Thursday, December 6, 2018

DPC: 20 Practices, 40 Doctors for the Miami Valley in 3 Years

Direct Primary Care, the movement, is energized, enthusiastic and expanding.  About 1000 practices currently exist in the United States.  There are two DPC practices in the 13 counties that constitute the Miami Valley around Dayton, Ohio.
I predict that we can have twenty practices including 40 physicians within three years.  Yes, by the end of 2021, we'll have twenty DPC practices.

There are hundreds of disaffected physicians in the area looking for an alternative to the grind that leads to burnout.  Many are already burned out.  Many intend to retire early or at the earliest realistic point in their life to escape and survive.  Many newer physicians and physicians in training are trying to avoid the misery that they notice in their faculty and mentors.
Medical students are avoiding primary care specialties and many are becoming hospitalists instead of pursuing a primary care career.  Less than ten percent of students actually enter into a primary care career.

Its time to reconstitute primary care into a career path that is fun again.  Direct Primary Care is one business model that seems to allow that.  Direct pay practices are here again.

Further definitions and information about Direct Primary Care can be found at www.dpcare.org and www.dpcfrontier.

More later.

Sunday, December 2, 2018

Nutrition and Health Interview: Healthy Brains and Bodies

Nutrition is a huge factor in our health.  Our genome and microbiome are other
huge factors. The environment and toxins are others.
The interview with Robert Lovegren on my 12/3/2018 Dr. Synonymous Blogtalk Radio Show
may address all of them. Bob is a retired physicist and electrical engineer.
He is a scholar in health and education.

Some questions that we may discuss include:
How did you get interested in nutrition, Bob?
What would an ideal state of health be?
What factors might lead to an ideal state of health?
What do you mean by “Bio-exhuberance?”
What role might be played by heat therapy?  Cold therapy? Red light therapy?
What are your thoughts about mitochondria in cells?
What toxic diet components are “poisoning” us?  What should we not eat?
What about fasting?
How about exercise strategies?
How do you get people to listen to your strategies for health, especially considering
our addictions to sugar, grains and high fructose corn syrup?

Are you finding like-minded people in the area of cellular and brain health?



Saturday, November 10, 2018

We Have Stories to Tell

As a holistic minded Family Physician, I notice a lot about the human condition in the context of health care, mostly in the office practice of Family Medicine.  The plight of humanity is still a fascinating work in progress.  We have an infinite array of response repertoires to our lives, many of which are unpredictable.  We have stories to tell.

I love to hear the stories and listen for the health related components that are misaligned with the dreams of the patients.  

I also enjoy reading blog posts and often have reviewed them on my Blog Talk Radio Show of the same name as this blog.  Medical Mojave, who used to call her blog Pissed Off Patient, is one I've followed for a few years.  She has been off line for a while and just reappeared with a couple blog posts and a comment on my last blog post.  Here is my response to her comment with more:

Thanks for your comment. Your blog, Medical Mojave is a Blog that I always read and used to comment about on my Blog Talk Radio Show. It points out the tensions between patient and physician from the patient side of a rare condition. A good book about thinking limitations in scientific and medical professionals that reaffirms the patient perspective that the physician could reflect a bit deeper on the patient story/ plight is The Limits of Scientific Reasoning by Faust 1984 U of Minnesota. From the preface: "human judgment is far more limited than we have typically believed and that all individuals, scientists included, have a surprisingly restricted capacity to manage or interpret complex information."
We have to work to process the complex information/situations better. The current Electronic Medical Record seems to have set back decision making considerably for physicians due to excessive administrivia and less time for patient care and clinical decision making.

I still believe that the patient's story is the most important part of the patient-physician encounter, in the context of an effective relationship between patient and physician.  It tells us us who the patient is and where they have been and where they are headed and more.  At the same time it resonates with who the physician is and where they have been and where they are headed.  The patient-physician dyad is powerful if allowed to be powerful.

