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).

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.

Our first few days were complete chaos. They moved the furniture in on Thursday morning and we opened Thursday afternoon, with unpacked boxes in the hallways, no equipment, no printer, copier or office supplies.

A sensible person would surely have waited until Monday, but the truth is I had a lot of patients who really needed to be seen and I did not want to put them off another four days…

They forgave us the mess and disorganization. And, as the days went on, we got things put away and figured out. It’s running suprisingly smoothly now.

I’m doing things the old-fashioned way – patients have a consultation in my office, then go to the exam room for the physical, then back to my office to finish up.

Some of my doctor friends tell me I won’t be able to keep this up when I’m seeing a full slate of patients – it’s just too slow. Maybe true. I just have this odd idea that patients feel more comfortable talking to the doctor when they are sitting in a chair with their clothes on

We have two great staff – Velma is our medical assistant. She got the lab stocked in no time and has also volunteered for laundry duty so that we can have cloth gowns (the paper ones tear if you breathe too hard on them). Sarah, our receptionist, is terrific.

My wife Rebecca is there every day greeting patients, solving problems, dealing with vendors, keeping people happy, running to Staples, and seemingly endless ad hoc tasks. I am so lucky to have her. Plus, it’s fun to work together, even when the work is hard.

Our friends know, but I don’t think I’ve mentioned here – Rebecca had a novel accepted for publication on Riverhead Press, which is an imprint of Penguin.

It’s not every medical practice that has a published novelist as an office manager. Though Dick Greene, a Pittsfield dermatologist, published a novel last year… so maybe this is a trend!

We’ll have our electronic medical record up and running in a couple of weeks. I’ll write more about that in future posts.

For now… if you are reading this… consider yourself invited to come in and see the office. If you need medical attention, give me a call. And tell your friends. We are accepting new patients. Out phone number is 442-5670.

We are open 8:30 to 5:30 Monday thru Wednesday, and we stay open until 8 pm on Thursdays. We close a little early on Fridays, for Shabbat (the Jewish Sabbath) – but I’m usually in the office, catching up, and will see people if it’s urgent.

It’s my own practice. I can do that if I want to.

It looks like Lenox Internal Medicine is really going to happen.

In fact, it’s going to happen tomorrow. We have our first patient coming in at 9 am.

It will be our “petit opening” – I scheduled a few patients for Thursday and Friday, who couldn’t wait until next week.

The office looks beautiful. A week ago, the foreman threw up his hands and said “You have twelve different colors of paint!” (Rebecca, who chose the colors, looked innocently at the doorframe next to her). The painting threw us behind schedule a bit – but I wouldn’t change a hue.

We had a great architect, Dana Bixby. She’s based in West Stockbridge. If you live in this area – or anywhere, for that matter – and need an architect, you won’t find one better than Dana. A sixteen-hundred square-foot doctor’s office is not exactly an architect’s dream project, but Dana put thought and imagination into every detail and it really shows. The space is warm and welcoming, attractive, and easy to work in.

John Salvini of T & J Contractors was the builder. I really did not believe it could be done in six weeks but, lo and behold, here we are. We were on site a lot during the construction and I know that all the builders put care and craft into their work. I am so grateful for their efforts.

There are many other people to thank – Ross Kuntzman, our landlord, who owns Berkshire Lighting, who didn’t mind having three exam tables on his showroom floor for weeks; Beverly, who let us use Bellissimo Dolce in downtown Pittsfield as a substitute office while we were waiting for this one to open; Josh and Kathy Yurfest for convincing us it was possible; my patients, for believing in me.

Of course, without Rebecca, it really couldn’t have happened. She’s given so much to making this practice a reality. I am very fortunate to have her as my wife.

Right now I’m awfully tired. I’ll head home and get some sleep.

Wish us luck. And stop by to take a look at the place. We’d love visitors.

More soon.

For now, though, if you’re looking for Lenox Internal Medicine: we’ll be opening in the middle of August, at 450 Pittsfield Road, in Lenox. That’s at the intersection of Route 7/20 and Holmes Road, right in between Berkshire Lighting and Subway, across the street from Essentials Day Spa. I’ve added a handy map, here.

We’ll provide all primary care services – office visits, hospital care, general physicals, urgent visits, etc. I’m board certified in Internal Medicine and have admitting privileges at Berkshire Medical Center. I have ten years of experience in Internal Medicine. I have been practicing for the past four years at Dalton Medical Associates.

We will take Medicare, Mass Health and most private insurances and HMOs.

For more information, or to schedule an appointment for after August 15, please call 413 637-1976.

If you are my patient and trying to reach me, or if you need an urgent appointment, you can leave a message for me at the above number, or at Dalton Medical Associates – 413 684-2110. I will stop in there to check my messages once a day through August 14.

Thanks for your interest, and check back here soon for more information.

I see on the UPI wire that the ongoing Lung Health Study at the University of Minnesota has finally proven what a lot of my patients have been telling me for years: you gain a lot of weight when you quit smoking…

It’s conventional wisdom that many who quit smoking may gain 5 to 15 pounds, but a U.S. study finds many smokers who quit gain about 20 pounds…

Eisenberg and Quinn re-analyzed data from the Lung Health Study, in which 5,887 American smokers were randomly assigned to either a smoking cessation program or usual care and then followed for five years. The authors of the 1998 study had estimated that quitters gained nearly 12 pounds.

