Diabetes and Vascular Disease

Vascular Diseases are the principal cause of disability in diabetic patients. To understand the reason for this, we will briefly explain the role of your vascular system.

Your vascular system is part of your circulatory system, which includes your heart. Your vascular system consists of blood vessels; arteries, veins, arterioles, venules and capillaries. The blood vessels are the transit system, so to speak, where blood travels throughout your body. After the heart pumps oxygen rich blood into the aortic valve and into the aorta which is the largest artery in the body, the arteries, arterioles and capillaries deliver oxygen rich blood and nutrients to all of our organs, and extremities, and then the veins return deoxygenated blood and waste back to the heart, and the process begins all over again. Without oxygen rich blood and nutrients being constantly delivered, our brain, organs and extremities will suffer. This is where complications of diabetes come into play.

People with diabetes have too much sugar in their blood. Excess sugar in our blood damages the inner linings of both our large and small arteries by decreasing the elasticity of blood vessels. The damaged blood vessels respond by layering on plaque, a substance made from fatty substances, calcium, waste products, cholesterol and fibrin, that fills in the arteries. This causes our blood vessels to narrow, impeding blood flow and reducing the supply of blood and oxygen to our organs, extremities and nerves. Oftentimes people with diabetes also have high blood pressure. High blood pressure damages arteries too, as plaque will accumulate along tears in your artery wall, which stresses our circulatory system. Consequently, people with diabetes are at a higher risk for certain vascular diseases.

Of particular concern are the eyes, kidneys, legs and feet. Diabetics must pay close attention and visit their doctor and specialists regularly, to have their levels checked, and to keep a close watch on any changes they may experience. Here are some of the ways in which people with diabetes may experience vascular disease.

  • Eyes – The tiny blood vessels in the retina may become inflamed, which blocks oxygen rich blood from reaching the retina. If the condition becomes severe, blindness may occur.
  • Peripheral Arterial Disease (PAD) – PAD occurs when plaque builds up in the arteries and reduces blood flow to your legs and feet. The first signs may be pain in your legs while walking which subsides while resting. Wounds that will not heal often develop in advanced PAD. If left untreated, gangrene can develop and amputation may result.
  • Renovascular Conditions – Diabetes affects the blood vessels of the kidneys and can lead to kidney failure and the need for a kidney transplant. Oftentimes damage goes undetected until it is advanced and is not reversible.

Prevention is the best course of action. If you suffer from diabetes, your best defense against vascular complications is a good offense!

  • Get an annual eye exam and be on alert for any changes.
  • Exercise is the best way to keep your circulation in tip top shape! Consistent exercise, especially walking, can lessen the symptoms of PAD, and over time can create more blood vessels by expanding the network of capillaries! Patients who have PAD symptoms, should have regular checkups with a vascular surgeon and podiatrist. Always speak to your doctor before starting an exercise routine.
  • See a doctor regularly for blood tests which can detect kidney failure in its early stages. Keeping an eye on your blood sugar and blood pressure can reduce the risk of diabetes related kidney failure. If caught early, kidney problems may be treated with medications and may prevent the need for dialysis in the future.
  • Stop Smoking! – Cigarette smoking also damages blood vessels, particularly for those people with diabetes. Tobacco causes inflammation, which in turn causes plaque buildup.

Self-care is an important part of staying healthy and living a longer life. Your body will thank you!

For more information, please visit our website at: www.sfvvg.com

Does Walking Help Peripheral Artery Disease?

Do you have pain and cramping in your lower extremities after minor activity? Do you experience numbness or weakness in your arms or legs? Do you have wounds on your toes, feet or legs, that won’t heal? If you answered yes to any or all of these questions, you may be suffering from peripheral artery disease or PAD. PAD is caused by the narrowing of blood vessels that supply blood to your legs. PAD can occur in other parts of your vascular system, but it is most common in your lower extremities.

Over time, fatty deposits or atherosclerosis, and calcium, can build up inside the walls of the arteries, causing narrowing of the artery and reducing blood flow to your legs, which causes pain. If left untreated, peripheral artery disease can have serious, and debilitating side effects, which can include sores on your toes or feet that will not heal and become infected, progressing to an ulcer or gangrene. Tissue needs blood to survive, and without adequate blood flow, progressive gangrene, enlarging wounds or continuous ischemic rest pain, can signify a threat to the limb.

