November/2014
Issue: 34

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Let Us Give Thanks! Food for Thought as We Celebrate Thanksgiving!

We have so much to be thankful for! The air we breathe, the friends we've made, the family we love! But I'm most grateful for the people who make sacrifices to make ours a better world. As an example, catch the program entitled "Trailblazers in Habits" which is airing on ABC-TV affiliates through Thanksgiving. It recounts the work and sacrifices of the Maryknoll Sisters who care for "the least of my brethren" around the world. Their sacrifices made and make the world a better place.

 

Most of the Maryknoll Sisters made a life-long commitment at a very young age. The same was true of my deceased uncle whom I eulogized last month. Thank you for your many heartfelt condolences! He entered the Jesuits at age 18 and never looked back. Other than entering the military, most of our young people are unprepared or unwilling to make such a monumental life decision so early in life.

 

So I was pleasantly surprised during a recent trip to St. Joseph's University, my alma mater, where freshmen are enrolling in unprecedented numbers in the FaithJustice program. These job-hungry students, often laden in debt, participate in a weekly off-campus outreach and then bring their experiences back to class for discussion and constructive debate. Much has been written about secular "social justice." FaithJustice is different. As Fred Kramer S.J. writes in his monograph by the same name, "FaithJustice is a passionate virtue, rooted in Faith in a generous God, which disposes men and women of all faiths to protect and enhance human dignity, develop their gifts for the common good, and treat the poor and disadvantaged with respect and a special love." This is a walk-by-faith restatement of the great Judeo-Christian value: Love of God and Love of Neighbor are inseparable! I am impressed that this program focuses the minds and hearts of gifted students on the needs of society so that they can begin to fashion creative solutions to build a better and more just world!

 

John A. Schmidt, MD 

Internist
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Time to Visit HealthCare.gov!

After a disastrous kick-off last year, Healthcare.gov appears to be working better since reopening on November 15. Some important points. Even if you already have a subsidized insurance policy through Obamacare, it is in your best interest to go back online and shop around. Premiums, subsidies, coverages, and your projected income have changed so go back online to find the plan that best fits your budget and your health care needs. If you decide to change your policy, notify your current insurance company to avoid double billing! Complete your application by December 15 (not February 15 when the site closes) to secure coverage by January 1! Don't let all the recent political hubbub distract you. Visit Healthcare.gov ASAP. I accept Medicaid patients and patients insured through HealthCare.gov.

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Non-obstructive Coronary Artery Disease and Risk of Myocardial Infarction (Heart Attack)

Most patients are relieved when their cardiologist performs a cardiac catheterization and reports no blockages. However, a study published in the November 5 issue of the Journal of the American Medical Association points out that even non-obstructive disease in one coronary artery increases the risk of a heart attack. Patients with non-obstructive disease in two or three coronary arteries have a fourfold increase in heart attack risk after only one year. The explanation is straightforward: even non-obstructing plaques can rupture and cause a heart attack. These results suggest two things: First, coronary angiography (and coronary CT) are useful because they detect obstructing and non-obstructing coronary plaques, both of which carry higher risk. Second, patients with non-obstructing plaques shouldn't rest on their laurels! They should minimize risk of a heart attack by (1) taking low dose aspirin; (2) reducing blood cholesterol through diet and medication; (3) reducing blood pressure and abdominal girth; (4) stopping smoking; (5) exercising vigorously; and (6) achieving normal weight!

Patients Taking Anticoagulants for Atrial Fibrillation (AF) Should Avoid NSAIDs!

Anticoagulation with warfarin (Coumadin) or one of the newer drugs (Pradaxa, Xarelto, Eliquis) protects AF patients against catastrophic stroke. A study published in the November 18 issue of the Annals of Internal Medicine warns patients taking anticoagulants for AF to avoid use of Nonsteroidal Anti-inflammatory Drugs (NSAIDs) such as ibuprofen and naproxen. Why? Because use of NSAIDs for as little as fourteen days significantly increases the risk of serious bleeding and, perversely, increases the risk of stroke! NSAIDs are widely available without a prescription in the United States. Patients are advised to use acetaminophen instead!

