Issue: 28

May is for Moms

It is impossible to savor the loveliness of May without reflecting on the meaning of Moms. My own mom will be celebrating her 86th birthday in a few days! She lost her mom when she was only 14. Her father devastated, her sister in the convent, and her brother off to build highways with the WPA, she held down the fort, graduated from high school, and got a job. She was a typist at the Presbyterian Hospital in West Philadelphia. Six children, 23 grandchildren, and twelve great grandchildren later (with two more on the way!), "mom" means life itself. Thank you, mom, for your bravery, your generosity, and the encouragement that motivated your children to pursue their dreams!


My mom is a feminist and a pragmatist. Here are some things she would want you to know to stay healthy!


John A. Schmidt, MD

"Door to Needle" Time a Critical Parameter in Surviving a Stroke!

Clot busters like tPA have the potential to reverse a stroke provided they are given quickly. A study published in the Journal of the American Medical Association (JAMA) on April 23 showed that the implementation of a national quality improvement initiative was associated with speedier tPA administration and lower in-hospital mortality and intracranial hemorrhage, along with an increase in the percentage of patients discharged home.


A study from Berlin in the same issue reported that using tPA in the emergency vehicle reduced "alarm to treatment" times by more than 15 minutes with no increase in intracerebral bleeding or mortality.


Indecision and waiting for written consent can waist precious minutes. However, in another article, 76.2% of the older adults surveyed wanted a clot buster for acute ischemic stroke, the same percentage who wanted CPR for sudden cardiac arrest, These findings support clinicians' use of tPA if patient surrogates are unavailable to provide consent.


I advise my patients to be on the lookout for signs of acute ischemic stroke such as sudden inability to speak or loss of power in an arm or a leg. Call 911 immediately, go to Jersey Shore University Medical Center, and say "Code Stroke". Have your medication list with you. The doctor will ask you if you have had a bleeding problem (hemorrhage). Generally, the answer is "No." The stroke team will rapidly perform a CT scan of the head to check for bleeding and quickly determine if you are a candidate for tPA therapy. 


Breast Density, Breast Cancer Risk, and Screening

High breast density is associated with increased risk for breast cancer. Most of this increased risk occurs in women between the ages of 40 and 49 years, that is, before menopause generally leads to an increase in breast fat and a decrease in breast density. Breast cancers that occur before the age of 50 tend to be larger and more aggressive. In a study published in JAMA Internal Medicine in May 2013, compared with every-other-year mammography, annual mammography was associated with lower risk for advanced cancer and large tumors in women aged 40-49 years with extremely dense breasts. Federal law requires that women receive written notification of mammography results but only thirteen states require notification of breast density results. New Jersey is unfortunately not one of them. Keep in mind that more screening increases the risk of false positive results and the need for follow up testing such as MRI. I advise all of my patients between the ages of 40 and 50 to know their breast density. Ask your radiologist to include the information in your report. If you have dense breasts consider having annual mammograms at a specialized facility dedicated to early diagnosis of breast cancer. 


Colonoscopy vs. CT Colonography ("Virtual Colonoscopy") for Early Detection of Colorectal Cancer

I am proud to announce that I have just completed my colonoscopy! It's a good thing I did, too! Three polyps, the precursors of colon cancer, ranging in size from 0.5 to 1.5 centimeters in diameter, were safely removed! What if I had chosen CT colonography, a less invasive test that requires bowel preparation but no sedation? As reviewed in the May 6 issue of the Annals of Internal Medicine, CT colonography detects large polyps as well as colonoscopy so my two largest polyps would have been detected but the smallest one could have been missed. I still would have required a follow-up colonoscopy to remove the two larger polyps. No wonder my insurance company only pays for colonoscopy! Having said this, colonograpy may be a safer option in high-risk elderly individuals who have a positive stool test for blood. I can help you decide which test is best for you. 


