Congestive Heart Failure:

This is a condition where the heart does not effectively pump blood to your body. It is very important to take your medicines and monitor your fluid intake. It is also important to avoid too much salt. Taking a daily weight can also be helpful to monitor fluid accumulation. It is important to regularly be seen by your doctors to help avoid medical problems.

COPD (Emphysema/Chronic Bronchitis):

This is a condition where the lungs have difficulty doing their job. Coughing and shortness of breath are common as this condition worsens. A variety of medicines can be of help including inhalers. Some of these medicines are needed daily to help prevent problems. This helps to “keep your lungs open” . In some cases oxygen is needed. Smoking commonly can lead to this COPD. If you are a smoker, you should stop immediately. Also, be aware of what environmental conditions may worsen your symptoms. For example, hot weather, some aerosol sprays and a simple cold can cause severe exacerbations of your condition.

Smoking Cessation: Smoking continues to be the number one cause of preventable death in the U.S. It is the leading cause lung cancer and can lead to cancer of the mouth, larynx, esophagus, stomach, kidney, cervix and bladder. It also leads to an increase in stroke, heart attack and vascular disease. COPD is the third leading cause of death and results from smoking. Smoking costs about 200 billion dollars annually. Fortunately, quitting smoking has health benefits and smokers are encouraged to quit.

Quitting: smoking is hard to quit because it is addition. Many want to quit but the tolerance and withdrawal make it difficult. Effective, successful strategies include the following:nicotine replacement, counseling, quit line (800 QUIT NOW) and medication.


This continues to be a major health problem for the entire country. Once diagnosed, it is important to continue to exercise, watch your diet and take your medicines. Some medicines, are prescribed just to help prevent problems. Heart disease, strokes, vision problems and kidney disease are chronic complications of out of control diabetes. Aggressive control of you cholesterol is important, and may require a medicine for this. ACE inhibitors help to protect the kidneys and also can improve blood pressure. Important tests include the hemoglobin A1C, Cholesterol, urine micro albumin and other routine tests. It is very important to have a hemoglobin A1C of less than 6.5 to help avoid complications. A yearly eye and foot evaluation are very important. Routine lab work is important to manage the diabetes and to make sure that your medicines are not causing any adverse effects.


also known as high blood pressure is a very common condition. This is also referred to as the silent killer. Normal blood pressure is considered 120/80 range. Keep in mind that your blood pressure is expected to rise under certain conditions. This includes: pain, exercising, stress, anxiety and sometimes when you are at the doctor’s office (White Coat Hypertension). Uncontrolled blood pressure can lead to heart failure, a stroke, kidney disease and cardiovascular disease. High salt diet, inactivity and other health conditions can lead to high blood pressure. Sleep apnea and obesity are becoming an increasing cause of high blood pressure. Exercise regularly, eat well, maintain a good weight and avoid salt to improve your blood pressure.

Obstructive Sleep Apnea:

Sleep apnea is becoming more and more common. One in five adults have mild sleep apnea and one in fifteen have severe sleep apnea. It is a condition associated with snoring that results in a person stopping breathing at night while sleeping. Most times the person will not know this. They will notice tiredness during the day. In addition, signs and symptoms include: headaches, obesity, depression and high blood pressure. This condition is associated with a higher chance of having a stroke, a car accident, heart disease, erection problems and can be easily treated. A sleep test is used to diagnose this condition and more and more these tests are done in the home. This condition is treated with CPAP (oxygen) and surgery. Weight loss can also be very helpful.

Urine Infection (UTI):

A UTI can be very painful and there will be an increase in urine frequency. Most will experience a burning with urination. A urinalysis and culture are very important to confirm the presence of bacteria that cause the infection. Antibiotics are needed to help treat this condition. In some cases, the presence of a catheter can make it very difficult to confirm the presence of significant bacteria and thus an infection. A catheter is foreign to your body and as a result it will cause an increased amount of bacteria and white blood cells in the urine when examined. It is very important to use antibiotics wisely under these conditions to avoid antibiotic drug resistance.

Vitamin D Deficiency:

Vitamin D deficiency is a very common condition. This vitamin has been found to be more important than previously thought. Most vitamin D comes from sunlight and even those exposed to regular sunlight are commonly deficient.

