Internal Medicine Of Southwest Florida Newsletter
In This Issue
Cough and Cold Season
Healthy Winter Squash Recipe
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Dr. Raymond Kordonowy MD
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Issue: # 10October/2010

Fall has now arrived. With the great weather we also are seeing our northern patients return- welcome!  The respiratory season is upon us and hopefully all our readers have been vaccinated for flu. To our new readers, if you scroll over some of the highlighted text you will see you can click over the text and you will be linked to additional information.  This makes reading the newsletter much more informative (and sometimes fun) so please do this. Remember also our prior newsletters are archived on our website. Feel free to read prior topics of interest from those newsletters.
There is an article presented as a refresher about what is common with cold and similar viruses. This article also lists signs and symptoms that should prompt you to seek medical evaluation.  It is a myth that antibiotics are going to make these viral illnesses better.  Recently, the removal of a long time weight loss medication Meridia (generic name is sibutramine) made the news headlines- this prompted me to delve a bit into this story and to review what medical options are out there presently to help with weight management.

Cough and Cold Season
Cough and Cold Season  

By definition an acute cough is one that has lasted less than 3 weeks. Most coughs are not serious and are due to viral illnesses or allergies. There is truly no point seeking medical attention for typical viral infections and contrary to popular myth- antibiotics do not help these syndromes. Most folks are going to get better on their own in 3-10 days.  Reactive airways disease/asthma can also be a reason why someone doesn't recover quickly. In that instance inhaler prescriptions can provide significant relief of symptoms.


Hopefully you have had your seasonal flu vaccine and thus your chances of getting the seasonal flu have been cut down by approximately 75-90%.  We do have vaccine available if you haven't been vaccinated. There is always a chance the flu virus will change and if it does the vaccine provided might not offer protection. Depending upon the year and patient group studied the effectiveness of the influenza vaccine is different. I wanted to remind everyone that there is a good, rapid nasal/throat swab test which we have available in our office that can diagnose definitively influenza (the flu). 


If we know for sure a person has the flu, we can provide antiviral prescription medication for the infected patient as well as consider preventive medication for those living in close contact with the patient. This protocol can greatly lower the chances of spreading infection within the community. Antiviral medication for the flu can also shorten the duration and severity of an acute influenza infection if the patient can get diagnosed within 2-3 days of their symptoms.


Many of you have seen the following information concerning Upper Respiratory Illnesses (URI) in a handout that I dispense to most of my new patients and during the cough, cold and flu season . Use this reference in order to manage cold symptoms at home on your own. Please do note the indications for medical evaluation  such as pneumonia can develop as a complication to URI's.



Upper Respiratory Illnesses (URI)


URI's are very common through the fall, winter, and early spring seasons.  Most causes are viral and cannot be treated with "antibiotics."  We do not want to use antibiotic medication unless there is evidence clinically of an actual bacterial infection- this will only promote bacterial resistance and not increase your rate of recovery.


EmergencyWhen is my cough possibly an emergency?  Symptoms that should prompt your immediate concern and a request for a same day appointment are: teeth-chattering chills, sudden onset of local rib or localized chest pain, bloody sputum, fever over 101.5, shortness of breath, confusion, or wheezing.  Our clinical staff have been instructed to work such complaints in on the nursing schedule in order to facilitate a rapid triage of the patient.  As noted below we can test for influenza if a review of symptoms suggests this is possible. We are also able to check your oxygen levels with a simple finger probe- low oxygen raises concerns for much more serious illness than a simple cold or allergy.


Clues for typical viral illnesses such as the common cold include: occurring in outbreaks (the neighbors or other family have had it), sudden onset of nasal stuffiness, muscle aches, sneezing, and sore throat.  Mild fever is common (under 101.5). Yellow and green sputum or nasal discharge is also common and not specific for bacterial infections.   Most viral illnesses last between 3-14 days.  You should definitely be trending in the improved direction by the end of 10 days; if not, an evaluation in the office is recommended.


For Viral illnesses some remedies do make sense and are backed up by reasonable studies.  There are a few things that can be used and probably won't hurt you in any significant way.  These include:

            1) High doses of vitamin C can shorten the duration of the common cold.  Studies show taking daily vitamin C (citric acid) does not prevent the common cold, but can shorten the duration by taking 1000mg 3 times a day.

            2)Zinc gluconate (Coldeez brand specifically) at 13.3 mg dissolved in the mouth every 2 hours does improve symptoms and decrease the number of days you are ill.  Take 5 to 6 lozenges per day.

            3) Both green and black tea have antibacterial activity against multiple bacterial pathogens that can complicate the typical respiratory illness.  No studies prove it helps definitively, but theoretically it may improve your symptoms and complication rates.

            4) Antihistamines include Loratidine, Tavist, Claritin, Alavert , and Zyrtec as directed for drying secretions/nagging cough can be very helpful. Don't forget the old Vicks menthol rub to the chest, throat, and upper lip at bedtime.

            5)Nasal saline to irrigate the nostrils and over the counter guaifenesin or dextromethorphan cough formulas can be helpful although not officially endorsed by most physician sources.  An excellent nasal irrigation product is NeilMeds nasal wash system.

            6)If you are not allergic to or have contraindications to  ibuprofen (Motrin or others), this over the counter pain and anti-inflammation medication can be very helpful in reducing fever, muscle aches, and producing an overall improved sense of well being when ill from respiratory viruses. Contraindications to ibuprofen include a history of gastric bleeding or being on blood thinners.


