About the Shortage of Primary Care Physicians

Certified by the American Board of Internal Medicine, Dr. Rex Mahnensmith serves StayWell Health Center as an internal medicine physician. Over the past 30 years, the majority of Dr. Rex Mahnensmith’s career has been in primary care.

One of the most pressing barriers to Americans’ access to improved health is the shortage of primary care physicians. As the population grows and ages, the crisis is expected to grow direr over the next decade. Primary care physicians are in demand particularly because their services help to decrease the incidence of heart failure and coronary heart disease, improve rates of early detection of cancers, and prevent certain diseases through vaccination.

Primary care physicians will account for 40 percent of physician vacancies in the coming years. As reported in 2017 by the Association of American Medical Colleges, by 2030 the US will experience a deficit of close to 105,00 physicians, 43,000 of which are primary care physicians.

Several factors contribute to the shortage of primary care physicians. One is the coming retirement wave of older primary care physicians. Other factors include the increasing number of medical residents seeking specialties other than primary care, the growing number of older Americans who use more health care services, and the expanding population.

The Relationship Between Glucose Intolerance and Prediabetes

Since 2015, Dr. Rex Mahnensmith has treated patients as an internal medicine physician at StayWell Health Center in Waterbury, Connecticut. Dr. Rex Mahnensmith previously served as a full-time geriatric physician from 2014 to 2015 with Genesis Physician Services and was the clinical director of nephrology at the Yale School of Medicine from 1992 to 2014. Dr. Mahnensmith has received numerous awards as a professor and researcher and is the author of more than 20 original articles, many of which focus on kidney disease.

One of the common causes of kidney disease is diabetes mellitus, a condition involving poor blood glucose control. However, before diabetes develops patients may experience glucose intolerance.

Glucose intolerance occurs when the blood sugar remains above 100 mg/dL for more than two hours after eating or drinking or if it rises above 140 mg/dL. It occurs when the cells and tissues are unable to use ingested glucose to produce energy due to insulin resistance or insufficient insulin production within the body. People with diabetes mellitus also experience insulin resistance and reduced insulin production, but to a much greater extent than people with glucose intolerance.

Glucose intolerance is considered a prediabetic condition, since 25 to 50 percent of people with the condition will eventually develop diabetes. Prediabetes has been associated with reduced life span and health complications including organ dysfunction, eye disease, and cardiovascular problems.

How Obesity Impacts the Body

Dr. Rex Mahnensmith is an internal medicine physician with Stay Well Health Center in Waterbury, Connecticut. A graduate of the Yale School of Medicine, Dr. Rex Mahnensmith is familiar with common health conditions and their impact on the body, including obesity.

Obesity is a medical condition defined by a body mass index (BMI) that equates to more than 30 kilograms of body weight per square meter of height. A person with a BMI of between 25 and 30 kilograms, meanwhile, is considered overweight. An individual's BMI can be calculated by dividing his or her weight in pounds by height in inches squared, then multiplying that number by 703. Medical professionals believe a person’s optimal body weight should fall between 19 and 24 kilograms per square meter of height.

Any individual classified as obese is at risk for a wide range of health conditions, including diabetes, high blood pressure, and progressive atherosclerosis. Furthermore, obesity puts constant pressure on a person’s heart and lungs. Existing health conditions, such as coronary heart disease and various arthritic conditions, can be exacerbated by obesity. 

An obese individual who decreases their weight by just 10 percent will notice measurable health benefits. To learn more about the impact of obesity on the body and how to address the situation, individuals should reach out to an experienced physician.

Annals of Vascular Surgery Publishes Telemedicine Study

A Yale-educated physician who completed a dual internship and residency in internal medicine at the Yale-New Haven Medical Center, Dr. Rex Mahnensmith has treated patients at Waterbury, Connecticut’s StayWell Health Center since 2015. One of Dr. Rex Mahnensmith’s areas of professional interest is telemedicine.