However, the researchers used a complex statistical method that allowed them to compare “apples to apples” in the two groups, and they found that average weight gain was actually 21 pounds.

I find that this is a serious obstacle to quitting for many of my patients – especially now, with a health campaign underway to educate the public on the dangers of obesity. Cosmetic issues aside, patients are not sure which is worse – smoking, or the weight gain associated with quitting.

The answer is: smoking is far worse. There’s hardly an organ system in the body that’s not affected by smoking. In addition to lung cancer and heart attack, smoking greatly increases the risk of stroke, emphysema, cancer of the mouth, stomach, kidney and bladder, cataracts… you name it. If you want to see an illuminating little graphic on the dangers of smoking, click here. Even if you do gain twenty pounds when you quit smoking, you’ll live longer with the twenty pounds than you would with the cigarettes.

Still, I usually counsel patients to think of quitting smoking as one part of a bigger effort to improve their health through lifestyle change. If, in addition to quitting, you begin exercising (or increase your exercise) and make healthy food choices, you’ll minimize weight gain, improve your cardiovascular health, and also have more fun.

The Lung Health Study data should increase the interest in topiramate as an aid to smoking cessation. Topiramate is an anti-epileptic medicine that, in addition to preventing seizures, has some other interesting properties. It inhibits the release of dopamine in the mesocortocolimbic area of the brain – the part thought to be responsible for addictive behaviors. In other words, it helps to block one chemical pathway for addiction.

Topiramate has been used successfully to treat alcoholism. One study showed that it also reduced smoking in alcoholics; and in another, published last month, six out of thirteen non-alcoholic smokers quit cigarettes after being given topiramate. So, early data suggest that topiramate is effective in helping people to quite smoking.

A very common side effect of topiramate treatment is: weight loss. I saw a very dramatic case of a young woman with epilepsy who lost thirty pounds in a couple of months after being started on topiramate. I worked her up for cancer before figuring out it was the medicine that caused it.

Topiramate is being studied as a therapeutic drug for obesity. Subjects lose, on the average, eight to ten percent of body weight over two months, and maintain it over a three year period with continued treatment.

This would make topiramate an appealing drug to aid in smoking cessation, since it could blunt the weight gain associated with quitting.

It’s definitely not ready for prime time yet. The studies are preliminary, and topiramate has some significant side effects that could limit its use. The FDA has not approved it for this indication. But keep your eye on it. It may turn out to be a good adjunct to behavioral measures in smokers who want to quit and are afraid of weight gain.

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And here’s what’s going on inside:

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Photos courtesy of my lovely wife Rebecca. While the construction guys are tearing the place up and I’m taking call and working on the website, she made a quick escape up to my parents’ house in Plainfield:

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Nophie asleep in the car: [photopress:sleeping_baby_car.jpg,thumb,pp_image]

The lease at the Lenox Shops fell through. Just could not come to terms with the developer there. Luckily, I found another space, just up the road. It’s at the corner of Route 7 and Holmes Road, next door to Berskhire Lighting.

Ross Kunzmann, the landlord there, is a very nice guy and very straighforward. I think, I hope, we will work out a long term lease that allows me to stay there for – well, twenty years or so. I really do not want to move once I’m settled in there.

We have a wonderful architect, Dana Bixby. The plans are nearly done and we put them out to bid on Monday (gulp).

I’m also in the final phases of choosing an electronic medical record vendor. I think it will be a completely paperless office. Will write more about this later, but here are just a couple of neat features:

• Much better tracking of patient information than paper charts.
• Greatly improved screening, preventive health, and risk calculation – which allows for individualized risk factor management in patients.
• For patients, secure and private online access to their medical information. I should be able to post lab results, x-rays – basically, anything – in a way that patients can access it at their convenience.
• Communication with patients via email and maybe even instant messaging.

I’m going to work a bit on this web site too. I like fooling around with web sites but I might hire a professional designer for this one.

I’m on call today, so I have to go. I promise to keep this site better updated though, for anyone who is following my progress here.

Rebecca and I looked at a space on route 7 near Holmes Road, and then went back to the developer at the Lenox Shops to negotiate the lease he’d offered. He was pretty accomodating. It looks like we’ll be paying $16-18 per square foot for commercial space anywhere in Lenox. The Lenox Shops is closer to my house, which is nice; and I think we could get the build-out done sooner there. The lawyers have the lease now, so we’ll see what happens.

In other words: I still don’t have an office. But we’re making progress.

John Burnham asked me if I would stay through July at Dalton Medical. I’m thinking about it. I had started scheduling patients for July but I’m not sure the new office will be ready by then – so, if worse came to worse, I could see them in Dalton. And I’d have an extra month of salary and health coverage, before taking the plunge.

Maybe part-time in Dalton in July.

So many people have helped us along the way. Good advice from Larry at Arcadian Shop, Dave Nadig, Kathy Yurfest (big time) and of course Richard Simons. Even one of my patients – ill, bedbound, and awaiting a major surgery – volunteered to help when she recovers. I practically cried.