Internal Medicine, Lipid & Wellness of Fort Myers
Internal Medicine, Lipid & Wellness of Fort Myers Newsletter
In This Issue
Influenza Update
Membership Has Its Advantages
Can I Have My Hormones Please?
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Issue:  Nov 2017
Ferns grow in the understory of Highlands Hammock State Park of central Florida.


We are heading into our holiday season which also means cough, cold and flu season. I want to cover three items in this newsletter. First will be a  brief update on the influenza status.  I would also like to update everyone on the upcoming changes in the practice and our exciting plans for changing the location of my office. Lastly, there was an excellent review of hormone replacement therapy in women that warrants reporting to you.
2017 Influenza Update

Influenza A (H3)

Influenza Activity

The first case of influenza that I am aware with one of my patients occurred in an elderly patient during hurricane Irma.  This patient was confirmed to have the A H3 strain by nasal secretion analysis at the local hospital.  My physician colleagues have confirmed several test positive cases around that same time.  This past 2 weeks the number of respiratory complaint cases has actually eased off. 

The A H3 is the primary strain being documented across the country so far.  It is very early into the season for this illness and Florida is documenting only sporadic cases.  January is the month that flu typically becomes widespread in Florida. 

Historically we are experiencing a typical number of cases presenting to ER departments.  In 2014 there was a much higher rate of presentations compared to the normal trend. 

Practice Update 
The Membership Model (DPC) is a way forward!

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By now all of my existing patients should have received letters regarding my decision to opt out of Medicare and also to go to a membership model of care (DPC). I had indicated on The Doctor's Report blogsite that the present coded services/insurance and government policed health care delivery system has become outdated. 
This weekend we updated the website so that the public can see the various services and memberships offered. The memberships follow an age categorization based upon the average consumption of primary services as well as the desire to get younger people engaged with a medical home and information source.  The Premier Membership is required of those 65 and older but is available to anyone who desires to have unlimited Inpatient Advocate Service. 

The level of services included in these memberships is unprecedented in our community and perhaps even in the country.  The generic prescription dispensing service adds tremendous value and convenience for most of the patient members. For less than your entertainment package or in many cases your monthly phone bill you can have access 24/7 to a board certified internist, an annual health exam, full comprehensive labs, typical vaccines and numerous ways to get answers to your medical questions  AND Inpatient (Hospital) Advocacy from your primary physician! 

I have had 3 open meetings for my patients that had questions regarding the memberships and my decision to opt out of Medicare. I will continue to offer meetings on Fridays from 1-2 for  any patients wanting to ask questions about these changes. 

Last month we dispensed over 200 prescriptions and/or supplement requests.  The dispensary is rapidly being preferred for cost reasons as well as convenience.  If you wish to have your generic medication priced please call our office.  Dispensing in a physician office in Florida is limited to patients active in the practice. 

We are hoping to be moving to our new office at the beginning of the year. We are dependent upon the permitting and occupancy process. As we get closer to confirming our dates, I will inform everyone.  The new location will be 6160 Winkler Road in Wildwood Hammock.  This is 0.4 miles from the current office location off of Winkler and just south of College Parkway. 

Margaret, Danielle, April and I are very excited and working hard to incorporate changes and improvements as efficiently and "quietly" as possible.  We are very excited about next year's simpler and less bureaucratic practice we have planned for you!

An Updated Review of Menopause Hormone Therapy

Female Hormone Replacement Shouldn't Be Off The Table 


An August 2016 review on this topic was printed in the Cleveland Clinic Journal Of Medicine. The information included input from the American College Of Obstetricians and Gynecologist (AGOG) and the North American Menopause Society (NAMS).  They reviewed and referenced data from The Women's Health Initiative, The Nurses Health Study, The D anish Osteoporosis Study and a Cochrane review.  Cochrane library is a repository site from 6 data bases used by health professionals in healthcare decision making. 

Following is a summary of "bullet points" for folks to know:
  • It is likely not helpful overall to start hormone replacement after the age of 60.
  • The average "natural age of menopause is age 51 years.
  • The highest incidence of adverse side effects from by mouth hormone replacement in menopausal symptoms is venous thrombosis.  A personal history of venous clotting is a contraindication to oral hormone replacement.
  • There is arguably significant benefit for hormone replacement in women early in menopause. 
  • Studies suggest that there is an actual lower mortality associated with early perimenopausal hormone replacement. 
  • In patients with a history of hysterectomy estrogen alone is adequate hormone replacement to manage vasomotor symptoms and help prevent osteoporosis. Estrogen alone has a lower incidence of any concerning harmful side effects. 
  • Topical estrogen replacement (patches) has lower rates of blood clots than the pill forms. 
  • There appears to be cardiovascular protection with early use hormone replacement but increased risk in the first 1-3 years of use in replacement in women 60 years and older (late onset use). 
  • Being menopausal is not an immediate "deal breaker" for hormone replacement.  A reasonable review of various risks and concerns combined with "lowest helpful dose" replacement can greatly improve quality of life with potential mortality benefit. 
  • The "scares" of cancer risk and other "bad outcomes" may have resulted in the last decade of depriving many women the benefits of early hormone replacement.  More recent follow-up data from the recognized larger studies of hormone replacement suggest a more comprehensive discussion and decision analysis for hormone replacement should be considered. 
I hope everyone has a terrific and safe upcoming holiday season.  I wish to thank you for your ongoing patronage and look forward to the upcoming positive changes that is our present undertaking. 

Raymond W. Kordonowy MD

Raymond Kordonowy MD
Internal Medicine, Lipid & Wellness of Fort Myers