By Dr Kosins for my patients:
WE NOW HAVE A MOBILE SITE.
TYPE IN MARKKOSINSMD.COM
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Mark Kosins MD & Michael Roham PA
302 N. El Camino Real #112
San Clemente, CA 92672
949 489 9898 Markkosins@aol.com
Board Certified Psychiatrist
Professor of Psychiatry and Family Medicine
Western University of Health Sciences
We hope you know that we try to make your interaction with us a special experience. We are very committed to providing you with a kind and polite and respectful environment. When you engage our office on the phone with Ingrin or Susan, we hope it is a helpful and pleasant experience. We hope that when you
come through the door you find a quiet, pleasant, and a safe environment.
We are committed to seeing one person at a time, and we hope that you find the time spent with us demonstrates a sense of caring, is educational, and is compassionate. Any of you who know me know that I have tried to continually challenge
myself with new areas of knowledge dedicated to TO further complete myself as a physician.
Dr Kosins, Michael Roham PAC, Ingrin Curry and Susan Villlasenor
THIS COULD BE VERY IMPORTANT:
INTERCONNECTED IS PROVIDING US WITH A SEMINAR ON THE MICROBIOME.
If you haven’t had time to watch Episode 1 yet, check out the link below:
Watch Episode 1 NOW - go to https://www.interconnectedseries.com/episode1sct
sign up for www.interconnectedseries.com to see it all
a lot of this is new information that you may find useful and interresting to read and knowa bout
Healing begins within,
Dr. Pedram Shojai
Host of INTERCONNECTED: The Power To Heal From Within
Episode 1 will be open and available for the duration of the 9 day event because so many people had trouble getting to it yesterday. It's the foundational opening piece to the rest of this powerful series and I highly recommend seeing it first.
Last night we met some amazing people who suffered with ailments and diseases… until they turned their health around by looking within, to their microbiomes. That galaxy of TRILLIONS of bacteria, viruses and fungi that live within (and on) us.
Guaranteed, if this is your first introduction to the ‘good germs’ that exist inside all of us, this episode will blow your mind.
Best part? We’re just getting started. Next up:
Episode 2: The Human Microbiome: The Raging Battle Within
If you’re suffering from any kind of illness, especially obesity, headaches, memory loss, and immunity issues, it’s likely your gut holds the key.
Don’t let your doctor throw expensive pills at your pain. Let me (and over 70 experts) share with you you how to turn the corner into natural healing, all by concentrating on your 2nd brain.
We’ll also discuss the rise and rise of autoimmune disease like arthritis, Hashimoto’s, Crohn’s and Celiac disease.
Why has there been such a dramatic upsurge in these diseases?
The answer, again, lies in the microbiome.
You don’t want to miss this episode.
I’ll give you more details AND your Episode 2 links in the next email.
First, be sure to watch Episode 1 if you haven’t already, it sets the stage for the health revelations to come.
To the next frontier of health,
NOT a Normal Part of Aging: Geriatric Depression
“I’m growing old
And I don’t wanna know
I’m growing old
And I wanna go home.”
– Nick Drake “Black Eyed Dog”
Is depression a foregone conclusion as you get older?
No, according to the National Institute on Aging.
“Depression is a common problem among older adults, but it is NOT a normal part of aging. In fact, studies show that most older adults feel satisfied with their lives, despite having more illnesses or physical problems,” the NIH wrote on its website. “However, important life changes that happen as we get older may cause feelings of uneasiness, stress, and sadness.”
If you are an older adult and are experiencing depressive symptoms, you aren’t alone. As many as 7 million Americans 65 years of age and older suffer from geriatric depression, according to research from the Centers for Disease Control.
It’s important to get help to address depression. Left untreated, the CDC says depression in the elderly can “complicate chronic conditions such as heart disease, diabetes, and stroke; increases health care costs; and often accompanies functional impairment and disability.” Further, depression can lead to “higher mortality from suicide and cardiac disease.”
Understanding the symptoms of depression and how you may be at risk is the first step in getting help.
