Issue: 49

February-a cold Valentine from Mother Nature!
Looking out my window, I have already seen bands of robins bravely making their way northward despite the frigid cold. Isn't it marvelous how nature anticipates the thaw!

John A. Schmidt, MD 
Justice Antonin Scalia
Justice Scalia died suddenly on February 13, after serving 30 years on the Supreme Court.
The only child of immigrant parents, and a native of Trenton, Justice Scalia modeled how one makes the most of humble beginnings and God given talents. An excellent student, he attended parochial school, Xavier Prep in Manhattan, Georgetown University, and Harvard Law School. Like Pope Francis, he was Jesuit trained and therefore mission oriented. Gifted intellectually, his faith was his guiding light.
He and Maureen McCarthy Scalia, his formidable wife of more than fifty years, were gifted with nine children and more than twenty grands!
His fellow justices mourned him despite their strong philosophical differences. Justice Ginsberg, his polar opposite in terms of her constitutional views, was a particularly close friend.
The crowning glory of the funeral ceremony was the homily offered by his son Paul, a Catholic priest. He said that all of us, including his revered father, are sinners. The miracle, he said, was that the Son of God was willing to die to make sure that a U.S. Justice would receive mercy in the kingdom of heaven!
Oh so good, in this political season, that we have an authentic example of what it means to be a salt-of-the earth AMERICAN!
Zika Virus
Named after the Ugandan forest in which it was first isolated from a sentinel monkey in 1947, this mosquito transmitted virus is now spreading in the tropics of the Americas, especially northeastern Brazil. Zika has been linked to a sharp uptick in the number of children tragically born with microcephaly, defined as abnormally low head circumference and a paralytic syndrome known as Guillian-Barre.  
The virus is in the class known as Flavivirus, a family of RNA viral pathogens to which Yellow Fever, West Nile, and Dengue also belong. The strain is similar to Zica found in Asia raising the possibility that the virus was imported during the 2014 World Cup soccer games held in Brazil and raising concerns for athletes traveling to Brazil for the 2016 summer Olympics to be held in Rio de Janeiro. Vaccines have been developed for Yellow Fever and Dengue giving hope, as Dr. Anthony Fauci of the NIH recently said, that a vaccine can ultimately be developed to prevent Zika.
The symptoms are similar to Dengue, one of the most common infections found in travelers returning to the U.S. from Asia and India, and consist of a rash and muscle aches. Almost all recover spontaneously without specific treatment. The complications of paralysis and fetal damage, however, are potentially disastrous.
There is no known reservoir for Zika other than humans. Thus the usual mosquito control measures consisting of permethrin impregnated clothing with long sleeves and pants, permethrin-impregnated mosquito nets, application of DEET and drainage of standing water are your best protections if you plan to travel to the tropics of the Americas. Women who are pregnant or contemplating pregnancy would be wise to stay home.
Several persons returning to the U.S. from Brazil have tested positive for the virus. As reported in the February 10 issue of the Annals of Internal Medicine, one of these was a Massachusetts resident who traveled to Costa Rica, a favorite Central American resort destination for U.S. Americans.
Are there other examples where virus infection of the mother can lead to serious birth defects? Yes, the best known being rubella, aka German Measles. Because infections in the first trimester pose the greatest risk, it is essential that women contemplating pregnancy be tested for immunity to rubella and, if necessary, be vaccinated with the vaccine known as MMR (measles, mumps, and rubella) one month in advance of conception, as this is a live attenuated vaccine. MMR has prevented thousands of birth defects!! Vaccination of healthy children prevents birth defects by halting the spread of rubella. Do your part by making sure your children receive MMR!
Cancer in Elephants
As published online in the Journal of the American Medical Association (JAMA) on October 8, 2015, a group of researchers at the University of Utah found that elephants have a lifetime cancer mortality rate of less than 5 percent. The lifetime cancer mortality rate for humans, in contrast, is about 20 percent.
Cancer is caused by genetic changes, DNA mutations, that allow cells to grow and divide uncontrollably. Agents such as tobacco smoke and UV rays found in sunlight are known to damage DNA and predispose to cancer.
As summarized on the NIH web site (nih.gov) the researchers looked into the elephant genome and focused on the TP53 gene which encodes a protein called p53. p53 is a tumor suppressor that stops cells with damaged DNA from dividing. People normally have two copies while patients with only one have a 90 percent lifetime risk of developing cancer. African elephants have at least 40 copies. The scientists concluded, "Nature has already figured out how to prevent cancer. It is up to us to learn how different animals tackle the problem so we can adapt those strategies to prevent cancer in people!"
Medicines Used to Treat Heartburn Pose Long Term Risks
Proton pump inhibitors (PPI's) such as omeprazole (Prilosec) and esomeprazole (Nexium) turn off stomach acid and have revolutionized the treatment of ulcers and GERD. Most patients only have to take the medications for a few days or, at most, a few weeks in order to heal. Some, however, take the medicines for years because they have persistent symptoms or forget to stop.
As published in the February issue of JAMA Internal Medicine, Johns Hopkins researchers found that chronic use of PPIs is associated with chronic renal disease. Other problems associated with long-term use include reduced absorption of important minerals such as calcium, magnesium, and iron, as well as osteoporotic fractures. While not proof, the results remind us that long term use of PPIs, especially in the elderly, is to be strongly discouraged. For those with chronic complaints, elimination of problematic foods such as caffeinated beverages and chocolate and/or switching to H2 blockers such as famotidine (Pepcid) should be seriously considered.
Hats Off to the Spring Lake/Spring Heights EMT Team!                                                            
I was recently called over to a neighbor's house late one night to find an elderly patient vomiting. I asked the caregiver to call 911. Within 2-3 minutes, a police cruiser pulled into the driveway. The Spring Lake Heights officer immediately donned gloves and measured the patient's blood pressure. No sooner had he done so than the EMT squad, six persons strong, came through the doorway and promptly assessed the patient and evacuated him to the ER at Jersey Shore University Medical Center, all in the space of a few minutes. We are so fortunate to have such talented and dedicated professionals who, no matter the time of day or night, rush to our side to keep us safe. 
Now Hear This!
I am pleased to announce that Ms. Monica Clark, a certified Physician Assistant, will be joining my practice to help me provide you the prompt, excellent, and comprehensive care you deserve. A New Jersey native, former officer in the Navy, and mother of two, Ms. Clark brings more than ten years of experience to this important role. I look forward to introducing you in the near future!
Valerie, Morgan, Monica, and I wish you an early Spring!
In This Issue
February-a cold Valentine from Mother Nature!
Justice Antonin Scalia
Zika Virus
Cancer in Elephants
Medicines Used to Treat Heartburn Pose Long Term Risks
Hats Off to the Spring Lake/Spring Heights EMT Team!
Now Hear This
John A. Schmidt Jr., M.D.
Board Certified 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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"They say an elephant never forgets. Well, you are not an elephant. Take notes, constantly. Save interesting thoughts, quotations, films, technologies...the medium doesn't matter, so long as it inspires you."
Aaron Koblin

Monica Clark

Certified Physician Assistant

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.