a range of health problems. In relation to cholesterol levels, smoking lowers HDL levels and makes it harder for the body to transport excess cholesterol from the blood to the liver. This means that most of the excess cholesterol stays in the bloodstream, increasing the risk of clogged arteries. 


Manage Stress: 

Woman doing yoga outside

Keeping your stress levels at bay is another way to improve your cholesterol. It has been found that chronic stress can raise LDL levels while simultaneously decreasing HDL levels. Exercise is a great stress reliever as well as yoga, reading, meeting with friends, and breathing techniques. Ultimately, you will have to find what works for you and then incorporate that into your routine when you feel stressed. 



Improve Your Cooking Methods: 

Although many traditional methods and recipes often call for shortening, oil, or butter, you can substitute with cooking spray or a healthier oil. Additionally, you should avoid frying and instead opt for baking, steaming, or broiling foods. Finally, you can use fat-free broths, herbs, spices, and lemon juice to add flavor to foods. 


Consider Medications or Supplements: 

Your doctor can provide you with medications that will help you lower your cholesterol. It is important to take any medication as prescribed and discuss any concerns about side effects with your doctor before discontinuing the medication. 

Additionally, certain supplements such as fish oil, psyllium, and coenzyme Q10 may also provide benefits to your cholesterol levels. Fish oil provides the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) which can raise HDL levels and reduce the risk of heart disease. Psyllium is a soluble fiber supplement that helps to reduce total and LDL cholesterol levels. Finally, coenzyme Q10 helps cells produce energy and can reduce total cholesterol levels. 



Do you know your cholesterol levels or are you looking for more information on how to lower and manage your cholesterol? Schedule a consultation with one of internal medicine specialists at Overlake Internal Medicine Associates today!



The Importance of Sleep

clock with the word "sleep" on a blue, starry background

Did you know that the average human spends about half their lifetime sleeping? Makes sense when you think about it. If the average lifespan is approximately 79 years and you sleep for about 8 hours a night, that equates to about 26 years of sleep.


Sounds like a lot of sleeping, right? Well actually that’s just about the right amount of sleep, according to the National Sleep Foundation. In fact, the NSF recommends that adults 18-64 get an average of 8 hours a night, while younger children and teenagers require even more sleep.


Yet, many people don’t get the required amount of sleep per night. With busy schedules, sleep is often the first thing to be sacrificed. Sleep patterns can also be negatively affected by a variety of factors that can make it hard to fall or stay asleep.


Harvard medical school quoted a recent study that noted an increasing number of people are sleeping for less than 6 hours a night. They also found that as many as 75% of individuals have problems sleeping a few nights every week.


While sleeping away 26 years of your life may seem extreme, this amount of sleep is quite necessary to make sure you get the most of your waking hours. In fact, it is right up there in importance level along with eating and drinking. Some scientists have even stated that people can live longer without food than they can without sleep.


When we sleep, we undergo something called the sleep cycle. The average person undergoes about 4-5 sleep cycles per night and each cycle lasts about 90-120 minutes. During a single sleep cycle, our brain goes through two different types of sleep: rapid-eye movement (REM) and non-REM. Our sleep cycle begins with non-REM sleep. There are three different stages that occur during non-REM sleep:


  • Stage 1: this is the transition between being awake and being asleep. During this period, your body starts to relax, but can easily be awoken. Some people are known to jerk or twitch during this stage.
  • Stage 2: this is where you enter light sleep and are not as easily awoken. During this period, your heart rate and breathing slow, and your overall body temperature decreases.
  • Stage 3: this is the deepest level of non-REM sleep and is where your body gets the most restoration. During this period, it is very difficult to be awoken. Also, sleepwalking, sleeptalking, and night terrors generally occur during this period.


Next, comes REM sleep. During REM sleep, your brain is highly active, which is why it is also known as the dreaming stage. You can also be more easily woken during REM sleep, however it will leave you feeling groggy. This is why you feel so tired when you wake up out of a dream.


Sleep cycles don’t operate in a sequential manner though. Instead, our bodies go through non-REM stages 1-2-3 and then backwards 3-2-1 before transitioning to REM sleep. Then the cycle starts again. Basically, it looks something like this:

Diagram of the average sleep cycle


Each piece of the sleep cycle can also be broken down into terms of how long it lasts. Stage 1 is the shortest of all the stages, however it is hard to quantify into exact terms. However, to give you an idea, the National Sleep Foundation estimates that the average person takes 10-20 minutes to fall asleep. Stage 2, on the other hand, is one of the longest sleep stages and makes up 40-60% of the total sleep time. Stage 3 only lasts for about 5-15% of sleep time for adults, however is much longer for children and teens.


Finally, REM sleep varies depending on which REM period it is. During the beginning of the night, REM sleep is shorter, while the periods gradually extend as the night goes on. The first REM cycle generally occurs 90 minutes after falling asleep for the night. The length of REM sleep will increase throughout the night because non-REM stage 3 sleep decreases.


Now that we understand a little more about how your sleep cycle works, let’s take a look at just how important sleep is. While scientists can’t exactly agree on why humans sleep as much as they do, most scientists agree that sleep is extremely important. There are several different theories on what happens while we sleep, and the simple answer to why we need so much sleep is that there is no single answer.

Woman sleeping with clocks in the background

First and foremost, sleep is an essential bodily function that allows many different processes to take place. One of the most important processes that happens during sleep is the consolidation of memories from the previous day. Consolidation is a process by which short term memories become long term memories.


Another thing that happens during sleep is simply that our bodies are rejuvenated. However, this only happens if we sleep enough to enter non-REM stage 3: deep sleep. Physically, deep sleep allows us to grow new muscle, repair damaged tissues, and properly synthesize hormones. In fact, human growth hormone is released during deep sleep. This hormone is essential for the repair and restoration of muscles and tissues.  Mentally, this means that we can retain more information and increase our memory.


In addition to missing out on all the many benefits of sleep, your health can also be negatively affected by lacking in sleep. In fact, chronic sleep loss can cause weight gain, high blood pressure, and a decreased immune system. It can also cause your mood to fluctuate and you will likely feel irritable, impatient, unable to concentrate, and overall moody. You will also just feel generally fatigued and may even experience daytime sleepiness which hinders your overall productivity.


Sleep deprivation is also one of the leading risk factors for obesity. Yes, not sleeping enough can actually make you fat. This is primarily because without sleep, your body cannot properly process carbohydrates or the hormones that affect appetite. Also, daytime sleepiness and fatigue weaken your motivation for exercise, which amplifies the problem. It is estimated that people who sleep less are 55-89% more likely to become obese.


As you can see, sleep plays an integral role in our waking lives. Considering we spend half our lifetime sleeping and the other half being directly affected by our sleep patterns, I’d say it’s pretty important. This raises the question: are you getting enough sleep? If you are having trouble falling or staying asleep, you should schedule a consultation with one of Belluvue’s best sleep doctors today. We can help evaluate your sleep patterns and provide solutions so that you wake up every morning feeling like you just had the best sleep of your life.


May is National Cystic Fibrosis Awareness Month

Did you know that May is Cystic Fibrosis Awareness Month? According to the Cystic Fibrosis Foundation Patient Registry, there are over 30,000 cases of cystic fibrosis in the United States and approximately 1,000 new cases continue to be diagnosed annually. In honor of Cystic Fibrosis Awareness Month, Overlake Internal Medicine Associates has compiled a brief guide on frequently asked questions about this disease.


What is Cystic Fibrosis?

Cystic Fibrosis (CF) is a genetic disease characterized by recurrent lung infections and a reduced ability to breathe. CF also affects the pancreas and other organs in the body. It occurs as a result of a mutation in the cystic fibrosis transmembrane conductance regulator (CFTR). This mutation limits the function of the CFTR protein, which reduces its ability to move chloride to the surface of the cell and attract water. Without the attraction of water, a thick mucous forms around various organs in the body.

