Flashbacks to the Sixties: Was Life Better?

 What an intense time we live in.  Where do we hide?  Where do we find peace?

Remember the Sixties?  Hectic.  Unless you were in high school in a small Ohio school.  I loved it!  The class of 1964! Slotted in the middle of a chaotic decade.  Was life better?  (Duh!)  

JFK, RFK, MLK.  Three significant assassinations, just unraveling in 2025.

Elvis. The Everley Brothers.  Pat Boone.  Connie Francis.  The Ronettes.  Leslie Gore.  Aretha Franklin.  Bill Haley.  Patsy Cline.  The Beatles.  The Supremes.  Cilla Clark.  The Limeliters.  Peter, Paul and Mary.  Joan Baez. Bob Dylan. Joni Mitchell. and many more singers carried the sixties with music.

Transister radios made it happen. 78 RPM records preceded 45 RPM.  Suddenly w had record players that would play both and allow stacking for longer play.

Sock Hops at school events enabled expression through movement- up to a point.  We weren't supposed to gyrate like Elvis.  Even Elvis was censored on TV which wouldn't show him on the screen below his waist when he sang on the Ed Sullivan show.

It was a good time to be young.  What do you think?

"Opening and Closing a Family Medicine Career with Direct Primary Care (DPC)"

Dr Jonas, your host, is excited to interview Lily White, MD about the start of her Direct Primary Care practice in the Cleveland area at Rocky River.  Empowered Health DPC opens in October, 2023 

https://www.empoweredhealthdpc.com/

Lily decided early in her career to be a holistic physician.  She will explain how that happened and what path she followed to follow her dream into her first practice.  She will speak of medical school at Wright State and her Family Medicine Residency at the Cleveland Clinic, revealing some highs and lows as she explored the options available to Family Physicians who are just launching into post residency positions.

She is a leader and an author.  We'll hear about those aspects of her training years and more.  Including something about her values, goals and dreams as a unique person.

Dr. Jonas also has a DPC practice- Neighborly Family Medicine in Beavercreek, OH.  It's been 50 years since he started medical school at Ohio State.  He's ready to wind down and get another holistic minded Family Physician to take over his practice.  He's interested in hearing about how Lily sees her future in DPC and comparing how a start up career differs from a winding down career.

They worked together at Open Arms Health Clinic- a free clinic in Bellbrook, OH where Lily founded Paths to Wellness, a lifestyle counceling program with medical and psychology students at WSU.

They have shared in planning and presenting the DPC Ohio Unsummit last February and are repeating for the 10th Unsummit February 17, 2024 in Dublin, Ohio.

Last Day in Vietnam 7/25/1971: We Made It!

 

On my last day in Vietnam, I signed out at 45th engineer Group Headquarters, sent my trunk of whatever possessions I had to be shipped to my home of record in Ohio and went to an out-processing center in Danang to be tested for illegal substances and sent home, if I passed the urine test. The DC 10 jet was packed with 210 people in Danang. After taxiing onto the runway, most of us seemed to be quiet or engaged in conversation with our seat neighbor. Going down the runway with increasing speed the jet seemed to generate total silence in the plane, until we broke ground and, suddenly, there was a spontaneous roar of 210 new Vietnam Veterans with more enthusiasm than the best sports victory we had ever seen. Incredible feelings of intense relief poured through all of us at the same moment.

We made it!

We are goiWe made it!We are going home!

Is the COVID-19 Pfizer Vaccine Going to Protect Your Child? Guest Post by Pediatrician Patricia Fine, MD

The past 15 months have been difficult for all mankind. Each one of us have suffered a loss of some kind or another. During this time, we have desperately attempted to protect ourselves and those we care for. Fortunately, we have also learned more about the new SARS Co-V2 COVID-19 coronavirus organism. Recognizing what we have learned and using that information accurately is important when making recommendations for prevention and treatment of this disease.

One important piece of information we now have is that children 17 years old and younger have such a low rate of death if they become infected with COVID-19, that their survival rate is essentially 100%. Their risk of getting post COVID-19 MIS-D (multi system inflammatory disease) is also less than 0.1%. Additionally, there are several treatments available that when given early in COVID-19 infection dramatically decrease the risk of being hospitalised or dying from the infection, even in the most at risk. We have several new vaccine products intended to prevent severe disease that are also available.