Influenza is best prevented with vaccination.  Despite this, you may still get an active infection.  We now have an office test that can quickly confirm influenza infection (the flu).  If you believe you may have the flu please inform the  scheduler/clinical staff and we can arrange same day testing and evaluation.  Signs of true influenza include invariably: fever of at least 100.5 orally, sudden severe muscle aches (especially in the back) running nose, followed in 2 hours by a sore throat, nonproductive cough and often frontal headache.  


Strep throat can also be diagnosed quickly with a throat swab office test.  Symptoms include: very sore throat (painful to swallowing), fever over 99.5, fatigue, muscle aches, and whitish coating in the tonsil areas located at the back of the throat.

Meridia In The News

Meridia Weight Loss Medication In the Headlines

Recently Abbot Laboratories voluntarily pulled its medication, Meridia, from the US Market.  Upon exploring this story I learned that this outcome had been potentially in the works for several years.

In Europe there was evidence that Meridia raises blood pressure mildly (statistically appx 1-3 mm Hg) and heart rate about 4-5 beats per minute more than the non treatment group.  This information was made public to physicians and so if prescribed we monitored patients for these possible side effects. In follow-up we would weigh the risk of any blood pressure and heart rate elevation against any benefit (if experienced) as it related to weight loss and reduced complications associated with obesity.  I have written and have counseled extensively regarding the health risks of obesity in prior articles and on a daily basis in my practice.

Due to the findings reported in Europe, the FDA requested that Abbot Laboratories conduct a prospective trial looking at outcomes for cardiovascular risk in patients 55 years and older who were at increased risk for cardiovascular disease.  It is relevant to point out that this trial as conducted went against the current prescription label information for prescribing Meridia. 


The trial is known as the SCOUT trial and the findings were published at the first of the year 2010.  The data showed that there was approximately 1 % more actual stroke and heart attack events in the group that used medication- this translated to a statistically significant 16% increased risk of events compared to the non treatment group (11% vs 10% rate of events).  There  was no significant difference in death rates between the groups.  Only 2.2 lbs of weight loss was noticed between the groups as studied as well.  Before Meridia was approved there was more than 5% difference in weight loss (approximately 9.7-16  lbs in the middle dose of 10 mg) over non treatment.  It was the lack of effective weight loss in conjunction with the slightly higher rate of heart attacks and strokes that lead the FDA to seek recommendation for a voluntary removal of the medication from Abbott Laboratories.

Abbot has officially removed the medication from the market- stop taking it now if you haven't been contacted to do so.  With Meridia's removal, there is only one medication available for long term (up to and beyond one year) use in the management of obesity.  This medication is orlistat (generic) and branded as a prescription called Xenical and is available over the counter in 1/2 the prescribed dose as Alli.

There are two other medications currently FDA approved for weight loss but are recommended to only be used up to 12 weeks.  These medications are phentermine (name brand Adipex-P) and diethelypropion (name brand Tenuate).  Medication/Pharmaceutical therapy may be considered in conjunction with diet and exercise for individuals with BodyMassIndex > 30 kg/m2 or from 25-30 kg/m2 if they have comorbid conditions.

As my patients know, I have explained repetitively that there is no safe short cut to weight loss and risk reduction of the illnesses associated with obesity.  This is the main reason our practice has made a Certified Dietitian available in our practice and to our patients.  What is needed is proper nutritional education to empower people to make permanent lifestyle changes at it relates to how we approach food and eating along with a commitment to regularly engage in exercise. 


Having made this statement again and without detracting the emphasis of this position, I am sure the reading audience is interested in knowing if other options regarding possible medications are in the works. One combination medication which was going to be called Qnexa  just went before the FDA and it was denied approval. I will send you to the following link  reviewing the 3-5 possible medications /combinations currently showing promise as taking each in review would take an entire article.  The link takes you to one of the medications. On the linked page if you scroll to the left corner you will find likes to the remaining pipeline medications and a description of them. This link lists the current promising medications so readers may learn what might be in the future arsenal of therapeutic options.  


Finally the surgical approach to obesity surprisingly shows the most impressive statistics as it relates to meaningful weight loss and improved morbidity and mortality (if lifestyle changes don't work).

Another Healthy Recipe
Winter Squash Soup Winter Squash and White Bean Stew

This recipe is submitted by a Mary E. Herr from Three Rivers, Michigan and is published in the Fix-It and Forget-IT Cookbook Feasting with your Slow Cooker by Dawn J Ranck and Phyllis Pellman Good (Good Books Publishing - .

Makes 6 servings

1 cup chopped onions
1 Tblsp. olive oil
1/2 tsp. ground cumin
1/2 tsp. salt
1/4 tsp. cinnamon
1 garlic clove, minced
3 cups peeled, butternut squash, cut into 3/4 inch cubes
1 1/2 cups chicken broth
19 oz can cannellini beans, drained (you can pre-soak 8 oz dried beans overnight, then cook until soft instead)
14 1/2 oz diced tomatoes, undrained
1 Tblsp. chopped fresh cilantro

I have used pumpkin flesh in place of squash and find it very good. Also I recommend garnishing with fresh nutmeg to taste at time of serving. Low fat sour cream can also be added at serving time for a little added flavor.

Remember as well my prior recommendation for getting magnesium into your diet using squash and pumkin seeds.
As always, Internal Medicine of Southwest Florida appreciates the opportunity to serve you. I am hopeful that these newsletters find you well and help you maintain good health and provide useful information.  Feel free to consider us your "Medical Home" whether you are here in Florida full or part-time.


Raymond Kordonowy MD
Internal Medicine Of Southwest Florida
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