Internal Medicine Of Southwest Florida Newsletter
In This Issue
Featured Article
Weight Loss Update
Supplement Discussion
Healthy Recipe
Quick Links

Join Our List

Join Our Mailing List
Dr. Kordonowy MD

 If you haven't already, subscribe to my blog and follow me on Facebook and Twitter.  Hopefully you'll find my posts informative and useful.

Like us on Facebook

Follow us on Twitter

Visit our blog

Issue: #16June /July 2012

Greetings! I wish to announce to our readers that there have been some significant changes regarding our website. Since I pen most of the newsletter information and I maintain the blog information, the group has chosen to move that content to my personalized website which last week, I launched - From this site, you will be able to access my blog and archived newsletters.  Additionally, I have decided to create a new personal blog, The Doctor's Report, because I will be posting content more often. I will continue providing my personal commentary on controversial issues such as the healthcare debate. The group website will remain the same and be maintained by the group. Some sections link to my personalized site will take there, if clicked. New readers and WordPress members are invited to explore and subscribe to the new blog to learn about new developments in the field of Internal Medicine and to read my commentaries.  I also invite you to join me on Facebook and Twitter. From here I will be posting links to interesting medical articles, weekly nutritious recipes, and informing people of special events such as nutrition drink taste testings, wellness lectures, discounts for Pure Encapsulations vitamins, and weight loss challenges.  It is my goal that this online social interaction will motivate people to learn more about wellness, common illnesses and be healthier! 

In this issue, I'll be discussing opioids and Florida's new narcotic prescribing law, informing you of impressive weight loss goals of IMSWF patients, discussing the benefits of branched chain amino acids, and providing you with another tasty recipe!

-Raymond Kordonowy, MD
Opioids: A Historical, Scientific, and Legal Perspective


Proven by Ancient Egyptian papyrus records, opioids have been used for thousands of years for the treatment of pain. Opioids come from the opium poppy which was cultivated as early as 3400 BC in Mesopotamia. Opioid is the broad term used to describe all of the compounds that come from the poppy and that act on opioid receptors in the brain (Pain Physician 2008 S133-S135).


With the evolution of modern medicine, we have been able to isolate many different compounds in this opioid family. Among them are commonly used drugs for pain management such as morphine, codeine, hydrocodone, oxycodone, methadone, and fentanyl. Heroine is also a drug that can be manufactured from the poppy plant, but it is typically associated with recreational abuse, not medicine. All of these opioid compounds have the basic structure of morphine, but have small differences (such as additional hydrogen, oxygen, or carbon molecules).


Opioids are powerful pain relievers because they act on very specific receptors in the brain. These include the Mu, Kappa, Delta, and Sigma opioid receptors. Because of their slight differences in structure, each of the isolated opioid compounds (ie morphine, codeine, etc) "fits" differently into the receptors. The way they "fit" into the receptors, dictates what effect is produced on the body. For example, opioids that act on the Mu receptors cause more euphoric effects than opioids that act on Kappa receptors. Stronger Kappa effect is why morphine might be prescribed rather than hydrocodone. While they are from the same opioid family, their slight differences in structure cause differences in their ability to relieve pain.

The differences in structure also correlate with differences in the strength of the medicine.  For example, hydrocodone is 6 times as strong as codeine and morphine is about 7 times as strong as hydrocodone.  To see a full comparison chart, click here.


While being highly effective in relieving moderately severe to severe pain, opioids also have a high potential for abuse. This is because of the euphoric effect they cause on the brain. When opioids interact with various receptors in the brain, the brain releases extra dopamine (the chemical associated with pleasure) and changes the pathways of other chemicals. Because of the pleasurable effects of opioids and because frequent use causes tolerance, many people use the drugs recreationally rather than eliminate pain, and quickly become addicted.


Due to the euphoric effects,opioids have such a high prevalence of abuse associated with them. Especially in Florida the amount of prescription drug related deaths is significant. The Drug Enforcement Agency (DEA) has put them on various controlled substance lists. The prescribing of medically indicated opioids is a highly regulated process. Because of the rising incidences of prescription drug abuse in Florida, the state legislature recently passed even more stringent legislation regarding opioid medications. 2007 data indicates Florida physicians prescribe 5 times as many narcotic prescriptions than the national average. New legislation now requires practitioners to register with the DEA, they must have additional security features on their prescriptions, hand written signatures are required and narcotic prescriptions may not have refills. These regulations ensure that opioids are being used properly and help keep people safer.  


In addition to these prescribing laws, patients currently using opioids may see their doctor screening their urine for the presence of the drugs.  A comprehensive drug screen like Ameritox tells doctors if the patient is using the drug correctly. The test can determine how often and what dose the patient is taking.  This is important because sometimes, children or grandchildren take advantage of their parents and grandparents by taking their narcotic prescriptions for their own elicit use. An Ameritox screen will prove whether or not the patient is actually using the narcotic prescribed to them.  If it comes back negative, it will clue the doctor that someone might be taking advantage of the patient.  Likewise, if the test indicates that a patient is taking more than her prescribed dose, it will clue the doctor that the patient is abusing the drug and likely "doctor shopping" to obtain multiple narcotic prescriptions.  