There are ways to prevent PAD, or keep it from progressing. At the top of the list is, you guessed it, exercise! Exercise has many benefits, and PAD is one disease that benefits greatly. If you already suffer from symptoms of PAD, walking may be difficult at first. But if you begin slowly, the benefits to your overall health are worth it. Exercise elevates your heart rate, and an elevated heart rate increases blood flow, delivering more oxygen-rich blood to your extremities. It is a safe, low impact way to better health! You should consult with your doctor about how to start a walking routine, because if you have been diagnosed with PAD, it can be unsafe to jump into a strenuous exercise routine.

With regular walking, your circulation will improve over time, as new blood vessels form to provide the body with needed blood. With a regular walking routine, you can expect your PAD to improve significantly over 3-6 months! A good routine would be to set a goal for a 50-minute walk, 3-5 times a week.

Always start your exercise with a few minutes of stretching to warm up muscles. Start out with a nice brisk walk, but if you feel pain, stop and rest and don’t begin again until the pain subsides. Once the pain subsides, begin again, and walk and rest a few more times. Try to increase your walk a few minutes every day, until you’ve reached the 50-minute goal. Once you have established a routine, you should be experiencing much less pain, as your circulation will have improved.

A few other lifestyle changes will also help with managing your PAD. Here are a few:

  • Quit smoking! Nicotine is known to restrict blood vessels
  • Reduce your salt intake. Salt can raise your blood pressure.
  • Reduce your intake of sugar, especially if you are diabetic.
  • Keep your cholesterol in check by eliminating saturated fats from your diet. Eat a diet rich in fruits and vegetables, and reduce your intake of processed foods.
  • Take care of your feet by washing them daily, and keep your toenails trimmed to avoid infection. Wear cotton socks and avoid temperature extremes.

If you experience symptoms of PAD, make an appointment with your vascular surgeon, who can make a proper diagnosis for you, and treat your PAD before it progresses.

For more information, please visit our website at: www.sfvvg.com

May is Stroke Awareness Month

May is Stroke Awareness Month so it’s a good time to brush up on the facts about strokes. Strokes are the 5th leading cause of death in the U.S., and a leading cause of disability. Anyone can experience a stroke, but about ¾ of all strokes occur in people over 65. However, 80% of strokes are preventable.

Do you know the signs of a stroke and what to do if someone is showing symptoms? While each individual may experience different symptoms, there are ones that are the most common. The acronym F.A.S.T. has been developed to assist in remembering what to do in the event of a stroke.

F – Face – One side of the face is drooping. Ask the person to smile. Is their smile uneven or lopsided?

A – Arms – Is one arm weak or numb? Ask the person to raise both arms, does one arm drift downward?

S – Speech – Is speech slurred? Is the person unable to speak or hard to understand? Ask them to repeat a simple sentence.

T – Time – If the person shows any of these symptoms, even if they go away, call 911, and get them to the hospital immediately! Note when the first symptoms appeared.

Time is of the essence when treating a stroke, so acting quickly is crucial! A stroke is a medical emergency and every second counts!

What causes a stroke?

A stroke is caused by blocked blood flow to the brain. When a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot, or ruptures, part of the brain cannot get the oxygen-rich blood it needs, so brain cells die.

There are different types of strokes. An ischemic stroke is caused by a clot obstructing the flow of blood to the brain. Ischemic strokes account for about 87% of strokes.

A hemorrhagic stroke is caused by a blood vessel rupturing and preventing blood flow to the brain. The two types of blood vessels that usually cause hemorrhagic stroke are aneuryms and arteriovenous malformations or AVM’s. The most common cause of hemorrhagic stroke is uncontrolled high blood pressure.

A transient ischemic attack, also known as a TIA or “mini stroke”, is caused by a temporary clot. Since a TIA doesn’t cause permanent damage, it’s often ignored. But TIA’s may be a signal that a full-blown stroke may happen in the future, so help should be sought immediately.

A cryptogenic stroke is a stroke without a known cause. 25% of ischemic strokes are cryptogenic. It can be frustrating not knowing what caused your stroke, but with the help of your physician, and a proper diagnostic work-up, you can help your doctor find the cause of your stroke and help prevent another one from occurring.

