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Author Archives: Dr. Raymond Kordonowy

Dr. Raymond Kordonowy

About Dr. Raymond Kordonowy

Private Practice Medicine. President of IPALC. Delegate for the FMA,. Member of the National Lipid Association, and Florida Lipid foundation. I have provided CME lectures in the area of cholesterol disorders. Areas of interest : General Internal Medicine are advanced lipid testing/Lipidology, difficult to manage lipid cases, obesity, diet and nutritional assessment, wellness. I am married to Margaret and our two grown boys are Nicholas and Matthew. Hobbies mostly reading, listening to music economics, jogging, bad mandolin playing and upland bird hunting.

What Are Heat Exhaustion and Heatstroke?

Summer is here, which means it’s extremely hot and humid in Florida. In this state, the average temperature is around 82 degrees Fahrenheit during the summer. Last year, the National Weather Service issues its first heat advisory for south Florida in seven years. Many Florida cities even see several 90+ days throughout the summer and year, which can bring a lot of health problems to people, including death. Each year, around 600 people die from complications related to heat in the United States, according to the Centers for Disease Control and Prevention. This means, more people die from heat-related illnesses than from any other weather event (hurricanes, floods, lightening).

Below, I wanted to discuss both heat stroke and heat exhaustion to explain the signs, symptoms and differences, and what you can do to avoid experiencing these complications from the heat. Both heat exhaustion and heat stroke can be scary, and if ignored can be fatal.

Heat Exhaustion – When the body overheats, this is heat exhaustion. It is a precursor to heat stroke. When a person has heat exhaustion, he or she will experience excessive sweating, muscle cramps, headache, dizziness, a rapid pulse, and nausea. These symptoms can gradually appear or appear suddenly, depending on how much and how often a person is exposed to the heat.

If you are experiencing heat exhaustion, it’s best to get inside to a cool place. Make sure you put on light, loose clothing, and drink plenty of water. Sitting in front of a fan and spraying mist over the exposed body is the best way to cool your body temperature if you are experiencing heat exhaustion or heat stroke.

Heatstroke – Heat stroke begins at a core body/internal temperature reaches 104 degrees F. Unlike heat exhaustion, heatstroke can lead to death. When the body is this hot, a person’s heart, brain, muscles, and kidneys can become damaged, which can cause all sorts of problems.  The body’s proteins begin to break down at these temperatures. With heatstroke, a person will experience nausea, vomiting, flushed skin, rapid heartbeat and breaking, and a change in his or her behavior. Often with heatstroke, a person no longer sweats, but has become dry.

If you’re experiencing heatstroke, get medical attention immediately.

How can you prevent heat exhaustion or heat stroke? The best way is to properly hydrate. If you think you’re going to be out in the sun or heat for an extended period, drink even more water than you usually do, and bring water with you. Other ways to prevent these conditions: Wear lighter clothing and hats, use sunscreen, use an umbrella, take frequent breaks in the shade or indoors, avoid drinks with caffeine or alcohol in them, and do not sit or stay in a hot car.

If you are obese or have heart disease, you are at a higher risk of developing heat exhaustion or heatstroke. Medications can impair the body’s ability to naturally cool itself as well.

If you have any concerns about these heat-related illnesses and are looking for a primary care doctor, call Dr. Kordonowy of Internal Medicine, Lipid, & Wellness to set up an appointment today. Dr. Kordonowy is a concierge and direct care primary care physician in Fort Myers. Click here or call 239-362-3005, ext. 200.

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June 21, 2017
Dr. Raymond Kordonowy

About Dr. Raymond Kordonowy

Private Practice Medicine. President of IPALC. Delegate for the FMA,. Member of the National Lipid Association, and Florida Lipid foundation. I have provided CME lectures in the area of cholesterol disorders. Areas of interest : General Internal Medicine are advanced lipid testing/Lipidology, difficult to manage lipid cases, obesity, diet and nutritional assessment, wellness. I am married to Margaret and our two grown boys are Nicholas and Matthew. Hobbies mostly reading, listening to music economics, jogging, bad mandolin playing and upland bird hunting.

What is Aortic Valve Disease?

Heart disease isn’t just one thing. There are many different cardiovascular conditions that are categorized as heart disease. For this article, I wanted to focus on one type of heart disease: aortic valve disease.

Aortic valve disease is when the aortic valve is malfunctioning in some way.  The aortic valve is located between the left ventricle of the heart and the aorta, which is the main artery in the body. People can either be born with this condition (congenital heart disease), or it can be caused by other factors like age, infections, or chronic kidney disease.

There are two different types of aortic valve disease: aortic valve stenosis, and aortic valve regurgitation.

Aortic Valve Stenosis: This is when the aortic valve’s flaps (leaflets or cusps) have thickened or stiffened. When this occurs, the valve’s opening narrows and the blood cannot flow as easily. Blood flow is reduced of blocked from the heart into the aorta and throughout the body.