Diabetes and Prediabetes in the United States

As reviewed in an editorial published in the April 15 issue of the Annals of Internal Medicine, more than one third of U.S. adults are obese. A concomitant increase in type 2 diabetes parallels the increased incidence of obesity. Type 2 diabetes is associated with many complications, including neuropathy, retinopathy, nephropathy, as well as cardiovascular and cerebrovascular disease.   The cost of diabetes and its complications was estimated to be $245 billion in 2012, representing approximately 9% of the health care costs in the United States. From 1988 to 2010, as measured by a hemoglobin A1c greater than or equal to 6.5%, the total prevalence of diabetes increased from 5.5% to 9.3%, corresponding to nearly 21 million U.S. adults. The incidence of prediabetes (hemoglobin A1c 5.5-6.4%) more than doubled from 5.8 to 12.4% of U.S. adults. These data should serve as a warning to all of us to stay trim and exercise vigorously. I measure hemoglobin A1c in all of my patients on an annual basis and post the results to your patient portal account. See which way your hemoglobin A1c is trending and take the necessary steps to avoid diabetes and prediabetes! 

Ah, Spring! Refresher on Lyme Disease

Lyme Disease is the most common reportable vector borne disease in the United States. It is caused by a bacterium injected into the skin at the time of a tick bite. Initial symptoms include fatigue, headache, arthralgia, myalgia, and less often, fever. Pictures of the rash that follows in one-two weeks can be found in the May 1 issue of the New England Journal of Medicine. The great majority of cases occur in New England and the Mid-Atlantic states including New Jersey. Peak incidence is in the Spring and Summer months. While pregnant women can be infected, there is no evidence of transmission to the fetus. Application of insect repellants (DEET), long pants, and shirts is effective in preventing tick bites. DEET appears to be safe in pregnant women. As an extra precaution, apply DEET to your clothing instead of your skin or buy clothing impregnated with DEET. There is currently no vaccine. Doxycycline, the antibiotic typically used to prevent and treat Lyme disease, is contraindicated in pregnant women. Amoxicillin can be used instead. Contact me if you think you have been bitten by a tick to determine the best course of action. Once treated for Lyme disease, the risk of "chronic Lyme" disease, if it exists at all, is extremely low.

Vitamin, Mineral, and Multivitamin Supplements for the Primary Prevention of Cardiovascular Disease and Cancer

As published in the April 15 issue of the Annals of Internal Medicine, the United States Preventive Services Task Force has concluded that, "Evidence on supplementation with multivitamins to reduce the risk for cardiovascular disease or cancer is inadequate, as is the evidence on supplementation with individual vitamins, minerals, or functional pairs. Supplementation with beta-carotene or vitamin E does not reduce the risk for cardiovascular disease or cancer." As summarized in the article, the National Institutes of Health, the Academy of Nutrition and Dietetics, the American Cancer Society, the American Institute for Cancer Research, the American Heart Association, and the American Academy of Family Physicians all agree. Conclusion: Eat a balanced diet, exercise, if you smoke, stop, stay up to date on your age appropriate screens (see above), and avoid risky behaviors.


In Conclusion

Valerie (the mother of four beautiful children!) and I wish you a safe, happy, and healthy Spring! Call your mom! She made you happen!

In This Issue
'Door to Needle Time"
Breast Density, Cancer and Screening
Colonoscopy vs. CT Colonography
Diabetes and Prediabetes
Lyme Disease
Supplements for Cardiovascular Disease
John A. Schmidt Jr., M.D.

 is one of the leading Internists in Monmouth County offering  Medical Home Services 



"Always laugh when you can, it is cheap medicine."  
- George Gordon Byron 


John A. Schmidt Jr., MD
Meaningful Medicine in Your Medical Home
709 Seventh Avenue
Belmar, NJ 07719
Phone:  732-282-8166  .  Fax:  732-280-0147 .  E-Mail: 
Disclaimer: The articles in Healthy Living are for general information only and are not medical advice.
Discuss all medical concerns and treatment options with your physician.