Issue: 67

August: E Pluribus Unum Under Fire!
Read the back of your dollar bill!  The banner held tightly in the beak of our national emblem says: E Pluribus Unum, "one from many."  It means that the great melting pot known as the United States of America embraces everyone from native Americans to the descendants of slaves to every immigrant from every nation, regardless of gender, race, religion, or sexual orientation.  It is therefore disheartening and frightening, just as our country and our allies have come under nuclear threat from a rogue totalitarian regime, that our President and his staff are condoning dissension, bigotry, and hate at home when we can least afford it!  As Benjamin Franklin famously said, "If we don't hang together, we shall surely hang separately!" Our history has proven him right.  Our strength doesn't come from our nuclear arsenal; it comes from our resolve to stand together as a unified people committed to preserving and defending our freedoms no matter what the personal cost.  "Our finest hour," paraphrasing Winston Churchill, is when we stand up to oppression together.  The recent excellent film, "Dunkirk," captures in visceral detail what all patriots know instinctively: "Work together for a common cause!  Those who would tear the tapestry of our nation into shreds make us prey for our enemies abroad. Take heed! Our country is at stake!  Our enemies are seeking to destroy us from within!"
John A. Schmidt, MD 
Identity Politics
I'm the last one to agree with the ousted White House Advisor, Steve Bannon , but he might have one thing right.  " Identity Politics " is partly to blame for the dissension in our nation.  Columbia University Professor, Mark Lilla , an avowed liberal, is equally critical of identity politics.  As reported on on August 25, "Democrats have thrown themselves headlong into identity politics, focusing on what divides rather than what unites.  As a result, many feel alienated from a party that once knew how to bring people together." IOW, Democrats have taken the bait from the Divider-in-Chief and need to rethink their strategy.  Republicans should do the same if they hope to represent a broad cross section of Americans, not just a distorted patchwork of gerrymandered voting districts! 
Flu Vaccine: Get Yours Now!
Though it's still summer, it's time to prepare for the autumn/winter flu season. The flu vaccine isn't perfect, we know that. The virus is capable of mutation and thereby evading the protection afforded by the vaccine.  As reported by the Centers for Disease Control (CDC) in the New England Journal of Medicine on August 10, last year's flu-vaccine was 48% effective "against any influenza illness."  Some scoff at such results.  But let me ask you, would you pay $30 to avoid missing two weeks of work, missing a family reunion, spending Christmas/Hanukkah/Kwanzaa flat on your back in bed, or escaping a potentially life-threatening flu-pneumonia? The other thing to remember is that if you skip the vaccine and get the flu, you will infect everyone you love and many you will never know, including pregnant women who are especially susceptible. Get your flu vaccine!  It's your duty to yourself, the ones you love, your coworkers and you neighbors! The life you save may be a pregnant mother you will never know.

Seniors need a stronger vaccine to protect themselves and the ones around them. This year there are two good options. The first is Flu-HD , which is four times the standard dose. The second is new and is called FLUAD because it incorporates an adjuvant (AD) to make the vaccine more effective.  The CDC say both are appropriate for seniors. A sore arm is little price to pay for added protection!
Statins, Cholesterol, and Impaired Cognition
Statins , your best defense against heart attack and stroke , have been dangerously vilified by the internet, as discussed in last month's newsletter.  Even astute physicians occasionally fall prey to the "alternative facts" offered up by Twitter.  One of the many apocryphal tails is that statins cause impaired cognition , aka dementia . To wit, I recently took my mom to her cardiologist after she suffered a transient ischemic attack (TIA) , expecting him to prescribe a statin in accordance with every guideline when he shockingly said, "There is some data that statins cause mental decline in seniors." WHAAATT!  I was torn between undermining my mother's trust in her (otherwise excellent) cardiologist and getting her the protection, she needed to prevent a stroke!

