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April: We Can Do Better!!
As I lay awake at night asking myself how to help you achieve a healthier, happier, and more fulfilling life, it occurs to me that we must begin with a joint commitment to do better! This means constantly working together to prevent the medical catastrophes that would otherwise keep you from enjoying the long life you deserve! The solution lies in the details and frequent communication! Many of my patients are, regrettably, averse to details and communication. They often suffer the dire consequences. For those who are willing to pay attention to detail and communicate with Ms. Clark and me by text, patient portal, and phone, the future is bright!
John A. Schmidt, MD
Internist
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Hypertension Revisited A Higher Level of Care!
As published in a landmark study in the April 19 issue of the New England Journal of Medicine, high blood pressure (
hypertension
) is the most important risk factor for
heart attack
, stroke, and
congestive heart failure
, the diseases that most often incapacitate and kill my patients. Fortunately, it is the easiest risk factor to treat.
This excellent registry study, conducted in Spain, encourages us to identify hypertension in all its nasty forms:
high blood pressure
in my office including
"white coat" hypertension
, hypertension in your home using a
battery-operated cuff
, and hypertension measured over 24 hours with an
automated blood pressure cuff
(available at Jersey Shore University Medical Center and Monmouth Cardiology Associates). The study showed that 24-hour recordings are the best predictor of
cardiovascular outcome
. Based on this study, I will encourage my hypertensive patients to wear an automated blood pressure cuff for 24 hours. Follow up recordings will tell us if your blood pressure medications are sufficient to keep you safe.
Sodium restriction continues to be the cornerstone of systolic blood pressure control. No salt! (Kosher Salt, Sea Salt, it's all salt, forget about it, don't be like my dear mother! It's still salt!!!!). For those unwilling to take blood pressure medications, exercise vigorously and lose weight!! Better yet, exercise, lose weight, avoid sodium/salt, and take medication to achieve an average systolic blood pressure less than 120 mmHg as recommended by the landmark
Sprint Trial
. Except on rare occasions, avoid
nonsteroidal anti-inflammatory drugs
(NSAIDs) such as ibuprofen, etc. which cause sodium retention and higher blood pressure.
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Opioid Epidemic-Join the Fight!!
I have to be honest. My Puritanical-Catholic instincts told me I should avoid opioid addicts like the plaque. But things have changed for the worse. As reported in the April 26 issue of the
New England Journal of Medicine
, it's no longer about addiction; it's about premature death and human trafficking. Last year, our dear country lost more people to opioid deaths than in the entire Viet Nam War!! The worst people in our society prey on addicts and enslave them!! Let's prosecute those who prey on addicts, not those they enslave!
The main reason addicts die is because the heroin they buy, pimp their body, and steal for, is often laced with
fentanyl
without their knowledge. Fentanyl is six times more potent than heroin. They stop breathing and end up in a flowered coffin!!
As reported in the Journal, our good neighbor to the north, Canada, has proposed several creative, yet unproven, solutions that our former and present governor should consider if they are serious about confronting the epidemic.
One innovative idea, crazy though it sounds, is to provide centers where addicts can safely inject heroin. This allows usage of clean needles, to prevent transmission of
HIV
and
Hepatitis C,
and testing to make sure that the heroin is unadulterated. In the event of an overdose,
naloxone
(
Narcan®
) can be give on the spot to avoid respiratory failure. Such out-patient centers introduce patients to safer alternatives such as
methadone
,
buprenorphine
, or
naltrexone
and tend to their other health needs. In-patient detox centers, though heavily favored by current legislation and lucrative for their owners, are at best half-way houses to better, more durable out-patient solutions.
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Gene Therapy for Beta-Thalassemia!
Hemoglobin
is the essential protein your red blood cells use to transport oxygen to your tissues.
Lance Armstrong
, a disgrace to the international cycling community and the United States, used an illegal hormone to boost his hemoglobin levels and win the Tour de France. But what if one or two of the genes encoding your hemoglobin are defective? Such conditions are called
hemoglobinopathies
and include the
thalassemias
and
sickle cell disease
. I have many patients in my practice with thalassemia minor. They have small red blood cells and are generally
asymptomatic
. Patients with severe disease, on the other hand, require frequent
blood transfusions
to survive.
Now comes a breakthrough alternative to blood transfusion for severely affected patients. As reported in the April 19 issue of the
New England Journal of Medicine
,
bone marrow stem cells
were safely harvested from the
peripheral blood
of patients with severe
beta-thalassemia
. After an engineered virus was used to insert a
gene encoding
the correct form of the
hemoglobin molecule
, the stem cells were infused back into the patients. The stem cells "homed" to the bone marrow and made red blood cells carrying normal copies of the hemoglobin molecule. After a median follow up of 26 months, patients required either no, or significantly less, transfused blood.
A competing technology known as
CRISPR-Cas9
repairs the mutation in the defective hemoglobin gene and is showing great promise. As with
CAR T therapy
for
acute lymphoblastic leukemia
(ALL), these technologies depend on the ability of scientists to culture, engineer, and grow normal blood cells outside the body (ex vivo) before they are infused back into the patient.
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My wife, Dr. Rita Watson, has resumed golf at Fairway Mews! We are very grateful to the many patients who have given us encouragement and moral support!!
I am also pleased to announce that Ms. Suzette Catong, APN, has joined my practice and will assist me in caring for patients in nursing homes and rehabilitation facilities. Ms. Catong has extensive experience as an advanced practice nurse. Welcome!!
Valerie, Ms. Clark, Ms. Catong, and I wish you a pleasant Spring!!
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Board Certified Internist
Dr. Schmidt is one of the leading internists in Monmouth County offering
Medical Home
services.
He is an attending physician at Jersey Shore University Medical Center.
Dr. Schmidt is enrolled in the Maintenance of Certification Program of the American Board of Internal Medicine
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"The best preparation for tomorrow is doing your best today."
- H. Jackson Brown, Jr.
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