This is especially noticeable in the lungs, where the mucus builds up and makes it difficult to breathe. Additionally, excess mucus in the lungs also traps bacteria and leads to frequent lung infections and overall inflammation. Excess mucus can also affect the digestive system through the pancreas and liver by blocking the release of digestive enzymes and bile. The result is inadequate nutritional and growth, as well as possible liver disease.


Possible symptoms for CF can include:

  • Persistent coughing
  • Constant phlegm
  • Slow growth rate despite eating well
  • Frequent bronchitis or pneumonia
  • Skin that tastes excessively salty
  • Difficulty breathing/wheezing
  • Mucus in the stools


Who is affected by Cystic Fibrosis and how is it diagnosed?

To be affected by CF, an individual must have inherited two defective CF genes from their parents. To be a carrier of CF, an individual must have inherited one defective CF gene. However, just having the gene for CF doesn’t automatically mean one will be affected by it. The chances of two carriers of CF having a child with CF is 1 in 4. The chances of the child not having the disease, nor being a carrier, is also 1 in 4. However, the chances of the child not having the disease, but being a carrier is a 1 in 2 chance.

Diagnosing CF is a process consisting of a newborn screening, a sweat test, a genetic test, and a clinical evaluation. Newborn screenings are a simple blood test that screens for a variety of health conditions, including cystic fibrosis. A sweat test is an additional test used to determine the amount of salt present in the sweat. Finally, a genetic test is used to determine if the parents and the affected individual have the gene mutation associated with CF. With this diagnosis protocol, the majority of people with CF are diagnosed by the age of 2, if not sooner.


What treatments are available for Cystic Fibrosis?

Although Cystic Fibrosis is not curable, with treatment people with cystic fibrosis can live relatively normal lives to adulthood. In fact, many adults with CF are able to attend college, get married, and have children. Individual treatment for CF can vary depending on the individual’s needs, however some examples of CF treatment include:

  • Clearing the airway of mucus to prevent it from accumulating in the lungs
  • Taking inhaled medications to fight infections, thin the mucus, and keep the airways clear
  • Taking pancreatic enzyme supplements to properly digest and absorb nutrients from food
  • Creating a fitness plan that improves lung function, boosts energy, and is beneficial to one’s overall health


A popular airway clearance technique (ACT) is chest physical therapy (CPT or chest PT). CPT consists of systematic clapping, vibration, deep breathing, and coughing to dislodge and eliminate mucus from the lungs. During CPT, the affected person is placed in certain positions facing the lung down so mucus can make its way to the airways and be coughed out. CPT is initially performed by a respiratory therapist, but it can also be performed by parents, siblings, and friends.

Young boy playing with a rocket ship and doing a cystic fibrosis breathing treatment

Inhaled medications generally include antibiotics used to prevent lung infections and mucus thinners. They are usually delivered through a nebulizer, or a medical device that converts liquid medication into a mist that can be safely inhaled. Often times, specific inhaled medications must be used with specific nebulizers to work properly. These nebulizers can be purchased and cared for at home, which allows people with CF to complete their respiratory treatments in their homes.


Pancreatic enzymes supplements consist of a capsule filled with tiny beads of digestive enzymes that are digested in the small intestine. These enzymes are essential for properly breaking down and absorbing nutrients from food. Once taken, these enzymes will continue to work for the next 45-60 minutes.


Establishing a regular fitness program is another important treatment for CF. Exercise offers many benefits for overall health and can help those with CF. The key to developing an ideal fitness program is to find one that works for the individual. Often consulting with a CF physical therapist can help individuals design a workout plan, manage pain or other complications, and help teach airway clearing techniques.


Additionally, cystic fibrosis transmembrane conductance regulator (CFTR) modulators are also beneficial for CF treatment because they work to correct the defective protein. However, only certain types of gene mutations can be effectively treated this way. Currently, there are three CFTR modulators for certain mutations including: ivacaftor (Kalydeco®), lumacaftor/ivacaftor (Orkambi®), and tezacaftor/ivacaftor (Symdeko®). 


Ivacaftor addresses gating mutations and works by holding the chloride channel open to allow water to form on the cell’s surface. Lumacaftor/ivacaftor addresses protein shape and gating mutations. Lumacaftor helps form the protein correctly, while ivacaftor holds the channel open. Tezacaftor/ivacaftor is an alternative treatment for people who cannot take Lumacaftor/invacaftor.


CFTR modulators are often prescribed as oral medications that are generally taken once every 12 hours. They are usually taken in coordination with fatty foods such as eggs, nuts, butter, avocado, and peanut butter. However, individual dosing can vary depending on an individual’s treatment plan.


If you are in need of top pulmonary or pulmonology services, schedule a consultation with Bellevue’s top internal medical doctors today at Overlake Internal Medicine Associates.


Measles Outbreak 2019: What You Need to Know

3-d rendered image of the measles virus

As of April 11th, 2019, 555 new cases of measles have been reported and confirmed in 20 states, including Washtington. The other states are Arizona, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Missouri, Nevada, New Hampshire, New Jersey, New York, Oregon, and Texas. According to the Centers for Disease Control and Prevention (CDC), this is the second highest number of measles cases since it was eliminated back in 2000.

The CDC defines a measles outbreak as three or more confirmed cases. As of April 10th, 2019, the measles outbreak in Washington state has 74 confirmed cases, with 73 cases in Clark County and 1 case in King County. These cases are being attributed to international travelers who unintentionally brought measles back with them from their travels.

While there are currently large measles outbreaks in Israel, Ukraine, and the Philippines, measles is also common in various European, Asian, Pacific, and African countries. Because the majority of domestic measles cases occurred in unvaccinated individuals, the CDC is urging that everyone get their measles vaccine to prevent the disease from spreading further. Currently, the two main reasons for measles outbreaks are the increasing number of international travelers bringing measles home and pockets of unvaccinated individuals allowing the disease to spread through American communities.

The most effective way to protect against and prevent the spread of measles is to get the MMR vaccine. The MMR vaccine is a live virus vaccine, meaning that it contains a weakened form of the measles, mumps, and rubella virus. This weakened form of the disease essentially teaches your body how to fight the disease if it is ever exposed to it in the future.

Child receiving vaccination for measles

The MMR is highly effective against preventing measles, mumps, and rubella. In fact, a single dose of the MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella. A second dose of MMR is recommended for lifetime immunity and because it makes the vaccine 97% effective against measles and 88% effective against mumps.

Although the MMR vaccine is effective in most cases, there are rare cases (3 in about 100 people) where individuals who have had two doses of MMR will still get measles. In these cases, however, it is important to note that the disease is usually more mild and cannot be as easily spread to others.

The CDC recommends that children get their first dose of MMR at 12-15 months and their second dose around 4-6 years of age. Adults who have not had the measles vaccine or are unsure if they’ve had the measles vaccine, should have at least one dose of the MMR vaccine. Finally, any international travelers who have not had the measles vaccine should have two doses of the MMR vaccine 28 days apart before they travel.

After having the MMR vaccine, the next way to prevent the spread of measles is to be aware of how it spreads, what its symptoms are, and what to do if you believe you or someone close to you is exhibiting symptoms.

Measles is highly contagious, and if you have not had the measles virus, you are almost guaranteed to get it if you are exposed to someone with the disease. Measles travels through the air and the virus can live for up to two hours in a room after someone with the infection has been in that room. Also, measles is highly contagious for four days before and after a measles rash develops, meaning the infected person may not even know they are infected.

Child with measles rash

Symptoms of measles include fever, diarrhea, coughing, runny nose, red and watery eyes, tiredness, and the well-known rash. The cold of flu type symptoms will begin about 7-14 days after exposure to an infected person, but the signature rash won’t start until about 3-5 days later.