Aortic Valve Regurgitation: This is when the aortic valve’s flaps do not close properly, which causes blood to flow backward into the left ventricle.

If a person has aortic valve disease, these are symptoms they may experience; however, they may not experience many of these symptoms even if they have the disease.

  • Dizziness
  • Fainting
  • Chest pain and/or tightness
  • Irregular heartbeat
  • Heart murmur
  • Shortness of breath when active or laying down
  • Fatigue
  • Swelling of ankles and feet

Besides having a heart defect at birth, here are some other causes of aortic valve disease: high blood pressure, heart injury, changes to the heart due to age, prior remote strep throat infection with autoimmune attack on the valve, or prior radiation therapy to the chest.

Aortic valve disease treatment options depend on severity of the disease.  If it is a minor case, your doctor or cardiologist will monitor you in the upcoming years. The doctor may recommend medications or lifestyle changes to treat symptoms. Aortic stenosis tends to slowly progress.  For more serious/advancing cases, surgery may be appropriate.  Aortic valve repair and aortic valve replacement are both surgical options; the type of surgery you will get depends on the damage of the valve.

If you are experiencing any of the above symptoms, or if heart disease runs in your family, it’s time to go to the doctor get tested. Dr. Kordonowy of Internal Medicine, Lipid & Wellness is a concierge and direct primary care doctor in Fort Myers. Dr. Kordonowy will meet with you, listen to your heart and symptoms, and determine what tests should be done, and if you should see a cardiologist. Click here or call 239-362-3005, ext. 200 to schedule an appointment with Dr. Kordonowy.

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June 14, 2017
Dr. Raymond Kordonowy

About Dr. Raymond Kordonowy

Private Practice Medicine. President of IPALC. Delegate for the FMA,. Member of the National Lipid Association, and Florida Lipid foundation. I have provided CME lectures in the area of cholesterol disorders. Areas of interest : General Internal Medicine are advanced lipid testing/Lipidology, difficult to manage lipid cases, obesity, diet and nutritional assessment, wellness. I am married to Margaret and our two grown boys are Nicholas and Matthew. Hobbies mostly reading, listening to music economics, jogging, bad mandolin playing and upland bird hunting.

The Puck Is Moving Fast

Past Present and Future:

 

Where We Have Been; Where We Are Going

 

Wayne Gretzky famously stated: “I skate to where the puck is going to be, not where it has been”.
Read more at: https://www.brainyquote.com/quotes/quotes/w/waynegretz383282.html.

It has been a few months since I last blogged about health care and the practice of medicine.  I have been feeling a lack of inertia regarding anything that might be “news” given the ongoing congressional “gridlock” regarding addressing Federal health dare policy.

The present failure to change the government’s stance seems to be a combination of “political paralysis” – our congress and even the president is fearful that any action will be associated with the inevitable market chaos- along with a dependency on the present Patient Protection and Affordable Care Act subsidies for those Republican governors who accepted the Federal carrot offered as a “bribe” to the states. 

I am pleased to report that the proposed legislation is a step in the right direction. I propose ideally any tax deduction incentive should be available to all US taxpayers regardless of employment status or Medicare status.  This “credit” should be across the board regardless of income as an incentive to take personal responsibility in the health care market.  Such responsibility should be an individual choice which includes demanding transparency from the health care market.  Individual choice increases our freedom to engage the market and that is always a good and better thing than centrally controlled economics.

I have been informing my patients and readers for a few years that the government’s policies and behaviors indicate that the Medicare program is insolvent.  Any rational person should conclude that it is not reasonable to expect the system to provide us with anything that resembled the past Medicare program.

It is time for the ostrich to take its head from under its wing and survey the landscape. No American  long term is willing to stand in queues and allow their freedom to seek services to be sacrificed to a niggardly, rationing health care system.  Furthermore if anyone at the store was paying attention it is high time that our citizens/buyers demand a semblance of reality regarding hospital charges and name brand prescription medications. It appears that our federal policies have completely neglected to confront the “someone else is paying” robbery model presently in place. This is why I believe a rational person should conclude that asking the government to continue to try and control the health care market is just not a doable task.

The past 3 years has seen a surge in Direct Primary Care private practices.  This is a result of physicians finally concluding that they can no longer nor will any longer tolerate the price fixing, work adding, fraud risk-taking model that Medicare has become.  These doctors are preparing (I am now one of them) for the demise of the where the puck has been and are moving to where the puck is going.

Where has the puck been?  

 

Price Fixing Creates Shortages

 

The puck has been on the ice of coded services.   The Medicare Relative Value Unit system of payment was born out of the  Omnibus Budget Reconciliation Act of 1993.  It was here that the Republican Congress under President Bill Clinton decided to put a price on physician services using a formula whose concept was born out of the Marxist economic concept that goods are valued strictly by the cost of labor.

