Raymond W. Kordonowy MD 
In This Issue
Cough and Cold Season
Influenza And Cough and Cold Season
No Recipe This Issue, Instead My Plate Building Strategy
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Cough and Cold Season Coming!
This is the month to schedule your flu shot. Also check out the links in this month's Newsletter. Lots of information is provided. 
Issue: #22September 2014

It is September and the beginning of flu season. I have added additional services to my practice . The first article provides you with links and actions to get ready for the cough and cold season.  Readers will notice at the bottom of the newsletter a link to fill out a survey of my practice if you are so inclined-good, bad or otherwise. I wanted to share my plate-building technique as it is working very well to help clients improve their nutrition and body fat content.  Remember regular activity and measuring your weight and nutritional status provides you with the feedback necessary to keep yourself healthy and fit. My patients can call or send an email request to schedule 5 minutes with my clinical staff to get your flu shot and review your pneumovax status. 

Remember to go to my blog.  I have been posting very frequently on the blog's facebook page so if you want to stay current with my literature and other perusals, please like us on the blog facebook site. 
Influenza And The Cough and Cold Season
Syringe and vaccine bottle on white background Flu Vaccine Available 

September kicks off the fall/winter flu season. Vaccination and illness prevention is the most cost-effective way to address this. This is also a great time to review your adult vaccine schedule status.  Follow this link to see what is recommended for adults (on the left side of my webpage). 


The Center for Disease Control stated that patients should begin getting vaccinated "soon after vaccine is available" with a goal of all persons vaccinated by the end of October.  The vaccine's effectiveness for generating an immune response lasts at least 6-8 months and in one study prevailed for up to 3 years in 67% of recipients. The immunity is only for the actual strains in the vaccine. Remember influenza changes with some regularity and this is why an effective vaccination program involves annual vaccines.  Given the prevalence of influenza, I recommend most everyone be vaccinated.  According to the CDC site, during 30 seasons from the 1976-77 season through the 2005-06 season, estimated influenza-associated deaths ranged from 3,000 to 49,000 annually.  We lose folks every season in Fort Myers to this illness. 

My patients know that I am not an advocate of giving antibiotics unnecessarily.  The side effects of antibiotics are significant and common, from gastrointestinal changes to rash and in rare instances, anaphylactic shock.  Traditional antibiotics only work for bacterial infections. 

Luckily, we now have medication for Influenza infection-technically called antiviral medication, not antibiotic medication.  Such medication (Tamiflu for instance) is very effective for preventing others around an infected case from getting the flu (this is known as prophylactic therapy).  If antiviral influenza therapy is given within 48 hours of diagnosis it has reasonable effectiveness for getting someone well faster.  Our office provides a rapid onsite test for active influenza infection.  If you believe you have a case of true influenza, then I recommend you call the office and request a same day/acute "flu" evaluation appointment.  My staff have a protocol to bring you in and begin an efficient evaluation to help us determine how best to manage you. I will recommend prophylactic medication be prescribed for persons living in the same household as an index (confirmed) case.

My patients are familiar with my Upper Respiratory Handout which I give out to office patients this time of year. In it I explain that there is no "magic prescription" for most viral respiratory infections in adults (above information an exception). Most respiratory viruses are caused by the common cold virus and rhinovirus. Most "bronchitis" is not bacterial contrary to popular belief.  My handout explains when you may be ill enough to require an urgent appointment for antibiotic or more serious complications such as bacterial pneumonia.  These instances include: sudden pleurisy, high fever with teeth-chattering chills, bloody sputum, significant shortness of breath with "cold like symptoms" or not trending toward improvement within 10 days of the initial onset.  I have put together most of my typical over-the-counter recommendations for symptomatic relief on my new e-retail store.  

For your cough and cold comprehensive kit of remedies, go to THIS LINK. If you are on blood thinners or have a history of significant intolerance to aspirin replace the ibuprofen recommendation for pain and fever with acetaminophen/Tylenol. 

I hope to have acetaminophen and a 12 hour cough tablet on the site very soon. The store charges a flat rate of just under 2 dollars for shipping, has great prices and pharmacy grade medications and products.  They will deliver within 3 business days and usually within 1-2.  What's not to like?
My Plate Building Strategy
Veggie Soup Nutrition is Everything

Earlier this past year I had confirmatory data from HDL laboratories that my patient group has a lower body mass index compared to the state population reference group. HDL laboratory is who I use to assess advanced lipoprotein (cholesterol) analysis as well as cardiovascular risk factors and other nutritional information. 