A measles rash generally begins around the face and will gradually spread to the remainder of the body. It is reddish-brown in color and will be a series of tiny spots that start at the face and gradually move down the body.  Additionally, there may be tiny red spots with blue-white centers inside the mouth called Koplik’s spots.

As soon as you notice measles symptoms, you will need to isolate the affected individual to prevent the disease from continuing to spread to others. Measles can last from 7-10 days, but the individual will still be contagious for about four days after that. Unfortunately, there is currently no treatment for measles besides allowing the body to rest and providing plenty of fluids. Fever can be managed with Acetaminophen (Tylenol), but never aspirin.

Little boy with fever lying on the couch with a thermometer in his mouth

According to the CDC, about 30% of individuals with measles can develop further complications including pneumonia, ear infections, diarrhea, and encephalitis. The most serious of these complications are pneumonia and encephalitis.

Pneumonia is a lung infection that can cause symptoms such as fever, chest pain, trouble breathing, and coughing up mucus. Encephalitis is swelling of the brain and affects about 1 out of every 1,000 children with measles. Encephalitis can occur during a measles outbreak or months after, and can cause seizures.

Although some people argue that vaccinations are dangerous, the consequences of not getting vaccinated are far more prevalent and more likely to affect you and your family. While there may be cases of vaccine reactions, these are extremely rare, while the chances of being infected by measles are significantly higher.

Finally, it must be stated that vaccines do not cause autism. The CDC, Autism Speaks organization, and the American Academy of Pediatrics have explicitly stated that vaccines do not cause autism. Although there have been several claims to this, there is no substantial or realistic evidence to support these claims. Conversely, there is significant evidence in support of the many benefits of vaccination.



To protect you and your family from contracting measles, Overlake Internal Medical Associates of Bellevue, WA strongly encourage you and your family to get the MMR vaccine to make sure you and your family are immune during the measles outbreak of 2019. Although there is currently only one case of measles in King County, this number can quickly spread. Protect your family and schedule a consultation today.



March is Endometriosis Awareness Month


March is endometriosis awareness month with yellow tulips on wood background


Did you know that March is Endometriosis Awareness month? Did you also know that 176 million women worldwide are currently affected by Endometriosis and that it is the leading cause of infertility in women?

Endometriosis is a condition affecting women in which the endometrium, or tissue that normally lines the inside of the uterus, grows outside the uterus, as well as on the ovaries, Fallopian tubes, and the tissue around the pelvis. Endometriosis can also cause growths on the vagina, cervix, vulva, bowel, bladder, rectum, and, in extremely rare cases, the lungs, brain, and skin. Despite not being inside the uterus, the endometrium still thickens, breaks down, and bleeds with each menstrual cycle.

uterus with endometriosis

Symptoms for endometriosis may include some or all of the following:

  • Pain: Often the most common symptom, women with endometriosis can suffer from different types of pain including: painful menstrual cramps, long-term pain in the lower back and pelvis, a deep pain felt during or after sex, intestinal pain, and pain during bowel movements or urination.
  • Bleeding or spotting: Menstrual periods may be heavier than usual and bleeding between menstrual periods can occur.
  • Digestive problems: these can include diarrhea, constipation, bloating, nausea, and may become more severe during menstrual periods.
  • Infertility
  • Fatigue

While nothing can prevent Endometriosis from happening, regular pap smears and gynecologic exams can help to identify possible cases of Endometriosis early-on so that they can be properly treated and managed. Overlake Internal Medicine Associates provides pap smears, gynecological exams, and endometrial biopsies in order to identify and diagnose Endometriosis.

Female gynecologist performing a vaginal exam on a patient

Pap smears and gynecological exams are part of what is often referred to as a well-woman visit. How often you will need to have a well-woman visit will depend upon your medical history. Generally, women ages 21-65 will have a well-woman visit once every three years, however you may need more frequent exams if you have abnormal pap test results, have a history of sexual health problems, have a family history of certain cancers, have an STD or partner with an STD, or have recurrent vaginitis.

During a gynecological exam, sometimes called a pelvic exam, our doctors will examine your vulva, vagina, cervix, ovaries, Fallopian tubes, and uterus. You will likely be asked to wear a paper gown and will lie down on an exam table with your feet spread apart and resting in stirrups. Although this can be an uncomfortable position, the more you can relax your butt, stomach, and vaginal muscles, the more comfortable you will be.

Your gynecological exam will generally begin with our doctors performing an external exam of your vulva for signs of cysts, abnormal discharge, genital warts, irritation, or other issues. Next, they will perform a speculum exam of your internal structures, as well as a pap smear.

Diagram of a pap smear

During the speculum exam, a metal or plastic speculum will be gently inserted into your vagina to separate the vaginal walls and allow for the viewing of your cervix. This will likely feel somewhat uncomfortable, but it should not hurt. If you feel pain, be sure to tell our doctors so that we can adjust the size of position of the speculum to make you more comfortable.

Once the speculum has been inserted and your cervix is visible, our doctors will use a tiny, specialized tool to wipe a sample of cells from your cervix in order to test for pre-cancer or cancer. If you are also being tested for STDs such as chlamydia or gonorrhea, additional samples of your cervix discharge may also be obtained. Again, this should not hurt, but it will feel slightly uncomfortable and may cause some mild cramping.

The final part of your gynecological exam is a bimanual exam in which our doctors will gently insert 1-2 fingers into your vagina while using their other hand to apply pressure to your lower abdomen. Because their fingers are lubed and gloved, this should not hurt, but can feel uncomfortable and you may feel sensations of pressure.

During the bimanual exam, our doctors can feel the size, shape, and position of your uterus, can test for tenderness or pain that may indicate infection or endometriosis, and can feel for enlarged ovaries, fallopian tubes, ovarian cysts, or tumors. Our doctors may also insert a finger into your rectum to check the tissue between your vagina and anus, as well as to check for tumors behind your uterus, on the lower wall of your vagina, or in your rectum. If a rectovaginal exam is performed, you may feel a bowel movement sensation. This will only last for a few seconds and you will not actually have a bowel movement.

If our doctors suspect endometriosis, additional diagnostic techniques may be performed. Once such technique is a transvaginal ultrasound. During a transvaginal ultrasound, a transducer, similar in shape to a long, skinny wand, is pressed against your abdomen and/or inserted into your vagina to get an internal view of your reproductive organs. While a transvaginal ultrasound won’t diagnose endometriosis alone, it can make our doctors aware of cysts that may occur as a result of endometriosis. It may also help to rule out other conditions with similar symptoms to endometriosis. An endometrial biopsy may also be performed to help rule out other conditions with similar symptoms.

Another way to diagnose endometriosis is to take hormonal birth control or a Gonadotropin-releasing hormone (GnRH) to block your menstrual cycle, lower your estrogen levels, and reduce pelvic pain. If these treatments reduce your pain levels, then you most likely have endometriosis. However, some doctors believe that endometriosis cannot be diagnosed by medications alone.

In these cases, a Laparoscopy may be performed to see inside your pelvic area and look for the exact location of endometrial tissue. During this surgical procedure, a small camera attached to a slender tool is inserted into your abdomen. This procedure is the only way to accurately diagnose endometriosis, although some doctors may take a tissue sample to evaluate under a microscope to be completely sure.


How long has it been since your last pap smear and gynecological exam? For all your well-woman needs, schedule an appointment today with Bellevue’s top internal medicine doctors at Overlake Internal Medicine Associates.  

New Year, New You: Don’t Forget Your Immunizations!