A recent study in the Annals of Vascular Surgery established a link between telemedicine access and overall patient satisfaction. Titled, "Results of Telehealth Electronic Monitoring for Post Discharge Complications and Surgical Site Infections Following Arterial Revascularization with Groin Incision," this study concentrated on patients in the Appalachia region in the wake of a specific form of cardiovascular surgery.

West Virginia University School of Medicine professor and leading researcher Albeir Mousa worked with 30 participants and supplied 16 of them with the telemedicine app Enform. When compared to the 14 participants who didn’t receive the app, the Enform app users experienced fewer limitations due to health problems and received higher scores when it came to overall physical function and mental health. Roughly 90 percent of patients also claimed that access to telemedicine boosted their overall quality of care.

The Prediabetic Health Impact of Glucose Intolerance

Dr. Rex Mahnensmith is a respected Waterbury, Connecticut, physician who treats chronic kidney disease cases at the StayWell Health Center. In a paper authored by Dr. Rex Mahnensmith, he examined glucose intolerance as a prediabetic condition.

Utilized by human tissues in generating energy, glucose is ready to absorb through the blood stream once it is broken down by the intestines from starches. Following absorption, glucose is transported to specific cells, tissues, and organs with the assistance of insulin, which is secreted by the pancreas. The secretion of the glucose ­transport hormone insulin is triggered by glucose surges in the bloodstream. 

Glucose intolerance arises when glucose levels rise above 140 mg/dL or stay at a level higher than 100 mg/dL for more than two hours following ingestion. With the body unable to tolerate the load of glucose placed on it within a specific timeframe, the glucose ingested is not utilized completely by tissues and cells for production of energy. 

Glucose intolerance is tied to the development of diabetes mellitus in many patients and has serious ramifications. The reason for this has to do with the way in which glucose molecules unused for energy production ultimately bind toxically with blood vessel walls and cell membranes, and result in adverse reactions and microscopic scarring.

Fructose, Glucose and the Danger of Glycation Reactions

Based in Waterbury, Connecticut, Dr. Rex Mahnensmith is an internist who practices with StayWell Health Center. Having lectured extensively on issues such as kidney disease, Dr. Rex Mahnensmith authored the article “Glucose Becomes A Toxic Molecule in Prediabetes and Diabetes.”

Focusing on an element of diet typically consumed in starchy plants such as corn, potatoes, yams, wheat, and rice, Dr. Mahnensmith describes chain-bound glucose as distinct from sucrose, which chemically combines fructose and glucose within a two ­molecule compound. Sucrose is found in numerous fruits, vegetables, and other plants, including beets and sugarcane. 

When ingested, sucrose is split into its fructose and glucose components. The glucose is rapidly absorbed through the intestinal tract to the bloodstream and provides a ready energy source for a variety of tissue and cell functions. This process takes less than a day and results in cells stocking up with energy that is either consumed through activity or stored for future use as glycogen starch.

By contrast, fructose is not absorbed readily. In cases where it is bonded with cellulose, it passes through the intestinal system and is finally eliminated. In cases of bloodstream absorption, it enters the liver and is turned into fat cells that serve as an “energy depot of last resort” when glycogen starch is used up by the body 

Where glucose becomes harmful - and often serves as an indicator of prediabetes - is when it is not transported to tissue cells efficiently. Oxygen and other circulating reactive molecules ultimately cause the glucose molecules to undergo a molecular structure change while still in the bloodstream, leading to random glycation reactions that impact tissue and organ structures adversely.

Chronic Kidney Disease - Causes and Risk Factors

Drawing on over 30 years of medical experience, Dr. Rex Mahnensmith has served patients at the StayWell Health Center in Waterbury, Connecticut, since 2015. Dr. Rex Mahnensmith has experience treating a number of significant health conditions, including chronic kidney disease.

Chronic kidney disease, or chronic kidney failure, is the medical term used to describe the gradual loss of proper kidney function. Chronic kidney disease is a progressive condition that can culminate in a patient requiring life-saving kidney dialysis. While the effects of the disease can be mitigated and managed, particularly with early intervention, individuals should do everything in their power to maintain healthy kidney function.

