What You Should Know About Cholesterol

Since September is National Cholesterol Education Month, our concierge doctors want to review the often-confusing facts about this vital blood component.

What is cholesterol?

Cholesterol is a type of waxy, fat-like substance found in every cell in your body. Made by your liver and also present in some foods, it allows your cells to function properly. It helps synthesize Vitamin D in the body as well as some necessary hormones. These include cortisol and cortisone, and the sex hormones estrogen, testosterone and progesterone, among others. It also helps create the bile you need for digestion.

Cholesterol gets transported through the body on proteins called “lipoproteins.” There are two types of lipoproteins: high-density lipoproteins (HDL) and low-density lipoproteins (LDL). The LDL type makes up most of the cholesterol in the body (between two-thirds to three-quarters). The HDL type absorbs excess LDL cholesterol and returns it to the liver, where it gets flushed from the body.

Why is high cholesterol bad for you?

Despite the role cholesterol plays in keeping the body healthy, only a small amount is needed to maintain critical functions. When your body has too much of the LDL-type of cholesterol, it can build up on the walls of your blood vessels. This causes them to become narrow. This in turn begins to block the free flow of blood to and from your heart and other organs in the body. When blood flow to the heart is blocked, it can cause chest pain (angina), a heart attack or a stroke, among other cardiovascular problems. Therefore, too much LDL is “bad” for your body when it isn’t balanced by higher HDL levels.

The confusion surrounding “high” and “low” cholesterol no doubt arises from their names. If we say your cholesterol levels are too high, you might think, “But isn’t ‘high’ cholesterol the good kind?” High-density lipoproteins (HDL) are good, and the higher that number, the better. But when we say you have “high” cholesterol, we’re talking about the “bad” type, meaning the low-density lipoproteins.

To confuse matters even more, triglycerides that are too high further contribute to fatty buildup in the arteries. Triglycerides are the most common type of fat in the body. High levels of triglycerides combine with high levels of LDLs to raise the risk of cardiovascular disease even further.

How to lower bad cholesterol

The optimal mix is low triglycerides, low LDL levels and high HDL levels in the blood.

According to the National Heart, Lung, and Blood Institute (NHLBI), the leading cause of high LDL cholesterol and triglycerides are unhealthy lifestyle choices. Certain medical conditions and medications, as well as genetics, also play a role.

There are a number of LDL lowering drugs available, including the very successful statins. But, as always, it is preferable to try to lower LDL levels naturally first. There are a number of ways to go about this:

  • lose weight
  • avoid trans fats (most commonly found in fried foods and pastries as well as margarine)
  • avoid red meat and dairy products
  • cut sugar consumption
  • keep alcohol consumption no greater than one drink daily
  • keep stress levels low

These steps, combined with increasing HDL levels in the blood, are often sufficient for many people to remain healthy.

How to raise good cholesterol

Medications to raise HDL cholesterol have not proved effective in lowering the risk of heart attacks and strokes. The best way to increase your supply is through lifestyle changes:

  • quit smoking
  • increase aerobic exercise to a total of at least one hour a week
  • consume more monounsaturated fats, e.g., nuts, seeds, avocados
  • increase intake of polyunsaturated fats, e.g., salmon, tuna, trout, and walnuts
  • consume more soluble fiber, e.g., fruits, vegetables, whole grains, beans, and legumes

In addition, avoid drugs that contain testosterone or other anabolic steroids, which have been shown to lower HDL levels.

Because there are no symptoms of high cholesterol, the only way to know for sure if your levels are within acceptable levels is through a simple blood test. This is especially important if you have a family history of heart disease, are a smoker, are regularly exposed to cigarette smoke or have high blood pressure or diabetes. The National Institutes of Health recommends that all adults have their cholesterol levels checked beginning at age 20.

It’s not difficult to keep “bad” cholesterol levels in check, unless you have a genetic predisposition toward high LDLs. Let us help you sort out the confusion surrounding cholesterol and heart health.

coronavirus symptoms

One More Reason to Avoid COVID-19 Infection

“I feel like an old person; I’m only 46,” a bank examiner from Brooklyn, told the New York Post recently. “I don’t wish this on my worst enemy.” She contracted the virus March 23, and still experiences body aches, hot flashes, arthritis and her hair has been falling out in clumps.

As some people toss around phrases like “herd immunity” (the notion that the virus should spread through the population to eventually produce a general immunity) and blithely attend “covid parties” hoping to achieve the same effect, our concierge doctors thought we’d explore one of the lesser-known risks involved in that type of thinking.