When used appropriately (especially for acute, postoperative pain and terminal painful conditions), opioids such as codeine, hydrocodone, and morphine are very effective in relieving pain.  Their unique chemical structure that allows them to act on the central nervous system makes them the most effective analgesic available. In my experience the more potent products if chronically used result in more significant health problems than they help. I often strive to get patients' chronic pain managed without the use of narcotics, whenever possible.  Additionally, there is cause for concern due to their potential for abuse.  It takes a joint effort between doctors, patients, and law enforcement to keep people safe by making sure that these drugs are being used correctly.  It is a tragedy (not to mention it goes against the Hippocratic oath) to learn of young people overdosing on prescription medications, with narcotics being one of the lead causes.

Weight Loss Update
Success with dietitian Marcy Russo
All of you know that as a part of my holistic approach to healthcare, I believe that proper
nutrition is paramount to a
healthy body.  This is why, since 2009, I have offered a dietitian counseling service to help patients lose weight, take control of diabetes, and fine tune their dietary supplement requirements.  Since certified dietitian, Marcy Russo, has joined our practice, she has helped many people reduce their Body Mass Index, control their blood sugar, and feel healthier.  In fact, she just sent me a progress report of the impressive goals that her patients have met. 
In the past 9 months, patients seeing Ms. Russo have
lost a total of over 270 pounds.  That's an average of 20 pounds per person! Apart from shedding weight, Marcy's diabetic patients have
all improved their blood sugar levels and some have even avoided the need to use insulin.
Even for people at an ideal body weight, Ms Russo's nutrition guidance has helped them feel better.  Take me for example.  I was having difficulty maintaining my energy levels throughout the workday, and I didn't want to drink excessive amounts of coffee.  Instead of resorting to sugary energy drinks, I consulted Marcy about what foods would help me stay alert all day and make me feel strong enough to exercise after work.  She had some great tips, and informed me about many cool foods like sprouted grain bread (look for it in the frozen foods section!) which breaks down slowly in your stomach,  providing you with energy that lasts throughout the day.  Combine this with my PureLean breakfast shake, and I no longer feel the need to take a nap at 2:30.
Marcy Russo has been a great addition to our team, helping people take control of their diet and customize their eating habits to help them meet their goals of feeling and looking healthier. I would be remiss not to also remind you that regular exercise is an integral part of weight loss and especially maintaining weight loss success.  Studies have shown repeatedly that individuals that maintain exercise after weight loss are far more successful at permanent weight loss relative to those who lapse back to sedentary habits.
PureCaps Recommendation
Branched-Chain Amino Acids (BCAA)
BCAA is commonly used to improve exercise performance among athletes, increase appetite in anorexic patients, and its use may also result in a leaner body mass.  This is because it facilitates energy storage into muscle glycogen instead of fat. A leaner body mass means less total body fat and more glycogen storage means more readily available energy.  There is also evidence that taking BCAA with carbohydrates promotes an insulin response in type two diabetics and may also promote protein syntheses and energy production in people with type 2 diabetes. 

I would not recommend this product to patients on Parkinson medication as there could be a minor interaction.  There also may be a small interaction with thyroid medications, so I recommend not taking them within 4 hours of each other.

Personally, I use this product as part of my nutrition routine because I find that it helps me build lean body mass and give me additional energy during exercise.  It comes in a capsule and powder form.  I recommend the capsule, because I have found that the powder doesn't dissolve well in water.

Pure Encapsulations BCAA is available online, or in suite 200 of IMSWF (use the coupon at the bottom of this email for a 15% discount on your first purchase)
Healthy Recipe
Curried Sweet Potato Soup

Sweet potato, not only is just sweet to your taste buds but also good for your cardiovascular health. This starchy root vegetable is rich source of flavonoid anti-oxidants, vitamins, minerals, and dietary fiber that are essential for optimal health.  

Curry is a mixture of several spices, mainly turmeric. Curry powder has many antioxidants and anti-inflammatory compounds.  Curcumin is one of the main substances that gives turmeric its health benefits.  Curcumin supports colon health,brain function, and helps the cardiovascular system.

This recipe combines sweet potato and curry in a delicious soup.

 4 1/2 Cups vegetable broth
1 Cup dried onion
2 teaspoons curry powder
5 Cups chopped sweet potato
1 Cup water
1 Cup + 6 Tablespoons non dairy or 0-1% dairy fat yogurt

Use vegetable peeler or knife to remove skin from sweet potatoes.  Chop sweet potatoes into small pieces.  Put potatoes in pot with vegetable broth, dried onion, and curry powder. Cook over medium-high heat until potatoes are tender.  Once potatoes are tender, puree sweet potato mixture with the water and yogurt .  I puree it in my food processor or blender (depending upon my mood) in small portions, then transfer the portions back to my large pot for further simmering.  You could also blend it in the pot with a hand blender, but the consistency wouldn't be as smooth. This could be enjoyed as a cold soup as well. It is such an easy and affordable recipe! Top with more yogurt and or parsley (totally optional).
Founded 1998, Internal Medicine of Southwest Florida is a primary care practice located in Fort Myers, Florida. Privately physician owned. As always I appreciate your participation with our group and the information for health that we provide.

   Visit my blog                                                Like me on Facebook




Raymond Kordonowy MD
Internal Medicine Of Southwest Florida
Save 15%
Save 15% on Pure Encapsulation's Branched Chain Amino Acids (BCAA).  Present this coupon to Sarah in Suite 200 and receive 15% off of your purchase of BCAA capsules or BCAA powder. Offer not available for online purchases. 

Offer Expires: August 1st, 2012