December in Philly: A Doctor's Guide to the Month

December in Philadelphia runs on two clocks at once. There is the warm one, the tree lots on Passyunk, the lights on Miracle on South 13th, the office parties and the family tables. And there is the quieter one counting down to December 31, when a good chunk of the money set aside for your health this year disappears if you have not used it. This guide walks through the 4 things December asks of you, so the month stays about the people at the table and the year ends with your health in better shape than it started.

How to use the year-end dollars that are already yours

If you have a Flexible Spending Account through work, some of the money in it is on a clock. Many FSA plans follow a use-it-or-lose-it rule, and for those plans the deadline is December 31. Whatever is still sitting in the account after that date, in most cases, goes back to the plan, not to you. That is your own pre-tax money, set aside from your own paychecks all year, and December is the month to make sure it does something for your health instead of vanishing.

A few plans soften this. Some allow a small carryover into the next year, and some give you a grace period into the spring to spend the prior year's balance. But the terms are set by your specific employer's plan, not by a general rule, so the honest move is to log into your benefits portal this week and read two things: your remaining balance, and your plan's exact cutoff. Do not assume you have a carryover until you have seen it in writing for your plan.

Once you know the number, the question becomes what to do with it. Everyday eligible items are the easy floor: prescriptions and copays, glasses and contacts, dental work you have been putting off, a dentist or dermatology visit you keep rescheduling. But if the balance is more than pocket change, the stronger use of that money is a deeper look at your health while the year still has room in it. Lab work and a thorough workup are FSA-eligible when they are part of your medical care, and they tend to give you far more back than another drugstore run does.

Here is why that matters, and where the December calendar comes in. A meaningful workup is not a single blood draw and a same-day answer. Blood gets drawn, and then results take 7 to 10 days to come back. After that, the results are worth reading with a physician who has the time to walk through what they mean for you, not a portal message that says "normal" next to numbers that are technically in range but far from optimal. Add the holiday crunch, when labs and offices run short-staffed and appointment slots fill, and a December 20 start can easily slide past the 31st before anything useful happens.

So the timeline is the whole game. If you want to turn year-end dollars into answers rather than a forfeited balance, the booking and the blood draw want to happen in the first half of December, not the last. Get the draw done early, let the 7 to 10 days pass, and you close the year with a set of numbers and a plan instead of a receipt for a lost balance. If you are not sure what is worth testing, that is a conversation worth having before you spend, so the panel fits your history rather than a default template.

How to keep holiday weeks from unraveling

The stretch from the first office party to New Year's Day is where a lot of steady, healthy people watch their routines come apart. It is rarely one big collapse. It is a late night, then a travel day, then a house full of relatives, then a party, and by the end of the second week the sleep is ragged, the workouts are gone, and the person feels worse than the fun seemed worth. What I want you to know is that the way through is structure, not willpower, because willpower is the first thing the season spends.

The structure that holds up is small and boring, and that is the point. A few anchors you keep no matter what beat one strict plan that breaks on day 2 and takes your morale with it. Here are the ones that carry the most weight through a Philly December:

• Keep your wake time steady, even after a late night. Sleep is the load-bearing wall of the whole month, and the single most protective thing you can do is get up within about the same hour every morning, holidays included. A late night costs you less than a wandering wake time does, because a consistent morning keeps your body clock anchored and makes the next night's sleep come easier. Our sleep optimization guide walks through why the morning anchor matters more than the bedtime.
• Put water between the drinks. At the party, at the table, a glass of water between each drink slows the pace, blunts the next-day headache, and cuts the total without any counting or announcing. Alcohol is a diuretic and it fragments the back half of your sleep, so the water between drinks is protecting tomorrow morning as much as tonight.
• Take the short daily walk, and keep it short. A 15 to 20 minute walk after a big meal does more for how you feel than an ambitious plan you will abandon by the 27th. Bundle up and take a loop around the neighborhood, down to the river, around the block with whoever will come. The walk you take is worth infinitely more than the workout you skipped because it felt too small to bother with.

Then there are the specific pressures the month brings. Travel days scramble sleep and meals, so protect the wake time on the far end and pack water and a proper snack rather than arriving depleted and ravenous. Hosting is its own kind of exhausting, the standing and the managing and the last guest who will not leave, so plan for it to cost you and guard one full night of sleep in the middle of the run. Parties stack late nights back to back, so if you have two in a weekend, treat the night between them as a recovery night on purpose.

The gentle math is this. Two weeks of small anchors held imperfectly will leave you in far better shape on January 1 than one strict plan that shattered on day 2 and left you feeling like you already failed. Nobody arrives at the new year having done the holidays flawlessly. The people who feel good in January are the ones who kept the wake time, drank the water, and took the walk, and let the rest be the holidays.

How to keep norovirus out of your kitchen

December gatherings are norovirus season's favorite venue, and it is worth knowing why. The virus spreads person to person and through food and surfaces, it takes only a tiny amount to make someone sick, and it moves fast through the settings the month is full of: crowded tables, shared dishes, a cookie exchange, a potluck, a house packed with relatives and kids. The winter uptick comes every year, and Philadelphia sees it right alongside the rest of the Northeast. You can follow how much is circulating in the region on our norovirus tracker, which is worth a glance before you host.