Geriatric Depression Symptoms & Risk Factors
Geriatric depression presents similarly to major depressive disorder. Sami, an older adult, describes her battle this way:
“…an emotional bankruptcy. My depression, anxiety and post-traumatic stress syndrome were all-consuming. The only way to describe it is that I felt hungover – exhausted, dehydrated, and had the worst headache. Most days, I couldn’t get out of bed.”
While geriatric depression is a form of major depressive disorder that presents similar symptoms (e.g., sadness, tiredness, and/or feeling overwhelmed), the Cleveland Clinic reports that older adults will often report different symptoms to their doctors, including:
- “Cognitive problems
- Loss of interest in activities
- Loss of concentration
- Nagging aches and pains
- Digestive problems”
Older adults face risk factors that can increase the likeliness of depression. From the Cleveland Clinic’s website, the following conditions can prompt a mood disorder:
- Heart disease
- Chronic obstructive pulmonary disease
- High blood pressure
- A disability
- A new medical illness
- Poor self-perceived health
Multiple Medications May Complicate Depression Treatment
A complicating factor for geriatric depression treatment is that many people take multiple medications to manage diseases that come with advancing age.
“Many of the patients who come in to see me are on multiple other medications. Cardiac medicines, medicines for pulmonary disease, medicines for pain, chronic osteoarthritis is a very common presentation for many of my patients,” said Dr. Allan A. Anderson, a specialist in geriatric psychiatry and past President of the American Association of Geriatric Psychiatry. “It’s uncommon for me to have a geriatric patient who isn’t on any medication.”
One of the ways Dr. Anderson helps patients taking multiple medications is through the GeneSight® Psychotropic test. Analyzing a person’s DNA can help healthcare providers develop an individualized treatment plan for their patients. The report includes helpful information about how the patient’s genetic makeup may affect their response to psychotropic medications.
While genetics provides an important piece of the puzzle, there are many other factors that influence medication response and susceptibility to side effects, such as drug-drug interactions, diet, environmental factors, age, etc. The GeneSight test can serve as an objective tool that can be used in concert with these other factors to help guide medication selection.
You can watch Dr. Anderson talking about how he treats patients with geriatric depression here: https://www.youtube.com/watch?v=dXhv6HvHs0M.
Getting Depression Help
As always, recognizing the signs of depression is the first step. And while you might not recognize it – or want to admit it – you may be depressed. Your loved ones may see a change in your behavior and encourage you to get help.
In fact, in a U.S. News & World Report article, Dr. Philip R. Muskin, a professor of psychiatry at Columbia University Medical Center and a member of the American Psychiatric Association’s Scientific Program Committee, says that it is the responsibility of family and friends to look for signs of depression in their elderly loved ones – and take action.
“If you think it, don’t let it slide,” he says. “Bring it up. When grandma says go jump in the lake, bite your tongue and encourage her to see her doctor. It’s hard to do, but once done, it may really save a life. It is treatable, whatever it might be.”
News for Healthier Living
Many With Opioid Addiction Don't Get Meds That Can Help
WEDNESDAY, March 20, 2019 (HealthDay News) -- Most people struggling with opioid addiction lack access to FDA-approved medications that can head off withdrawal symptoms and quell their cravings, a new report finds.
Methadone, buprenorphine and extended-release naltrexone all help opioid addicts by targeting the same brain receptors triggered by narcotics, and they have been proven effective and lifesaving, the report says.
More than 2 million people in the United States are thought to have opioid use disorder (OUD), and 47,000 died from an opioid overdose in 2017.
Studies have shown that opioid users are up to 50 percent less likely to die when they're receiving long-term methadone or buprenorphine treatment, according to the report.
Unfortunately, most opioid users in the United States don't receive any treatment at all, and only a fraction of those in treatment have been prescribed any of these medications, the researchers said.
The report, from the National Academies of Sciences, Engineering, and Medicine, argues for removing barriers that have made these medications inaccessible to many.
For example, methadone can only be administered through specialty opioid treatment programs, even though evidence shows it's just as effective when handed out by a family doctor.
Buprenorphine can be prescribed by doctors, but only if they've had specialized training and received a waiver from the Drug Enforcement Administration, the report noted. Fewer than 3 percent of health care providers have bothered to jump through those hoops, and those who have face regulations limiting the number of patients they can treat with buprenorphine.
