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Notes on health, from a concierge practice
Articles from the practice on blood pressure, kidney health, prevention and getting the most out of your care. General information, not advice for your situation.
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Hydration for older adults: how much is enough
Thirst fades with age, and Florida heat raises the stakes. What the reference numbers say, the early signs of dehydration, and when drinking more is the wrong advice.
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Women’s health after 50: the checkups that matter
Mammograms, bone density, the heart, and when cervical screening can stop: the checkups national guidelines recommend for women over 50, with the year of each.
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Men’s health after 50: the checkups that matter
The screenings and vaccines that national guidelines recommend for men over 50, with the year each recommendation was issued, and the ones that call for a conversation first.
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Mosquito-borne illness in Florida: dengue and West Nile basics
Palm Beach County has had a mosquito-borne illness advisory this year. What dengue and West Nile look like, who is at higher risk, and how to drain and cover.
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Seasonal allergies in South Florida
Florida’s pollen seasons run longer and overlap more than up north. What triggers allergies here, how to tell them from a cold, and which treatments work best.
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Traveling with medications: packing, time zones and refills
How to pack prescriptions for a flight, handle doses across time zones and avoid running out when you split the year between two homes.
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ER, urgent care or call your doctor: how to decide
When to call 911, when the emergency room is the right place, when urgent care will do, and when a call to your own doctor comes first. Stroke and heart attack signs included.
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Reading your blood work: the CBC and metabolic panel in plain English
What each line on a complete blood count and a metabolic panel measures, and why a single flagged number is rarely the whole story.
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How to prepare for a doctor’s visit: a simple checklist
A short checklist for getting the most out of any appointment: what to write down, what to bring, and what to ask before you leave.
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Advance directives in Florida: health care surrogate and living will basics
How Florida law handles a health care surrogate, a living will and decisions when there is no directive, with links to the statute. General information, not legal advice.
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Caregiver burnout: looking after yourself while caring for a parent
Caring for a parent is meaningful and exhausting. The warning signs of caregiver stress, how to ask for help, and where to find respite.
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Keeping your brain healthy: what the evidence supports
Blood pressure, hearing, exercise and social contact have real evidence behind them. Supplements and brain-training apps mostly do not. A plain look at the research.
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Loneliness and social connection as a health issue
Loneliness and isolation are linked to heart disease, stroke, depression and dementia. What the research shows and practical ways to rebuild connection.
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Depression in older adults: signs that are easy to miss
Depression in later life often looks like tiredness, aches or lost interest rather than sadness. The signs, what can mimic it, and how it is treated.
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Eye health after 50: glaucoma, macular degeneration and cataracts
Three common eye conditions of later life, how each one shows up, who is at higher risk, and the eye symptoms that need same-day care.
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Hepatitis C and hepatitis B screening for adults
The CDC now advises every adult to be tested for hepatitis C and hepatitis B at least once. Why, which blood tests are used, and what a positive result means today.
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Abdominal aortic aneurysm screening: who should get the one-time ultrasound
A quick, painless ultrasound can find a weak spot in the body’s largest artery before it causes trouble. Who the guidelines say should have it, and when.
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Prostate cancer screening and the PSA test: making a shared decision
The PSA test is a choice, not a routine. What the official guidance says, the real numbers on benefit and harm, and questions to bring to your doctor.
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Colon cancer screening: colonoscopy, stool tests and when to start
Screening for colorectal cancer now starts at 45. The test options, how often each one is repeated, and what happens after an abnormal result.
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Pneumococcal (pneumonia) vaccines for adults: current recommendations
Since late 2024, the CDC recommends a pneumococcal vaccine for all adults 50 and older. Which vaccines are used, who needs one sooner, and what to do if you had one before.
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The shingles vaccine after 50
About 1 in 3 people get shingles. Who the CDC recommends Shingrix for, how well it works, what the side effects feel like, and how Medicare covers it.
