Wednesday, March 31, 2010
I’m delighted to welcome a new provider at Lenox Internal Medicine. Three years after opening the practice, I have more patients than I can easily manage on my own. I had always intended to share the practice with a colleague, and now, after a long search, I think I’ve found the right person.
Joanne Michonski, Family Nurse Practitioner
Joanne Michonski is a family nurse practitioner with four years of primary care experience in Holyoke; and twenty years before that as a registered nurse in the emergency room of a busy inner city hospital in Hartford. She was awarded her advanced practice nursing degree from the University of Massachusetts in Amherst and is certified by the American Academy of Nurse Practitioners.
Joanne started here at the beginning of March and she is already building up a panel of patients who want to see her as their primary care provider. She’s highly competent and knowledgeable and has a great bedside manner. In addition to seeing regular primary care problems (i.e. physicals, colds, rashes, back pain, etc.) she specializes in patient education in areas like diabetes, hypertension, nutrition and weight loss. She also does a great job on women’s health. Feedback from patients who’ve seen her has been extremely positive.
Having Joanne here means that we can accept new patients without the long wait for a first appointment. If you would like to see her, or find out more about her practice, give us a call. As of now, Joanne can see new patients within a week or two (once you’ve filled out the paperwork the insurance companies require).
Let’s face it: women hate taking Fosamax for osteoporosis. It’s a pain to administer (you can’t eat for an hour before and after the dose, you have to stay standing up for an hour after), it upsets the stomach, and it can cause serious jaw complications after dental surgery. Furthermore, it’s only mildly effective in slowing bone loss.
Well, here’s some encouraging basic research from the latest issue of Nature Medicine. It turns out serotonin produced by the gut has a powerful inhibiting effect on bone synthesis. Vijay Yadov and colleagues have tested a compound (”LP533401″) that inhibits synthesis of gut-derived serotonin, and found that it prevents osteoporosis in rats who’ve had their ovaries removed; and improves bone density in rats who already have osteoporosis.
Here’s a picture of the molecular structure of TPH-1, the first enzyme needed to synthesize gut derived serotonin, being blocked by LP533401.
Blocking serotonin formation in the gut improves bone density in rats
Serotonin is an interesting chemical – in the brain, it is a neurotransmitter that plays a role in migraines and depression. Happily, the compound administered in the study does not cross the blood-brain barrier, and thus does not interfere with brain functions that depend on serotonin.
It will be a while before this is tested in humans (if it ever gets to that stage) but it’s encouraging to know that there are promising new ways to improve bone mass and prevent fractures in post-menopausal women.
Very useful article in this week’s New England Journal. We usually screen healthy adults for diabetes by drawing a fasting blood glucose as part of the annual physical. This study from Johns Hopkins suggests that glycated hemoglobin might be a better test.
Particularly impressive is the accuracy with which glycohemoglobin predicts cardiovascular outcomes such as heart attack and stroke in non-diabetics.
Glycohemoglobin is a well-known predictor of vascular events in people with diabetes – but the fact that it is such a powerful predictor of vascular disease and death in non-diabetics is big news.
Many of my patients have slightly high fasting blood sugars on their physical. It’s hard to know what to tell them. Does a blood sugar of 103 mean they are going to get diabetes? Do they need to be on medicine like metformin to lower their sugar?
It looks like glycohemoglobin (which gives an “average” for the blood sugar over a three month period) will be a much more accurate test. We can avoid frightening patients over meaningless random fluctuations in glucose; and we can better identify those in need of real risk factor modification or medicine to lower their blood sugar, before frank diabetes develops.
Tuesday, September 15, 2009
Swine flu (H1N1 influenza) may be contagious for several days after the fever breaks, according to an abstract presented at the American Society for Microbiology today. Usually we tell people to go back to work when their temperature returns to normal. With H1N1, it may be necessary to stay home and take precautions for as long as you are coughing.
AP article here.
Tuesday, September 15, 2009
Primary care doctor shortage continues in Mass
MMS Physician Workforce Study 2009
Mass Medical Society has released this year’s Physician Workforce Survey. The number of primary care practices accepting new patients has dropped from 58 to 44 percent. The practice climate for primary care is getting more difficult every year, with the flood of paperwork coming from the insurance companies, the advent of “tiering“, and primary care reimbursement dropping every year while specialty incomes rise. Most physicians completing residency programs and looking for careers in general medicine are sensibly choosing hospital medicine, where salaries are higher and the hours better.
I am a Democrat. I supported Barak Obama in his campaign. I think he’s a good president. From a citizen standpoint, I think his healthcare plan, if passed, will probably improve health care quality and access at least modestly. But from a primary care standpoint, I’m disappointed. None of the various drafts and proposals I’ve seen do a thing to address the crisis in primary care.
If we keep paying enormous sums for invasive procedures, and next to nothing for doctors to listen, think and communicate with patients, then we’ll continue to have an expensive, fragmented, procedure-based healthcare system rather than a humane and rational one focused on patient needs.
Friday, September 11, 2009
The New England Journal has the first two clinical trials of the H1N1 Influenza vaccine. The data are summarized in an editorial: NEJM — Pandemic Influenza Vaccine Policy — Considering the Early Evidence.
The standard vaccine seems to generate an adequate immune response in healthy adults after a single dose. It depends on the results of other trials, but maybe we’ll only need one dose of this vaccine. They were talking about two doses for everyone, which would pose a problem since supplies will be limited.
One dose should also be OK for older kids and pregnant women. No data yet on younger children and immunosuppressed persons (older and/or with chronic diseases).
No major adverse effects seen but the studies were not large enough to detect rare side effects.
Friday, February 20, 2009
I finally had a few minutes to look at the website again. I upgraded Wordpress. I put a new theme in place, hope you like it. There are some things in the About section that I need to update.
Maybe I will start posting blog entries again – I keep reading interesting journal articles and meaning to share them. Too busy taking care of patients to blog! Yikes. Remind me why I started this practice again?
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