Additionally, most residential treatment centers don't offer any of the medications, and if they do, they rarely offer all three.
"The factors impeding full use of FDA-approved medications to treat OUD must be addressed, including stigma surrounding both addiction and the medications used to treat it, as well as counterproductive ideologies that consider addiction simply a failure of will or a moral weakness, as opposed to understanding that opioid use disorder is a chronic disease of the brain that requires medical treatment," said Alan Leshner.
Leshner is retired chief executive officer of the American Association for the Advancement of Science and head of the committee that conducted the study.
Only 6 percent of treatment facilities offered all three medications in 2016, Leshner said, while only 5 percent of those addicted to opioids received medication for their addiction.
"The regulations that currently exist restrict access to methadone and buprenorphine in ways that our committee believes are far too prohibitive, and that accounts for the fact that too many people who might provide these medications don't," Leshner said.
The report's committee included Walter Ginter, a person with opioid use disorder who now serves as project director for the Medication-Assisted Recovery Support (MARS) network in New York City.
"I first entered medication-based treatment in 1977," Ginter said. "It's hard for me to envision a way in which I would still be alive if not for medication."
Ginter agreed that regulations need to be revamped to better help addicts.
"The burden of regulatory compliance directly affects patients greatly," Ginter said. "When I ask patients leaving medication-based treatment if they would stay if they could get their methadone from an office-based provider, as I do, they always say yes."
The report highlights four barriers that prevent effective medication-based addiction treatment:
- Misunderstanding and stigma about the nature of drug addiction and the medications used to treat it.
- Inadequate education and training of professionals who most often deal with opioid addicts, including treatment providers, police and corrections staff.
- Regulations restricting methadone and buprenorphine prescription that are not supported by the evidence or applied to medications used to treat other types of brain disorders.
- A fragmented system of care for people with opioid use disorder, including insurance coverage for their treatment.
Lindsey Vuolo is director of health law and policy for the Center on Addiction in New York City. "This report underscores one of the greatest tragedies of the opioid epidemic. We have effective treatments but most people with opioid addiction don't receive them, significantly increasing their risk for death," she said.
"With 130 Americans dying every day from an opioid overdose, we'd expect more to be done to address the barriers identified in this report, and implement solutions to expand access to treatment," Vuolo continued. "Stigma -- against addiction and its treatment -- prevents the type of response we'd see for any other disease."
Use of these medications should be extended to many other health care settings, including pharmacies, mobile units, community health centers and hospital emergency departments, the report argues.
The medications also should be used more often in jails and prisons, the report suggests. Even though more and more people who are addicted to opioids are being incarcerated, OUD meds are often withheld from prisoners or provided only on a limited basis for medically supervised withdrawal.
As a result, few people in prison or under supervision of drug courts are prescribed these medications. The lucky few who do receive medication are not connected with care upon their release, leaving them on their own to deal with their addiction.
According to Leshner, "Curbing the epidemic will require an 'all hands on deck' strategy across every sector -- health care, criminal justice, people with OUD and their family members, and beyond -- in order to make meaningful progress in resolving this crisis."
The American Psychiatric Association has more on opioid use disorder.
News for Healthier Living
Giving OD Antidote to Those Using Powerful Painkillers Might Save Lives
Finding supports naloxone prescriptions for patients taking opioids for chronic pain
At our office we use a nasal spray called Narcan. Anyone taking a large dose of any opiate and anyone taking any combination of Benzodiazepines (or sleeping medicine or sedative or alcohol )and any opiate including suboxone or subtext must have a prescription for Narcan or Naltrexone. Ask us for one as well as information about it and how to use it and how to teach a family member or friend to do so.
MONDAY, June 27, 2016 (HealthDay News) -- In the wake of the musician Prince's death from a painkiller overdose, a new study suggests some opioid-related deaths could be prevented by routinely prescribing an antidote for certain patients who take the medications.
Researchers found that those who received prescriptions for the antidote naloxone (Evzio) were less likely to return for emergency care related to their painkiller use.
"The study should encourage primary-care providers to prescribe naloxone to their patients on chronic opioid therapy," said Dr. Alexander Walley. He's an addiction specialist and assistant professor of medicine at Boston University School of Medicine. He was not involved in the study.