Many people start the new year resolving to exercise more, eat better, and to achieve an overall greater sense of health and wellness. While exercising and eating the right foods are certainly important to your overall health, so are getting the necessary vaccinations. Despite the debate around vaccinations, Overlake Internal Medical Associates believes that immunizations are an integral part of keeping yourself and your family healthy. As such, we have put together this brief guide on immunizations so that you can make the best decisions for you and your family’s health in this new year.


What is the difference between a vaccine, vaccination, and immunization?

First things first, let’s get our definitions straight. A vaccine refers to the dose of the disease you are being injected with. Vaccines contain tiny amounts of weak or dead viruses, bacteria, or toxins that cause the disease. By injecting this content into your body it teaches your immune system how to combat the particular virus, bacteria, or toxin and prevent the disease from spreading. A vaccination refers to the act of getting the vaccine injected into your body. Immunizations refer the process by which you body builds up an immunity to a particular disease.


Different Types of Vaccines:

There are four different types of vaccines including live-attenuated, inactivated, toxoid, and subunit, recombinant, polysaccharide, and conjugate vaccines.


Live-Attenuated Vaccines:

Live-attenuated vaccines use a live form of the disease that has been attenuated, or weakened. Because this type of vaccine offers long-lasting immunity, only 1-2 doses are needed to provide a lifetime of immunity. However, because they are a live form of the disease, live-attenuated vaccines may be risky for individuals with weakened immune systems, long-term health problems, or individuals who have undergone an organ transplant.

Examples of Live-Attenuated Vaccines include:

  • Measles, Mumps, Rubella (MMR)
  • Rotavirus
  • Smallpox
  • Chickenpox
  • Yellow Fever


Inactivated Vaccines:

Inactivated vaccines use a dead form of the disease to build immunity. Because they use a dead form of the disease, they usually require a series of doses over time, also known as “boosters”, to maintain immunity.

Examples of Inactive Vaccines include:

  • Hepatitis A
  • Flu (shot only)
  • Polio (shot only)
  • Rabies


Toxoid Vaccines:

Toxoid vaccines use a toxoid produced by the germ that causes a specific disease to build immunity. With toxoid vaccines, the immunity is directed against the toxoid the germ produces and not the actual germ itself. As a result, boosters are required to maintain immunity to these toxins.

Examples of Toxoid Vaccines include:

  • Diphtheria
  • Tetanus


Subunit, Recombinant, Polysaccharide, and Conjugate Vaccines:

This type of vaccine uses specific pieces of the germ, such as its protein, sugar, or the casing around the germ (capsid) to establish immunity. Although they only target specific pieces of the germ, they are actually highly effective in targeting these parts of the germ to keep the body immune. Also, because they only target key parts of the germ, they can safely be used in individuals with weakened immune systems or long-term health problems. However, they may still require booster shots to maintain immunity.

Examples of Subunit, Recombinant, Polysaccharide, and Conjugate Vaccines include:

  • Hib (Haemophilus influenzae type b) disease
  • Hepatitis B
  • HPV (Human Papillomavirus)
  • Whooping cough (part of the DTaP vaccine)
  • Pneumococcal disease
  • Meningococcal disease
  • Shingles

Time to vaccinate

How Often Do I need to Get Myself or My Family Vaccinated?

To keep yourself and your family protected from harmful diseases, it is key that you remain up to date on the necessary vaccines. Remember, only a small amount of vaccines offer lifetime protection. The remainder of vaccines require intermittent booster shots to maintain immunity. However, your individual vaccination schedule is dependent upon your age and whether or not you are at an increased risk for certain diseases.


Infants and Young Children:

Infants and young children will require certain vaccines to protect them from potentially harmful diseases. The most common are chickenpox, measles, and whooping cough. The Centers of Disease Control (CDC) has provided this 2018 Schedule of Recommended Immunizations for Children from Birth Through 6 Years Old.


Preteens and Teens

Preteens and teens (ages 7-18) will need to either or catch up on their childhood vaccines, as well as get vaccines for Meningitis, cancer caused by HPV, whooping cough, and flu. The CDC has provided this 2018 Schedule of Recommended Immunizations for Preteens/Teens Ages 7-18.



Adults need a variety of vaccines depending on what they had during their childhood and what age they are currently. Some vaccines are for adults only, others are boosters of childhood vaccines, some may be new vaccines, some vaccines may change as the virus changes, and some vaccines may be required as a result of travel plans, job, or personal health conditions. The CDC has provided a 2018 Schedule for Adult Vaccines for Adults ages 19-26, Adults ages 27-64, and Adults age 65 and older.



Individuals with Increased Risk:

  • Gay or Bisexual Men: In addition to the routine vaccinations, gay or bisexual men should also get vaccines that protect against the flu, HPV, Hepatitis A, and Hepatitis B. 
  • Health Care Workers: In addition to the routine vaccinations, health care works should also get vaccines that protect against the flu and possibly Hepatitis B. Certain institutions may also have their own required vaccinations. 
  • Military: Most military members are required to have all their routine vaccinations, however depending on travel plans additional vaccines may be required. 
  • People with select health conditions: Individuals with asplenia, type 1 or 2 diabetes, heart disease, HIV, liver disease, lung disease, renal disease, or a weakened immune system will need to speak with a doctor before receiving certain vaccines. 
  • Pregnant women: In addition to being up to date on routine vaccinations, pregnant women may also require Rubella, Hepatitis B, the flu, and whooping cough. 
  • Travelers: In addition to routine vaccinations, travelers may require additional vaccines depending on their travel destination, health, and vaccination history. 
  • People who inject drugs: Speak with your doctor about what possible vaccines you need


vaccine over a paper cut out of a family

Are Vaccines Safe?

Recently, the safety of vaccines have been called into question. Specifically, people are questioning their side effects and the belief that vaccines cause autism. However, vaccines are tested for years before ever becoming available for public use and continue to be tested throughout their continued use. The Food and Drug Administration (FDA) and CDC will not approve nor recommend a vaccine until it has been deemed safe for public use. The process for ensuring vaccine safety is quite extensive and contains many essential steps

To determine if a vaccine is safe, the vaccine is first tested for years in a lab. Once lab results indicate it can be used safely, it then can be used for clinical trials. Clinical trials will initially test the vaccine on 20-100 volunteers, and then expand to the thousands to ensure the vaccine’s safety. During the clinical trial phase, questions about the vaccines safety, dosage, and how the immune system reacts to it are closely examined. Every possible safety concern must be thoroughly addressed before the FDA will license a vaccine.

Once a vaccine is licensed, each individual batch of that vaccine is still tested before it is sent out for public use. Each vaccine batch is tested for its potency, purity, and sterility. This constant testing of vaccines maintains their quality and safety. Even once a vaccine has been recommended to the public, it continues to be closely monitored.


Possible Vaccine Side Effects

The vast majority of people who receive vaccines do not suffer from serious side effects. When side effects from a vaccine do occur, they are generally mild in nature and can include: mild fever, chills, feeling tired, headache, muscle and joint aches, and generalized pain, swelling, or redness at the injection site. While severe side effects do exist, they are extremely rare and generally only affect 1-2 people out of every million. Overall, the possible side effects from vaccines are still considered much safer than getting the diseases themselves.


Vaccines Do Not Cause Autism

Another large claim surrounding vaccines is the notion that they cause Autism Spectrum Disorder (ASD). states that autism “refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication”(Source). According the CDC’s Autism and Developmental Disabilities  Monitoring (ADDM) Network, it is estimated that 1 in 59 children have been identified with autism.  Although the exact cause of Autism has not be identified, current research points to both genetic and environmental risk factors as being influential. However, these factors are still currently labeled as causing an increased risk and are not considered to be actual causes themselves.