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Iron deficiency and anemia in adults
Iron deficiency is the most common cause of anemia. The symptoms, why the cause always matters in adults, and how iron is replaced safely.
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Vitamin D: who needs testing and supplements
Vitamin D blood tests and supplements are everywhere. What the NIH, the Endocrine Society and large trials say about who benefits, how much is enough, and how much is too much.
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Heartburn and GERD: when it is more than indigestion
Occasional heartburn is common. When reflux becomes GERD, what helps, how to use acid-reducing medicines wisely, and the warning signs that need a doctor.
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Sleep apnea: signs, testing and why it matters for the heart
Loud snoring and daytime sleepiness can be signs of obstructive sleep apnea. How it is tested, how it is treated, and its links to blood pressure and AFib.
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Atrial fibrillation: symptoms, stroke risk and treatment
AFib is the most common irregular heart rhythm and a major cause of stroke. The symptoms, who is at risk, and how blood thinners, rhythm care and lifestyle fit together.
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Statins: who benefits and what to know about side effects
Who the 2026 cholesterol guideline says should consider a statin, what the best evidence shows about muscle aches and other side effects, and what to ask.
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Living well with type 2 diabetes: the numbers that matter
A1C, blood pressure, cholesterol, kidney tests and eye exams: what the 2026 American Diabetes Association standards recommend, and how often to check each one.
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Underactive thyroid (hypothyroidism) and the TSH test
Tired, cold, gaining weight? What an underactive thyroid is, how the TSH blood test works, and how thyroid medicine is started and checked.
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Resistant high blood pressure: when three medicines are not enough
What counts as resistant hypertension, the common reasons blood pressure stays high, hidden causes like primary aldosteronism, and the next steps in the 2025 guideline.
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Potassium: when it is too high or too low
Potassium keeps the heart and muscles working, and the kidneys keep it in range. What high and low results mean, which medicines affect it, and when it is urgent.
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White coat and masked hypertension: when office readings mislead
Blood pressure can read high in the office and normal at home, or the reverse. What white coat and masked hypertension mean, which one carries more risk, and how to tell.
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Salt, sodium and blood pressure: how much is too much
The sodium limits in the 2025 blood pressure guideline, how much cutting back lowers blood pressure, where the salt actually comes from, and a caution on salt substitutes.
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Gout and uric acid: flares, kidneys and long-term treatment
What causes gout, how flares are treated, why the uric acid target is 6, and how gout and kidney disease are connected, from the ACR and other official sources.
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Medicines and supplements that can strain your kidneys
NSAIDs, acid reflux pills, some supplements and contrast dye can affect the kidneys. Who is most at risk, what the guidelines say and what to ask before you stop anything.
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Diabetes and your kidneys: testing, risk and the treatments that protect them
Diabetes is a leading cause of kidney disease, and it is usually silent. Which yearly tests to ask for and the medicines now shown to slow kidney damage.
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Kidney stones: why they form and how to keep them from coming back
Why kidney stones form, why South Florida heat matters, and the fluid, diet and medicine steps that help prevent the next one, based on current guidance.
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Protein in the urine: what a UACR test tells you
The urine albumin-to-creatinine ratio is a simple test that can find kidney damage early. What the numbers mean, what can throw them off and what happens next.
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Chronic kidney disease stages: why eGFR and albuminuria belong together
How chronic kidney disease is staged with two numbers, a G stage from eGFR and an A stage from urine albumin, and what each combination means for follow-up.
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Strength training after 50: why muscle matters as you age
Muscle strength shapes how well you age. What the federal guidelines recommend, what the research shows, and how to start lifting safely after 50.
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Body composition vs. BMI: what the scale misses
BMI is a quick screening number, not a verdict. What it cannot tell you about fat, muscle and where weight sits, and better questions to ask as you age.
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VO2 max: why fitness may predict a longer life
Cardiorespiratory fitness is one of the strongest predictors of how long people live. What VO2 max means, what the studies show, and how to improve yours.