According to a federal report released earlier this month, an estimated 2 million people in the United States were addicted to prescription opioid painkillers like OxyContin and Vicodin in 2012-2013. Misuse of the drugs has skyrocketed over the past decade, the U.S. study found, and local officials are seeing high numbers of overdose deaths.
The new study examined the use of naloxone, a drug that's used to reverse the effects of opioid painkillers.
Study author Dr. Phillip Coffin, director of Substance Use Research with the San Francisco Department of Public Health, said, "Since the mid-1990s, programs have been dispensing naloxone directly to people who use [illegal] drugs, as they are the most likely people to be present when an overdose occurs." These programs have had a "remarkable" impact on overdose death rates and are cost-effective, he added.
In the new study, researchers tracked what happened after 38 percent of nearly 2,000 opioid painkiller patients at San Francisco clinics received prescriptions for naloxone. All of the patients took the opioid for chronic pain, such as pain related to cancer, Coffin said.
The idea was that these patients would have the antidote on hand if they overdosed. The "rescue kits" require a witness to respond and administer the drug to the person who overdoses, said Walley.
"Naloxone blocks the effects of opioids and will cause a person who is overdosing to be able to breathe again and wake up," he explained. "It has no effect on people who are not using opioids and therefore is very safe."
The researchers found that those who received naloxone prescriptions had 47 percent fewer opioid-related emergency room visits per month over the following six months, and 63 percent fewer over a year, compared to opioid patients who didn't receive naloxone.
However, only about 12 percent of all patients went to the emergency room for opioid-related issues during the study period. Overall, the findings suggested that naloxone prescriptions for 30 patients would translate to one averted ER visit, Coffin said.
In a related study, Coffin said, researchers found that the antidote saved 5 percent of a randomly selected group of patients.
As for cost, Coffin said insurance companies generally paid for the antidote medication without a struggle. The retail price for the drug is about $15 to $30 per dose, he said.
But shouldn't these patients not be taking opioids at all if they're at risk for overdose?
Some patients require opioid treatment for their pain despite the risk of overdose, Coffin explained, and some are at risk of an overdose because there's such "a narrow window" between taking enough and taking too much.
Walley praised the study and said he doesn't see any downsides to offering the overdose antidote.
"Friends and family of people at risk for overdose should also be included in efforts to implement overdose prevention education and naloxone rescue kits," Walley said. And emergency training in first aid and CPR should include education in how to use the rescue kits, he said.
Coffin said it's especially important for certain painkiller patients to have the antidote on hand.
"The [U.S.] Centers for Disease Control and Prevention now recommends offering naloxone to patients on long-term opioid therapy who are taking more than 50 morphine-equivalent milligrams daily, who have a history of overdose or substance-use disorder, or who are also taking medications such as benzodiazepines [a class of tranquilizers]," he said.
Coffin urges steps beyond those recommendations: "Even for patients who are unlikely to overdose, it may be important to have naloxone in the house in case of accidental exposures or unintentional diversion of medications," he said.
The study appears in the Aug. 16 issue of Annals of Internal Medicine.
For more about opioid addiction, try the U.S. National Institute on Drug Abuse.
NOW FOR SOME NEW INFORMATION
I believe that it is a good idea to have this on hand depressioncenter.org/toolkit
please type it in your browser and see all the great
||We do not provide refills on evenings, weekends, holidays or Friday since we are not in the office.If you need a refill for any scheduled medication such as stimulant, benzodiazepine, sleeping medication, sedative, muscle relaxer or pain medication, we only do that with an appointment. We always try to make sure you have enough medications till the next visit. Please do not ask for any refill without giving us at least 3 days notice. The rules for prescribing have changed and we have to have a way to all deal with this.
If you need a refill, go to an emergency room or take the prescription we gave you or your bottle that has refills to your pharmacy.
Mark Kosins, M.D. Trained at University California Irvine-Graduated 1975-board certified-caring-willing to go the extra step to help you. He works closely with Michael Roham PA to provide comprehensive and quality care.
302 N. El Camino Real #112
San Clemente, CA 92672
To reach the office via e-mail, please click the Contact Us form on this website. Thank you.
