October. It's all about Transitions!

The leaves begin to fall and many of us begin to reflect wistfully on our mortality/immortality. Mortality because life inevitably takes its toll. Immortality, because many of us believe that life on earth is the entrée to something sublimely better. This dichotomy came crashing home when I received a phone call from my dad last weekend that his lone surviving brother and my dearest uncle had suddenly died. I wept inconsolably because my uncle, a Jesuit priest, had played such an important role in my life. It was difficult to imagine life without him. Then I realized the excellent way in which he had led his life. Generous, patient, and humble, he was called home to a better life, the life he had longed and prepared for.

My uncle was all about life. He married us, baptized our four children and our first grandchild at Old St. Joseph's - a most glorious day! He made Jesus present in our midst!

My uncle left a legacy of love. To wit, our youngest daughter was engaged within two days of his funeral (to a wonderful guy!) Eileen Monesson, the publisher of this newsletter, is on route to Florida to care for her soon-to-be-born first grandchild! My uncle is alive in them in ways that his mortal life did not permit!

Enjoy the fall colors and know that they foreshadow the ending and beginning of life!

For those of you who find the above morose, I suggest you reflect on the quotation by John Donne in his famous poem, No Man is an Island: "Ask not for whom the bell tolls; it tolls for thee!" This means we are all connected. When one suffers, we all suffer. When one rejoices, we all rejoice. That's what my dear uncle said.

John A. Schmidt, MD 

Medicare Open Enrollment Period Runs from October 15-December 7

As reported at Medicare.gov, your best on line resource for all things having to do with Medicare coverage, this is the period to: change from Original Medicare to a Medicare Advantage Plan, change from a Medicare Advantage Plan back to Original Medicare, switch from one Medicare Advantage Plan to another Medicare Advantage Plan, switch from a Medicare Advantage Plan to a Medicare Advantage Plan that offers a prescription drug plan (part D), join a Medicare Prescription Drug Plan, switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan, or drop your Medicare prescription drug coverage completely.

Remember, you must first sign up for Medicare parts A and B beginning three months before the month of your 65th birthday. This is best done on-line at Medicare.gov. Medicare Advantage Plans are from insurance companies. They generally cost less than Original ("traditional") Medicare but the networks are more restrictive and the coverage is often less generous. So...Buyers Beware. Do your homework and be a smart shopper. Hospitals and doctors, myself included, prefer Original Medicare and, better yet, Original Medicare backed up by a Medicare supplemental (Medigap) policy to cover costs that Original Medicare does not cover.

On the Topic of Prescription Drug Coverage (Part D)

Many of my patients are constantly denied coverage for common drugs, even generic drugs, because their part D plan does not include a particular drug in its formulary. Valerie and I spend countless hours filling out appeals which are generally denied, wasting valuable time and frustrating you, your pharmacist, and your doctor! Please, please, please discuss your current medication list with your current insurer or use the Medicare Plan Finder available at Medicare.gov to find out if your medications are covered and what they will cost you. All of my prescriptions allow for generic substitution but there is currently no automatic mechanism for substituting one medication of the same class to match your insurer's formulary. Yes, the insurance companies send us their formularies and occasionally my software will warn me when a drug isn't covered. But the formularies change frequently and the software does not differentiate on the basis of tier, which can mean a big difference in your out-of-pocket costs. Oh, did I mention that you should review your medication list with your part D provider? And watch out for donut-holes, politely referred to as "coverage gaps"!!!

October is Breast Cancer Awareness Month

Breast cancer can be cured if caught early. Early detection is your best defense. Though controversy exists following the publication of the Canadian National Breast Screening Study in the British Medical Journal in February, the National Cancer Institute and the United States Preventive Services Task Force still contend that Screening Digital Mammography, every two years in women of average risk beginning at age 40, is still the best early detection tool. The specificity and accuracy of the test generally improves after menopause as breast density decreases. Women should ask the radiologist to notify them if their breasts are dense because breast density confers increased risk for breast cancer. The value of other screening techniques including other imaging modalities, Clinical Breast Examination and Self Breast Examination is less clear.

Remember that the incidence of breast cancer, like most cancers, increases with age. In fact, as pointed out by the NCI, the strongest risk factor for breast cancer is age! At age 70, a woman has a 1 in 26 chance of being diagnosed with breast cancer and women diagnosed at an advanced age are more likely to die of the disease. Other facts: Approximately, 12.3 percent of women will be diagnosed with breast cancer at some point during their lifetime, based on 2009-2011 data. In 2011, there were an estimated 2,899,726 women living with breast cancer in the United States! The five year survival rate for all age groups is 89.2%. The five year survival rate for localized breast cancer is 98.5%! The median age at diagnosis is 61 and the median age among those dying of breast cancer is 68.