January 2019
Happy New Year !

I hope everyone has a healthy and happy 2019:

I have taken this recent holiday season break from the office.  This is the time of year to reflect on our accomplished goals as well as plans for this upcoming year.  As indicated in the last couple of newsletters and update notices, we are continuing to pursue additional staffing so we may maintain a high level of quality and timely service.   Many of you have recently met Natalie our new office manager.  We are very excited about having her on the team.

Kiley is entering RN school next week and we are going to miss her.  She has done a great job and already is an excellent clinical caregiver.  We will be adding another LPN to our team very soon to assist Danielle. 

We have purchased the office building and anticipate expanding our model of care.  I am hearing daily both at the local and national scene how disenfranchised patients and doctors have become.  The primary care membership model called Direct Primary Care (DPC) is gaining traction all across the country.  I continue to try to convince our local doctors this is the way forward for the future of the profession and ideal patient care. 

I have been interviewed several times regarding the Direct Primary Care model as well as free market principles in health care.  Jeff Kanter has been the one interviewing me. He is involved in developing an association called the MPowering Benefits Association.  Combining this with a strategy platform called Health Excellence Plus,he and others are offering a more affordable alternative to the status quo insurance structure.  Through the association they are offering health sharing through a strong health sharing company called Sedera Health as the way to contain high cost health events.  They offer a special pricing program for Direct Primary Care physicians including my practice.  I have stated in the past there are several health sharing alternatives. Those of you not trapped in Medicare's program may find this a very desirable way forward.  Maybe one day in the future we can legislate Medicare beneficiaries an alternative like this as well- one can hope.  

Later this month I will be going to Tallahassee mid week so some appointments will have to be moved.  This is because I have been deposed as a witness in favor of hospital competition in Lee County. A state hearing is underway to review the decision to allow 2 entities to open up two 80 bed hospitals in the Estero/Bonita area.  I hope my feedback can be helpful for our community.

What The Doctor Is Reading-Newsworthy Items with Dr. Kordonowy's Commentary

Open book_ hardback books on bright colorful background. Back to school. Copy space for text. Set of books in the library. Knowledge_ Science.

From a  supplement booklet from the Practical Pain Management Journal for pain specialist:
There is apparently an Indiana Polyclinic Combined Pain Scale.  This one made me laugh out loud so it is a must share.  My reference for pain scoring has always assumed a pain we can relate to.  My patient discussion example of a 10 of 10 pain is childbirth (real to all mothers and imaginable to the rest of us).  The Indiana Polyclinic Combined Pain Scale descriptor for a 10 level of pain is...get this-"Being Torn Apart While Still Alive"!!! How does one report that back to us in the land of the living?

Comparison of Cannabinoids.  From the Prescriber's Letter- a pharmacists edited periodical on medication and health- "What is CBD? It's a cannabinoid found in marijuana and hemp...two varieties of the cannabis plant. But CBD does not cause a "high" like THC...since these cannabinoids seem to work on different receptors.
Epidiolex oral solution is purified CBD...while Rx dronabinol (Marinol, Syndros) and nabilone (Cesamet) are synthetic THC."

Realize that all your present street products and other CBD products are not FDA approved. There is limited scientific data regarding the various claims made for these products.  Presently, I don't condone these options due to lack of quality control and science.  I also feel it is important for people to know there are many potential drug interactions with CBD's.  Despite my position I don't wish my patients to hide using these products from me as I want to be aware should drug interactions or interferences need to be considered. 

Testosterone replacement increased hemoglobin.  Many men take testosterone replacement.  One of the potential complications of excess use is overproduction of hemoglobin.  Too much hemoglobin can make an individual susceptible to clotting (thrombosis,stroke and heart attack). From the Journal of Gerontology Series A: Biological Sciences and Medical Sciences 2014 Jun; 69(6) 725-735,   a study in the elderly showed that hemoglobin (the protein that carries oxygen in our red blood cells) increases 7-10% with testosterone replacement.  This is associated with increased levels of a blood cell growth factor known as erythropoietin.  Clearly testosterone in truly deficient patients may resolve a deficiency related anemia but likewise - if taken in the presence of normal blood counts it might result in an abnormally high hemoglobin.  Blood counts should be monitored in testosterone replacement. Some women are getting testosterone via "bioidentical" hormone replacement and while the amounts are lower in men this information may be relevant to those individuals as well.

Cervical Cancer Screening Update: 99 % of cervical cancer is linked to the Human Papillomavirus which is sexually transmitted. We now have a vaccine offered to adolescent girls and boys with the goal of preventing this disease in the latest generation of youths.  A recent review  published by The American Academy Of Family Physicians and the U.S. Preventive Services Task Force recommend starting cervical cancer screening at age 21.  Women aged 21-29 years of age should be screened every 3 years with a normal cytology (PAP) smear. Women 30-65 years of age should be screened every 5 years with cytology (PAP) smear and HPV testing OR every 3 years with cytology (PAP) alone. Screening is not recommended for women under 21 years of age or women over 65 with an adequate history of negative prior screening.  Women 65 and over (post menopausal actually) can stop getting routine PAP smears. 

Prostate Cancer Update:  What is new is that we are nearly back to the original recommendation for prostate screening. The PSA test was never recommended to be used for screening after the age of 70.  It was originally recommended to start being measured at age 50 years. More recently, The US Preventive Task Force (May 2018 JAMA article) is recommending that for men age 55-69 "individualized decision making regarding screening based upon personal values and risk factors".  This is a C recommendation which means the preponderance of data is "at least moderate certainty the net benefit is small"   Based upon a D recommendation the task force recommends screening stop at age 70. A D recommendation means "There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits".  I suspect the recommendations will change again in the future noting a recent study indicating watchful waiting was inferior to surgical intervention in specific grades of prostate cancer. More studies are ongoing as it relates to trying to risk stratify prostate cancer at the time of diagnosis. 

A new potential role for CoQ10 supplementation.  A somewhat rare but definitely diagnosed condition called multi-system atrophy (a neurologic disorder) is when three problems coexists in the same patient.  The coexisting findings include: a wide drop in blood pressure with standing, Parkinsonian signs and cerebellar (gait and balance) problems.  It turns out recently that mutations in the COQ2 enzyme (it is involved in coenzyme CoQ10 synthesis has been associated with this condition.  A very small study of just 7 patients showed that using an average of 257 mg daily CoQ10 resulted in a dramatic (statistically and clinically relevant) improvement in the drop in blood pressure in these subjects.  

The Free Market Approach to Health Benefits
I recently have posted to the Doctor K ordonowy social media posts about a novel and potentially useful benefits association   With the help of Sadera Health Sharing, MPowering Benefits Association  incorporates many cost saving and health improvement incentives while maintaining MEC required insurance with HSA qualification.  While this program isn't allowed to be offered to Medicare patients and it may not be right for everyone, I truly believe this could be useful to many individuals and small business owners who have found health insurance coverage unattractive and unaffordable. 

Close-up Of Doctor Holding Mobile Phone With App For Health
Alternative to Traditional First Dollar Health Insurance

The link below shows you a programed priced at a discount for using the DPC membership model (my practice) option.

Recipe Section
obesity prevention stop over weight start campaign with low fat diet for obese children and adults with eating disorder
Get the pre-holiday weight back

No recipe this newsletter. If you experienced the holiday season like I did you need to check this book out and follow the program.

You can also check out my link on my website  to our recipes section.

Raymond Kordonowy MD 

Call us for you medical needs.