Dr. Susan Jacob

11/03/2026

My oldest patient is 97. My youngest is 9 months. Most of my panel is between 40 and 60, and I have watched a lot of people arrive at the same decade in very different shape.

Here is what the ones doing well have in common.

1. They moved, and they did not wait until they could do it properly. 150 minutes a week is the target. The ones who got there started at 5 or 10 minutes on a regular basis, because the habit is the hard part, not the minutes.
2. They picked a doctor and stayed. Not because loyalty is a virtue, but because I cannot tell that something changed if I have no idea what it was before.
3. They mentioned the small things. The fatigue that arrived gradually. The thing they assumed was aging. The ones doing well are not stoic. They said it out loud early.
4. They protected sleep like it mattered. 7 to 8 hours, and the phone out of reach. Most people think they are fine on 5 or 6, and it catches up.
5. They came in once when nothing was wrong. The physical with no complaint attached is the one that finds things, and it is the first appointment people cancel.

I want to be careful here. Some of this is luck and genetics and things nobody chose. These 5 are just the ones that showed up over and over in the people who got to 80 and 90 still doing what they wanted to do.

Save this and send it to someone in their 40s.

10/30/2026

Urgent care exists because people need to be seen when their doctor is closed. That is a real problem and urgent care is a reasonable solution to it.

Here is what it cannot do.

Whoever sees you has never met you. They do not know your history, your medications, what your heart sounded like last year, or what is normal for you. So they treat what is in front of them and send you back out.

That is what I mean by a partial answer. Not a wrong one. A partial one.

Most of the 9pm situations my patients have get settled by text. They send me what is going on, I ask 2 or 3 questions, and usually the answer is that it can wait until morning and here is what to watch for overnight.

Sometimes it is not. I have had patients send me something they were not sure was even worth mentioning, and it turned out to be a medical emergency, and we got them where they needed to be within a day or 2.

The part people do not expect is that you can see your own doctor about as fast as you could get into an urgent care.

Some things still need an emergency room, and I will say so rather than troubleshooting it over text.

Save this for the next time you are sitting in an urgent care parking lot at 9pm.

10/29/2026

Arthritis pain does get worse in the winter, and you are not imagining it. When it gets cooler, joints get stiffer.

The instinct is to rest the joint. That is usually what makes the next morning worse.

Keeping the joints moving is the single most useful thing, and it does not have to be vigorous or outside. Walking in place inside counts. An exercise bike counts.

There is a gentle stretching program I recommend to a lot of my patients called Essentrics Classical Stretch. It is movement based and people actually keep going with it.

Medication can be part of the plan too, and that is a conversation for you and your own doctor rather than something to start off a video.

Movement is the part that does the most work, and it is the part that costs nothing.

Save this for the first properly cold week.

10/27/2026

Most people cannot feel high blood pressure. That is the whole problem with it.

When they do notice something, they usually describe it as stress. Feeling wound up, feeling tense, feeling like there is a lot going on. So the reading gets explained away before anyone looks at it twice.

Meanwhile it runs day in and day out, and the consequences are both short term and long term.

Here is what I do differently, and it is not clever. Your blood pressure gets checked every time you are here, including the visits that have nothing to do with it. Come in about a sprained ankle and I still have a reading.

That means I am watching a line instead of a dot, and a line is where a problem shows up before it is a problem.

When something does show up, we start with what can be changed without a prescription. That is not me being precious about medication.

When medication is the right answer we use it, and then we actually follow up. Dosing gets adjusted, side effects get sorted out, and we can see each other as often as that takes rather than once a year.

Save this if the only time your blood pressure gets checked is at a physical.

10/23/2026

Nothing on this list is urgent. That is exactly why it gets skipped.

➔ Ask what your blood pressure has been doing over time, not just today. Most people cannot feel it. They feel what they think is stress. One reading is a dot, and the pattern is the information.

➔ Tell your doctor if you snore, or if you are tired no matter how long you slept. Untreated sleep apnea contributes to high blood pressure and cardiovascular disease. A sleep study is easy. Saying it out loud is the part that does not happen.

➔ Ask for a review of every specialist you see and every medication you take, in one place. Usually nobody is holding the whole list.

➔ Ask whether your BMI is the right tool for tracking your health or whether there is a better measure for your situation.

➔ Ask whether an EKG makes sense for your age and history.

I want to be honest about the deadline in that first line. There is no cliff at 60. What actually happens is that every year you wait, you start from a little further back, and the conversation that takes 10 minutes at 45 takes a referral at 60.

Save this and take it with you.

10/21/2026

Most colds do not need me.

They start with a sore throat, turn into congestion, run a low grade temperature, peak around day 5 to 7, and then improve. The cough can hang on for 2 or 3 weeks after everything else is gone, and that is still normal.

These 5 are the ones I want to hear about.

A very high fever, or feeling short of breath. Those 2 I want to know about quickly.

If you have another condition that already puts you at higher risk and you are feeling worse as this goes on, reach out then rather than waiting to see.

If it has been more than 10 days, come in so I can listen to your lungs. A lingering infection can turn into a secondary one that needs treating.

And if you got better and then got worse again, that pattern is worth a call on its own.

I am not trying to make anyone nervous about a cold. Most of this resolves on its own and you will never need me for it. These 5 are just the ones where waiting costs you something.

Save this for the next time you are 10 days in and not sure.

10/20/2026

Most habit advice fails because it is designed for someone with a different schedule, a different body, and a different amount of willpower than you actually have on a Tuesday.

These are the ones I have watched stick. Not because they are the most rigorous or the most optimized, but because they are specific enough to do and forgiving enough to keep doing when the week falls apart.

The last one matters most. A question you send before you are sure it is worth coming in is almost always easier to answer than the thing it becomes if you wait.

10/16/2026

These are the ones people apologize for mentioning.

➔ Tired all the time. Not sleepy, tired. It is one of the most normalized symptoms in primary care and one of the least investigated.

➔ Weight settling around the middle that will not move. 60 percent of women over 35 have insulin resistance and are not aware of it. The look is fasting insulin next to fasting blood sugar, not blood sugar on its own.

➔ Feeling stressed when nothing in particular is stressful. Most people cannot feel elevated blood pressure. They feel what they assume is stress, and the pressure runs day in and day out underneath it.

➔ Waking several times a night. In perimenopause and menopause, alcohol is a common reason, and most people have never connected the two.

➔ Snoring that someone else notices. Untreated sleep apnea contributes to high blood pressure, cardiovascular disease, and feeling exhausted no matter how long you were in bed. A sleep study is straightforward. Bringing it up is the hard part.

➔ A cough past 10 days. Colds linger, so most of the time this is nothing. Past 10 days I want to listen to your lungs.

➔ Getting better and then getting worse again. That pattern is worth a call on its own.

Most of these turn out to be nothing, and I want to be clear about that. The point is not that you are sick. The point is that none of them get 4 minutes of attention in a 10 minute visit, so they go unmentioned for years.

Save this and bring it to your next appointment.

10/14/2026