Type 1 and type 2 diabetes represents one of the most common diseases that places excess stress on the kidneys. Other diseases that pose a similar threat include polycystic kidney disease, interstitial nephritis and glomerulonephritis, and vesicoureteral reflux. Physical injuries or conditions can also lead to chronic kidney disease, such as an extended blockage of the urinary tract.

Finally, a variety of risk factors can elevate a person’s chances of developing chronic kidney disease. In addition to diabetes, individuals living with cardiovascular disease are more likely to develop chronic kidney disease than those with regular blood pressure levels. Smoking, obesity, and advanced age are also risk factors.

Potential Symptoms of Chronic Kidney Disease

Dr. Rex Mahnensmith joined the StayWell Health Center in Waterbury, Connecticut, as an internal medicine physician in 2015. In this position, Dr. Rex Mahnensmith primarily diagnoses and treats patients living with chronic kidney disease.

Chronic kidney disease (CKD), sometimes referred to as chronic kidney failure, is the gradual and consistent loss of proper kidney functions, a condition that can lead to dangerous levels of fluid, electrolyte, and waste build up throughout the body. Treatment of CKD involves identifying the cause of kidney failure and taking the appropriate steps to mitigate further damage.

In the early stages, symptoms and signs of CKD can be hard to pinpoint. As the disease progresses, individuals may experience any number of non-specific symptoms, including changes in sleeping patterns, impaired mental acuity, nausea and vomiting, and hypertension. Fluid build ups in certain parts of the body can trigger additional symptoms. For example, build ups around the lining of the heart can result in chest pain, while shortness of breath may indicate fluid build-ups in the lungs.

Individuals who feel they may be living with symptoms of kidney disease should reach out to a trusted medical professional for further testing.

Researchers Create Nanoparticle for Treating Kidney Disease

Dr. Rex Mahnensmith serves as an internal medicine physician at the StayWell Health Center in Waterbury, Connecticut. Dr. Rex Mahnensmith comes to this position as the former clinical director of nephrology and the medical director of dialysis at the Yale Medical Group, where he cared for numerous patients with kidney disease.

Chronic kidney disease has traditionally been a difficult condition to treat. Conventional options have been limited to dialysis, kidney transplantation, or strong systemic medications, all of which are intensely demanding on the body. Recently, however, researchers at the University of Southern California have begun to explore the option of targeted drug delivery. 

The research team began by developing a nanoparticle known as a micelle. Created from a peptide chain that includes glutamic acids and lysine, it is 10 to 20 times smaller than the typical nanoparticle. Its size enables it to pass through the kidney filtration system, while the peptide component allows the kidneys to retain the particle instead of excreting it as waste. 

Retention of the nanoparticle by the kidneys is crucial, as it allows for the release of the drug at the site of the disease. This in turn minimizes side effects and may increase the likelihood that the drug will have its intended effects. 

In vivo testing has shown that when injected into mice, the nanoparticles concentrated in the kidneys and were safely expelled within a week. This promising result suggests that the method may be effective not only in treating disease but also in preserving other organs.

Five Life Habits That Make a Difference for Health and Survival

A graduate of Yale University School of Medicine, Dr. Rex Mahnensmith is a professor emeritus at the university, where he began teaching a clinical track more than 15 years ago. In addition, he leverages his training and experience to serve as internal medicine physician at StayWell Health Center in Waterbury, Connecticut. Also an author, Dr. Rex Mahnensmith has written a number of articles, including a piece titled Five Life Habits That Make A Difference for Health and Survival.

Public health researchers have published five habits that correlate to poor health: cigarette smoking, excessive alcohol consumption, inadequate exercise, obesity, and inadequate sleep. When it comes to the first habit, doctors recommend complete abstinence from tobacco, as toxic chemicals irritate respiratory tissues and can lead to various forms of cancer. Physicians also recommend abstinence from alcohol or consuming only moderately on occasion to avoid damage to the liver and other organs.