Genetic factors for autism include changes in certain genes that may either be passed to the child or that may happen randomly in the egg or sperm that creates the embryo. It has been found that there may be a hereditary relationship concerning autism. Certain environmental factors can also pose a possible risk. Some examples of environmental risk factors include:


  • Advanced age of either parent
  • Pregnancies that occur less than one year apart
  • Complications that occur during pregnancy or birth such as extreme prematurity, low birth weight, multiple pregnancies at once


It is currently believed that the genetic and environmental risk factors can affect the development of the brain, particularly early brain development. This results in a change in the way brain nerve cells communicate with each other. Despite many people believing that vaccines cause autism, Autism Speaks, the Centers for Disease Control, and The American Academy of Pediatrics, to name a few, adamantly state that vaccines do not cause autism.


Are you and your family up to date on all your immunizations? Schedule a consultation with Bellevue’s top internal medical doctors today at Overlake Internal Medicine Associates.


3 Ways To Boost Your Immune System For Flu Season

According to the Centers For Disease Control, flu season is officially here! That means many of your classmates and coworkers in Bellevue will soon be sniffling, coughing, shaking with fever, and just generally spreading contagious pathogens all over the place.dreamstime_4850780

If you’re terrified of contracting the flu this winter, it’s important to visit your primary care physician for a flu shot. If you’ve already done that, and are still worried that you might fall victim to the dreaded flu, here are some ways that you can give your immune system a much-needed boost.

And don’t worry, these immune system-boosting tips come from the physicians at Harvard Medical School so they’re based in science, not old wives tales.

  • Stop smoking
  • Increase the number of fruits, vegetables, and healthy fats
  • Maintain your level of physical activity (even though it’s cold out!)
  • Watch your blood pressure (if it’s high, visit your primary care physician)
  • Reduce your drinking
  • Get plenty of sleep
  • Washing your hands frequently
  • Take a multivitamin and/or probiotics

Of course, even doing all of these things can’t guarantee that you won’t fall ill at some point during this cold and flu season. You never know where a pathogen may be lurking, just waiting to invade your body as soon as your immune system shows even the slightest sign of weakness.

If you do get sick, remember that the primary care physicians at Overlake Internal Medicine Associates are always available to help diagnose the problem and do whatever they can to get you feeling better fast.

How To Prepare For Your Urgent Care Appointment


Visiting an urgent care clinic in Bellevue isn’t the same as planning an appointment with your primary care physician. On one hand, urgent care appointments are rarely planned in advance. That’s why they’re urgent! On the other hand, urgent care doctors probably haven’t had the opportunity to get to know you like your primary physician has over the years.

Reasons To Visit An Urgent Care In Bellevue

The reasons you make an appointment with our urgent care clinic in Bellevue are different from the reasons why you would visit your primary care physician. While your primary care physician helps handle things like immunizations, annual physicals, and serious illnesses, an urgent care is equipped to handle:

  • Acute illnesses (cold and flu)
  • Fevers
  • Vomiting, Diarrhea, and Stomach Pain
  • Cuts and Severe Scrapes
  • Minor Broken Bones
  • Minor Burns
  • Rashes Without Fever
  • Sports Injuries

Things To Do Before Your Bellevue Urgent Care Appointment

In order to make the most of your urgent care appointment and speed up the process, be prepared to:

  • Present Identification
  • Present Insurance Card
  • List Current Medications
  • Discuss Your Medical History
  • Ask Questions

We hope we’ll have the pleasure of serving you soon at Overlake Internal Medicine Associates urgent care clinic!

Going Back To School? Time To Visit Your Primary Care Physician!

The summer days will soon be behind us, taking with them all the joys of waking up late and spending all day at the pool. Children all over the Bellevue area will soon be returning to school, which means it’s already time to schedule their appointments with the primary care physicians at Overlake Internal Medicine Associates.

You may be thinking, “But my child isn’t sick. Why should I make an appointment with our primary care physician?” Here are three reasons why back-to-school can also be considered back-to-the-doctor season!

Annual School Exam

Many schools Washington require children to have an annual physical exam before starting or returning to school. This is a very important health task in a young child’s life, ensuring the developmental goals are being met while also catching potential health issues while they’re still small problems. If your child plans on playing sports in school, it’s almost certain that a physical exam conducted by a primary care physician will be mandatory.


Like physical exams, many schools in Washington require that children stay up to date on their immunization schedule in order to attend classes. This keeps the children safe from communicable diseases, as well as the rest of the population.

Hearing Test Screening

Another reason to visit your primary care physician during back-to-school season is to make sure your children have a hearing test screening. Like poor vision, poor hearing can make it hard to excel at school, and might be hard for teachers to detect.

Ready to get health and go back to school? Contact the primary care physicians at Overlake Internal Medicine Associates today.

What Is Sleep Apnea?

In addition to being one of the best providers of primary care and internal medicine services, Overlake Internal Medicine Associates is proud to serve as a comprehensive sleep disorder center for patients in the Bellevue area.

As with issues involving internal medicine, many people are inadequately informed about sleep disorders. Some people even suffer from sleep disorders for years without realizing that they’re medical conditions that can be treated at a sleep disorder center.

In this post, we’ll take a look at sleep apnea, one of the most common sleep disorders treated at our center.

Understanding Sleep Apnea

Sleep apnea is difficult for primary care physicians to diagnose because, well, most people aren’t asleep when they come in for their annual exam. In many cases, it’s a family member or spouse that first spots the signs of sleep apnea, because they’re the ones who have to listen to it.

Signs Of Sleep Apnea

Symptoms of the most common type of sleep apnea, obstructive sleep apnea, include shallow breathing or pauses in breathing during sleep. Loud, pronounced snoring is also a symptom of sleep apnea.

Dangers Of Sleep Apnea

If left untreated, sleep apnea can increase chance of high blood pressure, heart attack and stroke. Sleep apnea can also increase the risk of heart failure.

Don’t live with untreated sleep apnea! The experienced physicians at our sleep disorder center are well-equipped to diagnose your sleep apnea and provide recommendations for treatment. Contact Overlake Internal Medicine Associates in Bellevue for more information about how our sleep disorder center can treat narcolepsy, sleep apnea, insomnia, and more.

Most Common Reasons To Visit An Urgent Care In Summer

Overlake Internal Medicine Associates is proud to be a trusted provider of primary and urgent care services in the Seattle area. Along with extra fun and sunshine, summer comes along with its own set of illnesses and health threats. Here are some of the most common reasons people visit our urgent care in the summer time.


Summer brings people out of their houses, and the same is true for bugs. With more mosquito, spiders, and biting flies out and about in the summertime, it’s no wonder that we see an uptick of people visiting our urgent care because they’ve been bitten.


There are three different types of burns we see a lot of in the summer: those caused by the sun, those caused by the grill, and those caused by fireworks. All three of these types of burns can be very serious, and it’s important to seek medical attention at an urgent care if you feel you’ve been severely burned for any reason.

Broken Bones

People, especially children, feel emboldened to go on new adventures in the summertime. Unfortunately, these adventures in rock climbing, mountain biking, trampoline jumping and other activities can sometimes lead to broken bones.

When dealing with any of the illness and health threats posed by summer, remember to come into OIMA for all your urgent care needs. Our primary care physicians will be happy to help!

Why You Need A Primary Care Physician

There are many people out there who do not have a primary care physician because they feel that they do not need to see a doctor often. If they get sick, they will just head to their local urgent care or emergency room if they are really ill. But the truth of the matter, having a primary care doctor is a great thing to have and will benefit you in more ways than one. So we thought that we would go over some of the many reasons you need a primary care physician.


If you have a doctor that you see often, they are more likely to see changes in your health and have tests done to get a diagnosis faster than it would be if you wait for symptoms to show up and go to an urgent care.

Lower costs

Whether you have insurance or not, going to your primary doctor is always going to be cheaper than going to urgent care or the emergency room. An emergency room visit without insurance is sure to cost you thousands.