Fortunately, there is clear evidence showing that those taking statins need not worry about "losing their marbles."  As reported in the August 17 issue of the New England Journal of Medicine ,"...the Statin Cognitive Safety Task Force in 2014 concluded that statins are not associated with adverse effects on cognition.  Furthermore, a study using eight neuropsychological measures and functional magnetic resonance imaging (MRI) showed no convincing evidence of memory dysfunction as a result of atorvastatin therapy ."  Atorvastatin is the statin I prescribe.  The article went on to report that further reductions in LDL (bad) cholesterol to an unprecedented low level of 33 mg/dL with an anti-PCSK-9 antibody ( Evolocumab ; Repatha® ) had no effect on cognitive function .  Heart attacks and strokes will take away your marbles but statins do not!
Effect of Intensive Blood-Pressure Treatment on Patient-Reported Outcomes
Most of my patients know by now that Ms. Clark and I treat high blood pressure aggressively according to the norms established by the Systolic Blood Pressure Intervention Trial (SPRINT) reported in the fall of 2015 by the National Institutes of Health.  SPRINT showed that among older adults with hypertension and a high risk of cardiovascular disease , treatment to a systolic blood pressure (top number) of less than 120 mmHg led to lower rates of cardiovascular events and death than treatment to a systolic blood pressure of less than 140 mmHg.  We are gratified that the majority of our hypertensive patients have wisely accepted this guidance, purchased blood pressure cuffs , limited their sodium intake, and faithfully taken their blood pressure medicines every morning to realize the benefits of aggressive blood pressure lowering therapy .  Inevitably, there has been push back with some patients saying that they feel less well.  Addressing their concern, the Sprint investigators report in the August 24 issue of the New England Journal of Medicine "that participants who were treated to a systolic blood pressure of 120 mm Hg experienced the same quality of life as those treated to a systolic blood pressure of 140 mm Hg, including participants with decreased physical or cognitive function."  Interestingly, patients knew which group they had been assigned to. The authors conclude, "...patients should be reassured that intensive treatment not only reduces the risk of cardiovascular events and death, but will result in few side effects as shown in patient-reported assessments."
Patient Portal Please!!
To encourage you to try the  Follow My Health Patient Portal, we decided to offer an incentive. Everyone that communicates with me during the month via email on our secure portal will be placed into a drawing for a $50 AMEX gift certificate. One lucky patient will win the gift certificate each month. I hope this will encourage you to give the Patient Portal a try. Not only will you save time when you need to make an appointment, request a prescription refill, ask me a question, or review your lab results, but you can enjoy dinner on me!

As discussed in previous newsletters, the patient portal is one of the most efficient ways to keep in touch with us and manage your health care. The portal gives you access to your personal health information (PHI), including LabCorp results, and it also allows you to communicate with me using encrypted, HIPAA compliant, email. You will get faster answers and notifications of your lab results. 

If you do not already have a portal account, kindly ask Valerie to send you an invitation today!!!
Now Hear This!
Always remember to bring all of your prescription and over-the-counter medicine bottles/inhalers to each and every office visit!! The labels on the bottles/inhalers are very helpful to us because they show not only the name of the medicine, but the strength, schedule, name of the prescriber, the number of refills remaining, and name of the dispensing pharmacy.  This helps us avoid medication errors and serve you better!!

Ms. Morgan Richardson, RN, will be leaving us soon to work for Hackensack-Meridian at their Riverview Hospital facility.  Congratulations, Morgan!!  We will miss you!  Morgan has had such a positive impact on our practice that Valerie and I are actively recruiting a Certified Medical Assistant to assist Valerie in our front-office.  The job posting can be found on the Indeed website.  Referrals of qualified applicants are gratefully appreciated. 

Ms. Clark, Valerie, Morgan, and I wish you and yours a restful Labor Day weekend!!
In This Issue
August: E Pluribus Unum Under Fire!
Identity Politics
Flu Vaccine: Get Yours Now!
Statins, Cholesterol, and Impaired Cognition
Effect of Intensive Blood-Pressure Treatment on Patient-Reported Outcomes
Patient Portal Please!!
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 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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Click here to learn more about the benefits of our Follow My Health Patient Portal and register today! You can make appointments and get your lab results on the portal. Simply ask Valerie to send you an invitation. Call 732-282-8166.

"I am concerned for the security of our great Nation; not so much because of any threat from without, but because of the insidious forces working from within." 
- Douglas MacArthur


Dr. Schmidt's New Office in Spring Lake Heights
John A. Schmidt Jr., MD
Meaningful Medicine in Your Medical Home
2006 Highway 71, Ste. 3, Spring Lake Heights, NJ 07762
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.