Internal Medicine, Lipid & Wellness of Fort Myers
Internal Medicine, Lipid & Wellness of Fort Myers Newsletter
In This Issue
PKS9 Inhibitors Here For Real
Pneumonia Update
Happiness/Friends & Survival
Aneurism and Survival
NSAID's and Meds
A Recipe to Rock Your Tastebuds!
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Also check out my website revisions.  I have 3 services concepts to offer. 
Issue: # 3

There continues to be a lot happening in the health care field. Keeping with the "what is the doctor reading" format, I will provide a synopsis and perhaps a "bottom line" comment as to why I felt the items featured is worth bringing to your attention. I will link you to actual articles or other relevant information so you may dig deeper into the details if you wish.  Please click links which are present when you see color changes in the text- simply scroll over the colored text and then left click to open more information.

September marks the end of the summer and the beginning of influenza vaccination for the year.  The CDC is asking providers and patients to get vaccinated "by October".  I began vaccinating patients last week and I and my staff were inoculated this Friday. Many of my readers know last year's vaccine was minimally effective due to a strain mutation. This years vaccine has a changed formula.  There is a 3 or 4 strain vaccine available in the market. I am providing a 3 strain product from Novartis called Fluvirin. Those readers that are patients are encouraged to use your patient portal to conveniently schedule 10 minutes with my nurse to receive your vaccine. Feel free to call as well if that is easier.  Call extension 200 and request an appointment with my receptionist. If small business owners wish for us to arrange coming to you to vaccinate you and your employees, feel free to make a service request

New Cholesterol Medication Class- Now Here 
Proprotein convertase subtilisin-kexin type 9
PSK9 Inhibitors Now FDA Approved

In June I informed readers that a novel treatment for cholesterol was "on the horizon".  Since then both medications mentioned are now available for the proper indications.  I stated the following in June's article:

"We haven't had any new/novel medication offerings for people who can't tolerate or can't get adequate response to statin therapy.  The class of medications known in the industry as PSK9 inhibitors are showing terrific promise.Two recent published studies demonstrate tolerance and effectiveness for lowering LDL cholesterol." 

The first drug is made by Regeneron and name branded as Praluent.  It is dosed every two weeks.  The drug is an antibody that inhibits the PSK9 enzyme. It is injected under the skin of the patient. When this enzyme is inhibited the body is allowed to clear LDL cholesterol from the serum/blood stream. This then lowers measured cholesterol dramatically.

Following very favorable trial results in medical publications,  the FDA announced they are recommending allowing approval of this medication to be used in a restricted setting of familial hypercholesterolemia.  This condition affects between 1:10,000 to 1:100,000,000 people.  It also is indicated for patients with established atherosclerosis who cannot tolerate current therapy and remain with sub-optimal cholesterol levels.  As one of the few cholesterol experts in the area I have already been inserviced on this product and it is available now for treatment for the indications above. The company will provide medication and support services to provide medication while they work out payment details with the prescription insurance managers.  This will be very expensive treatment and thus must be judiciously used. 

The next product reported to be equally as impressive in terms of results is made by Amgen pharmaceutical and is called Repatha. This medication works on the same mechanism, again an antibody to the enzyme (the antibody diminishes the enzymes activity which translates to more LDL clearance from the serum).   It lowered LDL cholesterol 61%. 

The rate of heart attack events went from 2.8% absolute incidence in the standard treatment (which included statins) to 0.95 in the treatment group. That is a very significant drop.  If100 people were treated there would be 2 less heart attacks. This product has the same indications as the first approved medication Praluent. Having been approved only August 27th 2015 I am sure I will be inserviced very soon on this product as well. 

An Update On Community- Acquired Pneumonia In Hospitalized U.S. Patients 
Male doctor looks at x-ray picture of lungs in a clinic
Most Clinical Pneumonia Cause Remain Unknown
Most cases couldn't confirm the infecting agent. 

Bottom Line:  2% of hospitalized pneumonia patients died. Bacterial isolates were confirmed in only 11% and 1/2 of these were from pneumococcus (this is what we vaccinate for with Pneumovax and Prevnar vaccines). 1/4 of patients required the intensive care unit for care. The clinical diagnosis increased in incidence with each passing decade and is 3 times as likely in the 80 yeas plus group. 

Perhaps the biggest advance diagnostically for pneumonia is our rapid viral testing now available in hospitals.  This report is confirming that when we can identify an infectious cause that viruses are what are most commonly identified.  Despite this information 62% of clinical cases remain culture or pathogen negative as to the specific cause. Clinically antibiotics against bacteria are prescribed and as reported 98% of admitted patients survive. I am working on getting viral testing for acute respiratory illnesses available at the office. I feel this would be an incredibly helpful tool to have. 
How Many Friends Should We Have?
Having Friends Improves Our Survival- Happiness Factor?
The Mayo Clinic Journal Reports Friends Matter

Bottom Line:  It appears having 6-7 friends along with support from spouses and relatives keeps us alive longer. Participants reporting social contact with 6 or 7 friends on a weekly basis had a 24% lower mortality risk than did those in contact with 0 or 1 friend.

