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Dr. Kordonowy's Patient Newsletter
This is an interactive newsletter, click colored links to get more information.
Fall is here- and holiday season will be near.
Due to the COVID-19 pandemic many are wishing to get vaccinated for influenza as soon as possible. We currently have 2020 seasonal flu vaccine at the office and are highly recommending all our patients receive this vaccine. Recently a person reported cases of Influenza A in their children here in Lee County. You are encouraged to contact us to schedule a vaccination appointment. This vaccine is included, free of charge, as part of your membership.
As the COVID-19 story unfolds, we are learning that the situation is improving and is much more manageable than initially feared. You can follow the numbers on the CDC website for up-to-date information.
I have ordered, but we have yet to receive, a point of care nasal/throat office testing assay that will include testing for acute influenza as well as Covid. I will send a separate email when that service is available. It was not until recently that recommendations for outpatient management for COVID were published in the medical literature. I find it paradoxical how the panic generated by this virus resulted in the paralysis of the healthcare system. There was so much focus on inpatient (hospital) concerns the result was a literal shut down of outpatient access to physicians and diagnostic services. There is a huge lesson for all of us in that part of the story. Thankfully due to our practice model and being in a private practice setting, my office remained open and available to our patients throughout the entire panic.
Dr. Kordonowy
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Some patients have voiced concern that we aren't wearing masks routinely in the office. Some believe masking is a mandate (legally required) and are certain that masking in public is preventing infection rates. I have repeatedly checked and confirmed there are no legal local/county nor state mandates for masking.
The CDC clearly recommends persons wear masks (no clear evidence to support this position) IF they are unable to properly social distance. Clearly, we ask persons who believe they have symptoms of COVID or any respiratory infectious illness to inform us ahead of time as well as wear masks if they are coughing or sneezing. Additionally we encourage you to be as safe as you feel you need be when entering our office-including donning a mask if you wish to. If visibly ill with respiratory symptoms we will require you to wear a mask.
I have explained in my prior newsletters on this topic that masking is very helpful when dealing with an acutely ill or active index case. The initial Wuhan Hospital article I reviewed clearly showed this BUT only when wearing masks that are specifically designed to withhold small infectious particles. See the COVID-19 update article below and video link to see why global data does not provide support for general population masking. Per the CDC website this virus is spread by direct human contact. Verbatim from the site: Person-to-person spreadThe virus is thought to spread mainly from person-to-person.
This is the same language used for all infectious respiratory pathogens including influenza. May be does not mean "DOES". Reported outbreaks consistently indicate active (ill with symptoms - cough, fever, etc) initial contacts not persons in the pre-clinical incubation period (not exhibiting symptoms) as sources for spread.
Noting the above, as well as common clinical practices and nearly 3 decades of experience, I continue to use normal office procedures which include the following: . - Disinfecting rooms between patients.
- Disinfecting tables,furniture, knobs,etc... throughout out office.
- Cleaning hands with disinfectants and/or soap and water between patient cases.
- Single gown use and bleaching patient gowns after use.
- Disposing of infectious material.
- Vigilance for signs and symptoms of infectious or contagious disease with proper triage procedures to isolate such patients from others.
- Wearing proper fitting masks,gowns and eye protection while treating patients with upper respiratory symptoms and/or Covid symptoms.
- Treating and testing possible Covid patients outside (on our bench or in their car).
- Bringing outside air into our building daily with a specific A/C unit.
- Meticulously steam cleaning our floors weekly.
- Bringing in outside air to improve circulation of fresh air.
With COVID-19 and its novelty we are checking temperatures of the doctor and staff each morning as well as taking personal inventories of feeling healthy or otherwise. We offer phone appointments for patients that wish to avoid office contact. We also ask anyone with acute symptoms to remain in the parking lot until we either triage them outside or arrange safe escort into the building. We have set up a station whereby we can use our back/side entrance to avoid those cases walking through our waiting room and exam rooms. I would submit that these procedures are historically effective and reasonably adequate to protect patients and our staff.
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Newsworthy Items with Dr. Kordonowy's Commentary
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Membership Health Examination and Services Protocol Update
In 2017, I wrote a blog about health care in 2017 and beyond. It seems prophetic now after the COVID-19 healthcare crisis. I had to leave traditional payment models in order to provide the access that modern technology allows. Ironically, now the government is scrambling to allow and provide payment for "telehealth" care.
We are many months into our health maintenance program. You may recall that we started to audit each patients record when their annual physical was due. Using a disciplined approach of review and applying the latest health prevention recommendations, patients are now getting personalized summary letters documenting the status of their health. These annual letters are delivered to your email with a link to your patient portal. The letter asks you to contact us to schedule any due services including labs and vaccines. The idea is for you to complete preventative care tests (colonoscopies, mammograms, etc...) accomplished while meeting your time and schedule preferences. We would appreciate any feedback about this new service we are providing.
Disease and Health Screening Update Reminders
There are many misunderstandings about health disease screening recommendations. Through population analysis and outcomes review, we have learned that in some instances we are over-testing people. Below is a summary of present generally agreed screening guidelines.
- For women, the US Preventive Task Force consensus for mammography screening for breast cancer is that for average risk (most women) screening is advised for ages 50-74. Screening is recommended not annually but rather every other year. The greatest benefit for cancer death reduction is for women age 60-69 years. Evidence is insufficient for recommending screening for age 75 and above. If there is a family or personal history of breast cancer or genetic predisposition, more frequent and or additional modalities may be appropriate. Interestingly, the new guidelines recommend against teaching women self-examination and inconclusive for physician physical examinations for benefit.