A brain stem stroke is complex and can be difficult to diagnose. A person may experience vertigo, a severe loss of balance, and dizziness without experiencing weakness on one side of the body, which is a characteristic of most strokes. All motor control function flows through the brain stem, consequently, a brain stem stroke can impair any or all of these functions. As with all strokes, brain stem strokes produce a wide range of disabilities and recovery. The location of the stroke within the brain stem, the extent of injury and how quickly treatment is administered, will determine whether a survivor has minor or severe deficits.

What are the risk factors for stroke?

  • High blood pressure
  • Diabetes
  • Smoking
  • High cholesterol
  • Heavy drinking
  • A diet high in saturated fat, and salt but low in fiber, fruit and vegetables
  • Lack of regular exercise
  • Obesity

How can I prevent a stroke?

Lower your blood pressure. High blood pressure is the biggest contributor to stroke in both sexes. Monitor your blood pressure and if it is elevated, treating it is one of the most important things you can do for your vascular health.

Lose weight. Obesity and the impact on your health, like diabetes and high blood pressure, increases your odds of having a stroke. Even losing 10lbs, can have a positive effect on your health.

Exercise. Exercise has been proven to be one of the most beneficial things we can do for our overall health.

Drink in moderation. Two or more drinks per day, sharply increases your risk.

Treat arterial fibrillation. Arterial fibrillation carries a five-fold risk of stroke. If you have it, get it treated!

Treat Diabetes. High blood sugar damages blood vessels over time, making clots more likely to form. Keep your blood sugar under control.

Quit smoking. Smoking thickens blood and increases the amount of plaque build-up in your arteries. Quitting smoking is one of the most powerful lifestyle changes that you can make.

Remember the signs of a stroke and what to do if someone is experiencing a stroke, you could save their life!

For more information, please visit our website at: www.sfvvg.com

Be well!

What is an Arteriovenous Fistula?

An arteriovenous fistula (AV Fistula), is a connection of an artery to a vein that is surgically created by a vascular surgeon. It is one type of vascular access for long term use in hemodialysis, the treatment for kidney failure. An arteriovenous fistula is usually placed in the forearm or upper arm. The fistula creates extra pressure and extra blood flow in the vein, causing it to grow larger and stronger. A vascular access such as an AV fistula, is a lifeline for patients suffering from kidney failure as it makes life-saving hemodialysis treatments possible.

To prepare for your fistula, your veins and arteries will be evaluated to make sure they are healthy enough to support the fistula. Usually this involves a physical examination by your vascular surgeon, and an ultrasound and possibly an angiogram. The results will let your surgeon know the size and depth of your arteries and veins and will determine whether or not your blood vessels are able to support an AV fistula. If you are a candidate, an appointment will be scheduled for its creation.

Your AV fistula creation will most likely be performed under conscious sedation, on an out-patient basis. You will get pre-op instructions before your appointment. Your surgeon will begin by making an incision in your arm, allowing access to the specific veins and arteries chosen for the fistula. He will then make a surgical connection between the artery and the vein. The connection causes increased blood flow to the vein from the artery, as the pressure in an artery is much higher than the pressure in a vein, which results in enlargement of the vein and thickens the vein walls. The enlarged, thickened vein will provide a reliable, and easily accessible access for dialysis. After the fistula has been created, it needs to mature to the point where it can be used for dialysis. This usually takes about three months.

You will be sent home with post procedure instructions, which could include keeping your arm elevated to reduce swelling. You may be prescribed pain medication to manage any post-op pain.

For more information, please visit our website at: http://www.sfvvg.com

What is Atherosclerosis?

Atherosclerosis is a disease where plaque, comprised of fat, cholesterol, calcium and other substances found in the blood, builds up inside your arteries. Remember that your arteries carry blood away from your heart to the rest of your body. The narrowing of your arteries caused by atherosclerosis, limits the flow of oxygen-rich blood to your organs and the rest of your body.

Atherosclerosis can affect any artery on the body. This includes the brain, heart, legs, kidneys, pelvis and arms. Different diseases may develop depending on which arteries are affected, and can lead to serious problems.

As vascular surgeons, we treat atherosclerosis that affects the vascular system, including carotid artery disease, peripheral artery disease and the vascular impact of kidney disease.

The carotid arteries are located on either side of your neck. The carotid artery supplies oxygen-rich blood to your brain. If blood flow to your brain is reduced or blocked, you could suffer from a stroke. Screening for carotid artery disease is a quick and painless ultrasound, performed in our ultrasound lab.

