Fellow Physicians:
As I continue to see pressures everywhere in medicine to over-prescribe statins to lower cholesterol, I wonder why we sold out the medical profession on this issue. Are we for sale? Are we just "Statin Sluts"?
Are we a CT scan sales force? Are we shareholders in chemotherapy manufacturers?
When did we decide that "More is always better"?
When did we decide that "Life is medical"?
When did we decide to ignore the principles of medical ethics and expose our patients to "Bonus Based Medicine"?
Let's stop being leaderless lemmings and act like physicians. Not spineless, un-scientific shills for hospitals and the pharmaceutical industry.
What do you think?
Thursday, April 30, 2015
Thursday, April 9, 2015
N Acetyl Cysteine: A Powerful Glutathione Precursor
Getting a NAC for Health A. Patrick Jonas, MD
Institute of Holistic Leadership Presentation April 9, 2015
1.
Introductions
2.
We covered some methylation issues before
3.
Tonight we’ll add some sulfation issues,
especially N Acetyl Cysteine and Glutathione
4.
In the beginning, 60 trillion cells- each with
100,000 chemical reactions per minute
5.
Genomics ID 30,000 genes. At OMIM.gov 20,000 single gene disorders,
etc. etc. etc.
6.
Look at methylation sheet starting with leafy,
green and yellow vegetables
7.
B’s to methylation to homocysteine to methionine
to SAMe and back.
8.
If methyl toxic or homocysteine remains too
high, CBS mutation may be operative
9.
See the confusing handout: NAC comes to the rescue. Usual dose: 600mg
twice daily
10.
N Acetyl L Cysteine, N Acetylcysteine, NAC -carries
the amino acid L Cysteine.
11.
Precursor to Glutathione “The Mother of All Antioxidants”
12.
What happens then? Let’s start low in the body and work up
13.
Connective tissue, immune system, autoimmune
effects
14.
Ovaries –PCOS ovulation/pregnancy
15.
Liver- hangover cure, Tylenol toxicity and
others, fatty liver, cholesterol, hepatitis, etc.
16.
Pancreas- Diabetes, Insulin Resistance, Weight
17.
Kidneys- IVP dye reactions
18.
Heart- increased blood flow, enhanced work outs,
lower LDL Cholesterol, Lower Homocysteine
19.
Lungs- mucolytic in CF, CB, Flu
20.
Brain- “Brainitis” (All psychiatric diagnoses,
all addiction diagnoses studied), chronic pain, cognitive impairment (see
methylation page briefly), (Maybe gliaden addiction from wheat) CN & NA
21.
Infection, degeneration, malignancy, toxic,
stroke, dental plaque, gambling, nail biting,
22.
Fibromyalgia
23.
Negative:
Cysteine kidney stones, nausea
24.
Etc. NAC-
WOW!
Questions?
Sunday, April 5, 2015
Interview with Therese Zink MD, MPH on the Dr Synonymous Show
Dr. Synonymous Interview with Therese Zink, MD, MPH
Department Chair, WSUBSOM Family Medicine
Tuesday April 7 9:40PM Click Here for Link to interview
Guiding Questions for direction:
1.
Congratulations, again for becoming Chair of
Family Medicine at Wright State. How
long have you been on the job?
2.
How is it going?
What’s fun? What’s
challenging? What’s surprising?
3.
What’s different compared to MN?
4.
How does a community based medical school keep
focused on the mission these days?
5.
How is your writing going? I really enjoyed The Country Doctor Revisited
which we discussed on a show a couple years ago. I have Confessions of a Sin Eater. Would you explain the title to our listeners?
6.
Where is the department headed next? What’s your vision/ plan?
7.
What do you notice in the WSU medical students
that’s different/ similar to MN?
8.
How about our specialty? What’s the future? How are medical schools adjusting for the
coming needs of society?
9 How’s your life away from the farm? The cold of MN?
1 What else should our listeners know about
you? Your career? Life?
