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September Brings the Equinox and SAD
September 23 marked the fall Equinox when the sun was directly over the Equator equally dividing the day between sunshine and darkness. For some, it is a time to "take back the shore," sip pumpkin spice lattes, and decorate their threshold with bundled corn stalks. For others, it marks the dreaded beginning of shorter days and longer nights. If that is how you feel, you may suffer from Seasonal Affective Disorder (SAD) and should seek help NOW to head off the gloomies. I can help.
John A. Schmidt, MD
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Planned Parenthood Tissue Donation Violates Bioethics
Blood, tissue, and organ donation requires the permission of the donor. For example, when you renewed your driver's license, you may have granted permission to remove and donate your organs following a fatal motor vehicle accident. Without your permission or the permission of the proxy you identified in your living will, your tissues cannot be donated no matter how worthy the intent or desperate the recipient. Furthermore, donors must not be paid. Why? To avoid coercion, especially when the donor or the proxy may be in dire financial straits. Now comes news in the September 3 issue of the New England Journal of Medicine and other media that Planned Parenthood provides fetal tissue for biomedical research in exchange for money and without the permission of the donor. All juveniles must have a guardian until they reach majority age. In utero, the mother serves as the fetus's legal guardian and is thus empowered to authorize in-life procedures such as amniocentesis. Because abortion puts the fetus in an adversarial relationship with the mother and the persons performing the abortion, Planned Parenthood in this case, the courts should provide a neutral guardian to advocate for the fetus's pre and post abortion rights without taint of coercion or financial gain.
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Healthy Wall Woman Succumbs to West Nile Virus
As reported by the Asbury Park Press on September 15, a resident of Wall Township unfortunately died of mosquito-borne West Nile Virus (WNV), the second New Jersey resident to die of WNV this year. The disease is known to peak in August and September and mosquitoes in all twenty-one counties have tested positive for the virus which they typically acquire from the carcasses of infected crows. Several patients have come to my office covered in mosquito bites. I tell them that their best defense is to apply insect repellent, especially DEET, before going outdoors. DEET-impregnated clothing is available for outdoor enthusiasts. I also encourage long sleeve shirts and pants, staying inside at dusk and dawn when mosquitoes feed, and elimination of pools of standing water where mosquitoes breed. According to the article, Monmouth County has sprayed the West Belmar section of Wall Township and Spring Lake Heights (where I reside!). Fortunately, only about 25 percent of those infected develop symptoms. Age is by far the most important risk factor. The virus kills by causing encephalitis, an infection of the brain. Symptoms include fever, headache, loss of balance, impaired memory, and weakness. The incubation period is highly variable, usually 2 to 14 days after a bite. Even though there is no cure, symptomatic patients should seek medical attention immediately for diagnostic testing and intensive care!
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Blood Pressure: How Low to Go?
As reported in past newsletters, blood pressure targets were recently and surprisingly revised upward (between 140/90 and 150/90) because there was no definitive evidence to aim lower. Now comes exciting new data from the National Institutes of Health (NIH) that their nine-year, $114 million study, called SPRINT (Systolic Blood Pressure Intervention Trial), showed that patients with a lower systolic blood pressure (the top number) did much better. As reported by the Department of Health and Human Services/NIH on September 11, "More intensive management of blood pressure significantly reduced rates of cardiovascular disease and death in a group of adults 50 years and older." The results were so dramatic that the trial was stopped ahead of schedule. The study population was large and diverse and included men, women, racial/ethnic minorities, and the elderly. The control group typically received two blood pressure medications to achieve a systolic blood pressure less than 140 mm Hg whereas the therapeutic group typically received three medicines to achieve a systolic blood pressure below 120 mm Hg. The study will be published in the next few months. While more is not always better, it now appears that patients with hypertension and at least one additional risk factor for cardiovascular disease (positive family history in a first degree relative, elevated cholesterol, smoking, diabetes, and/or kidney disease) should aim for a systolic blood pressure less than 120 mm Hg. The report made no mention of side effects, a critical part of the risk-benefit discussion when treating hypertension. In the meantime, I cannot over emphasize the importance of monitoring blood pressure at home, morning and evening, with a digital blood pressure cuff using fresh batteries and good technique. Buy an arm cuff and avoid wrist cuffs! Bring your results to your next appointment so that you and I can make sure that you are adequately treated!
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Aspirin Makes News Again!
One of the many things I learned in the Pharma Industry was that great medicines become greater as we learn how to use them better! Now comes guidance from the United States Preventive Services Task Force (your tax dollars at work!) that a daily low dose aspirin is beneficial in most patients between the ages of 50 and 60 for not one but two reasons. First, aspirin reduces the risk of heart attack and stroke among those at risk and, secondly, reduces the risk of colon cancer among those who take the medication for at least ten years. I appreciate the nuanced, context-dependent, guidance of the USPSTF. If you have a high risk of a heart attack or stroke, take the aspirin for goodness sake! If you have bled from an ulcer or take medicines that increase the risk of bleeding (NSAIDs, warfarin), think twice. I can help you weigh the pros and cons. I have many middle-aged patients who take numerous unproven supplements but not aspirin. They need to think again! Visit my website (www.SchmidtMD.com) for advice from the USPSTF on a whole range of medically relevant topics.
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Part D Enrollment Begins on October 15!
As you can tell, I am focused on medications because I believe in them. When used wisely, medications can prolong and save lives. Unfortunately, medications have become increasingly expensive. Your defense is to visit the Medicare.gov web site and choose the Medicare Part D plan that best meets your needs while reducing your out-of-pocket costs. Enter your medication list and choose the plan that gives you the best value for your hard earned dollars!
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Now Hear This!
My wonderful grandson, John Parker Hudson, turned one year old on September 23! He is an Equinox child and happy as can be (but only half as happy as his grandpa)!
Valerie, Morgan, and I wish you a wonderful autumn full of color, marshmallows on the campfire, and glorious sunsets!
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Internist
Dr. Schmidt is one of the leading internists in Monmouth County offering Medical Home services.
He is an Associate Attending in the Department of Medicine, Jersey Shore University Medical Center, and Clinical Assistant Professor in the Department of Medicine, Rutgers Robert Wood Johnson Medical School.
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