Following is an explanation of my plate building technique.  My scribe must be so tired of hearing this recommendation which I give at all my health physicals whenever a patient is dealing with being overweight or suboptimal in anti-oxidant/nutritional status.

Plate Building Strategy for Optimizing Nutrition



After 20 years in private clinical practice trying to help people manage their health as naturally as possible, I offer my patients a new way to think about eating and nutrition.


This new method is a result of trying to address certain metrics that I routinely perform during wellness/health evaluations.  The metrics include:  weight and body fat%, cholesterol levels and more importantly lipoprotein results, antioxidant status (using a technology called biophotonic scanning), oxidative stress, inflammatory biomarkers, B12 and vitamin D levels in the serum, red blood cell measurement of omega-3 fatty acid and finally serum glucose, and a 6 week average of blood glucose.


Under the current health care paradigm most physicians (myself included until recently) are counseling patients on the intake of macromolecules.  What I am referring to here is the discussion of the fats, carbohydrates and protein intake patients are asked to measure and monitor.  This conversation has resulted with an obsession with calories, cholesterol and blood sugar. These things are definitely important but when we only discuss these things we are missing the opportunity to emphasize nutrients over calories. My plate-building strategy combined with following the metrics I mentioned at the beginning changes the conversation from one of a lecture/chastisement on carbs/fats and proteins and portion controls to one of improving one's micronutrient/antioxidant status. 


This leads to an education and discussion about where highly nutritious food sources are found and a self-motivational desire to make food choices based upon nutritional "gold" .  The choices that follow can be positively reinforced when future follow-up measurements of the baseline metrics show improvement. Often supplementation may be required or chosen as well but now one can objectively measure whether the changes made positively affect one's results and are worth the trouble and expense (in the case of supplements).


My general plate-building conversation goes as follows:  Each meal start with 8-12 ounces of water. Part of our hunger is thirst so satisfy that first (the calories are "free"/zero). Next we need the building blocks of amino acids which come from protein.  Evidence indicates that in general we need and can use between 25-35 grams of protein each meal and 15 grams per snack. This amounts to 4-6 oz's of fish, meat, eggs or non-animal protein counting per meal and 2-3 oz's per snack. Regular adequate protein exposure optimizes our lean body mass/muscle as well as our cellular metabolism/basal metabolic rate. Next in the plate-building strategy is to have 2 or 3 servings of vegetables/fruit per meal and 1-2 per snack.  1/2 cup equals a serving. Beans/legumes count and in fact have some of the highest density anti-oxidant content as well as provide moderate protein.  Shoot for 3 vegetable services for every 2 fruits.  Daily include good fats/omega-3 intake such as walnuts/almonds, flax seed, chia seeds and hemp hearts. If after accomplishing these portion goals you still are hungry you may add grains, cereals or unrefined bread. You will find that the amount of this food source drops dramatically from the prior macromolecule diet routine.


What happens if folks use the plate-building design is they naturally move to very high fiber, high nutrient foods that on a per volume basis has far less macromolecule (calorie) content.  The result is fat burning, leaner body mass, highly optimized cellular nutrition/function with built in high anti-oxidant intake.  The anti-oxidant nutrients mitigate the oxidation damage that is inevitable as our cells burn calories.  High antioxidant (plant based eating) intake is associated with a much lower incidence of numerous medical diseases including: heart disease, cancers, strokes and kidney failure.


I hope you find this newsletter helpful and informative.  I am confident that going forward there is going to be a lot of change coming for the doctor patient business. This is due to the political decision to try to extend federal regulation of health care. Mandated health insurance and the "coverage of all things" which will make the traditional path of access cumbersome, expensive and massively complex. Sean Parnell in his book The Self-Pay Patient calls it bureaucratic medicine.  This is what the ACO/accountable models, hospital/institutional based integrated care concepts will create. I rated Sean's book recently on Amazon. 

It is also my belief that the paradox of this intrusion is that the savvy consumers will be going to the market of alternative ideas and options. I am surveying the landscape looking for what will add value and improved access and will keep you posted.  My recent e-retail store is an example of quick, less expensive, no hassle access to your physician's recommendations.  The store is just the beginning and the vetted products offered will expand and be tailored to the doctors practice. 

I have posted on twitter and facebook about another concept called Push Health which basically allows for service after hours and on the weekends for nonurgent prescription requests or consultation. This access does require the consumer be willing to pay for that assistance.  I am registered with this program.

Raymond Kordonowy MD
Internal Medicine Of Southwest Florida
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