Staying healthier

Having a primary care doctor who knows you and your habits can help you manage chronic conditions or make recommendations on how to become more healthy.


After seeing your doctor a few times, you will start to feel more comfortable with him or her and start opening up about your health concerns without feeling embarrassed.


Many insurances require referrals in order to see specialists and have your treatments be covered. Your primary care physician will be able to provide you with the referrals you need.

There are so many good reasons to have a primary care physician that you can trust. If you are in need of one, call Overlake Internal Medicine Associates for an appointment today.


At Home And Clinical Snoring Treatments

In our last blog, we talked, in depth, about snoring, so we thought that we would talk to you about how you can treat the issue. There are many different things that you can do to try to stop yourself from snoring and keeping your partner awake at night. Some snoring treatments can be done at home while others need to be treated at Overlake Internal Medicine Associates.

Lifestyle changes

One of the best things that you can do for snoring is to lose weight. This can help you lose the fatty tissue that is in the back of your throat so that you can stop snoring. Exercising is also a great way to help yourself stop snoring. Strengthening the muscles in your body can lead to stronger muscles in your throat. You should also avoid smoking, alcohol and taking medications. Smoking irritates the membranes in your throat, blocking your airways while alcohol and medications can relax your muscles in your throat causing you to snore. Another great way to quit snoring is to establish good sleeping habits. This will help you sleep better which will lead to less snoring

Bedtime remedies

There are several things that you can do before you head to bed. You could try some of those nasal strips to open up your airways while you are sleeping. Another idea is to keep your bedroom humid. Having water in the air can help your airways not become so dry.  You could also change your sleeping position. Add or remove pillows, or try to sleep with your tongue and jaw moved forward. Sleeping on your side can also help eliminate snoring. There is a trick  where you can sew a tennis ball or a sock into your pajamas so that it makes you uncomfortable when you lay on your back which will make you roll back to your side.

Throat exercises

The most important thing that you need to do to eliminate snoring is to strengthen your throat muscles so there are some exercises that you can do on your own:

  • Say each vowel out loud for three minutes a few times a day.
  • Put your tongue at the top of your front teeth and slide your tongue backwards for three minutes a day.
  • Purse your lips for 30 seconds.
  • Move your jaw side to side with your mouth open for 30 seconds a side.
  • Contract the muscle at the back of your throat for 30 seconds at a time. If you look in the mirror, you should be able to see your uvula move up and down.

Medical help

If none of these remedies are working for you, it could be time to seek treatment at Overlake Internal Medicine Associates. There are lots of things that we can do to try to cure your snoring. We want to help you get the sleep you need as well as keep your relationship from being strained. If you are tired of losing sleep, call the experts at OIMA to schedule an appointment today.

Everything You Need To Know About Snoring

When your partner snores, it can cause a lot of problems not only in the bedroom but in the relationship as well. It makes anyone having to hear it miss out on good quality sleep. When you don’t get enough sleep, you become irritable, fatigued and can create health problems. Many couples end up sleeping in other rooms so that both can get a good night’s sleep. Luckily, this isn’t the only solution.

What is snoring?

Snoring happens when air is not able to pass through your throat and nose. When this happens, the tissues in your nose and throat vibrate. There are many reasons why people snore but the main cause is because the person has too much tissue in their nose and throat. Where your tongue lays can also be a reason.

Causes of snoring

Figuring out why you are snoring is the first step to finding a solution to the problem, so we have come up with this short list of causes:

  • Weight – being overweight or out of shape can cause snoring because there is too much fatty tissue or not enough muscle tone gets in the way of the air.
  • Age – As you get older, your throat gets narrower and you lose the muscle tone that you are used to having.
  • Body – how you were born plays into snoring as well. If you were born with a narrow throat, enlarged adenoids, a cleft palate or something similar, you could be or become a snorer.
  • Sinuses – if you have allergies or other sinus issues, you could have issues with snoring down the road because you are not getting enough air in your passage ways.
  • Smoking and alcohol – both of these can cause your muscles to relax which can lead to more smoking.
  • Posture – the way you are sleeping has a lot of effect on your breathing as well. For example, sleeping flat can cause your muscles to relax and block the airway.

You can keep a sleep journal to see if you can do anything about your snoring. You can keep track of the different ways you sleep and if you are snoring because how you snore can tell you why you snore.

  • If you sleep with your mouth closed but are snoring, you could have a problem with your tongue.
  • If you sleep with your mouth open, you most likely have issues with the tissue in your throat.
  • Snoring while laying on your back is pretty normal and can usually be corrected by changing your sleeping habits.
  • If you are snoring in any and all sleep positions can mean that you need comprehensive treatment.

When it comes to the treatments for snoring, it varies between patients. There are some things that you can do at home but if your snoring is caused by something more comprehensive, you will definitely need to seek treatment from the doctors at Overlake Internal Medicine Associates. We can get you the help you need so that you and your partner can have a better night’s sleep.

Interesting Facts About Sleep Disorders

There are lots of reasons that a person develops sleep disorders and while we know that they are no laughing matter, there are some interesting facts about sleep disorders that will make you think.

  • The higher in elevation that you are, the greater the chance of sleep disruption. Scientists believe this is because there is a lack of oxygen. It takes a person two to three weeks to acclimate to the altitude.
  • Regular exercise is said to make it easier to sleep. Sporadic exercise and exercising right before bed can contribute to a bad night’s sleep.
  • You are more likely to experience insomnia if you are divorced, separated or widowed.
  • It is reported that caffeine is the most popular drug in the world. People from all over consume coffee, tea, chocolate, soft drinks and it is also found in lots of drugs.
  • The average adult needs seven to nine hours of sleep every night, however, many can perform just fine with as little as six hours or need as many as 10 hours a day.
  • For a healthy lifestyle, sleep is just as important as dieting or exercise.
  • Newborns need an average of 14-17 hours a day.
  • Healthcare professionals believe that it is the responsibility of both the patient and the doctor to bring up insomnia symptoms during an appointment.
  • Over 90 million adults in the U.S. snore and it is the primary cause of sleep disruption.
  • People who don’t get enough sleep often have bigger appetites due to their leptin levels falling.
  • Scientists are trying to figure out whether or not any other animals dream. They haven’t found an answer as of now and probably never will.
  • Some studies have shown that melatonin can help people fall asleep and stay asleep. Other studies have found that this is not the case.
  • Humans are the only mammals that willingly delay going to sleep.
  • According to a study done by the National Sleep Foundation (NSF) 36% of Americans have admitted to driving while being sleep deprived.

Sleep disorders occur in a lot of people. If you believe that you suffer from a sleeping disorder, call Overlake Internal Medicine Associates today.


Causes Of Night Sweats

Between 50 and 70 million people are living with some kind of sleeping disorder everyday. The most common disorders are sleep apnea, insomnia and narcolepsy. A lot of us don’t think about some of the smaller disorders or think they are something to worry about. Night sweats are one of those disorders that many people think are no big deal, but if you take the time to see your doctor about it you could find out something more serious.

Night sweats are described as severe hot flashes that can drench your clothes. This is not related to the temperature in the room. They can be caused by a number of things…


Sweating due to menopause is a very common symptom and will go away eventually.

Idiopathic Hyperhidrosis

This is a condition that causes your body to produce too much sweat. This doesn’t have an identifiable medical cause at this time.


Everyone knows that when you have an infection of any kind, your body tries to burn it off. This means that you can get night sweats from something as simple as the flu or as complex as tuberculosis, which is commonly associated with night sweats. Night sweats are also a symptom of HIV, so it is important to see the doctor if you experience them often.


Night sweats can indicate the presence of some cancers as they are an early symptom of the disease. If you have other symptoms such as unexplained weight loss or fever, contact your doctor.