Peripheral artery disease can occur in your legs, arms or pelvis. If blood flow to these areas is reduced or blocked, you may experience numbness, pain and sometimes wounds that will not heal, or infections. Again, ultrasound testing is a simple, and painless diagnostic tool. In some cases, further testing may be necessary to confirm location and severity of disease.

Another area of concern are the renal arteries. The renal arteries carry oxygen-rich blood to your kidneys. The main function of your kidneys is to remove waste and extra water from the body. If the renal arteries become narrowed or blocked by atherosclerosis, your kidneys will be unable to function, and you may develop chronic kidney disease.

There are certain factors that are believed to raise your risk for the disease, like smoking, lack of physical activity, an unhealthy diet and family history. Making some life changes, like quitting smoking, eating a healthy diet, and exercising regularly, may help you avoid atherosclerosis, and live a long and healthy life.

For more information about vascular diseases, please visit our website at: www.sfvvg.com

What is a Vascular Surgeon?

A vascular surgeon is a medical doctor who has completed additional, extensive training in the vascular system and its diseases. The vascular surgeon has expertise in the diagnosis and treatment of patients with vascular disorders and disease. Vascular surgeons focus on the part of the vascular system that includes the arteries, arterioles, veins, venules and capillaries. For example, a vascular surgeon may perform a procedure on the carotid artery in the neck, or they may treat an abdominal aortic aneurysm. They also treat varicose veins, or peripheral arterial disease, which often occurs in the legs and feet. The vascular surgeon does not treat the vessels in the brain or heart.

The vascular surgeon is trained to perform open surgery, as well as endovascular procedures. The vascular surgeon decides which approach is the best approach for his patient, based on physical examination, tests, medical history, risk factors, age, and lifestyle. The vascular surgeon is oftentimes a lifelong partner with his patients, with the goal of improving their quality of life.

What are some of the conditions and diseases that vascular surgeons treat? Vascular diseases and conditions can occur in our arteries, veins and capillaries. Some of these diseases are caused by narrowing of our blood vessels, which can cause lack of blood flow or blockages, and some are caused by aneurysms or “ballooning” of our blood vessels. We also have valves in our legs, and faulty valves can cause varicose veins or peripheral artery disease.

When should you see a vascular surgeon? You may visit a vascular surgeon if your primary care doctor refers you for swelling or pain in your legs. You may also establish a relationship with a vascular surgeon if you have risk factors for vascular disease, such as diabetes, or kidney disease, high blood pressure or if you are a smoker. And sometimes your first encounter with a vascular surgeon, may be because you end up in the hospital.

A vascular surgeon’s goal is to treat vascular diseases, so that patients can lead their best life possible. Lifestyle changes can have positive effects on your health, and your vascular surgeon may offer you advice and counsel you to make changes to improve your health.

For more information, please visit our website, www.sfvvg.com

Did you know that March is National Kidney Month?

The kidneys are a very important organ, so important that they have a month dedicated just to them! So, let’s talk about your kidneys! We’ll start with where your kidneys are located and what your kidneys do.

There are two kidneys about the size of a normal fist, located on either side of the spine, at the lowest level of the ribcage. Most of us know that kidneys are responsible for the life sustaining job of filtering waste from our bodies to the tune of about two quarts every 24 hours, in the form of urine. But did you know that the kidneys filter and return to the bloodstream about 198 quarts of fluid every day?! That’s astonishing!

But that’s not all the kidneys do. The kidneys release hormones that regulate your blood pressure and calcium metabolism. They also regulate salt, potassium and acid. Healthy blood pressure is essential, as hypertension contributes to many diseases. The kidneys also play an important role in making vitamin D. The kidneys convert the vitamin D from supplements or the sun, to the active form needed by the body. Kidneys also control the production of red blood cells, without enough red blood cells, we can become anemic.

“Of the 24 million American adults estimated to have kidney disease, most do not know that they have it,” states Dr. Joseph Vassalotti, National Kidney Foundation Chief Medical Officer. That’s why it is vitally important to take care of your kidneys. You should get tested for kidney disease if you have risk factors such as; diabetes, high blood pressure, or a family history of kidney disease.