In terms of exercise, five days of rigorous exercise per week can help burn calories and strengthen the heart, in addition to improving circulation and reducing stress. Finally, doctors recommend maintaining a body mass index of less than 25 kg. of weight per square meter of height and getting at least seven hours of sleep per night.

Stages of Chronic Kidney Disease

As a physician and chief medical officer at the StayWell Health Center in Waterbury, Connecticut, Dr. Rex Mahnensmith draws on more than 40 years of clinical practice experience. Dr. Rex Mahnensmith served for 20 years as medical director of dialysis and clinical director of nephrology at the Yale Medical Group, through which he treated numerous patients with kidney disease.

The course of chronic kidney disease involves five stages, which differ based on the kidneys' level of function and the amount of protein in the urine. Clinicians determine the former by testing the glomerular filtration rate, or GFR, which is defined by the amount of blood that the nephrons of the kidney can filter per minute.

A person with mild symptoms of kidney disease but normal or better GFR (90 percent or greater kidney function) receives a classification of Stage 1, which suggests potential kidney damage but normal levels of kidney function. Stage 2 correlates with a reduced GFR and 89 to 60 percent kidney function.

As GFR drops and kidney function decreases, the patient progresses through Stages 3a, 3b, and 4. A patient with Stage 5 chronic kidney disease, also known as end-stage kidney disease, has complete or near-complete loss of function, to the degree that there is a dangerous accumulation of water and waste in the blood. This causes a variety of symptoms including headache, cognitive disturbances, digestive distress, and changes in skin color.

Patients who reach Stage 5 chronic kidney disease typically need intensive treatment in order to survive. This may take the form of dialysis or a kidney transplant.

Challenges to Post-Acute Care

Dr. Rex Mahnensmith is an internal medicine physician at StayWell Health Center in Waterbury, Connecticut. Over the course of his long career, Dr. Rex Mahnensmith has also served in emergency, outpatient, nephrology, and geriatric settings. While employed in skilled nursing facilities, Dr. Mahnensmith participated in post-acute rehab care. Skilled nursing facilities face several challenges in providing post-acute care to patients recently released from a hospital setting.

Many patients, upon release from the hospital, need post-acute care in a skilled nursing facility before they are able to return home. In these types of situations, additional care and rehab services are necessary. While an important part of a patient’s healing process, skilled nursing facilities face several challenges that revolve around coordination of care and conflicting orders and documentation.

In facing these difficulties, medical professionals are seeking greater coordination between general practitioners, hospitals, specialists, and other involved parties. Utilizing electronic health records can help with essential communication. In addition, emerging technologies such as tracking devices that can detect decline and medication adherence can help. 

By embracing solutions to the challenges of care coordination, the medical community at large will be able to reduce preventable readmissions, strengthen partnerships, and increase the quality of care that post-acute patients receive.

Maintaining Hemostability during Renal Therapy

Yale-educated internal physician Dr. Rex Mahnensmith is an award-winning doctor at the StayWell Health Center in Waterbury, Connecticut. Dr. Rex Mahnensmith earned an ABIM Subspeciality Certification in Nephrology and has written several peer-reviewed papers on renal diseases and treatments. 

When determining the best course of treatment for kidney failure, nephrologists must balance between the duration of treatment and the level of hemostability maintained during treatment. To reduce hospitalization time for patients with chronic kidney disease, faster versions of intermittent rental therapy may be preferred. 

However, acute kidney injuries in critically ill patients often are treated with continuous renal replacement therapies (CRRT). CRRT filters blood at a slower rate than other rental therapies, making it ideal for patients who are more sensitive to large fluctuations in fluids. 

This type of hemodialysis is considered safer for patients with high risks of hypotension. CRRT was first pioneered in the 1990s and uses a series of tubes and membranes to pass blood through a hemofilter, removing excess water and waste. To meet the needs of hospitals and dialysis patients, smaller and more economical versions of CRRT are currently in development.

Dr. Rex Mahnensmith, MD - International Association of HealthCare Profess...