Some medications list night sweats as a side effect. Antidepressants and other psychiatric drugs are known for causing night sweats


When your body is fighting low blood sugar, it can result in night sweats. If you take insulin or other diabetes medications you could experience them more frequently.

Hormone Disorders

Disorders like hyperthyroidism, carcinoid syndrome and pheochromocytoma are all associated with night sweats. If you have not been diagnosed with these, see your doctor.

Neurologic Conditions

Although uncommon, people with conditions like autonomic neuropathy, stroke and syringomyelia have experienced night sweats.

If you are worried about the night sweats you are experiencing, it is important to come in and see the doctors at Overlake Internal Medicine Associates to figure out if they are part of a bigger health issue. Contact us today.

Links Between Sleep and Health

There is no getting around it; as we get older the more health issues we will encounter. Research has shown that our health is directly related to our sleep. The more sleep we get, the better we feel and vice versa. It’s a continuing cycle that never seems to end. Issues such as heart conditions and blood pressure can be linked to our sleep habits.


As we age, our bones and joints and just about everything starts to hurt. If we don’t take action and take care of the issues that we are having immediately, we will continue to hurt and be miserable. Exercise is a way to alleviate the daily aches and pains that we will undoubtedly go through. If we stay healthy by eating right and exercising regularly, then we will in turn get into a great sleep habit.


If you think that you are not getting enough sleep at night, try taking naps during the day. Make time for an hour or two for a nice, refreshing nap. A nap will reset the brain and allow you to not be too tired for the rest of the day. You will feel rejuvenated after a nap and will be able to mark more things off of your to-do list.

Sleep Over The Years

Over the years, the amount of sleep suggested a night per person has changed. We once believed that adults could function only getting about 6 hours a night. This has since changed. The amount of sleep that a person needs to be fully rested changes depending on how old you are. At OIMA, we would like to go over some of the recent findings when it comes to sleep patterns in humans.


Studies have shown that the average human needs between 7.5 and 8 hours of sleep a night, although this number often varies depending on genetics and how well a person is sleeping at night. If a person is getting a lot of stage 3 sleep, which has slow-wave deep sleep and is very restorative then they may only need 6 hours to be fully rested. This stage diminishes over time which means that as we get older, we can function on less sleep than we did as teens and young adults.


On top of all of the other things that we have to worry about as we age, we also have to come to terms with the fact that we will not be sleeping as much as we did when we were younger. The elderly don’t experience a lot of time in stage 3 of sleeping, usually because of some pain or ailment, which means that they are tired throughout the day. This is often why they nap in the afternoon; so that they can catch up on sleep that they are missing for whatever reason.

If you think that you are experiencing a sleep disorder and are in the Bellevue area, call OIMA and schedule an appointment to see how we can help you.

Insomnia May Be A Bigger Problem

Life is busy. It seems that time goes by faster and faster as the years go on. As humans, we internalize so much of life that we tend to overthink things and stress out over things that we cannot control. A lot of times, this causes us to lose sleep. We have issues falling asleep or staying asleep. But what if it is a more long term issue than the current stresses that you have going on in your life?

Insomnia is a medical condition that hinders you from falling asleep or staying asleep. Doctors will diagnose and treat you for insomnia if it has been an ongoing issue for a significant period of time. Some doctors will have you keep a sleep journal for a couple of weeks to document your sleep patterns and habits. They may also need to do a physical exam to make sure there is nothing else going on with your body preventing you from sleeping.

The symptoms of insomnia are very common, like general tiredness throughout the day and irritability. But who hasn’t been tired during the day for days at a time? Some of the causes for insomnia are significant stress, illness, and noise or light causing you to not be able to sleep.

There is not a treatment for insomnia that is one size fits all. If your insomnia is minor, you can cure it simply by practicing good sleeping habits, which we will talk about in our next blog. If you think your insomnia is getting worse and you would like to seek treatment, contact your physician immediately.

Why Do You Need A Primary Care Doctor

In this day and age, a lot of young people are forgoing seeing the doctor. Reasons like “it’s not that big of an issue” or “I don’t have insurance” are heard daily. At Overlake Internal Medicine Associates we want to tell you some of the benefits of seeing a primary care physician.

Get Better Faster

So you just have a standard, run of the mill summer cold. Or do you? Sometimes you could have something that is much stronger than a little cold. Without going to see the doctor, there is no way to be 100% sure. Even if it is just a cold, your doctor could prescribe some antibiotics or other medication so that you can get back on your feet sooner than when you stick it out on your own.

Health Screenings

When you go to see your primary care doctor, even if it is just for a check up, there is a possibility that he or she can see, hear or find something that is a little off. By seeing the doctor, you have the ability to catch an illness early and get started on the medication. Whether it’s as small as an infection or something major like finding cancer,early detection can be a matter of life or death. It is important to recognize if your body is doing or feeling something that is not normal. When you notice these things, call your physician immediately. Don’t put it off if you can help it.

If you are searching for the perfect primary physician for you, look no further than the doctors at OIMA for your health care needs. Call today!

What’s Causing The Need For All These Sleep Disorder Treatments?

If you have problems sleeping, you might have learned to live with it. But that’s not the way it should be, and though you may be functioning during the day, you might not be able to enjoy life and your productivity might be affected. What can lead to a need for a sleep disorder treatment?

Sleep apnea – One condition that can lead to interrupted sleep is sleep apnea. This is when you stop breathing when you sleep. While it can be life-threatening, it’s more likely that your brain realizes what has happened and forces you to wake up. This can happen many times per house, but you might not even remember waking. This might be happening and you don’t even know it, so your primary care physician might or sleep specialist might suggest a sleep study, and if sleep apnea is confirmed it is often treatable with a continuous positive airway pressure mask.

Stress – Sleep is supposed to be your minds time to sort through the happenings of the day and decide what to keep and what to pitch…as amazing as the brain is, it can’t keep everything! But the stresses of the modern word can cause you to worry too much about tomorrow, which leads to a lack of sleep, which leaves too much rattling inside your head, which just exacerbates the problem tomorrow. You’ll want to talk to your primary care physician to see if addressing these stress concerns might be the best sleep disorder treatment.

Forced sleep cycles – While there are arguments about the idea amount and timing of human sleep, there are certainly activities that upset a normal circadian rhythm. Sometimes it’s a work schedule, sometimes it’s distractions that keep us up too late…television, video games, and artificial light. A sleep specialist can discuss if your environment and habits are leading to a need for a sleep disorder treatment.

It’s important to address these problems right away, and the sleep disorder treatments offered by OIMA can help get your sleep cycle back on track. Call us for an appointment with a sleep specialist today.


What General Internal Medicine Might Mean For The Future Of Depression Treatment

When it comes to how general internal medicine works and what parts of the body that an internist treats, it might sound weird to suggest that internal medicine might be the future of mental health.

How can this be? Scientists are finding more and more that your microbiome, the creatures that live in your gut and outnumber your own cells 10-to-1, might have a large determination on your mental health and your mood.

Scientists at a university in Ireland took mice and fed them a probiotic-rich diet. (Probiotics are the living organisms that you often find in food such as yogurt.) Then they dropped the mice into a bowl of water. Mice are not fond of water and try to get out as quickly as possible, though the bowl they were dropped into had a lip so high that they weren’t able to get out.

What they found was that mice who’d been fed a probiotic-rich diet would continue to swim for longer than the control group of mice. The mice who had this particular strain of probiotic actually fought to live for a longer time! (Don’t worry, the mice were saved prior to drowning). They were found to have lower anxiety levels and lower levels of stress hormones. They literally wanted to live more!