This was interesting and unexpected information for me to find. Besides having more friends if you have spouse or relative who interacted with you regularly your survival was benefited similarly (but not quite as much as having 6-7 friends).  If you don't have 6-7 close friends science suggests for your health you better start finding them!  

Abdominal Aortic Aneurism Outcomes In Medicare Population
Our Endovascular Repair Procedures Reduce Surgical Mortality

Heart blood health with red cells flowing through three dimensional veins from the human circulatory system representing a medical health care symbol of cardiology and cardiovascular fitness.
The Aorta is the largest artery in our body

A July 2015 outcomes study reported an 8 year follow-up on AAA repair patients. 

Bottom Line:  There is a significantly higher mortality rate post-operatively with the open repair/traditional approach. 5.2% versus 1.6 % using the "through the artery graft repair" strategy. During 8 years of follow-up those that survived the open surgery had a far lower rupture rate 1.4% versus 5.4 %.
The rate of survival was significantly higher after endovascular repair but by 3 years of follow-up this separation for survival improvement is no longer present. 
An Important Medication Interaction Update
I detailed analysis from the explains that even a few days of over the counter medications can unwittedly increase a patients risk of severe bleeding and even death. 

Generic Pills

There are many heart attack survivors who take "blood thinners". Many of us take over the counter pain relievers without any concern.  A very large study recently demonstrated that this is not as safe as a person might think given the these medications are available over-the-counter.
A Healthy Home Made Recipe
Soused And Spiced Beans

Mixed dried beans - black turtle beans flageolet beans pinto beans brown beans haricot beans and split peas - in a blue and white porcelain bowl with a floral design isolated on a white background
When cooked as below this dish will be red/brown in color and taste both sweet and hot at the same time. The fresh ingredients make magic with the beans. 

I know one of my patients who frequents facebook page will remind me that this recipe is a no-no for renal/kidney patients beans are a very nutricious and affordable way to get fiber, minerals, anti-oxidants and plant based protein.  After some inspirational gifts from my new patient I rummaged through my fridge and cabinets and came up with this dish. 

This recipe is inspired and initiated from a new patient who enlightened me to Rancho Gordo Heirloom Beans from California. These are soused because dry beans should be soaked in water overnight before preparing them. Spiced because my patient introduced me to a Vidalia Onion Hot Sauce that absolutely makes this dish.  Adding to the flavor is a deli find at our local Polish deli- Dutch Bacon. WOW!

Here is the recipe as I recall it; inspiration for me is "work in progress" and so I didn't make detailed notes. 

  • soak 2-3 cups dried beans overnight (cover fully in water and let set for at least 8 hours).
  • place a Dutch oven or other deep skillet on medium heat
  • cut into smaller pieces - 3-5 slices of Dutch bacon, cook under medium heat until cooked through but not crunchy, drain fat
  • add another 2-3 tablespoons of olive or vegetable oil
  • add 1-2 chopped, medium to large onions, saute with the bacon 
  • add the cut stems of bunch of fresh beets (cut finely)
  • add 2-3 freshly shredded beats
  • add 1 cup of cut or shredded cabbage and also toss in the beet tops cut barely
  • add 2-3 tsp of fresh chili past (Sambal Oelek)
  • add fresh ground pepper
  • stir then simmer this until onions are clear and beet stems are barely soft
  • add the soaked beans with water included (just so the beans were covered)
  • add 2 cans of diced tomatoes (14.5 oz) 
  • I added some fresh tarragon (not much as this stuff is strong fresh)and chopped chives (both optional)
  • bring to a boil then cover and simmer low heat for 1.5-3 hours and beans are cooked through
  • add 2- 3 tablespoons of the Vidalia Onion Hot Sauce (4 if your brave). 
  • Add 1 tablespoon of fresh honey and 1 tablespoon of Organic Pure Cane Sugar 
  • Add kosher salt course grain to flavor for taste
  • I mash the beans with a potato or other masher to further soften and let the flavors leach in more. 
Enjoy.  It is even better if left in the fridge overnight and served again and again. It is ok to add some honey and limited unrefined sugar to a dish this size.  The overall sugar added is negligible relative to the entire dish/calories.

I hope you enjoyed this newsletter.  It was fun putting it together for you. I appreciate your patronage. Please read below about the new added products and improved options on the, e-retail store. The monitoring feature is really exciting. This store offers doctor vetted, commonly recommended products by both me and other specialty physicians. I shop there all the time for my OTC remedies. 


Raymond W. Kordonowy MD
I appreciate the opportunity to be of service.

Raymond Kordonowy MD
Internal Medicine, Lipid & Wellness of Fort Myers

See Cookbook Options
The retail e-store continues to be upgraded. Since it is cough and cold season I advise you go to the site before you are sick and  stock up on your OTC remedies.  There is a search box on the site if you can't find a product using the various links. I just began to offer two Withings products, one is a blood pressure monitor and the other a weight scale with body fat analysis.  that digitally link your measurements to my monitoring dashboard. Once you purchase your monitoring device and sync it with the download the app you can open an account on the dashboard site and request Dr. Kordonowy begin monitoring your data. I am unaware of any doctor in the community offering this kind of support for your health. 
There are many useful and affordable products on the website.