‘Long haulers’

Many of those who survived the disease are beginning to speak out about the long-term effects they’re still experiencing months later.

Shelby Hedgecock first tested positive for COVID-19 in April, negative in May. Nevertheless, she tells CNN she is still having neurological issues, cognitive issues, shortness of breath, chest pain, loss of smell, and body aches and pains that send her to bed for days if she participates in even the gentlest forms of yoga.

“[My symptoms are] just all over the place, and I’m insanely tired,” she told CNN’s Chris Cuomo recently. Cuomo, who also contracted COVID-19 early in the pandemic, reports similar lingering coronavirus symptoms.

Amy Watson, 47, of Portland, Oregon, appears to have been responsible for introducing the phrase “long hauler” which is now attached to the syndrome. Now in her sixth month of dealing with such coronavirus symptoms as painful burning sensations on her arms, torso, head and neck, she created a COVID-19 patient support group called Long Haul COVID Fighters.

Strange debilitating symptoms

Survivors on numerous online COVID-19 support groups describe a constellation of nearly 100 lingering symptoms.

Natalie Lambert, an associate professor of medicine at the Indiana University School of Medicine, surveyed more than 1,500 members of a group called Survivor Corps.

“They’re not quite sick enough to be hospitalized, but they are suffering from very severe symptoms, sometimes for a very long time at home,” she told NBC News.

Respondents to her survey reported 98 different coronavirus symptoms they’d experienced since their diagnosis, including:

  • dizziness
  • anxiety
  • headache
  • rashes
  • joint pain
  • shortness of breath
  • heartburn
  • diarrhea
  • fevers
  • memory impairment
  • cognitive difficulties
  • sleep disturbances
  • vision problems

Alexandra Plazas-Herrera, 41, told the Post she suffered bleeding from her nail beds and the skin was peeling off her face a few months after catching COVID-19.

“It was super weird, like horror movie stuff,” she said, adding that she has also experienced a lingering fever, fatigue, persistent brain fog, poor coordination and inability to concentrate.

Many of those who report chronic symptoms had only mild or moderate cases of COVID-19; most were not serious enough to be hospitalized. A large number of them report they were healthy and “in the prime of their lives” before becoming infected. The syndrome also appears to affect all ages.

How common is this?

The Centers for Disease Control and Prevention (CDC) released a survey in July of 292 people who had tested positive for the virus. It found 35 percent of respondents had not returned to their previous state of health. Other surveys, mainly in Europe, put the incidence as high as 80 percent.

Twenty percent of those in the CDC survey were between the ages of 18 and 34 with no prior chronic medical conditions.

“Data categorically show it’s a real thing,” David Putrino, a doctor of neuroscience and the Director of Rehabilitation Innovation at Mount Sinai Hospital in Manhattan, told ABC News. “These individuals are experiencing fatigue, dizziness, nausea, GI symptoms, pain . . . in the spine and chest.”

No one knows yet how long these troubling coronavirus symptoms will last; some survivors report early symptoms receding and being replaced with new ones.

Unanswered questions

Because the virus is still so new, medical science as yet has no answers for these people.

Jake Goldenstein, 20, still can’t walk down the street without becoming completely winded. He also suffers from debilitating headaches, digestive issues, congested sinuses and a racing heart.

“They gave me all types of medications. I was on a nebulizer, I was on multiple inhalers, they gave me multiple [antibacterial] medications, literally all types of medications,” the former hiker and baseball player told the Post. “None of them really seem to help.”

Lea Lane, a travel writer for Forbes caught COVID-19 in March. She’s seen pulmonologists, cardiologists, gastroenterologists, vascular specialists and neurologists. She reports her new primary care doctor told her she has “post-viral syndrome,” and “hopefully it will someday go away.”

If you experience lingering symptoms of COVID-19 infection, of course we will do our best to help manage them. But for now, our best advice is to avoid becoming infected in the first place:

  • avoid places with large crowds, especially indoors
  • always wear a face covering in public
  • wash hands frequently for at least 20 seconds

Remember the primary means of transmission appears to be aerosolized virus particles emitted—including by those showing no symptoms—when talking, laughing, coughing, singing or just breathing. These aerosols can linger in the air for many minutes or even hours. So never go any place where you don’t feel safe.