Here is the part most people get wrong, and it matters. Alcohol-based hand sanitizer, the thing on every counter and by every door, does not work well against norovirus. The virus has a tough outer shell that the gels struggle to break, so a squirt of sanitizer can leave you feeling protected while doing little. What beats it is old-fashioned handwashing: hot soapy water, 20 seconds, thorough scrubbing, front and back of the hands and under the nails, before you cook and before you eat and after the bathroom. The friction and the soap and the running water physically carry the virus off your skin in a way the gel does not.

For anyone doing the cooking, one rule prevents most of the December kitchen outbreaks I see: if you have had vomiting or diarrhea, stay out of the kitchen and away from other people's food for at least 48 hours after your last symptom. Norovirus keeps shedding from your body for days after you feel better, which is how one recovering cook turns a family dinner into a family outbreak. It feels overcautious. It is the difference between one sick person and eight.

Surfaces matter too, because the virus survives on counters, doorknobs, and faucet handles for days, and it shrugs off many household cleaners. What works is a dilute bleach solution: about 1 tablespoon of regular unscented household bleach per gallon of water, wiped over hard surfaces and given a few minutes of contact time before you rinse. Use it on the kitchen counters, the bathroom, and the high-touch spots after a gathering or after anyone has been sick, in a room with a window cracked so the fumes clear.

If a stomach bug does get through, most cases run their course at home in a day or 2 with rest and steady fluids. The thing to watch is dehydration, because the fluid loss is what turns a miserable bug into a medical problem. Sip water and something with a little salt and sugar in it through the day rather than gulping, which the stomach handles better. Seek medical care if you cannot keep any fluids down for a full day, if you see signs of dehydration (little or no urination, dizziness on standing, a dry mouth, unusual sleepiness or confusion), if there is blood in the vomit or stool, or if a high fever or severe belly pain comes with it. Older adults and anyone with a chronic illness dehydrate faster and deserve a lower threshold to call.

How to pick the question January should answer

Somewhere in the last week of the year, when the parties are done and the house is quiet, there is a natural pause worth using. Not for a resolution, and not for a list of everything you are going to fix. Just a few unhurried minutes to name the one health question that has been sitting in the back of your mind all year, the one you keep meaning to get ahead of and keep not getting to.

Everyone has one. It might be the fatigue that never quite lifted. The family history of heart disease you have been meaning to actually measure instead of worry about. The sleep that has not been right since the spring. A number from a checkup that got a "keep an eye on it" and no plan. The point of the year-end pause is not to solve it in December. It is to name it clearly enough that January has a job.

The move that makes this stick is turning the question into a plan rather than a resolution. A resolution is a wish with a deadline and no next step, which is why most of them are gone by mid-January. A plan is smaller and more durable: a baseline you are going to get, a conversation you are going to have. If the question is your heart, the plan is a lipid panel that includes the markers that move earliest, like ApoB, and a careful read of your family history. If it is fatigue, the plan is the boring labs that actually explain it, ferritin and thyroid and B12 and metabolic numbers, read by someone with time. The question does not need an answer in December. It needs a first step scheduled.

That is the warm note I want to leave you with as the year closes. You do not owe the new year a reinvention. You do not need to arrive on January 1 as a different person with a different life. What serves you is far smaller than that: one honest question, and one small step toward getting ahead of it. Pick the question this week, while it is fresh, and let January be the month you take the first step. The next chapter of this series, the January in Philly guide, is built around that first step.

Guidance from the clinic

"Every December I watch two things happen. People let good FSA money expire because they ran out of runway, and people set a January resolution so big it is gone by the 15th. Both come from the same place, waiting until the year is almost over to think about your health. The version I want for you is calmer. Spend the money that is yours on answers, early enough that the results come back. Hold a few small habits through the holidays instead of a perfect plan. And pick one question, just one, that January can actually work on. That is a good year's end."

Scientific References

1. Hall, A. J., Lopman, B. A., Payne, D. C., et al. (2013). Norovirus disease in the United States. Emerging Infectious Diseases, 19(8), 1198-1205.
2. Centers for Disease Control and Prevention. (2011). Updated norovirus outbreak management and disease prevention guidelines. MMWR Recommendations and Reports, 60(RR-3), 1-18.
3. Sniderman, A. D., Thanassoulis, G., Glavinovic, T., et al. (2019). Apolipoprotein B particles and cardiovascular disease: a narrative review. JAMA Cardiology, 4(12), 1287-1295.
4. Czeisler, C. A., Duffy, J. F., Shanahan, T. L., et al. (1999). Stability, precision, and near-24-hour period of the human circadian pacemaker. Science, 284(5423), 2177-2181.

Related at Fishtown Medicine

• Sleep optimization - why the morning wake-time anchor carries the whole month
• January in Philly - the next chapter, built around the first step you name this week
• Norovirus tracker - how much is circulating in the Philadelphia region right now
• Seasonal illness tracker - flu, COVID, and norovirus activity in one place
• ApoB and heart health - the marker worth putting on a year-end baseline