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May is in the Air (and so is Pollen!)
Perhaps it's a small price to pay for a lovely Spring but that green patina of pollen covering your windshield is also finding its way into your sinuses where it can cause sinus pain, sinus headache, post-nasal drip, and a sore throat. Asthma sufferers need to be prepared for exacerbations. Read the hay fever section in Medline Plus (from the National Library of Medicine, your tax dollars at work!) and then text or email me with any questions that you might have.
Over the counter remedies (fluticasone nasal spray (Flonase�), mometasone nasal spray (Nasonex�), fexofenadine (Allegra�), cetirizine (Zyrtec�)) used in combination with a sinus rinse
are often sufficient. Ketotifen (Zaditor�) is a topical OTC antihistamine for itchy eyes. Oral antihistamines that include pseudoephedrine as a decongestant (Allegra-DR, Zyrtec-DR, Claritin-DR and their generic equivalents) are often effective but should be avoided by patients with hypertension or cardiovascular disease. If needed, I can prescribe something stronger.
John A. Schmidt, MD
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High Flow Nasal Oxygen Better than Mask
Patients with serious underlying lung disease (emphysema and asthma) may experience exacerbations this time of year requiring supplemental oxygen. Many do not tolerate strapped-on oxygen masks because of claustrophobia. As reported in the May 17 online issue of the New England Journal of Medicine, there is now a more comfortable and more effective alternative that delivers high flow, warmed, and humidified oxygen through a comfortable nasal cannula called Optiflow�. John Barberio of Breathe Easy in Neptune recently recommended this device for a seriously ill patient of mine and the patient was far more comfortable and able to sleep soundly with the nasal cannula in place. The device is simple and rests easily on a night table.
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The 2.6 Billion Dollar Pill
The Tufts Center for the Study of Drug Development recently revised its bellwether estimate of what it costs to introduce a new branded medication: $2.6 billion, up from the 2003 estimate of $802 million. This is an important number because it has been used to defend the rising costs of new medicines. Interestingly, about half comes from the "cost of capital" which is the cost of borrowing the money to fund the project. This reflects the long cycle time for drug R&D, about eight years from the time the medicine is discovered until it reaches the market place. Only about 11 percent of medicines entering clinical trials make it to market so the successful products end up bearing the cost of the failures, reflecting the inability of the pharmaceutical industry to predict which drug candidates will ultimately succeed. As discussed by Dr. Avorn in the May 14 issue of the New England Journal of Medicine, this price tag may not adequately capture the investment made by taxpayers in National Institutes of Health (NIH) funded research. Given that so much innovation in medicine begins with research considered too risky by pharma companies, providing more funding to the NIH may be the nation's best health insurance policy.
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Telemedicine Practiced Here
As discussed in the April 30 issue of the New England Journal of Medicine, the use of phone and computer technology to provide medical advice is a growing enterprise with the potential to streamline care. Remember when you could only call your pediatrician between 8 and 9 AM? With today's cell phone, email and patient portal technology, 24-7 access to your primary care physician is a reality. I am a fan of telemedicine because it allows you and me to reach decisions faster. The flip side is accuracy. Accuracy depends on having as much reliable information at my fingertips as possible. I never cease to be amazed by patients calling or texting when I haven't seen them face-to-face for more than six months. In that setting, the risk of making the wrong decision trumps speed and convenience. If you keep me abreast of changes in your medical history by sending me records including medicines prescribed by other doctors, I can usually help you make the right decision quickly and accurately over the phone. How? Because I can see your Personal Health Information (PHI) on my laptop or iPAD no matter where you and I happen to be. And, even more importantly, you and I will have developed the trust that is essential to the patient-physician relationship. Even the tone in your voice gives me vital information once I get to know you. A prepared mind and attentive ears save the day!
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Dense Breasts
High breast density increases breast cancer risk and can mask tumors, decreasing the sensitivity of digital mammography. Since  2009, at least 21 states have enacted legislation mandating that women with BI-RADs-defined dense breasts receive information about this finding with their mammography results. Similar legislation is pending in Congress. More than 40 percent of women aged 40-74 (an estimated 27.6 million in the United States alone!) have heterogeneous or extremely dense breasts. Currently, there is no consensus on supplemental imaging in women with dense breasts. The authors of a study published in the May 19 issue of the Annals of Internal Medicine concluded that not all women with dense breasts were at sufficiently high risk to warrant supplemental screening with, for example, MRI or ultrasound. Rather, their data suggest that women know their five year risk score by using the Breast Cancer Surveillance Consortium (BCSC) calculator. Women with 5-year risk scores of 1.67 percent and extremely dense breasts or 2.5 percent and heterogeneously dense breasts may be appropriate candidates for additional imaging. Bottom line: know your breast density and calculate your five year risk score and then let's discuss if additional imaging is appropriate for you.
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Now Hear This!
I would like to thank the patients (more than 125!) who recently completed my online survey. Results will be presented next month! And if you haven't already, please visit my completely revamped website, SchmidtMD.com. Please send me your comments, preferably using the secure, encrypted email feature of your Follow My Health patient portal account. Thank you!
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The Greatest Mom in the World!
I can't conclude our May newsletter without mentioning my mom, mother of six, grandmother of 23, great grandmother of nine and a role model for hundreds. She will celebrate her 87th birthday this month. A high school graduate, she wrote and typed my dad's college term papers and continues to collaborate with him on everything. Mom has too many wonderful attributes to detail here but there is one that really stands out. She is an excellent correspondent. All of us have shoe boxes full of mom's beautifully inscribed birthday cards, anniversary cards, Valentine cards, and Father's and Mother's Day cards. Happy Birthday Mom!
Valerie, Morgan, and I wish you a safe and restful Memorial Day Weekend!
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