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.

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.

AP article here.

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.

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.

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?

They are so cool!

Here is a picture of a cedar leaf in cross section, using polarized light.

And here’s a marine worm using a technique called confocal photography (which is explained in detail on the site, for you photomicrography bugs.

This one is the seed of the small-flowered willowherb (Epilobium parviflorum).

And this lovely scene is some rat hippocampal neurons being attacked by Alzheimer’s related neurotoxins>

I don’t know that these images demonstrate the beauty of nature, so much as the beauty of photographic images that depict nature in clear lines and bright, nifty colors.

Still, they’re great to look at.

How he heard about Tregellys Fiber Farm in Hawley, I do not know. What he failed to tell us when we met up at the Creamery in Cummington is that is is a forty-five minute drive into the middle of nowhere.

He and my mom cruised on ahead, no doubt listening to classical music on the radio, chatting and enjoying the scenery.

In our car, Rebecca immediately starts on a migraine. The kids occupy themselves by making as much noise as possible: scatological screeching, punctuated by repeated demands for various things that cannot be procured on a small country road in Ashfield.

On and on we drive. We’ve been going for miles on a single-lane dirt road through a pine and beech forest. It’s been fifteen miles since we passed even a house.

Jane starts to feel carsick. Poor Rebecca is sitting silently with her eyes closed looking tense. I am thinking how much I would rather be almost anywhere than in this car on a beautiful fall day, and about the hydrocarbons we’re emitting, and global warming, and wondering what on earth my father was thinking; and also trying to concentrate on my out-breaths and relax into the moment, which is not working. I am not relaxing.

Then, suddenly, we come into a clearing and we’re in…

Tibet.

This farm is set on a steep, rocky hillside overlooking a forested valley. Just beyond the farmhouse, the ground falls away steeply and you can barely see to the bottom of the ravine, where another mountain rises just as severely, filling up the horizon.

Okay, it’s not the Himalayas, but it’s an incredibly beautiful, secluded corner of western Massachusetts. The hill above the road is figured with large stone terraces. At the edge of the rise stands a tall stupa (Tibetan prayer shrine).

In large wire pens, or roaming about free, are animals such as Bactrian camels, Royal Pinto Yaks and Icelandic sheep and rams. Plus pigs, sheep and chickens, and a pet duck who swims around in a spectacular hand-laid slate fountain the size of a small pond.

The kids, of course, had a great time running up and down the terraces and petting the animals. No, they had not, previously, seen Bactrian camels (native to the steppes of eastern Asia and domesticated around 2500 B.C.E., we learned).

Apparently Ed Cothey and Pamela Steward bought the land thirteen years ago and raised conventional animals there. They got a story in the local paper when they bought a llama. This attracted some visitors from Tibet, nostalgic for home. One thing led to another, and soon they had several Tibetan families living with them.

Then they started to import Asian animals. One of their guests contributed the terracing and the stupa; and stayed to open a Tibetan stonework business based on the farm.

Ed is an accomplished weaver, and Pamela is quite a good poet. She has a book with the University of Chicago Press.

Such a place, in the hills of Western Massachusetts. Who knew?

Plus they told us about Tibet Fest 2007, in Goshen, Connecticut. So we have next weekend planned already.