It hasn’t been tested on humans, but it’s promising to know that someday internists can use natural probiotics to treat conditions of both the mind and body instead of pharmaceutical products. Taking care of your gut bacteria is a good way feel good physically, but it might just be the best way to stay happy too. If you’re feeling off in the future, your internist or psychiatrist might just prescribe a probiotic.



Why Your Internist Wants You To Be Good To Your Liver


The liver is probably the most misunderstood organ in the body. While most people would say something like “it filters out…stuff…right?” your internist will tell you that the liver actually plays a vital part in your health throughout your body.

The liver is a gland and is vital to survival. It weighs about three pounds (making it one of the largest organs in the body) and is on the right side of your belly. And it does a lot…

Filtration: Here’s the one that most people are familiar with. Your intestines extract the vitamins and nutrients from food and pass it to the blood, where it travels via the portal vein. But before the blood gets to the bloodstream it passes through the liver, which collects the toxins and either breaks them down, converts them, or send them to the excretory organs.

Digestion: The liver is a producer of bile, which is a crucial ingredient of the digestion of fats. It collects in bile ducts and then releases it into the small intestine where it helps break down fats for you body. The liver itself helps to break down fats and produce energy. On top of all that, it also helps metabolize proteins for energy. When it’s doing this, toxic ammonia is formed. Not to worry though, because the liver cleans up after itself by transforming this into urea, which it passes along to the kidneys to be excreted in your urine.

Sugar storage: The liver helps to regulate the amount of sugar in your blood. If you have a big meal and there’s too much sugar in your blood, it stores it in a form called glycogen. When your blood sugar drops, it breaks down these sugars and releases them into your blood. In fact, it does the same things for other vitamins and minerals, storing them and releasing them when they’re needed.

So how can you take care of it? Well, avoid poisons for one…the liver will do what it can to filter them out, but it can’t handle everything. Secondly, being overweight can tax the liver. And of course you’ve heard of liver disease, most often brought about by hepatitis or excessive drinking.

Want to make sure your liver stays healthy. Stay in contact with an internist from OIMA!


Your Internist Still Wants To Know: Your Body Is Changing…Why Are You Still Eating The Same?

So we’re all getting older and can’t do everything we used to. So why do so many of us try to keep eating the same as we’ve always eaten? Previously on the last blog, we talked about some of the ways you’re changing…let’s look at some more.

How much you eat: Remember when buffets used to be the best thing in the world and you were determined to get your money’s worth even if someone else was paying for it? When we’re going through puberty, our bodies use up a lot of calories as we grow. Not to mention that most of us are much more active when we’re younger. But if we’re not burning all of those calories, we can start to grow outward instead of upward. Again, listening to your body when it says “stop” instead of trying to eat as you always have is a good step toward a healthier GI tract.

When you eat: When you’re younger, if you’re hungry, you eat. Midnight pizza? No problem. 3 a.m. Taco Bell Run? Let’s go! But as we age, our bodies react differently, and late night food can affect our ability to get to sleep and the restfulness of the sleep we do get. Don’t try to keep up with your young self when your body was telling you to absorb all of the calories you could no matter what time of day it was.

Sometimes it’s not just age that’s affecting what you eat and how your body responds to it. Your internist might have you see a gastroenterologist if diet alone cannot fix what’s ailing you. You may have to see someone who specializes in the digestive tract to see if there’s a more serious problem affecting you.


Your Internist Wants To Know: Your Body Is Changing…Why Are You Still Eating The Same?

Here’s some medical news you can figure out without a internist…you’re getting older!

Of course, we all know that we’re getting older, even if we don’t want to admit it, and even if we don’t mind the age, even if we’re keeping ourselves in good shape, we often don’t want to admit that our bodies are changing on the inside as much as they’re changing on the outside.

This can be especially true with men, who might have once bragged about having an “iron stomach” and find it hard to believe that food is affecting them differently now than when it did when they were 19 years old. They might notice these changes happening in their 30’s but won’t admit it until they’re closer to 40 when it can’t be ignored any longer.

Of course, one of the biggest things that affects your GI tracts is what you eat. Many things can affect how we feel after a meal, and the composition of the food is a huge area of study. Many adults find it harder to digest lactose as they get older, and it’s important to not ignore this when it happens. Similarly, intolerances to gluten can ramp up or hit all at once, and it’s one of the great challenges in the GI field. Changing your diet can be a huge help.


You Are Not Alone! The Microbiome Inside You (And Your Internist, And Your Mechanic, And Your…)

When you move, you move all of your 10 trillion cells, but you also take 100 trillion other organisms along for the ride. It may be hard to wrap your head around, but for each cell in your body, there are 10 bacteria cells. 100 trillion of them, and most of them are your friends.

If you are a fan of the Science Friday radio program, you have probably heard all about the microbiome of your GI tract. It’s the part of “you” that you never even think about. We’ll take an overview of it and then get more involved in subsequent blogs. If you’ve never heard about your microbiome, you’re in for a treat…

It’s a symbiotic relationship: Our biome affects us, and we affect it. We feed ourselves and at the same time, we feed the bacteria. Subsequently, it helps us digest our food.

It’s not like anyone else’s: Although our mothers helped us jumpstart our microbiomes, we’ve altered it over the years into our own. There are species of bacteria in your gut that are as unique to you as your fingerprint.

It can be wiped out: Antibiotics can be lifesavers, but we’ve found lately that there’s more than one reason to be careful when using them. In addition to helping drug-resistant biotics thrive, overuse of antibiotics can also have a negative effect on the microbiome.

It affects your mood: When your biome is healthy, you’re more likely to feel good. Scientists are experimenting with different gut bacteria (in non-human trials) to see how it alters mood. What they’re finding is absolutely amazing.

Some people have said that this is the Age of Man, but in many ways, it’s the Age of Bacteria. Check back soon to find out more on this incredible new field of study. 

Taking Sleep Seriously

Many people do not realize that there is a subspecialty of medicine call sleep medicine, and many also don’t recognize the importance of sleep to their overall health. Trying to function day-to-day on little to no sleep is hard on your daily life and your body. Sleepless nights make everything harder the next day, including, driving, working, concentrating, and it even affects your libido. Beyond the surface, sleepless nights make bodily functions like repairing cells, recharging the brain, and releasing hormones more difficult. Without sufficient sleep, over long periods of time, adults, teens and children, can suffer detrimental health problems and a deficient immune system.

Sleeplessness can be caused by a number of things, including:

  • Daytime tiredness
  • Snoring
  • Restless leg syndrome
  • Sleep apnea
  • Insomnia
  • Sleep walking
  • Sleep talking
  • Narcolepsy.

If you:

  • Have difficulty staying awake during the day (at work, school, or while driving)
  • Experience chronic fatigue
  • Take frequent naps
  • Have difficulty falling asleep
  • Have difficulty staying asleep
  • Have active sleep patterns with no memory

Please consider contacting our Sleep Center for help.

Why It’s Important to Establish a Relationship with an Internist

Internists are doctors who have spent 3+ years of their post-graduate training and education in the field of diagnosis and treatment of diseases that affect adults. These doctors have comprehensive knowledge and understanding of the body’s entire systems and know how to diagnose and treat patients’ medical concerns and symptoms. You may be wondering, “Why would I need to see an internist? What kind of problems require seeing an interest? Is my primary care physician an internist?”

We hope this list of bullets answers some of your questions:

  • All adults, age 18 and over, should have a primary care provider.
  • This primary care provider could be an internist or family medicine physician.
  • You should be able to discuss your current health and long-tern wellness goals with your internist.
  • Your internist should be your partner in preventing and maintaining your good health as well as treat you when you have symptoms of illness or disease or when necessary, refer you to a specialist or subspecialist.
  • You should feel comfortable with your internist, and, once you’ve established a continued relationship, confident that s/he knows your medical history, and are prepared to assist you with your medical issues and wellness goals throughout your life.