However, accepting what is unknown about the COVID-19 vaccines is vital to ensure they do not cause unintended harm. No long-term safety information is available for these vaccines, which have only been used in the general population for approximately six months. The FDA made their decision to grant an emergency use authorization for the Pfizer mRNA vaccine for children aged 12-15 using a single small study with only 1100 children receiving the vaccine. Of those 1100 children there were several serious adverse reactions. The vaccine was still pushed through without further evaluation of the observed concerning reactions. Since the roll out of the Pfizer product for children we are seeing rapidly rising rates of serious adverse reactions to these vaccines in children. Germany’s vaccine advisory board, called STIKO, has evaluated the data and ONLY recommends use of this product in children with underlying medical conditions. The CDC now recognizes there is a real concern and has called for an emergency meeting to discuss this issue on June 18th 2021.

As a pediatrician, I took a vow to “first do no harm” and to advocate for the protection of the children I care for. Using currently available data, I conclude that the risk of serious adverse reactions in children 17 years old and younger receiving the Pfizer mRNA vaccine is greater than the possible benefit they may gain. I implore all medical providers to “first do no harm” as well, and to stop advocating for these vaccines to be given to our youth. I strongly suggest all parents and caregivers stop vaccinating their children with mRNA-based vaccine products until they can be studied further. I request our leaders exercise patience and recommend holding off on COVID-19 vaccinations for those 17 years old and younger until potential risks are better understood. I suggest we all continue to recommend and use well vetted childhood vaccines with a long track record of safety for all children. Finally, we should all educate ourselves on how to rapidly access COVID-19 early treatment options should we become infected. Following these suggestions will ensure each citizen the opportunity to be protected from severe disease from COVID-19 infection with the least potential risk of harm.

Forty-Five Years since June 10, 1976

 I just realized tonight that today is actually June 10, 2021 and it's been 45 years since my graduation from The Ohio State University College of Medicine.   What a journey, from Columbus to Hershey, PA to Granville, OH, to Spring Valley Township/ Bellbrook, OH with practices at The Department of Family and Community Medicine at the M. S. Hershey Medical Center of Penn State University, The Granville Medical Center, Newark (2 different locations in Licking County, OH), Denison University Whistler Hall, OSU Department of Family Medicine, The Frederick A. White Center of Wright State University, The Indian Ripple Family Health Center, Family Health Connections, Inc., The Central State University Campus Health Center, Open Arms Health Clinic, and Neighborly Family Medicine.

I learned so much from, for and about  patients and health and disease and pain and suffering and the amazing talents of the human body by  about 225, 000 interactions with patients.  I'm still learning and listening and thankful for the opportunity.

The Dr. Synonymous photo with this blog was taken on that day.  The Class of 1976 of The Ohio State University College of Medicine has touched a lot of lives.  What a journey!

Family Medicine: Preventing and Treating COVID-19 with I-MASK+ Protocol

Yes, my practice, Neighborly Family Medicine in Beavercreek and the Free clinic where I'm Founding Medical Director, Open Arms Health Clinic (OAHC) both use the I-MASK+ Protocol to prevent and treat COVID-19.  Outpatient COVID Prevention and Treatment

The COVID-19 virus is a huge challenge and an important opportunity for physicians and others to help people and fix many elements of our health care system.  COVID-19 can be mild, moderate, deadly and/or confusing.  Especially the Long COVID-19 syndrome or Longhauler Syndrome as many call it.

The Front Line COVID-19 Critical Care Alliance (FLCC) worked together since March 2020 to identify re-purposed, existing medications that could prevent and treat SARS-CoV2.  They also developed an inpatient protocol called MATH+ Hospital Protocol for COVID-19

Most physicians seem to be, unfortunately, unaware of these protocols.  The FLCCC site  (FLCCC web site ) includes the protocols, Information to share with your doctor,  Information about Ivermectin for COVID-19, Prevention and Treatment Protocols, and more.

Here is a list of Doctors who prescribe Ivermectin, most of whom use the whole I-MASK+ Protocol (with personalized variations):  Doctors who Prescribe Ivermectin,  including Dr Jonas under Ohio (A. Patrick Jonas, MD in Beavercreek, OH.  Physicians are allowed to treat patients via video visits, which we do almost daily, only for patients in our own state).  We have a more flexible schedule than most physicians, enabling Dr. Jonas to provide the COVID-19 support service.  Our practice is one of a growing number of Direct Primary Care practices in the US which don''t accept insurance as payment for services.  We have zero contracts with insurance companies.