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How sleep changes with age, and what helps
Older adults still need seven to nine hours of sleep, but sleep changes with age. Insomnia, sleep apnea, and the evidence-based fixes worth asking about.
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Coronary artery calcium scoring: who it helps
A coronary calcium scan can sharpen a borderline heart risk estimate. Who guidelines say it helps, what the score means, and when it adds little.
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ApoB and lipoprotein(a): cholesterol numbers worth asking about
Beyond LDL: what apolipoprotein B and lipoprotein(a) measure, why Lp(a) is worth checking once, and how these numbers can change a heart-risk plan.
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Prediabetes and A1c: how to turn the numbers around
An A1c of 5.7 to 6.4 percent means prediabetes. What that number measures, why the evidence for lifestyle change is strong, and what to do next.
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GLP-1 medications for weight: what to know before you ask
Semaglutide and tirzepatide changed weight treatment. What the trials showed, common side effects, what happens when you stop, and questions to ask first.
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Menopause and heart health: why midlife is the time to pay attention
Heart disease is the leading cause of death for women, and risk rises after menopause. What changes, which numbers to watch, and where hormones fit.
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Bone density screening: who needs it, women and men
Osteoporosis is silent until a bone breaks. Who should have a DXA scan, what the T-score means, how often Medicare covers it, and why men count too.
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Midlife blood pressure and brain health
High blood pressure in midlife is linked to memory problems later. What the SPRINT MIND trial found, and why steady control protects the brain.
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Skin cancer checks for Florida residents
Skin cancer is the most common cancer in the US, and Florida sun adds up. How to check your own skin, what to watch for, and when to see a dermatologist.
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Alcohol after 50: what the newer guidance says
The 2025 to 2030 Dietary Guidelines dropped daily drink limits and simply advise drinking less. Why alcohol affects you differently after 50, and what to ask.
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Balance and fall prevention: staying steady after 60
More than one in four older adults falls each year, and most falls are preventable. The risk factors, the exercises that work, and what your doctor can check.
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Hearing loss, hearing aids and memory
Hearing loss is common after 60 and linked to faster cognitive decline. What the ACHIEVE trial found, over-the-counter hearing aids, and what Medicare covers.
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A longevity plan for the year ahead, built with your internist
Longevity medicine is mostly the basics done well and followed over time. A year-round plan built around your annual physical, without the hype.
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Can you pay concierge fees from an HSA or FSA?
A 2026 IRS rule lets HSAs pay some direct primary care fees. Why concierge fees may not qualify, how FSAs differ, and why to ask a tax advisor first.
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Does Medicare cover concierge medicine?
Medicare does not pay concierge fees, but it still covers your visits and tests. Here is how assignment works and what gets billed to Medicare.
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Concierge medicine and direct primary care are not the same
Concierge medicine and direct primary care both charge a membership, but they differ on insurance billing, fee structure, Florida law and the new HSA rule.
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Concierge medicine vs. MDVIP: how the models differ
How a national affiliate network like MDVIP differs from an independent concierge practice, and the questions worth asking before you join either one.
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How much does concierge medicine cost?
What shapes a concierge medicine fee, what a 2005 federal report found, why insurance is still billed for visits, and the questions to ask before you join.
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12 questions to ask at a concierge meet and greet
A practical checklist for your first meeting with a concierge doctor: what to ask about access, fees, insurance, hospitals, family updates and records.
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How to choose a concierge doctor in Palm Beach County
How to check a concierge doctor’s board certification, Florida license and hospital privileges, and how to judge the harder part: whether the fit is right.
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Telehealth with your own doctor: what works by video
Which visits work well by video with a doctor who already knows you, which ones still need the office, and how to get the most out of a video visit.
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Why it helps when your internist is also a nephrologist
Kidneys, blood pressure, diabetes and medicines are closely linked. Here is why it helps to have one doctor trained in both Internal Medicine and Nephrology.