Fall Allergies

Prepare Now for Fall Allergies

We love the sunny, warm weather here in southern Florida, but unfortunately it’s also a recipe for an extended allergy season. We not only get a longer time to encounter summer pollens, including flowers and grasses, soon we’ll be having to deal with the fall-blooming ragweed as well as mold allergies that arise from our state’s hot, humid weather.

Add to that the problem of having to endure the symptoms of fall allergies while wearing masks, and this year could prove even more troublesome for allergy sufferers. So our concierge doctors want you to try to get ahead of the curve and begin preparing now to keep your fall allergies under control as much as possible.

How pollen triggers allergies

Pollen is the yellow powdery microspore produced by the male part of a flower (anther) used to fertilize the female part (stigma). It travels by means of wind, insects, or birds.

Pollen is one of the most common allergens in the United States, affecting some 25 million people. Because the grains are so fine, they travel easily and are readily inhaled. Then the body’s immune system mounts a defense against what it interprets as a harmful invader, producing an outpouring of histamine to counteract the trigger. The result, known as hay fever or allergic rhinitis, produces a wave of uncomfortable symptoms:

  • sneezing
  • runny nose
  • itchy, watery eyes
  • cough
  • nasal congestion
  • sinus pressure, leading to facial pain
  • scratchy throat
  • decreased sense of taste or smell

Symptoms are not serious unless they trigger an asthma attack in those with the disease, but note that several of these—including a cough and a decreased sense of taste or smell—are also symptoms of infection with COVID-19. This is all the more reason to keep your allergies under control, so you can tell the difference.

Types of allergies

There are many types of pollen, including those from trees, grasses, weeds, including ragweed, and flowers, and different people react differently to each of them. That’s why the pollen counts announced on weather reports, while helpful in a general sense, don’t necessarily reflect your body’s immune reactions. It all depends on your particular allergy.

Mold can also trigger allergies in sensitive individuals. As mentioned above, Florida has more than our share of unwanted mold, thanks to our high humidity and warm temperatures. These conditions become even more pronounced following tropical storms and hurricanes, and unfortunately they create the ideal breeding ground for mold.

In those who are allergic to mycotoxins (the toxic compounds produced by mold), the symptoms are largely confined to respiratory issues, including wheezing, red or itchy eyes, or sniffling and sneezing. Those with chronic respiratory illnesses such as chronic obstructive pulmonary disorder (COPD) or asthma may have difficulty breathing in homes with mold, and some mold can trigger asthma attacks.


Because COVID-19 is known to attack the lungs, anything you can do to safeguard them against extra stresses like fall allergies will help if you should contract the coronavirus.

Depending on the severity of your symptoms, there are several ways to treat allergies.

Over-the-counter (OTC) remedies include:

  • nasal sprays
  • oral antihistamines
  • decongestants
  • combination oral antihistamines and decongestants
  • nasal irrigation, with an OTC saline spray or a neti pot

Medical treatments include:

  • medications to block allergic reactions
  • medications to ease symptoms
  • tests to determine which pollen triggers the allergy
  • immunotherapy (allergy shots) to overcome the allergy

How to avoid allergens

Of course, the best treatment is to avoid exposing yourself to pollens and mold as much as possible. If you have allergies:

  • Stay indoors on dry, windy days.
  • Avoid outdoor activity in the early morning when pollen counts are highest.
  • Change clothing and shower after spending time outdoors.
  • Keep windows closed, in the home and car.
  • Don’t line-dry clothing or bedding.
  • Wear a pollen mask if you need to work outdoors.
  • Use a vacuum equipped with a HEPA filter.
  • Use a portable air cleaner with a HEPA filter in your bedroom.

To keep mold under control, the Centers for Disease Control and Prevention (CDC) recommends that you keep humidity levels in the home no higher than 50 percent all day long, using an air conditioner and/or a dehumidifier to achieve this level. And make sure to use exhaust fans in the kitchen and bathroom.

On hard surfaces, mold can be removed with commercial products, soap and water, or a bleach solution of no more than one cup of bleach in a gallon of water, the CDC says. Be sure to thoroughly clean and dry the area because sensitive individuals can still have a reaction to the dead mold. In addition, mold contamination can recur if a source of moisture remains. Finally, if you know you’re allergic to a particular type of allergen, or that you begin having symptoms at this time of year, start taking your allergy medication before symptoms begin. And if you need extra help getting your symptoms under control, be sure to let us know.

proper breathing

Proper Breathing Can Improve Your Life and Help with COVID-19

Most adults breathe incorrectly, especially when they are experiencing stress, whether acute or chronic. The effects of improper breathing may surprise you: increased stress, insomnia, weight gain, high blood pressure, anxiety, a weakened immune system, and fatigue, among others.