Since the start of the Pandemic, patients recorded in our EHR at Neighborly Family Medicine with a diagnosis of "At risk for COVID-19 exposure", "COVID-19 exposure", "COVID-19" and "COVID-19 Longhauler" include more than 30, 44, 72, and 12 people respectively.  Most of these are after June, 2020.  Many other friends and family members of these patients  had similar diagnoses, but didn't seek care from my practice.  The patients with COVID-19 or Longhaulers that I've treated with the I-MASK+ Protocol (57+ patients) included persons with CHF, CAD, Diabetes, AFib, Renal Failure, Asthma, Allergic Rhinitis, Prostate Cancer, Chronic Lymphocytic Leukemia, Obesity, Chronic Anticoagulation, Depression, Anxiety, Bipolar, Ehlers Danlos Syndrome, Hypertension, Stroke History, Rheumatoid Arthritis, High Cholesterol, Migraine Headache, Irritable Bowel Syndrome, and others.  They included persons from age 24 to 94 (6 persons in their 80's).  After starting the protocol, everyone got better except 2 of the Longhaulers (who are improving) and no one was hospitalized or died.  The Longhauler treatment is based on the I-MASK+ protocol with personalized variations for the chronic inflammation and evolving literature about the Long COVID-19 Syndrome.

I've been pleased with the effects of the protocol on my patients so far.  Together, we actively go after prevention or treatment of COVID-19 and the Long COVID-19 Syndrome.

We're finding that many persons also want to prevent COVID-19 until they get their COVID-19 shot(s) or until an important event.  Many ask about using the protocol after they are vaccinated, if they ever get infected with a variant and/or find out that they are one of the 5% who didn't get full immunity from the vaccine.  Some are waiting for the oral vaccine (at least one is in development)  while others only want to get one shot and many are vaccine hesitant because of new shot technology and so forth.  

I'll be broadcasting about this post on my Blog Talk Radio Show during the next week to further clarify.

More later

 

Family Medicine: Straddling COVID-19, Influenza and Life

 What can we and our patients do as the cold and flu season nears and COVID-19 lingers?

First is to check what Dr. Google says about these infections, all of which are viruses.  What do we know about viruses?

Physicians have read a lot recently about SARS-CoV-2 also called COVID-19, coronavirus, Rona and other nick names.  Formally SARS-CoV-2 is the name, but COVID-19 is widely accepted and used, so I'll refer to it as COVID-19.  In spite of our reading and a wide variety of ongoing research, there are many mysteries about COVID-19.  With over 200,000 deaths in the United States attributed to COVID-19, it has generated a myriad of responses and expense from our whole society and its leaders. Most recently, schools have reopened with variations on the learning models including a lot of online and home learning.  

There is at least one dashboard for school data about the models of learning and COVID-19 impact.  School COVID-19 related data

How will physicians adjust the COVID-19 oriented systems we've organized for the Pandemic to respond to cold and flu season?

This question and many more pop up as we start to think about coughing, aching, febrile miserable patients who want to see their physician.  Will video visits suffice  for the coming viral onslaught this winter?  Will patients want to enter an office where coughing people have been?  Will we further develop the parking lot approach to patients with a drive through, service in your car approach?  Or a drive through or walk through tent in the parking lot for privacy during the physical exam?  Will we still do the ENT- ears, nose, throat - part of the exam or the lung exam which includes "take a deep breath in and out through your mouth" for each lung area? 

Many questions and many options arise as we ponder our response to the waves of mucous, droplets and mists of microbes that will greet us from our patients.   

One aspect of the viral mucous challenge is a major concern for physicians- the being unavailable for 14 days of practice.  Many patients will have needs for care during those 2 weeks of quarantine.  What will they do?  Will the physician have enough energy and focus to offer phone or video visits during the 14 days?  Will revenue generated or not generated during the time away from practice combined with losses during the first two months of the Pandemic lead to closing or selling the practice?  

Lots of family physicians went out of business already during the Pandemic.  There is very little in financial reserves for many who made it through the first half of 2020.  What's next?

Flu shots.  

Corona Sports: Buckeye Football, Buckeye Fans, and Buckeye Hearts

How do we understand the various football conferences "Postponing" their competition to spring?  As a Buckeye fan, I felt a vacuum suck out my gut when I heard the news.  As a Family Physician, graduate of The Ohio State University College of Medicine, former faculty in the Department of Family Medicine 1990-94 (when we, humbly, were honored as one of the top five primary care medical schools in America by US News and World Report twice), and a patient who had a 5.2 CM kidney stone removed at OSU Medical Center, I'm disappointed.

I love Ohio State.

OK, some people worship the Buckeyes, a concept I recognized by recognizing it with a song I wrote called:

"Jesus or the Buckeyes"

Jesus or the Buckeyes, Which one is your Lord?

Which one gives you hope Through the shouting of their word?