Wednesday, October 3, 2018

Breakfast Chat with Dr. Pat: Talking with Doctors

Dr. Jonas, your host for the Dr. Synonymous Show will discuss strategies that may enable patients to be better heard by their physicians.  Physicians seem to have less and less time to engage patients.  This may be detrimental to quality in healthcare.  How might we get around this?  Dr. Jonas will engage those present about ways to get their story heard.  This will include some information about how doctors think and make decisions. 
We will talk about some common problems and at least one rare disease- Ehlers Danlos Syndrome.  The EDS patients get rejected a lot by physicians before they finally get a diagnosis.  How can we get beyond these rejections in this era of opiate abuse and dependency in which patients with pain struggle to get it treated adequately?  The EDS patients might be the poster children for this quandary between pain and opiates.
Click below to listen to the podcast on Blog Talk Radio.

Thursday, September 27, 2018

The Brain Nutrients and Depression: Presentation by A. Patrick Jonas, MD


The Brain, Nutrients and Depression.         A. Patrick Jonas, MD
Institute of Holistic Leadership September 27, 2018

Outline

The Brain. The last frontier?  Nutrient Power by William Walsh, PhD
Nutrients:  Food, supplements, vitamins, minerals, phytonutrients= nutraceuticals
Depression:  Definition(s)
           6 types: Undermethylation, Folate Deficiency, Copper Overload, Pyrrole Disorder, Toxic, Other
Neurons- cells that process signals at 200 mph.  100 B in the brain
           4-100 microns diameter.  Up to 4 inches in length. Act as tiny battery cells
           Long axon transmit electrochemical signal across synapse to other cell.
           1000 hair-like dendrites branching from the cell body, receiving chemical messages
           100 T receptors in average brain
Neurotransmitters: are made, packaged into vesicles, release into synapse, interact w/adjacent cell,      reuptake, death
Most psychiatric meds alter neurotransmitter activity at synapses.  e.g., SSRI’s disable transporters
Nutrients
           Top six biochemical imbalances in brain disorders
           Copper overload, Vitamin B-6 Deficiency, Zinc deficiency, Methyl/folate imbalances, Oxidative stress overload, Amino acid imbalances
Methylation Pathway Model by Amy Yasko, PhD - See Handout
Spectracell Depression Wheel --See Handout
Epigenetics:  DNA wraps around histones which have “tails”, where chemicals may adhere.   Methyl groups- tighten DNA wrap around histone and decrease expression of genes
           Delivered by SAMe to histones
Acetyl groups- loosen DNA wrap around histone and increase gene expression
           Delivered by acetyl coenzyme A to histones, delivers hi energy acetyl groups to mitochondria for processing in the citric acid cycle.
Neurotransmitter Transporter Proteins.  Methyl vs Acetyl for histone tails.  Gene expression of serotonin, dopamine and norepinephrine transporters dependent on M vs. A competition.  E.g.,histone methylation promoters are natural SSRI’s
Nutrient therapy and epigenetics:  Methionine and SAMe, Folic Acid, Niacin (B-3), other nutrients.
Epigenetic disorders:  Autism, Depression, Schizoaffective Disorder, Paranoid Schizophrenia, OCD, ASPD, Anorexia, OCP
Transgenerational Epigenetic Inheritance
The Clinical Process hx and pe, labs, diagnosis, treatment, aftercare
Nutrients and Neurotransmitters
                                 Increased Activity                                 Decreased Activity
Serotonin
Dopamine
Norepinephrine
NMDA
GABA

Response times vary
           Pyrrole Disorder
           Zinc Deficiency
           Copper Overload
Overmethylation
Undermethylation
Toxic Metal Overload
Depression:  Undermethylation, folate deficiency, copper overload, pyrrole disorder, toxic, other
Schizophrenia:   overmethylated, undermethylated, pyrrole disorder
Autism:  Zinc deficiency, copper overload, B-6 Deficiency, Elevated toxic metals, oxidative stress, undermethylation
Behavioral Disorders and ADHD (94% with chemical imbalances):  Abnormal copper and zinc levels in violent persons, copper and zinc and Vitamin B-6