This RVU formula dictated the price that would be applied to physician services based upon the then time analysis for these services. It didn’t account for future time elements or other cost factors that couldn’t be predicted since no one knows the future.  This legislation also made it illegal after 1997 for Medicare providers to accept payment over and above the RVU fixed price.  It is this formula and price-fixing policy which is now making it impossible for physicians to comply with the ever rising bureaucratic demands of Medicare to prove a coded service was provided.  Furthermore, the cost of documenting requirements, filing, coding and collecting the revenues paid has stripped the physician’s interest in remaining a provider for Medicare clients.  The same follows for the insurance payers who are often paying BELOW Medicare’s fee schedule with even more “pre-authorization” requirements which means more staff and time overhead.

Using a coding model to document both what was provided as well as what the payment will be creates incentives to “optimize the higher paying codes” as well as optimize codable events. This means in order for your doctors to generate revenue they must provide a coded service and also require you have a face-to-face encounter in order to submit a bill for payment (by Medicare or your insurance provider).  This necessarily results in more visits, more fragmented and limited “coded services per interaction” and what initially provides proper incentive for productivity soon becomes an incentive to provide unnecessary and higher paying coded services- “churning” if you will.  It is any wonder that your insurance accepting providers now have you limited to 6 minute appointments?  Also how can anyone be surprised it they are recommended higher paying services or even (if hospital employed) higher paying locations for those services.  Hospitals under Medicare get much higher reimbursement for the same coded services provided in an office.

Where is the puck going?

 

 

Watch Where The Puck Goes- Breaking Into The Future!

Economics rewards efficiency.  Given today’s internet and improved communications capabilities it is now possible for the health care system/doctors to leverage technology to enhance and increase your points of contact.  It is also often more efficient for our personal lives and general economics to desire non office visit services.  The system of coding doesn’t allow for these dynamics to play out.  Membership payment for more comprehensive, personalized and modernized care now makes sense.  Guess what? This idea freaks your traditional model out!!! If your doctor can monitor your vitals from home, send you customized newsletters and educational materials relevant to your personal health concerns as well as monitor and provide your health prevention services via computerized reports and queries wouldn’t this convenience and “on demand” method of care be preferable?  Certainly you will need to be personally interviewed and examined depending upon your health issues but MUST you for all requests?  Some of us doctors are actually interested in providing excellent, convenient and preferred services to patients.  We are the ones that are taking the stand to offer these things BUT we understand trying to provide this kind of care in the present payment and coding constraints is not feasible.

What does all this mean- bottom line?

Independent doctors who hold their patient relationship as the highest goal will want to move to where the puck is going. This is better for the patient and it is better for all personas costs.  Technology is already making coveted services (cardiac monitoring as an example) obsolete.  Why wait for a doctor’s visit, pay for an expensive “coded” monitoring service when you can purchase a monitor or app and monitor for your i-phone allowing unlimited monitoring at the price of less than a consult? You still need your doctor and the health care system to deal with any pathology and this means you still have to pay for  your doctors.  Just not the traditional way.

 

Choice: Pay for Insurance You That Doesn’t Meet Your Needs or Keep Your Money For Services Rendered

 

It is time to question whether buying Medigap insurance is worth the 20% fictional payment assistance when your premiums routinely cost more than you consume year over year.  It is less expensive to purchase your generic medications “cash” then it is to submit it through your insurance plan- why pay premiums for the privilege of paying more at the window?

There is going to be a strain and competition for your health care dollars- pay your providers who actually take care of you or pay an insurance company out of fear of the unrealistic price-gouging that you hear about on the news.

As one who sees the puck moving by, I challenge everyone to question the value of “full coverage insurance”.  Hopefully we see legislation that allows for more freedom, less coercion regarding health care dollars and your personal money.

 

♦ Dr. Kordonowy offers memberships for all ages.  He is uniquely offering blue-toothed dashboard monitoring services as part of his membership. Presently the dashboard service monitors the Withings line including weight scales, wrist activity monitor and blood pressure home monitor units.  Fitbit units are also able to interface with the monitor dashboard.   He has created a generic dispensing program for his patients which has in some cases saved patient thousands of dollars in medication expenses.  The future is exciting indeed!

 

June 10, 2017
Dr. Raymond Kordonowy

About Dr. Raymond Kordonowy

Private Practice Medicine. President of IPALC. Delegate for the FMA,. Member of the National Lipid Association, and Florida Lipid foundation. I have provided CME lectures in the area of cholesterol disorders. Areas of interest : General Internal Medicine are advanced lipid testing/Lipidology, difficult to manage lipid cases, obesity, diet and nutritional assessment, wellness. I am married to Margaret and our two grown boys are Nicholas and Matthew. Hobbies mostly reading, listening to music economics, jogging, bad mandolin playing and upland bird hunting.