Although the amount of vitamin D adults get from their diet is often less than what’s recommended, exposure to sunlight can help improve your levels. For many people Vitamin D is a problem, especially for our older population.

The recommended dietary allowance (RDA) for adults with normal levels is 600 IU of vitamin D a day. That goes up to 800 IU a day for those older than age 70. To meet this level, choose foods that are rich in vitamin D. For example, choose fortified foods such as milk and yogurt and fatty fish such as salmon, trout, tuna and halibut.

For those with low levels (usually with levels less than 20) we recommend vitamin D 5000 units a day for at least 3 month then consider 1000 units once a day. Alternatively, you can consider 50,000 units once a week x 3 months then start a lower maintenance dose (1000 units daily or 50,000 once every week or two). These capsules are usually very small.

Serum concentration of 25(OH)D is the best indicator of vitamin D status.

Food Sources of Vitamin D :
Very few foods in nature contain vitamin D. The flesh of fatty fish (such as salmon, tuna, and mackerel) and fish liver oils are among the best sources [1,11]. Small amounts of vitamin D are found in beef liver, cheese, and egg yolks. Vitamin D in these foods is primarily in the form of vitamin D3 and its metabolite 25(OH)D3 [12]. Some mushrooms provide vitamin D2 in variable amounts [13,14]. Mushrooms with enhanced levels of vitamin D2 from being exposed to ultraviolet light under controlled conditions are also available.

Fortified foods provide most of the vitamin D in the American diet [1,14]. For example, almost all of the U.S. milk supply is voluntarily fortified with 100 IU/cup [1]. (In Canada, milk is fortified by law with 35–40 IU/100 mL, as is margarine at ≥530 IU/100 g.) In the 1930s, a milk fortification program was implemented in the United States to combat rickets, then a major public health problem [1]. Other dairy products made from milk, such as cheese and ice cream, are generally not fortified. Ready-to-eat breakfast cereals often contain added vitamin D, as do some brands of orange juice, yogurt, margarine and other food products.

Selected Food Sources of Vitamin D [11]:

  • Cod liver oil, 1 tablespoon 1,360 340
  • Swordfish, cooked, 3 ounces 566 142
  • Salmon (sockeye), cooked, 3 ounces 447 112
  • Tuna fish, canned in water, drained, 3 ounces 154 39
  • Orange juice fortified with vitamin D, 1 cup (check product labels, as amount of added vitamin D varies) 137 34
  • Milk, nonfat, reduced fat, and whole, vitamin D-fortified, 1 cup 115-124 29-31
  • Yogurt, fortified with 20% of the DV for vitamin D, 6 ounces (more heavily fortified yogurts provide more of the DV) 80 20
  • Margarine, fortified, 1 tablespoon 60 15
  • Sardines, canned in oil, drained, 2 sardines 46 12
  • Liver, beef, cooked, 3 ounces 42 11
  • Egg, 1 large (vitamin D is found in yolk) 41 10
  • Ready-to-eat cereal, fortified with 10% of the DV for vitamin D, 0.75-1 cup (more heavily fortified cereals might provide more of the DV) 40 10
  • Cheese, Swiss, 1 ounce 6 2

The U.S. Department of Agriculture’s Nutrient Database Web site lists the nutrient content of many foods. It also provides a comprehensive list of foods containing vitamin D. A growing number of foods are being analyzed for vitamin D content. Simpler and faster methods to measure vitamin D in foods are needed, as are food standard reference materials with certified values for vitamin D to ensure accurate measurements [15].

Lung Cancer:

  • The second most common cancer for men and women
  • The American Society of Cancer estimates there will be 228, 190 new cases of lung cancer
  • Leading cause of cancer related deaths
  • Low dose Cat Scan of chest may help to check for early lung cancer
  • If you are a smoker the best thing to do is to stop smoking immediately

Colon Cancer:

  • Third most common cause of cancer
  • In 2013 142,000 new cases of colorectal cancer is expected
  • Third leading cause of cancer related deaths in the United States
  • Screening tests are very good at helping to prevent colon cancer
  • Colonoscopy is recommended for everyone age 50 or sooner based on a family history of colon cancer.