 

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Adding Ezetimibe to Statin Therapy Reduces Cardiovascular Events in High-Risk Patients with Acute Coronary Syndrome

As reported by the New York Times on November 17, there is finally a study suggesting that the addition of Ezetimibe (Zetia) to a moderately potent statin (Simvastatin/Zocor)can significantly reduce a composite endpoint including heart disease deaths, heart attacks, strokes, bypass surgeries, stent insertions and hospitalization for severe chest pain. The study has yet to be published in a peer reviewed journal. Moreover, because patients receiving both Ezetimibe and simvastatin had lower LDL levels, the study reinforces the hypothesis that lowering LDL (the bad cholesterol) is beneficial. I measure LDL in all of my patients and we discuss steps to lower LDL at every opportunity. Your latest LDL value is available in your Follow My Health patient portal account. (If you do not have an account, please call or email Valerie at your earliest convenience!) Bottom line: For statin intolerant individuals, Ezetimibe in combination with a moderate potency statin appears to be a viable cardioprotective option. 

Visit LungForce.org
November is Lung Cancer Awareness Month

Lung cancer is the still the leading cause of cancer death among Americans and whereas the incidence among men has decreased somewhat over the past 35 years, the incidence among women has more than doubled! The National Cancer Institute recommends that individuals between the ages of 55 and 80 who have smoked for more than thirty years and who either continue to smoke or stopped within the last 15 years should undergo low dose CT to detect lung cancer at a curable stage. If you or someone you love meets these criteria, here are some points to consider as you weigh the potential benefits of screening, as published in the New England Journal of Medicine on November 6:

 

1) Annual lung-cancer screening of high-risk smokers and former smokers with low-dose CT is at least as effective in preventing death from cancer as annual mammographic screening for breast cancer in women 50-59 years of age.

 

2) Among high-risk smokers and former smokers, screening with low-dose CT (along with subsequent evaluation and treatment) prevents one of five deaths from lung cancer.

 

 3) Lung cancer screening with low dose CT is not a single test. It is a process that involves annual testing and follow-up of screening-detected abnormalities.

 

4) False positive test results occur in approximately one of five low-dose CT screening examinations. Each exam is approximately 20 times as likely to yield a false positive as it is to reveal lung cancer.

 

5) Most false positive results will require follow-up with one or more subsequent CT scans, but a minority (5%) will require evaluation with invasive biopsy or surgery.

 

6) Screening for lung cancer with low-dose CT is not a substitute for smoking cessation. Stopping smoking is the most effective way to reduce the risk of death from lung cancer and has other important immediate and long-term cardiovascular and respiratory health benefits.

 

To help you decide if you should have low dose CT, use the tool on the American Lung Association web site.

Rant: Where is the Surgeon General?

With Ebola having arrived on our shores, where is the Surgeon General?  As reported in the November 13 issue of the New England Journal of Medicine, the answer is simple. Just when we needed a Surgeon General most, we don't have one!! The President and the Senate have failed to agree on an appointee. Ron Klain, the "Ebola Czar", is not a physician! The Surgeon General is the head of the United States Public Health Service, a corp of more than 6,800 full-time, well trained, highly qualified public health professionals dedicated to disease prevention. As a proud alumnus of the U.S. Public Health Service, I am horrified! If ever there was a need for a Surgeon General, the time is now! C. Everett Koop, a great physician, defender of human life and child development, and practitioner of FaithJustice, must be turning in his grave!

 

Valerie and I are grateful for you, our patients, and your patience! We wish you the Happiest of Thanksgivings!!  

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In This Issue
Let Us Give Thanks
Visit HealthCare.gov
Non-obstructive Coronary Artery Disease
Avoid NSAIDs
Statin Therapy
Where is the Surgeon General?

  

John A. Schmidt Jr., M.D.
Internist

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


 

 

"Poor health is not caused by something you don't have; it's caused by disturbing something that you already have. Healthy is not something that you need to get, it's something you have already if you don't disturb it."

~Dean Ornish
 

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 
  
  
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.