February 2017
Issue: 61

February and Freedom
Freedom is so fundamental, so precious, and so fragile. Our country has prospered because we remain the leading laboratory for the exploration of what it means to be free. To the consternation of many, our nation has worked tirelessly to safeguard the rights of the accused, the rights of the unborn and the mothers who carry them, the imprisoned, the alien, the LGBTQ communities, women in our military, and the terminally ill. Do we always agree? Certainly not! But our continuous quest for freedom and our willingness to sacrifice to preserve it is what makes us great! Freedom, as Ronald Reagan said, makes us the " Shining City on the Hill!"
When we see eminent news organizations denied access to White House briefings and hear the press labeled as the "enemy of the people," we know that our cherished First Amendment freedoms are under attack. Sound the Alarm! Let Freedom Ring! 
John A. Schmidt, MD 
The Affordable Care Act
While repeal of the Affordable Care Act (ACA) seems likely, we must make sure that the principles enshrined in the ACA are not. These include access to care regardless of income or prior illness and safeguards against medical bankruptcy. Access to affordable medical care is a right, not a privilege. If the new legislation leads to improved access at lower cost, as promised, our freedoms will have been expanded. If access to care is denied or limited, an essential freedom will have been forfeited.
As discussed in the New York Times on February 25, some states are contemplating work requirements for Medicaid recipients. But as Leonardo Cuello, Director of Health Policy for the National Health Law Program in Washington said, "Applying work requirements to health coverage gets it exactly backward. An individual needs to be healthy to work, and a work requirement may prevent them from getting the health care they need in order to be able to work." This would be especially true in an economic downturn such as the "Great Recession."
Expansion of Addiction Coverage in New Jersey
Whatever you think of Governor Christie, he did expand Medicaid Coverage in New Jersey under the auspices of the Affordable Care Act (ACA) adding hundreds of thousands to the state's Medicaid program. In the same spirit of expanded coverage, he signed legislation on February 15 designed to address the state's narcotic addiction crisis. As reported in U.S. News and World Report, the legislation requires state-regulated health insurers cover inpatient and outpatient treatment for drug addiction. The law also limits initial opioid prescriptions to a five-day supply, making New Jersey's the most stringent in the country. The prescription drug limit would not apply to cancer and chronic pain patients or end-of-life care. The governor is encouraging those with addiction problems to call 1-844-ReachNJ. Nearly 1,600 people died from opioid overdose in New Jersey in 2015 
Osteoporosis: A Call to Action
Bone density peaks in late adolescence and then, like lung capacity, declines with age. The loss of bone density is known as osteoporosis (porous bones) and osteoporotic bones are more susceptible to fracture. As reported at the annual meeting of the American Society for Bone and Mineral Research (ASBMR) in September 2016, 1 in 2 women and 1 in 5 men over the age of 50 will have an osteoporotic fracture of the hip, spine, and/or wrist. With the introduction of effective treatments, the rate of hip fracture in the U.S. steadily declined but then leveled off in 2013-2014 most likely due to inflated fears about rare drug related side effects such as osteonecrosis of the jaw. Experts point out that the benefits of therapy far outweigh the risk of side effects. Once again, the abundance of misinformation on the internet has fueled irrational fears and degraded the health of seniors. Fearing a rebound in osteoporotic fractures, three dozen national and international organizations issued a "call to action" stressing the importance of early diagnosis and treatment of osteoporosis. The American Association of Clinical Endocrinologists (AACE) recommends alendronate ( Fosamax ®), risedronate ( Actonel ®), zoledronic acid ( Reclast ®) or denosumab ( Prolia ®) in patients with moderate risk, as determined by the FRAX calculator. In patients with high fracture risk due to advanced age, frailty, prior steroid treatment, very low T scores, or positive family history, the AACE recommends an injectable such as denosumab (Prolia ®), teriparatide ( Forteo ®), or zoledronic acid (Reclast ®). Let's discuss your bone density at your next visit! 
New 2017 GOLD Guidelines for Chronic Obstructive Lung Disease (COPD)
The GOLD ( Global Initiative for Obstructive Lung Disease) guidelines for diagnosis and treatment of COPD/ emphysema have been updated. The new guidelines suggest that severity be based on patient's symptoms as well as frequency and severity of exacerbations rather than spirometry because spirometry does not correlate well with functional limitation and quality of life.
According to the new recommendations, almost all patient with symptomatic COPD should be treated with a long acting inhaled beta agonist (LABA), such as salmeterol or formoterol) or a long acting muscarinic antagonist (LAMA), such as Spiriva ® or both, preferably using one of the newer once daily inhaled combination products ( Stiolto Respimat ® or Anoro Elipta ®).
In a major departure from previous guidelines, inhaled steroid products (e.g. Advair ®) are recommended only in patients who have failed treatment with a combination bronchodilator (i.e. LABA + LAMA).
Oral PDE4 inhibitors ( Daliresp®/roflumilast) are only recommended in patients who have failed inhaled steroids.
Treatment of pulmonary hypertension with Viagra ®/ Revatio ®/ sildenafil or Cialis ®/ Adcirca ®/ tadalafil) is not recommended.
The cutoff for oxygen therapy continues to be an oxygen saturation less than 88% while inspiring room air at rest.
Exercise and vaccination against influenza and pneumococci ( Prevnar-13, Pneumovax 23) are recommended for all patients. Patients with severe disease should enroll in a Pulmonary Rehabilitation program
Patient Portal Please!!
I continue to offer, at no charge and for your convenience, the Follow My Health Patient Portal. If you do not already have an account, kindly ask Valerie to send you an invitation. 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 notification of your lab results if you have a portal account. Sign up today!!!
Now Hear This!

I am grateful to the large number of Dr. Maseda's patients who have made appointments. Welcome!
We anxiously await the imminent birth of our fourth grandchild to our third daughter and her wonderful husband, both physicians in Philadelphia! Each pregnancy fills me with admiration for mothers and the spouses that support them!!! 
In This Issue
February and Freedom
The Affordable Care Act
Expansion of Addiction Coverage in New Jersey
Osteoporosis: A Call to Action
New 2017 GOLD Guidelines for COPD
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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"Free at last, free at last! Thank God, Almighty! I'm free at last!"
- Martin Luther King 

Dr. Schmidt's New Office
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.