In addition, although the novel coronavirus attacks every part of the body from the brain to the toes, it typically first makes its presence known with difficulty breathing. And those who experience lingering effects from its infection also complain of long-term breathing problems.

So our concierge doctors thought we’d offer a primer on correct breathing. Not only will this improve many aspects of your life, but it will also help strengthen your lungs before you contract the virus and assist in recovery afterward. It can also help relieve the anxiety so many of us are experiencing now during the pandemic.

Retrain your breathing habit

Babies breathe right naturally, but by the time we’re adults, we’ve been trained out of it. Between tight clothing, Spanx, or belts and constant admonitions to “suck in that belly,” shallow breathing becomes an unfortunate habit as we grow older.

Add to that the tendency to breathe quickly from the top of our lungs whenever we’re stressed, and you have a recipe for a cycle of more chest breathing. This creates more stress, leads to more chest breathing, more anxiety and so on.

Poor breathing habits disrupt the balance of oxygen and carbon dioxide in the blood. This tricks the body into thinking it’s constantly under attack: the so-called “fight or flight” mode.

Other symptoms of bad breathing can include:

  • frequent sighing or yawning
  • repeated throat clearing
  • lack of concentration
  • fatigue bordering on exhaustion
  • chest tightness
  • tingling in hands, lips, or feet
  • insomnia and disturbed sleep, including nightmares
  • cold hands and/or feet due to poor blood circulation
  • shortness of breath
  • headaches
  • panic attacks

If you are experiencing any of the above symptoms, be sure to let us know. They could signal a serious issue, but it’s possible they’re due simply to bad breathing.

Conversely, breathing from the abdomen, like we do as babies, can:

  • strengthen lungs
  • improve sleep
  • lower blood pressure
  • increase energy
  • aid weight loss
  • lower stress
  • improve digestion
  • improve symptoms of chronic obstructive pulmonary disorder (COPD)
  • strengthen the immune system

Are you breathing correctly?

To see whether you’re breathing correctly, place one hand on your chest and the other on your abdomen. Now take a deep breath. If you’re doing it right, the hand on your belly will rise, while the hand on your chest will barely move.

If you’re breathing incorrectly, the above exercise practiced three times daily will help to retrain your breathing. In addition, you can do it in the car, while waiting in line, watching TV, surfing the Internet, and—especially—at night in bed to help you fall asleep.

Be sure to always breathe in through your nose. Breathing from the mouth tends to encourage shallow breathing. In addition, breathing through your nose allows the cilia in your nasal passages to do their job. They protect you from invading viruses and bacteria.

Pre- and post-coronavirus exercises

If you should contract COVID-19, breath training can help boost the power of your lungs to fight off the illness. Many of those who have been infected find themselves struggling to relieve the congestion that settles in the lower part of this lungs with this disease.

Once you’re comfortable with belly breathing, practice the 4-7-8 technique three times daily for at least two minutes: Inhale (through the nose) to the count of four, hold it to the count of seven, and exhale (through the mouth) to the count of eight. If your lungs are so out of shape that these counts are difficult, lower them at first until you can work your way up to the 4-7-8 sequence.

As you learn to breathe correctly, you should find yourself with more energy during the day and more restful sleep at night.

And if you have contracted coronavirus, the following exercise has been touted by numerous survivors of COVID-19, including TV broadcaster Chris Cuomo and author J.K. Rowling. Developed by a British doctor, Sarfaraz Munshi of Queen’s Hospital in London, they can help the lower part of the lungs to expand and expel mucus. It’s a 5-5-5 twist on the 4-7-8 technique, followed by a strong cough at the end.

Munshi recommends beginning this exercise as early in the infection as possible and performing it five times daily.

Breath in for five seconds, hold for five seconds, then release for five seconds. Do this five times, then once more and cough strongly at the end of the release. Repeat this cycle twice.

The deep breathing followed by a cough helps release the mucus trapped in the lower lungs, a typical complaint of those who have COVID-19.

Finally, lie on your stomach taking slightly deeper breaths than normal for ten minutes. This position, called “proning,” has been used successfully in many hospitals to help coronavirus patients improve lung drainage and breathe more easily.

If you have any questions about proper breathing or COVID-19 recovery, please let us know.

