Internal Medicine Of Southwest Florida Newsletter
In This Issue
What is a Lipidologist?
A Healthy Recipe
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Issue: #7- April/May 04/2010

We hope this newsletter finds you in optimal health. The physicians of Internal Medicine of Southwest Florida have a primary mission statement that includes focusing on prevention and wellness. This mission statement was made long before the now politically correct statements about disease prevention.
We are going to cover two topics in this issue.  In an attempt to improve finding those individuals at risk for Alzheimer's Disease we have added a computer based neuropsychiatric testing system to our diagnostic toolkit in the office.  This test isn't for all people and will be used selectively in patients we might wish to screen for brain impairment.  The second article is about advanced lipid testing and how this can provide the doctor with more detail into a patient's cardiovascular risk. Cardiovascular disease remains the overwhelmingly number one cause of death in Americans over 50 years of age.  Understanding your immediate and long term risk for heart attack and stroke can translate into life extending advice from your physician.
Raymond W. Kordonowy MD
Alzheimer's Disease
BrainThe Leading Cause of Dementia In the Elderly

Dementia is an acquired chronic impairment of memory and other aspects of intellect that interferes with daily functioning. As we age the occurrence of this disease increases significantly. Data suggest at age 65 approximately 1.5% of Americans have this problem. By the time we are in our 80's this increases to between 20-50 % depending upon the information source. 5.2 million Americans are estimated to have this problem. The scientific community is placing significant resources not only in understanding and treatment considerations but also in the diagnosis of this condition.

A certain amount of memory impairment normally occurs as we age. In the case where we "forget" someone's name it is normal if it is a neighbor or acquaintance but not normal if it is a family member. It is normal to forget where you put something but you eventually figure it out. Someone with dementia forgets that they "forgot". Persons with dementia are usually unaware they are having memory concerns. In normal aging persons worry that their memory is "going".

Most cases occur sporadically; however, a family history of Alzheimer's increases a person's risk over their lifetime. If a person has one direct family member with Alzheimer's dementia their cumulative risk by age 85 is 27% in whites and 44% in blacks!

Signs and symptoms of this condition invariably involve memory impairment. Persons have an impaired ability to learn new information or to recall prior learned information. It tends to show up with short term/recent memory recall, i.e.     " what time did you say my doctor's appointment is today"?

Other common findings include language difficulty (word expression or recall) and difficultly with spacial planning such as illustration or model copying as well. Failure to recognize or identify objects is also a sign. Personality changes include: social withdrawal, depression or anxiety feelings, uncharacteristic aggressive or paranoid thoughts.

Testing for abnormally low ability to perform intellectual skills is how doctors evaluate for dementia. More in depth screening may help identify people who appear to be functioning normally but may be starting to have mild problems. As a patient, if there are concerns for yourself or a loved one for developing dementia you may hit the following link to request memory testing.  If a person is developing dementia there are medications to help stabilize memory.  Also progression over time is the norm for Alzheimer's disease. Medication can slow this progression allowing a person to remain independent and functioning well for a longer period of time.  Ruling out other reversible/curable forms of memory loss is important to do as well.

There are advanced brain imaging scans using PET technology. Positron Emission Tomography scans uses special tagged nuclear isotopes to look at diminished brain activity in sections of the brain known to be affected in Alzheimer's disease. This type of testing is available but currently there is no consensus as when or if to order this type of radiology test. Brain MRI's or CT brain scans are often performed mainly to rule out other causes of memory loss or diagnosis that can mimic Alzheimer symptoms.

There are medications for dementia and they are helpful. There currently is no cure nor any medication that stops this problem. There is a prevalent theory that identifying people very early and then placing them on medication could potentially prevent the clinical condition- this has not been proven. The future includes the possibility of using certain blood testing (genetic tests/risk factors in the blood) and possibly PET imaging. If testing suggested someone was highly likely to develop Alzheimer's, a person might be offered early medication ahead of symptoms. This concept is still in a theoretic stage and will need to be rigorously studied and proven to be helpful before such a protocol is followed.