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Your annual physical: what the evidence says you need
What a yearly physical is for, which screenings the U.S. Preventive Services Task Force recommends by age, and how Medicare’s wellness visit differs.
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A seasonal resident’s guide to primary care in Palm Beach
Splitting the year between Palm Beach and home up north? How to keep one clear medical picture, a current medication list and a doctor who knows you.
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How to move your medical records to a Florida doctor
A step-by-step guide to moving your medical records to a new doctor in Florida: what to ask for, your rights under HIPAA, fees, and timing.
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Medicare when you live in two states
How Original Medicare, Medicare Advantage and Part D drug plans work when you split the year between Florida and another state, with dates to know.
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A hurricane season health checklist for older adults
A practical hurricane checklist for older adults in Palm Beach County: medicines, records, power-dependent equipment, dialysis plans and family contacts.
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Heat, hydration and your kidneys in South Florida
How heat and dehydration affect older adults and the kidneys in South Florida, which common medicines raise the risk, and when to call your doctor.
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Concierge care for an aging parent: a guide for families
How families can coordinate a parent’s care with one doctor: HIPAA permissions, a Florida health care surrogate, shared visits and a plan for calls.
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Memory changes: what is normal, and when to see a doctor
How to tell normal forgetfulness from something more, what the National Institute on Aging says about treatable causes, and when to book a visit.
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Too many medicines? Why a full medication review matters
Several doctors, several pharmacies, a shelf of supplements. Why older adults benefit from a full medication review, and what the Beers Criteria are.
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eGFR, creatinine and UACR: reading your kidney labs
What eGFR, creatinine and the urine albumin-to-creatinine ratio measure, what the ranges mean, and why one result is rarely the whole story.
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How to check your blood pressure at home
How to choose a validated upper arm cuff, prepare, sit and record readings at home, following American Heart Association guidance, and what to share.
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Vitamins that can be taken in the morning
Vitamin B12, vitamin C, iron, magnesium and zinc are often taken in the morning. A short guide to why, and which other supplements are used for energy.
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Breast cancer screening update
The USPSTF’s 2024 update moved routine mammograms for average-risk women to every other year from age 40 to 74, and how the ACR and ACS differ.
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Magnesium: a forgotten electrolyte
Why magnesium runs low (diet, diarrhea, acid reducers, diuretics) or high in kidney disease, the symptoms of each, and why to check before supplementing.
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Non-steroidal anti-inflammatory agents: hidden dangers in the pharmacy aisle
Ibuprofen and naproxen are sold without a prescription, but NSAIDs can harm the kidneys, stomach, heart and blood. Why they are meant for short-term use.
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RSV infection in adults
How RSV spreads, which adults are at highest risk of severe illness, how long people stay contagious, and the everyday steps that help prevent infection.
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Benefits of yearly influenza vaccination
Why a yearly flu shot matters, who is at higher risk of flu complications, who should not get the vaccine, and when in the season to be vaccinated.
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How often should someone urinate?
Most adults urinate about 6 to 8 times a day. Common reasons for urinating more or less often, from fluids and medications to prostate and kidney problems.
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What is low-dose computed tomography?
Low-dose CT is a yearly lung cancer screening test. Who is eligible under USPSTF criteria, what a pack-year is, the risks of screening, and when to stop.
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The benefits of exercising
Regular exercise lowers the risk of heart disease, diabetes, some cancers and falls, and helps mood, sleep, bones and weight. Check with your doctor first.
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Potty like a rockstar: constipation and the squatty potty
What counts as constipation, which symptoms need urgent care, first steps with fiber, fluids and exercise, and how a toilet stool straightens the colon.
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What is a pulse oximeter?
How a fingertip pulse oximeter measures blood oxygen, how to take an accurate reading at home, what the numbers mean, and what can throw readings off.
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Safety of over-the-counter oral pain medications
Acetaminophen and NSAIDs such as ibuprofen and naproxen carry FDA boxed warnings. The liver, heart, stomach and kidney risks to know before you take them.