There are other simple things we can do to protect our kidneys:

  • Reduce the amount of NSAIDS (non-steroidal anti-inflammatory) drugs you take. NSAIDS can harm the kidneys, particularly if you already have kidney disease, and never go over the recommended dosage without consulting your physician.
  • Control blood pressure and diabetes. High blood pressure and diabetes are the leading causes of kidney disease and kidney failure. Managing high blood pressure and diabetes can slow the progression of kidney disease.
  • Cut processed foods. Processed foods contain high amounts of sodium, phosphates and nitrates, which have been linked to kidney disease and cancer.
  • Exercise! It’s not just your heart and vascular system that benefit from regular exercise, your entire body benefits! Regular exercise can help regulate blood pressure and blood sugar, and your kidneys will reap the rewards too!
  • Quit smoking! Smoking damages your heart and vascular system leading to poor blood flow to the kidneys, causing damage over time.

Follow these simple things and start protecting your kidneys.

For more information, please contact our website at: www.sfvvg.com

What is the Vascular System?

The vascular system is part of the circulatory system, which also includes the heart (cardiovascular) and lymph system. Today, we will just talk about the role of the blood vessels.

The vascular system consists of blood vessels, aptly named, because they transport blood throughout our body.

Fun Fact * If you lay out all of our blood vessels in a line, it would stretch for nearly 60,000 miles! That means, they could circle the globe more than twice!

 The blood vessels that make up the vascular system are:

  • Arteries – Oxygenated blood travels from the heart through the arteries, which branch into smaller and smaller vessels, eventually becoming arterioles.
  • Arterioles – Arterioles connect with even smaller vessels called capillaries.
  • Capillaries – Capillaries pass the oxygen and nutrient rich blood into the tissues. Waste products and deoxygenated blood then pass from the tissues back into the blood in the capillaries.
  • Venules – From the capillaries, the blood passes into the venules.
  • Veins – The venules then pass the blood onto the larger vessels called veins, and the veins take the deoxygenated blood back to the heart, and the process begins all over again.

The vascular system also plays other vital roles in other body systems too, like the respiratory system. As blood flows through the capillaries in the lungs, oxygen is picked up to be taken to the rest of the body’s tissues, and carbon dioxide is expelled. Our digestive system also gets help from our vascular system. As food is digested, blood flows through the intestinal capillaries and picks up nutrients like vitamins and minerals and sugar (glucose) and delivers them through our blood vessels to body tissues.

Fun Fact * Blood vessels act as a shield for the brainBlood vessels are part of an important defense system known as the blood-brain barrier. A network of blood vessels and tissue comprised of closely-spaced cells, helps keep harmful substances from reaching the brain.

Our vascular system is susceptible to disease. Most often, vascular disease affects the blood flow of our arteries and veins, either by blocking or weakening blood vessels or by damaging the valves that are found in veins. Organs and other body structures may become damaged by vascular disease as a result of decreased or blocked blood flow.

To learn more about vascular disease, please visit our website at: www.sfvvg.com

Be well!

What is deep vein thrombosis?

Deep vein thrombosis or DVT is a serious medical condition that requires immediate attention. DVT is when a blood clot forms in a deep vein. This usually develops in the lower leg, thigh or pelvis, but can also occur in the arm. DVT is often dismissed by patients, or misdiagnosed.

DVT can lead to pulmonary embolism. Pulmonary embolism occurs when a part of the clot breaks off and travels through the bloodstream to the lungs, causing a blockage. If the clot is small, treatment can be administered and people can recover, however, there may be damage to the lungs. If the clot is large, it can stop blood from reaching the lungs. This is a fatal condition.

Deep vein thrombosis is a condition that anyone can get. In the United States, DVT accounts for about 900,000 cases, and approximately 100,000 deaths per year. One third of survivors suffer from long term complications caused by the damage the clot does to the valves in the vein. This is called post-thrombotic syndrome (PTS). People with PTS have symptoms such as pain, discoloration, swelling, and in some more severe cases, scaling of the skin and ulcers in the affected part of the body.

