March: In like a lion and out like a ________?

Spring can't come soon enough!  In the meantime there is March Madness. I am proud to announce that the Hawks of St. Joseph's University, my alma mater, won the Atlantic 10 Conference Championship and earned a NCAA tournament bid for the sixth time under legendary coach, Phil Martelli. The Hawks lost to the UCONN Huskies in OT, an excellent performance considering the Huskies are in the Final Four. The Hawk will never die!

John A. Schmidt, Jr., MD

Proud To Be Irish!

I am proud of my German ancestry and equally proud of my Irish.  My great, great grandfather was James Patrick McKenna.  He arrived in Philadelphia in 1861 where he, at the age of 40, along with many countrymen enlisted in the 69th Pennsylvania Irish Volunteers.  He fought at Antietam, Fredericksburg, and marched overnight to defend the Union flank at the battle of Gettysburg.  On the third day, he and his surviving Irishmen were called to the center of the fight, Bloody Angle, and held. He later joined Sherman's Corps. where he was wounded at the Battle of Atlanta. He was a trench digger after the war, was seriously injured in a cave-in, and buried at Holy Cross Cemetery outside of Philadelphia. 

Caffeine: Double Edged Sword

There is a new book on our national obsession with caffeinated beverages called Caffeinated: How Our Daily Habit Helps, Hurts, and Hooks Us by Murray Carpenter.  While caffeine is generally safe, heart burn, palpitations, and headache may be the result of too much, or withdrawal from, caffeine. Keep track of your caffeine intake and decide if you are the beneficiary, or the victim, of caffeine. 

Amerigroup Managed Medicaid and Meridian Health Fail to Reach Agreement

I am sad to announce that after June 24, I will be unable to admit Amerigroup Medicaid patients to Jersey Shore University Medical Center. Why? Amerigroup and Meridian were unable to agree on reimbursement rates. United HealthCare Medicare Advantage patients were similarly affected earlier this year.

Since I admit patients exclusively to Jersey Shore University Medical Center, the Meridian flagship hospital, I will send my Amerigroup patients requiring hospitalization to Monmouth Medical Center or CentraState where inpatient care will be overseen by specialists known as hospitalists. Upon discharge, patients will return to my care.  Meridian continues to accept other Medicaid plans and insurance products established by the Affordable Care Act (Obamacare).  

Message: I remind everyone who is currently uninsured to visit healthcare.gov today and enroll no later than March 31. Carefully review the costs and also the doctors and hospitals in each plan. 

Colorectal Cancer Rates Drop Dramatically in Last Decade

As reported in CA: A Cancer Journal for Clinicians, colon cancer rates have fallen by 30% over the past decade in people over age 50.  Colorectal cancer is the third leading cause of cancer death in the United States. The American Cancer Society estimates that more than 136,000 Americans will be diagnosed with the disease this year and that more than 50,000 will die of the disease. The biggest declines were in people over age 65, who qualify for Medicare which makes colon cancer screening available for free. 

While colon cancer incidence dropped among all racial groups, death rates were 50% higher among blacks, probably because black Americans have less access to a colonoscopy. This is an area where the Affordable Care Act and Medicaid Expansion could make a big difference. I encourage those without insurance to apply for insurance before March 31. Let me help you arrange this important screening test and protect your life.

Screening for Lung Cancer

While death rates continue to fall for colon, breast, and prostate cancer, lung cancer continues to be the leading cause of cancer death. Why? There has been no screen for early detection--until now!  

As published in the Annals of Internal Medicine on March 4, the United States Preventive Task Force (USPTF) now recommends, "Annual screening for lung cancer with low-dose computed tomography (CT) in adults aged 55 to 80 years who have a 30 pack- years smoking history and currently smoke or quit within the past 15 years."  And the recommendation has teeth because the Affordable Care Act requires private insurers to pay for tests recommended by USPTF! 

Enter e-cigarettes.

As my patients known, I am completely dedicated to smoking cessation. My view of e-cigarettes is clear.  If e-cigarettes help you abstain from tobacco products, I am a fan.  Why? They are safe and do not contain the toxic chemicals that lead to lung cancer, heart attack, throat and esophageal cancer, bladder cancer, abdominal aortic aneurysm, and premature death.  But please, do not offer e-cigarettes to those who have never smoked for fear that they will transition from e-cigarettes to cigarettes that kill. This would be the cruelest reversal of them all!

Radical Prostatectomy

Because prostate cancers are typically slow growing, it has been difficult to demonstrate the value of surgery in short term studies.  As published in the New England Journal of Medicine on March 6, patients who underwent radical prostatectomy for prostate cancer lived longer than those who did not.

Diabetes Type II: FDA and EMA Find No Fault with Incretin-Based Drugs

Drugs like sitagliptin (Januvia�) have been very useful in the treatment of Type II diabetes mellitus but the news media have drawn attention to the risk of pancreatic cancer. 

As published in the February 27 issue of the New England Journal of Medicine, the Food and Drug Administration and European Medicines Authority (EMA) have thoroughly reviewed the evidence in animals and humans and have found no evidence to support the worries. The agencies promised to continue post-marketing surveillance for a late signal.  In the meantime, I continue to prescribe sitagliptin because it is efficacious, safe, and works well with metformin without causing hypoglycemia.

A New Class of Drugs Approved for Type II Diabetes

Patients with Type II Diabetes have elevated levels of blood glucose.  A new class of drugs reduces blood glucose by increasing kidney excretion of glucose. Dapagliflozin (Farxiga™) has now been approved as monotherapy or in combination with other oral therapies for the treatment of Type II Diabetes mellitus in combination with diet and exercise.

Influenza: It's Not Over Yet!

The predominant strain this season has been influenza A (H1N1), which is among the strains covered by this year's flu vaccines.  Influenza is a severe infection, especially among those older than 65.  It's not too late. Get your flu vaccination today!

Next Issue: Saturated Fats--are they safe?

Valerie and I hope you had a Happy St. Patrick's Day and Happy St. Joseph's Day. Enjoy March Madness and know warmth is on its way!!