Etc.http://www.theresezink.com/ http://www.med.wright.edu/fm
Tuesday, March 31, 2015
Family Medicine: Grieving and Crying With You
"Dr. Jonas, did you see this note yet?" I look. Someone died. A patient of mine. For 15 years. Gone. Complex disease. Complex life. Complex grief.
Next patient. Sinus pressure, sore throat, ear pain.
I read the death note again. Sad. I see his face. Reflect on our last encounter.
He was thankful. He was prepared.
Next patient. Hospital follow-up. Review meds. Change one dose. Review the hospital labs. Note the intentions of the surgeon. Clarify preparations for the surgery and timing of follow-up.
Phone call with widow. I listen to the story. I respond to her feelings. We agree a few times.
I hang up. A wave of sadness comes over me. A tear starts. I stand to go to the next exam room. A staff member asks me a question. I have to clear my throat to answer. One tear. One choke. One wave. Until the next patient.
Look at his name. Ask another staff if they saw that he died. Reflect again. Part of doctoring. Intermittent grief. Loss. The human condition. Ends for one. Starts for another.
Next patient. Can't get enough breath. Medication, Ohio, COPD all fight the lungs. Stop one drug. Start another.
Home.
Now I can cry with them. For them.
Pray for them. And me.
The blog. Not the next patient.
Peace.
Next patient. Sinus pressure, sore throat, ear pain.
I read the death note again. Sad. I see his face. Reflect on our last encounter.
He was thankful. He was prepared.
Next patient. Hospital follow-up. Review meds. Change one dose. Review the hospital labs. Note the intentions of the surgeon. Clarify preparations for the surgery and timing of follow-up.
Phone call with widow. I listen to the story. I respond to her feelings. We agree a few times.
I hang up. A wave of sadness comes over me. A tear starts. I stand to go to the next exam room. A staff member asks me a question. I have to clear my throat to answer. One tear. One choke. One wave. Until the next patient.
Look at his name. Ask another staff if they saw that he died. Reflect again. Part of doctoring. Intermittent grief. Loss. The human condition. Ends for one. Starts for another.
Next patient. Can't get enough breath. Medication, Ohio, COPD all fight the lungs. Stop one drug. Start another.
Home.
Now I can cry with them. For them.
Pray for them. And me.
The blog. Not the next patient.
Peace.
Sunday, March 15, 2015
Family Medicine: Following Patients with Ehlers Danlos Syndrome by K.M. Babbitt, MSIII and A.P Jonas, MD
Family Physicians follow a lot of patients with rare and unusual chronic disease states. Wright State University Boonshoft School of Medicine third year student Katherine (Casey) Marian Babbitt has worked with Dr. Jonas on a quality improvement project about one rare and challenging disease. This month we're looking closer at Ehlers Danlos Syndrome to develop a checklist for patient signs and symptoms that helps both patients and physicians. This will enable Family Physicians to better identify what problem areas and concerns each patient with EDS may have at each chronic disease management visit. It also reminds patients and physicians to remember multiple aspects of the EDS when managing acute problems.
We'll publish the fifth draft of the checklist to invite comments from patients and physicians to help us fine-tune the document before finalizing it and publishing it online.
What do you think of the current content? (not the format since the Word document didn't load perfectly) Please make comments, especially hypermobile persons and their families and family physicians. This is a complex disease and we are complex people, so we start with a complex form.
The patient would have one of these on their cell phone or computer or hard copy and note what symptoms and signs are "leading the way" in a negative sense. The physician would follow the form inputs from the patient via the patient portal of their EMR or hard copy and add/ subtract/prioritize care based on what seems to be happening. Etc.
We'll publish the fifth draft of the checklist to invite comments from patients and physicians to help us fine-tune the document before finalizing it and publishing it online.