If you feel there is concern for dementia in yourself or a spouse, please discuss this openly and bring your physician into awareness.  As a physician I have found it very difficult to pick up on this especially early in the process. The office visit is a fairly simple ritual that a person can get through without showing obvious memory problems.
What is a Lipidologist?
Dr. Raymond Kordonowy MD
Did you know Internal Medicine Of Southwest Florida has the only Board Certified Lipidologist in Lee County? Read the following personal experience. 
In layman's terms Lipids= Cholesterol.

A lipidologist is a cholesterol specialist.
 Most people think all cholesterol is the same and is treated with the same medication and lifestyle changes. This is far from the truth. Take me for example, I have had high cholesterol for years. I am in my 40's and am a slender female. I made an appointment with Dr. Kordonowy, the only Board Certified Lipid Specialist in Lee County. Besides measuring my traditional cholesterol levels, he ran a very specialized blood test which looked at all the different sizes and densities of my cholesterol particles. Dr. Kordonowy explained that the size and density of cholesterol/fat particles in the blood more clearly predicts risk than the traditional measured cholesterol results. Also common inheritable risk factors can now be affordibly tested for when there is a family history of premature heart attack. He found I had a high level of a particle called Lp(a). Lp(a) is associated with a higher risk of cardiovascular disease. It is an inherited trait and does not respond to diet, exercise or even statin drugs (lucky for me because I don't exercise and I don't like to diet)!  Treatment for me included taking a supplement called niacin and to aggressively treat my LDL cholesterol with more aggressive targets for therapy (due to my higher risk over time of a heart attack). 
Having more advanced testing resulted in a more personalized and targeted therapy then the typical recommendation of "you have high cholesterol, so let's put you on ___________ (a statin drug). " or " you are slender and so must be eating right- just try more exercise." Such recommendations would not have fully addressed my problem.  Lipidologists have a wider range of treatment recommendations due to their specialized knowledge of cholesterol, medication issues and complex diagnostic testing. From these more sophisticated tests they can also diagnose or predict other diseases that highly correlate with specific lipid densities and sizes such as metabolic syndrome and diabetes. 
In summary I highly recommend persons with very high or difficult to treat cholesterol, a family history of early heart attacks, or a personal history of vascular disease such as known coronary artery disease consider consulting with a Board Certified Lipidologist for the the most accurate evaluation and treatment for this very serious problem. 
If you are having difficulty managing a cholesterol problem or are experiencing progression of vascular disease despite traditional treatment, perhaps you would like to see Dr. Kordonowy for consultation and reassessment of your problem. IMSWF also has a dietitian on staff who can counsel on diabetes, cholesterol disorders and diet for weight loss/obesity.  Having a dietitian on the team has resulted in significant improved results in patient management.   Discuss this with your main doctor and if you wish to see Dr. Kordonowy.  Please follow the link to request his service.  Dr. Kordonowy is certified by the American Board of Clinical Lipidology (ABCL) and is also board certified and re-certified by the American Board Of Internal Medicine (ABIM). He is a member of the National Lipid Association and Florida Lipid Foundation.
You can learn more about lipids and cholesterol recommendations.
A Healthy Recipe
Last week I was able to still find some nice local beets.  If you replace the sausage component of this recipe with beef bullion you can eliminate nearly all the fat. The key to tasty borscht is adding sour cream at serving time- but remember for your heart get non-fat sour cream!
The Recipe comes from   Hit the following link to get to the recipe and enjoy.
Ray Kordonowy MD
On behalf of myself and my partners we want to express our continued gratitude for the opportunity to be your physicians.
I hope the newsletters are a value added service and are informative. We are happy to present topics of interest- all you need to do is send us your requests.

Raymond Kordonowy MD
Internal Medicine Of Southwest Florida
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