Marijuana During Pregnancy

Think Twice About Marijuana During Pregnancy

As more places around the country legalize marijuana for recreational use, many people have come to accept the idea that it is a harmless substance. As with any drug, however, our concierge doctors want to caution you that it does contain risks, especially for pregnant women. A new study underscores just how risky it could be during pregnancy.

Not your father’s marijuana

First, you should know today’s marijuana is far more potent than that used by previous generations.

Due to advanced growing techniques and hybridization, the marijuana available today has a far higher concentration of THC, or tetrahydrocannabinol, than even as recently as the 1980s. THC is the psychoactive compound that produces the classic marijuana “high.” Federal officials say the THC potency in those days averaged around four percent. In the 1960s it was around two percent. Today’s levels have been found to be as high as 20-30 percent.

Some products made from marijuana, often designed to be used with vaping devices—such as some edibles, oils, and substances called shatter, crumble, budder, and crystalline—have an even higher THC concentration. These products average 68 percent and occasionally reach as high as 95 percent. As the popular expression has it, “This is not your father’s weed.”

Side effects

These higher levels can increase the chances of an adverse reaction, either in new users or in those who haven’t used the drug in decades. These side effects can include:

  • anxiety or panic attacks
  • increased heart rate
  • dizziness
  • breathing difficulties
  • impaired memory
  • concentration difficulties

Special dangers during pregnancy

In addition to these unwanted side effects, many studies have highlighted special risks to the infants of women who used marijuana during their pregnancy. These risks include the possibility of low birth weight, impulsivity, and cognitive and behavioral issues, according to the Centers for Disease Control and Prevention (CDC).

Now, a new study released this month found marijuana use during pregnancy and breastfeeding may increase the risk of babies potentially developing autism. Researchers analyzed data from more than 500,000 Canadian mothers. They found a 50 percent increase in the risk of autism spectrum disorder in children whose mothers had used the drug while pregnant.

The study, published in the journal Nature Medicine, reviewed data from every birth in Ontario, Canada from 2007 to 2012. Researchers looked only at women who reported having used marijuana during pregnancy. They screened out reported use of other drugs such as tobacco, alcohol, or opioids to control for those substances.

“We know that cannabinoids can cross placental tissue and enter the fetal bloodstream,” Daniel Corsi, an adjunct professor at the University of Ottawa, and the study’s lead author, told NBC News. “Cannabis is not a benign drug and any use during pregnancy should be discouraged.”

Caveats, of course

As with any study of this nature, researchers cautioned their findings were based on association only, and further research is needed. That was especially true in this case. The marijuana use was self-reported by the women, and the time period of the study occured before Canada legalized recreational marijuana use. Other studies have found self-reports for marijuana use tend to understate actual usage, especially where it remains illegal.

“This is an interesting first step, but much more work is needed to implicate maternal cannabis use specifically in autism risk,” Daniele Fallin, director of the Wendy King Center for Autism and Developmental Disabilities at the Johns Hopkins Bloomberg School of Public Health, told NBC News. Fallin was not involved in the study.

Reasons for use in pregnancy

Women use marijuana during pregnancy for a variety of reasons, according to a CNN report. These include:

  • pain management
  • prevention of nausea or vomiting
  • sleep aid
  • stress relief
  • in lieu of other medications they consider more harmful

Some women also continue to use it during pregnancy because it’s simply a part of their lifestyle.

In addition, medical marijuana (low-THC cannabis or synthetic cannabis) can now be prescribed to legal Florida residents by qualified physicians for certain conditions. These include chronic pain, anorexia due to HIV/AIDS or cancer treatment, glaucoma, seizure disorders, terminal illness and more.

Depending on the type employed, users may or may not experience the “high.” Some medical marijuana has been specially formulated to eliminate the mood-altering effects while still providing relief from symptoms.

Nevertheless, doctors stress the need for caution during pregnancy.

“Pregnant women or women contemplating pregnancy should be encouraged to discontinue use of marijuana for medicinal purposes in favor of an alternative therapy for which there are better pregnancy-specific safety data,” the American College of Obstetricians and Gynecologists (ACOG) recommends.

While recreational marijuana is still illegal in Florida, we know that some will use it anyway. If you are pregnant or contemplating pregnancy, please feel free to discuss this issue with us.

lightning safety

Stay Safe from Lightning

Did you know that Florida tops the national list for lightning deaths every year? That’s why we’re known as the “lightning capital of the U.S.” And the southeastern coast of our state is second only to the Tampa area in reported fatalities. Finally, the deadliest month is July, which typically sees nine deaths per year.

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