There are certain factors that increase the risk of developing a DVT. Some of them may include:

  • Reduced blood flow which can be caused by confinement to bed during an illness or medical condition, or after surgery. Sitting for long periods of time, or limited movement due to having a cast on to heal an injured bone.
  • Injury to a vein caused by a severe muscle injury, or a fracture. Also, major surgery, particularly in the abdomen, pelvis, hip or legs. 
  • Increased estrogen, birth control pills, hormone replacement therapy used after menopause, and pregnancy, for up to 3 months after giving birth.
  • Chronic illness such as heart and lung disease, treatment for cancer, Crohn’s disease or ulcerative colitis.
  • Other factors include, previous DVT, or PE (pulmonary embolism), family history of DVT or PE, age (risk increases with age), obesity, a catheter in a central vein, or inherited blood disorders.

Symptoms of DVT can develop silently. Symptoms may include:

  • Pain or tenderness in a leg or arm that get worse over time.
  • Swelling in one leg or one arm.
  • A leg or arm that feels warm to the touch.
  • A reddish or bluish tinge to the skin of one leg or arm.

If you experience any of these symptoms, you should notify your doctor as soon as possible.

Symptoms of PE (Pulmonary embolism). You can have PE without any symptoms of a DVT. The symptoms of a PE, can include:

  • Difficulty breathing
  • Pain in the chest area, which may worsen when taking a deep breath or coughing
  • Irregular or faster than normal heart beat
  • Lightheadedness, or fainting. Lower than normal blood pressure
  • Coughing up blood

If you experience any of these symptoms, you should seek medical attention immediately!

Are there things you can do to prevent DVT? Yes there are! The following tips can help prevent DVT:

  • If you must sit for prolonged periods of time, get up and walk around every 2-3 hours. While seated, you can exercise your legs by keeping your toes on the floor and raising and lowering your heels. Reverse, and keep your heels on the floor and raise and lower your toes. Tighten and release your leg muscles.
  • Wear loose-fitting clothing.
  •  If you are confined to bed due to an illness or surgery, move around as soon as you are able.
  • If you are at risk for DVT, ask your doctor about compression stockings or medication to prevent DVT.
  • Maintain a healthy weight. Consult your doctor about an exercise program, such as walking or swimming.

For further information, please visit our website: www.sfvg.com

Lifestyle Choices May Decrease Stroke

Did you know that there are things you can do to decrease your risk of stroke? Some are simple lifestyle choices, and others, depending on any pre-existing medical conditions, may require the help of a physician.

To understand a stroke, it helps to understand how the brain works. The brain controls everything from our movements and digestion, to our emotions and breathing. In order to perform properly, the brain needs oxygen. Interestingly, the brain takes up only about 2% of our body weight, yet it uses about 20% of the oxygen we breathe.

A stroke occurs when a blood vessel in the brain ruptures and bleeds, or where there is blockage to the blood supply to the brain. The rupture or the blockage, prevents blood and oxygen from reaching the brain tissue causing damage to the cells, and within minutes the cells in the brain begin to die.

Depending on the type of stroke and the severity, a stroke can cause brain damage, long term disability, or even death.

These risk factors can increase your risk of a stroke:

Diet: A diet that is high in salt, trans fats, cholesterol and saturated fats.

Lack of exercise: Exercise has numerous health benefits. Even a brisk walk a few times a week can make a difference.

Tobacco: Using tobacco of any kind, causes damage to your blood vessels and your heart. Smoking further increases the risk as your blood pressure is raised when you use nicotine.

Alcohol Consumption: Alcohol consumption should be done in moderation, as excessive drinking also raises blood pressure and can increase triglycerides which are attributed to atherosclerosis (hardening of the arteries).

Family History and Health History: You may be more at risk for a stroke if your family has a history of high blood pressure. Sex may also play a role, as incidence and mortality rates of stroke tend to occur more often in men. Age, race and ethnicity, can also put you at a higher risk.

Age: The older you are, the more likely you will suffer from a stroke.

Medical Conditions: Certain medical conditions increase the risk of stroke: Previous stroke or TIA (Transient Ischemic Attack), high blood pressure, High cholesterol, diabetes, heart disorders, such as coronary artery disease, obesity, enlarged heart, sickle cell disease, to name a few.

The good news is, there are things you can do every day to decrease your risk of stroke:

Maintain a healthy weight

Reduce salt and fat intake

Eat more fresh vegetables and fruit and whole grains

QUIT SMOKING!

Limit alcohol consumption

Get out and exercise!

Before beginning any exercise routine, consult with your doctor about what the best type of exercise is right for you.

These simple lifestyle changes, can make a huge difference and you can get started today!

For more information, visit our website at: http://www.sfvvg.com