Issue: 64

May: Gratitude for Sacrifice!
If you are a believer in semiannual celebrations as I am, May and November have much in common: both kick off wonderful seasons with thanks. In November, we give thanks for a bountiful harvest. In May, we give thanks for our mothers and our fallen veterans. Coincidence? Mothers hope that their children will blossom and grow to experience a brighter future. They sacrifice self to give their child every chance to live abundantly. Our fallen and surviving veterans embraced the same vision: sacrifice self to safeguard the freedom of others. Remember that May, in all of its effulgence, is a celebration of hope and the sacrifice required to realize a better world! May we be worthy of the mothers and veterans who have struggled to make our world a better place in which to live and follow their wonderful example!!  
John A. Schmidt, MD 
Reflection on the Renaissance in Therapeutics!
I am an internist and medicines are my stock-in-trade.  I remember my days as a medical intern and resident at the Hospital of the University of Pennsylvania in Philadelphia surrounded by the Giants of Medicine.  My fellow interns and residents, my future wife among them, knew that we were surrounded by visionaries.  We were humbled by the experience, hoping that someday we might advance the practice of medicine as they had, painstaking step by painstaking step.  Therapeutics was on the eve of a renaissance. Fortunately, thanks in large part to their outstanding and selfless efforts, our field has advanced brilliantly and the renaissance is in full bloom!  We are grateful for their dedication and splendid example!  

My goal is to make sure my patients fully realize the blooming Renaissance in Therapeutics , albeit within the confines of their often-stingy insurance plans. Bring each and every one of your medicines to each and every appointment!! This helps me make sure you have everything you need to live your life to the full!!
Currents in Medical Therapeutics
I read the medical literature voraciously for Advances in Therapeutics  and currents in care. By currents I mean the ebb and flow of new information as each of the medical specialties work as a far-flung team sharing and comparing data to identify the next advance. As an example, thousands of oncologists from around the world will attend the American Society of Clinical Oncology  (ASCO)  meeting for four days in Chicago next week to discuss the latest advances in cancer diagnosis and treatment . (I am proud to report that our oldest daughter, a freshly minted oncologist with degrees from Northwestern, UPenn, and Duke, and mother of two beauties, will be among the presenters!! Great to see that moms have taken their rightful place among the modern Giants of Medicine!).

These meetings are important because they bring together the best and the brightest in each field of Medicine to distill what is truly of value to patients. For sure, the pharma companies are an important part of the mix, but leave it to discerning physicians (and the Food and Drug Administration) to figure out what is truly of value to the patients we serve.
Recent Examples of the Renaissance in Therapeutics by Medical Sub-Specialty
Oncology : The PD-1 antibodies  ( Opdivo®  and  Keytruda® ) and the PD-L1 antibodies ( Tecentriq®  and  Imfinzi® ) harness the power of the immune system to kill cancer cells. No doubt these medicines will be a major topic in Chicago as oncologists learn how best to use them for the treatment of non-small cell lung cancer, head and neck cancers , melanoma, renal cell cancer, and bladder cancer . These antibodies are not cures, and they may have serious auto-immune side effects, but their impact on cancer therapeutics  will no doubt grow as oncologists learn how to use them more safely and effectively and in combination with other modalities such as chemotherapy, radiation, and surgery.

Cardiology: The first of the ARNI's ( angiotensin receptor-neprilysin inhibitor known as Entresto®  which combines an angiotensin receptor blocker (ARB , e.g. valsartan ) with a neprolysin inhibitor  ( sacubitril ) was recommended for the treatment of low ejection fractionsymptomatic congestive heart failure in the 2016 ACC/AHA/HFSA guidelines. The guidelines went further and recommended that patients already tolerating an ACE inhibitor (e.g. enalaprilor an ARB should be converted to Entresto® to obtain the best life expectancy.

Endocrinology and Bone Metabolism: Prolia®   is an antibody that only has to be injected every six months to reduce the incidence of hip fractures in patients with osteoporosis. Trulicity® is a once weekly injectable which helps diabetics control blood glucose and lose weight. Jardiance®  is a once daily pill which reduces blood glucose, controls weight, and reduces the risk of cardiovascular death!

Gastroenterology: Entyvio® is a remission-inducing antibody useful in the treatment of Crohn's Disease and Ulcerative Colitis. It has less infection risk than the anti-TNF antibodies that have been the mainstay among injectable treatments for these two chronic inflammatory bowel diseases.

Pulmonary and Critical Care: Anoro Ellipta® and Stiolto Respimat® are two new once-daily inhalers that have been proven to reduce the frequency of exacerbations in patients with COPD.

Neurology: Activase® is a clot-busting enzyme given by infusion to stroke patients. It restores blood flow to the brain. It has revolutionized the treatment of stroke provided it is given as early as possible, preferably within three hours of symptom onset but no later than 4.5 hours after symptom onset. "Code Stroke" in the Emergency Department means a patient is under evaluation for Activase® treatment.

Rheumatology: The injectable TNF inhibitors, Enbrel® and Humira®, usually in combination with low dose methotrexate, are still the standard of care for treatment of rheumatoid and psoriatic arthritis and are still favored by the 2015 America College of Rheumatology guidelines over the newer oral agent known as Xeljanz®.

Infectious Disease: Harvoni® and Epclusa® are interferon-free medicines that have revolutionized the treatment of chronic hepatitis C infections, with most patients cured after 8-12 weeks with minimal side effects. All of my patients with chronic hepatitis C treated with one of these fixed dose combinations have been cured.

This is not an exhaustive list but you can see why "Renaissance" is no hyperbole! This is an exciting time to be an internist with a passion for medicines!
I began this newsletter by celebrating personal sacrifice. Those who sacrifice for the greater good, mothers and veterans especially, are our heroes. We are grateful for their service remembering that imitation is the highest form of praise.

Valerie, Morgan, Ms. Clark and I give thanks to the mothers and veterans we serve in our practice! May our generous God bless them richly for their devotion and reward them a hundred times over for their contributions to our society, community, and our blessed nation!!
Morgan, Valerie's oldest daughter, has graduated from Rutger's Nursing School!! Please congratulate Valerie and Morgan when you see them in the office!! Thank you!  

My mom, a tower of strength, with more than 23 grandchildren and twelve great-grands, has just turned 89!  When asked how old she is, she always says "28!"
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!
We continue to add services to better serve our patients. For example, if you give us your cell phone number, you will receive an automated reminder 48 hours in advance of your appointment. Also, Valerie usually has an assistant working with her so that we can answer most of your phone calls the first time you call us at 732-282-8166. This is the first number on my business card. Please put one in your wallet!
One area that needs improvement is the time it takes us to get back to you with lab and test results. You can help by setting up a Patient Portal Account and downloading the free app onto your smart phone and/or tablet. This allows us to notify you of results in a more-timely fashion. Simply let Valerie know that you want an account. Thank you for your cooperation!
Ms. Clark, Valerie, Morgan and I wish you, a wonderful Summer!!! 
In This Issue
May: Gratitude for Sacrifice!
Reflection on the Renaissance in Therapeutics!
Currents in Medical Therapeutics
Recent Examples of the Renaissance in Therapeutics by Medical Sub-Specialty
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.

"Our greatest glory is not in never falling, but in rising everytime we fall."


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.