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CDC COVID-19 booster update
The CDC’s November 2021 COVID-19 booster guidance for Pfizer, Moderna and Johnson & Johnson recipients, kept as a record. Current guidance is different.
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Bananas are an amazing source of nutrition
What a banana gives you: potassium, magnesium, fiber and resistant starch, plus why people with kidney disease or diabetes may need to limit them.
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Let’s talk about antibiotics: the good, the bad and the ugly
Antibiotics treat bacterial infections, not viral ones. The side effects of using them when they are not needed, and how overuse leads to resistance.
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Vitamin supplementation
How the FDA regulates dietary supplements, who may benefit from a multivitamin, and the risks of taking too much vitamin A, beta-carotene or vitamin D.
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The Mediterranean diet approach
What the Mediterranean diet emphasizes, why olive oil, nuts and fish matter for the heart, how wine fits in, and practical steps to start eating this way.
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Is cancer preventable?
Tobacco, infections, alcohol, obesity, air pollution, sun exposure and diet: the cancers linked to each risk factor and the prevention steps for each one.
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Fully vaccinated? Now what?
A short 2021 note for patients newly vaccinated against COVID-19: keep testing if you have symptoms and follow CDC and health department travel advice.
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Why is obesity a disease?
Why the American Medical Association has recognized obesity as a disease since 2013, how hunger signals are affected, and what modest weight loss can do.
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Are you getting enough sleep? Are you sleeping too much?
Adults should sleep 7 or more hours a night. The health risks of regularly sleeping less, when more than 9 hours may be fine, and habits that disturb sleep.
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What is hyperhidrosis?
Hyperhidrosis means sweating far more than the body needs. The difference between primary and secondary forms, likely causes, and the treatment options.
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Hair loss in men and women
Why hair thins in men and women, from androgenetic alopecia and DHT to stress, iron deficiency and thyroid disease, and the treatments that can help.
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Pandemic fatigue tips
Written in late 2020, these tips cover managing expectations, staying connected with people, and remembering why the COVID-19 precautions were in place.
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Concierge medicine pros and cons
The pros of concierge medicine, such as direct access, quick replies and fewer referrals, weighed against the con: a concierge fee insurance won’t cover.
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What is concierge medicine?
Concierge medicine is a membership model: an annual fee for direct access to your doctor, same-day visits and longer appointments. How it works and why.
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Arthritis: common helpful tips
Practical arthritis tips: know your type, keep your joints moving, mind your posture, choose low-impact exercise, know your limits and consider therapy.
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5 quick tips to reduce your stress
Five simple ways to lower stress: exercise, stop procrastinating, spend time with friends and family, try yoga or meditation, and write your worries down.
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The best way to wash your hands
Step-by-step hand washing with soap and water for at least 20 seconds, when to wash before and after, and when hand sanitizer with 60% alcohol will do.
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Top 10 foods that promote a healthy heart
Kale, oatmeal, blueberries, avocados, salmon, walnuts, black beans, dark chocolate, garlic and green tea: what each one offers your heart and blood vessels.
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How concierge medicine works with your hospitalization
How concierge care fits around a hospital stay at Legacy Medical, and the follow-up visit with Dr. Shtern after you are discharged.
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Everything you need to know about executive-level physical exams
What an executive-level physical includes (head-to-toe exam, blood work, ECG and screenings) and how a concierge physician reviews the results with you.
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How to know if a concierge doctor is right for you
Signs a concierge doctor may suit you: too many doctors, rushed visits, chasing results. What concierge care includes and how a smaller practice works.
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COVID-19: 5 tips on how to avoid spreading the virus
Our August 2020 advice on COVID-19: hand washing, distancing, masks, cleaning surfaces and watching for symptoms. Kept as a record; guidance has changed.
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Next step
Meet Dr. Shtern before you decide.
Every membership starts with a complimentary meet and greet. Sit down with Dr. Shtern, see the office, and ask whatever you like.