Do you need a touchdown To know that you’re alive,

Or prayer and praise and worship To learn how you should strive?

Jesus or the Buckeyes What can ease your stress?

Will script Ohio save your life And let you find your rest?

Will Urban Meyer call a play To save you from your boss?  

Will Jesus come and “dot your I” Just when all seems lost?

Jesus or the Buckeyes Which one makes you whole?

Which one gives you hope  For the healing of your soul? 

Will cheers and banners fill your heart With hope for victory?

Or heartfelt prayer and Jesus love At home upon your knees.

Chorus:

Jesus or the Buckeyes? Which one “dots your I?”

Which one gives you comfort When you’re about to die?

O-H, I -O may not set you free 

The I that you need dotted Is in B-I-B-L-E.

OK, I'm reminded that some priorities are above Buckeye football.  BUT... the decision to not play this fall seemed to be heavily weighted with a consideration/intense fear about athletes getting COVID-19 induced myocarditis and then, sudden death.  There are TWO examples of athletes having that problem, without the sudden death, in the news articles about the decision.  In hospitalized patients with COVID-19, many have a transient myocarditis.  BUT, the athletic and university leaders expect to have competition in the spring, when the corona virus will still be around and some may get the myocarditis, and it will get diagnosed and treated since they are in a good medical system with good team physicians. 

In the meantime, thousands of college athletes won't be playing sports, but they will be catching the virus.  They may not do as well fighting the virus, since well conditioned people fight viruses better than deconditioned people.  Some will get the myocarditis.  Will they be feeling good enough to play?  Will it be diagnosed and treated as well as it would be in the OSU healthcare system (for example, considering our athletes)?  Will some of our student-athletes get more exposure to the virus in the less controlled setting of the campus or their hometown?

The athletes in the SEC and ACC and my alma mater team, The Army Black Knights of West Point are going to play.  Navy and Air Force are also intending to play.  Air Force conference has cancelled fall sports, but agrees to let them play, at least the other service academies.  Are their health risks any different than the Buckeyes?   Is their healthcare from sports physicians and their campus healthcare systems better than the Buckeyes? 

AND, in the rest of America, those with COVID-19 in the under 50 age groups usuallydon't even get examined by physicians if they get COVID-19.  They might call their doctor with symptoms and get sent to the drive through testing site.  In 2-7 days of self quarantine, they may call their doctor again to clarify how they're doing.  At the appropriate time after fever and some other symptoms have resolved, they go back to work, following CDC website guidelines.  Do they have to get an EKG, Echocardiogram, Troponin blood test and see a cardiologist?  NO.  The NBA does since they are perceived to have extra risks of myocarditis and, therefore, increased risk of sudden death.  Fed EX workers don't have to get cleared by a cardiologist, even though they may be lifting a lot and chased by dogs sometimes, even after having COVID-19.

I was Head Team Physician for Denison University (Woody Hayes alma mater, by the way) for over a decade and remember the intensity and commitment of the athletes.  They love the competition.  They generally know and follow the in season training rules.  They all signed the consent forms acknowledging the dangers of their respective sports ("even death", was on the forms they signed).  Their conference, The NCAC won't have fall sports due to issues related to COVID-19.

The athletic systems haven't supported their arguments by producing the estimated numbers of actual at risk players who might die because they played after COVID-19.  They could have said instead that they are so afraid of COVID in athletes that any athlete who caught it would be banned from playing.  That would eliminate the risk of sudden death at practice or in a game, if that's their ultimate concern.  They didn't even have to do that.  Each athlete and/ or their parents signs a document acknowledging that they could be seriously injured or even killed playing their sport.  Parents even have to sign a similar form for little league players.  The authorities have only to add a clause about possible exposure to infectious diseases such as COVID-19 and, not surprisingly, almost every athlete and/or their parents would sign it.  They want to play.  I believe they should have the right to make that decision, since they are the reason given by the Big 10 Conference and others for the decision to cancel the seasons.

"I would say we have seen enough to develop a safe plan.  They have not," Dr. Catherine O'Neal said as an infectious disease specialist at LSU in the SEC, referring to the Big 10 and Pac 12 decisions not to play.  The (so-called) "Medical Facts" are the same for all the physicians, they just interpret them differently.

That's my opinion..What's yours?

Jesus or the Buckeyes,Which one is your Lord?Which one gives you hopeThrough the shouting of their word?Do you need a touchdownTo know that you’re alive,Or prayer and praise and worshipTo learn how you should strive?Jesus or the BuckeyesWhat canease your stress?Will script Ohio save your lifeAnd let you find your rest?Will Urban Meyer call a playTo save you from your boss?Will Jesus come and “dot your I”Just when all seems lost?Jesus or the BuckeyesWhich one makes you whole?Which one gives you hope For the healing of your soul?Will cheers and bannersfill your heartWith hope for victoryOr heartfelt prayer and Jesus loveAt home upon your knees.