He specializes in innovative diagnosis and treatment planning for the full spectrum of emotional and psychiatric problems including DEPRESSION, ANXIETY & PANIC DISORDERS, OCD, ADHD/ADD, BI POLAR, SUBSTANCE ABUSE DISORDERS, EATING DISORDERS, FIBROMYALGIA AND PAIN SYNDROMES .
He can provide both psychotherapy and medication management, or can work with your therapist/ practitioner. He works closely with Michael Roham PA.
SKYPE visits now available when appropriate. My Skype name is mskosins.
Our approach is to combine conventional and (when appropriate and requested) alternative-holistic medicine using the most suitable method that will work best for you. Often this can reduce the need for high doses of medication. The bottom line is to do what will help you feel well with minimal or no side effects.
• The patient gets a one-hour Psychiatric evaluation and often a nutritional evaluation as appropriate. The nutritional evaluation is generally done at a separate appointment.
CALL NOW FOR AN APPOINTMENT or second opinion AND STOP THE CYCLE OF EMOTIONAL PAIN.
IT’S NATURAL TO HAVE PROBLEMS, BUT DON’T WAIT TILL YOUR LIFE COMES APART. Dr Kosins has been treating patients ranging in age from 4 to 84 in Orange County for more than 20 years. Let him help you work toward a better life NOW.
Send an e mail. call and ask a question, (email@example.com) check me out further ( or go to www.southorangecountypsychiatrist.com or markkosinsmd.com)
See our nutritional health store at www.markkosinsmd.meta-ehealth.com
Our approach is to combine conventional and alternative medicine using the modality that will work best for you. If you prefer only medications we can do that as well. When appropriate, we use supplements to augment or replace the need for high doses of medication. At the same time, we will combine medications and or supplements based upon your symptoms and what you are comfortable with. We do not believe that you must comply with my plan for care. Instead, our approach is to partner with you regarding a plan of action that makes sense to you. We specialize in a wide variety of behavioral, learning and emotional problems for children, teenagers and adults with and without ADD/AHD. We also treat anxiety, depression, and bipolar disorder.
I have a reputation for evaluating and treating difficult diagnoses and chemical imbalances that may cause underachievement, school failure, depression, obsessive-compulsive disorders, bi-polar disorders, panic and anxiety, aggressiveness, and brain toxicity from drugs and/or alcohol abuse.
I work with a number of professionals on staff and in the community. These professionals evaluate and treat a variety of disorders, each specializing in specific areas of mental health ranging from stress, anxiety and depression to child, adolescent, family and geriatric therapy. This diverse expertise enables us to provide a broad range of quality mental health and other services to our community.
There are inexpensive genetic tests we can do to help determine which medicines will work best for you.
|Mark Kosins, M.D. and Associates
302 N. El Camino Real
Phone: (949) 489-9898
Fax: (949) 489-2569
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From the North:
Get off at Palizada and go Right. Take Palizada two lights to El Camino Real and go Left on El Camino Real. My office is on the right two blocks down. 302 N. El Camino real #112 San Clemente CA 92672.
Park in front or turn right on Miramir and park underneath.
From the South:
Take 5 freeway north. Get of at Presidio and go left to El Camino Real. Turn right on El Camino Real and go about 1/2 mile (two blocks past Del Mar) and we are on the left.
We are in the big white Spanish building. Street Level. In Front. #112.
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We are currently welcoming new patients.
Check out Mark Kosins MD on YouTube! And thanks for listening
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Our office hours are Monday through Thursday from 8:30 AM to 5:30 PM. Other times may be arranged by appointment.
No prescription refills are provided without a face to face visit. AHHD medications are the exception. We will give you enough meds till your next visit and refills. If you need a refill take your bottle or the prescription we gave you at your last visit to your pharmacy.Generally we must see you every three months at a minimum.
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|At this time, Dr. Kosins is not affiliated with any insurance plans. We can provide you with a "Superbill" at the end of your visit that you can submit to your insurance for reimbursement, however, the amount that is reimbursed is entirely up to the discretion of your insurance company.
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|Saddelback Memorial Hospital - Laguna HIlls|
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