What do you think of the current content? (not the format since the Word document didn't load perfectly) Please make comments, especially hypermobile persons and their families and family physicians. This is a complex disease and we are complex people, so we start with a complex form.
The patient would have one of these on their cell phone or computer or hard copy and note what symptoms and signs are "leading the way" in a negative sense. The physician would follow the form inputs from the patient via the patient portal of their EMR or hard copy and add/ subtract/prioritize care based on what seems to be happening. Etc.
Ehlers-Danlos
Signs and Symptom Checklist
Date ________________
Name
_____________________________________________
Neurological
system
New Old Stable Doctor Use
o o Y
N Obsessive
Compulsive Disorder o
o o Y
N Major
Depressive Disorder o
o o Y
N Social
Anxiety Disorder o
o o Y
N Body
Dysmorphic Disorder o
o o Y
N Chiari
I Malformation o
o o Y
N Syringomyelia o
o o Y
N Tethered
Cord Syndrome o
o o Y
N Migraines o
o o Y
N Syncope
Dizziness o
o o Y
N Paresthesia o
o o Y
N Dysautonomia o
o o Y
N Decreased
Vibrational sensation o
o o Y
N Other________________________ o
Musculoskeletal
System
New Old Stable Doctor Use
o o Y
N Joint
Instability o
o o Y
N Chronic
Muscle Pain o
o o Y
N Chronic
Muscle Fatigue o
o o Y
N Chronic
Muscle Weakness o
o o Y
N Dystonia o
o o Y
N Osteopenia/Osteoporosis o
o o Y
N Osteoarthritis o
o o Y
N Bunions o
o o Y
N Flat
Feet o
o o Y
N Scoliosis o
o o Y
N Kyphosis o
o o Y
N Early
Degenerative Disk Disease o
o o Y
N Herniated
Disks o
o o Y
N Other________________________ o
Cardiac
System
New Old Stable Doctor Use
o o Y
N Mitral
Valve Prolapse o
o o Y
N Tricuspid
Valve Prolapse o
o o Y
N Aortic
Root Dilation o
o o Y
N POTS
o o Y
N Other________________________ o
Optical
System
New Old Stable Doctor Use
o o Y
N Scleral
fragility o
o o Y
N Corneal
deformation o
o o Y
N Other________________________ o
Vascular
System
New Old Stable Doctor Use
o o Y
N Arteriole
rupture o
o o Y
N Abdominal
Aortic Aneurism o
o o Y
N Neurally
Mediated Hypotension o
o o Y
N Varicose
Veins o
o o Y
N Other________________________ o
Metabolic
System
New Old Stable Doctor Use
o o Y
N Early
Lipid Abnormalities o
o o Y
N Vitamin
C Deficiency? o
o o Y
N MTHFR? o
o o Y
N Drug
Sensitivity o
o o Y
N Other________________________ o
Gastrointestinal
System
New Old Stable Doctor Use
o o Y
N Irritable
Bowel Syndrome o
o o Y
N Constipation o
o o Y
N Gastritis o
o o Y
N Gastroesophageal
Reflux Disorder o
o o Y
N Delayed
Gastric Emptying o
o o Y
N Other________________________ o
Gynecological
System
New Old Stable Doctor Use
o o Y
N Premature
Rupture of Membranes o
o o Y
N Rapid
Labor and Delivery o
o o Y
N Uterine
Rupture o
o o Y
N Other________________________ o
Dermatological
System
New Old Stable Doctor Use
o o Y
N Hyperextensible
Skin o
o o Y
N Translucent
Skin o
o o Y
N Fragile
Skin o
o o Y
N Soft/Velvety
feel of skin o
o o Y
N Hemosiderin
Staining o
o o Y
N Stretch
Marks o
o o Y
N Atrophic
scarring o
o o Y
N Wound
dehiscence o
o o Y
N Prolonged
bleeding o
o o Y
N Easy
Bruising o
o o Y
N Other________________________ o
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