Chorus:Jesus or the Buckeyes?Which one “dots your I?”Which one gives you comfortWhen you’re about to die?O-H,I -Omaynot set you freeThe I that you need dottedIs in B-I-B-L-E.

Jesus or The Buckeyes by Pat JonasJesus or the Buckeyes,Which one is your Lord?Which one gives you hopeThrough the shouting of their word?Do you need a touchdownTo know that you’re alive,Or prayer and praise and worshipTo learn how you should strive?Jesus or the BuckeyesWhat canease your stress?Will script Ohio save your lifeAnd let you find your rest?Will Urban Meyer call a playTo save you from your boss?Will Jesus come and “dot your I”Just when all seems lost?Jesus or the BuckeyesWhich one makes you whole?Which one gives you hope For the healing of your soul?Will cheers and bannersfill your heartWith hope for victoryOr heartfelt prayer and Jesus loveAt home upon your knees.

Chorus:Jesus or the Buckeyes?Which one “dots your I?”Which one gives you comfortWhen you’re about to die?O-H,I -Omaynot set you freeThe I that you need dottChorus:

Jesus or the Buckeyes?Which one “dots your I?”Which one gives you comfortWhen you’re about to die?O-H,I -Omaynot set you freeThe I that you need dottedIs in B-I-B-L-E.

50th Anniversary Vietnam Service Post 3

  I followed orders and flew to Cam Ranh Bay, reporting to the 18th Engineer Brigade, which sent me to their aviation unit.  I was instructed to meet with someone the next day to get my specific assignment.  In the mean time, they had a cookout and a volleyball game which was a pleasant way to meet some other pilots who flew for the Engineers.  

The next morning, I got the word from a captain in their aviation unit that my assigned unit would be the 45th Engineer Group headquarters, which had an aviation section.  The captain pointed on the map of Vietnam to the location of the Group in Phu Bai (which I was later told meant the "land of the dead ").  "What are those red pins on the map?" I asked.  "Oh, that's where the 45th Engineer Group Aviation Section had been taking fire from the enemy."  I already noticed that there were no such pins in the area around Cam Ranh Bay.  My assignment might be more "engaging" in I Corps where I was headed.  The area of operations of the 45th Engineer Group was I Corps which was the northernmost area of military operations in South Vietnam, extending north to the Demilitarized Zone - DMZ (there was a II, III, and a IV Corps).  

I flew from Cam Ranh Bay to Phu Bai that day and reported to Headquarters of the 45th Engineer Group.  Personnel assigned me to the Aviation section and a hooch - Vietnam War slang for a thatched hut or improvised living space- my plywood home for the next several months.

Our Aviation section shortly after my arrival in Phu Bai: Cpt Sherk, Cpt Holland, Cpt. Jonas, Lt Marsh, CW2 Leo Childress, ?, SSG Cooper (L to R standing) Sitting Sp4 L. Kawai, ?, Sp4 Washington, ?, ?, Sp4 M. Metro. 2nd row includes Sgt. Jones, Sp4 Steele, May, (Sorry I don't remember everyont)

Some facts about the 45th Engineer Group:

45th Engineer Group (Construction)

Arrived Vietnam: 8 June 1966
Departed Vietnam: 30 January 1972
Previous Station: Fort Bragg
Authorized Strength
HHC
1966 - 98
1968 - 111
1970 - 111

The 45th Engineer Group was under the 18th Engineer Brigade throughout its service in Vietnam, planning a coordinating the activities of its assigned and attached units. These consisted of construction or other units engaged in the field construction, rehabilitation, or maintenance of facilities in support of the U.S. Army or Air Force operations. The group arrived at Cam Rahn Bay and moved to Dong Ba Thin on 15 July 1966. It relocated to Tuy Hoa on 15 October 1966, moving to Qui Nhon that December. It moved north to the Phu Bai area in February 1968, where it assumed general construction support missions for the I Corps Tactical Zone. The group then remained in the Da Nang area until departing Vietnam. The following engineer battalions served the group one time or another;

14th Engineer Battalion       39th Engineer Battalion
19th Engineer Battalion       84th Engineer Battalion
20th Engineer Battalion      299th Engineer Battalion
27th Engineer Battalion      577th Engineer Battalion
35th Engineer Battalion      589th Engineer Battalion

More later