- For Women PAP testing is specifically for screening of cervical cancer. This test does not screen for ovarian cancer. PAP screening is recommended to start at age 21. If the initial test is negative, screening need only be done at 3 year intervals. HPV (Human Papillomavirus) testing can be done/added at 5 year intervals. If the patient has never had an abnormal PAP smear and reaches age 65, in general, further PAP testing is not warranted.
- Ovarian Cancer screening for average risk patients is not recommended. Data shows no evidence of mortality benefit and a very high rate of false positive testing. The incidence of ovarian cancer in women is 11.4 cases per 100,000 women per year. Direct family history for ovarian cancer or positive genetic risk warrants a review for consideration of tumor marker testing and or pelvic ultrasound.
- Colorectal cancer screening has been effective. The incidence of this malignancy has declined 24% over the past 30 years. Five year survival rates have improved from 48.6% to 66.4% (1975 versus 2009). The incidence of colorectal cancer is rising in adults ages 20-49. The American College of Gastroenterology's recommendation to begin screening at age 45 for African Americans noting a higher incidence and mortality rate for colorectal cancer in this group. (This is a new recommendation.) If you are under the age of 50 and have symptoms of rectal bleeding, iron deficiency, persistent abdominal pain or persistent change in bowel movements screening is warranted. Age 50 is the starting age for the rest of the population. If there is a direct family history of colorectal cancer before the age of 60, then screening should begin at age 40 years. For patients ages 76-85 further screening should be individualized based upon past history and overall health. At 85 years and up screening should stop due to higher risk then benefit. There are other screening methods including periodic occult blood stool testing and FIT (fecal immunoglobulin testing) and the Cologuard stool DNA test.
- Prostate Cancer Screening with PSA is controversial. It is not recommended for men 70 years and older. The US Preventive Services Task Force rates PSA testing as a C recommendation for men ages 55-69. This means: The USPSTF recommends selectively offering or providing this service to individual patients based on professional judgment and patient preferences. There is at least moderate certainty that the net benefit is small.
- Lung Cancer Screening with low dose CT imaging is recommended for persons ages 55-80 years who have a 30 pack year history of smoking who actively smoke or have quit within the past 15 years. Screening is not recommended past age 80 or if medical conditions preclude surgical cure approaches to this disease.
- I recommend periodic screening for glucose intolerance/diabetes and abnormal cholesterol levels as cardiovascular disease is a major preventable condition highly associated with diabetes and metabolic syndrome/insulin resistance. Cancer is the 2nd leading cause of death and unintentional injury is the 3rd. For this year COVID-19 is approaching the 3rd leading cause of death. This will not be true in future years.
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Covid-19 Update:
I have been posting periodically on Dr. Kordonowy"s Facebook page some interval information on Covid-19. I was planning to show you various graphs and data that show, despite the news hype of rising cases, the mortality statistics across the globe are not rising commensurate to the case incidence. I stumbled upon this excellent YouTube discussion which does a tremendous job explaining what we are observing. As the data is unfolding, we are seeing patterns of infection that very much historically is the same as with seasonal influenza,as it goes across the globe from North to South. The US has climates of both and this can explain the observed "second surge".
In the YouTube discussion we can see that mandating masks and lock down timing has no clear association with the infection trends. The numbers indicate community spread (many cases not clearly linked to direct contacts). This is a scenario which occurs with ALL seasonal respiratory viruses.
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| | Viral Issue Crucial Update Sept 8th: the Science, Logic and Data Explained! |
Additionally, Florida COVID-19 case information looks very favorable as well. The positive testing rate is under 5% now and trending continues to go down. I haven't seen a case in the practice for approximately 3 weeks and we had less than half a dozen total cases during the pandemic so far. This week a patient reported two children were confirmed to have influenza A locally.
One conundrum I see in the press is that many recently polled people indicate they won't take a COVID-19 vaccine when it becomes available. When the vaccine is a reality we will have to review the status of infectivity, mortality trends, and review any new therapeutic literature to get a handle on the risk and benefit ratio of a vaccine. If a vaccine were helpful at all it would seem an intellectual disconnect to accept general masking as a way forward yet not accept a safe vaccine.
Given that vaccine supply is going to be limited, it makes sense to me to test people for IgG antibodies for COVID-19. If a person has measurable antibodies, I would suggest they likely won't benefit from a vaccine early into this story. I have pointed out in a prior newsletter that the microbiologists and immunologists indicate a person harnesses a protective immune response to the other common coronaviruses for approximately two years.
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Lean Eating Suggestion:
This summer, after catching some local Florida fish, I wanted to share one way to prepare fish. Steam it! Season as you would prefer and using a double boiler pot steam your fish. The flavor and tenderness can't be beat and it is very quick! It turns out fish protein appears to be the healthiest source of protein for your cardiovascular health. This is a great time to also share my plate-building strategy which emphasizes targeting high nutrient density with high natural fiber.
Plate-building for nutrition and easy weight management:
- Water first-feed your thirst. 8 oz plus another 8 with your meal.
- Protein to improve lean body mass and muscle density- this results in higher resting metabolism allowing more calories to be eaten without weight gain. 5-8 ounces per meal and half of this per snack. Fish protein is healthiest. Lean meats, low to 2% dairy such as Greek Yogurt, cottage cheese, beans/legumes are other sources such as tofu.
- 2-3 fresh vegetables or whole fruits per plate-emphasize freshness and color. 1/2 cup is a serving.
- Limited whole grains such as multigrain bread, quinoa, spelt, whole grain rice, whole bran grains etc.
- If desert desired I recommend whole fresh fruit if available.
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