Sochi was Amazing!

The winter Olympic games were amazing on so many levels! I loved the spectacle, the beauty, and most of all the teamwork that produced such amazing feats on the slopes, in the air, and on the ice!  Even when the teams didn't medal, they often achieved personal bests in their quest to succeed. In the same way, you and I are on a team dedicated to preserving your good health. The team includes your medical specialists, pharmacist, nutritionist and gym instructor.  When we work together, communicate, and build your Medical Home, you have the best chance of winning the biggest prize of all, your health!

John A. Schmidt, Jr., MD

Our New Electronic Medical Record System is Up and Running!

All of your medical records have now been successfully and securely migrated from Allscripts� MyWay to Allscripst� ProfessionalEHR.  This new medical records system has many advantages. It is fully compliant with the latest Meaningful Use Stage II Guidelines established by the Centers for Medicare and Medicaid Services, which specify the highest level of patient-centered care. For example, all patients will receive a typed summary at the end of each visit showing their diagnoses, new medications, and tests. 

New Patient Portal!

The feature I am most excited about is the new Patient Portal which is currently scheduled to launch in March. You will have secure access to your Personal Health Information (PHI) including Labcorps data and be able to send your PHI from one participating practice to another.  Be on the lookout for an email invitation. You have to respond to the invitation in order to obtain a password.  Once you have the password, you will have the opportunity to view your personal health information like never before!

Pharmacogenetics: The Next Step in Optimizing Your Medicines!

Did you ever stop and think about what happens to the medicines you take?  Most medicines are metabolized in the liver by a large family of enzymes known as "P450s." Much of my time in the pharmaceutical industry was spent understanding how new medicines were activated or destroyed by these enzymes and how one medicine might interfere with the metabolism of another by competing for the same P450. Our new software automatically searches for drug interactions that might result when two or more of your medicines are metabolized by the same P450 enzyme.  

Different People Metabolize Medicines Differently

Adding to the complexity is that your P450's may be different, just like your eye or hair color. And like most genes, you have two copies, one from your mom and one from your dad.  This can be important when prescribing certain medications. An excellent case in point is clopidogrel (Plavix�), a medication often taken by patients with coronary stents.  Clopidogrel must be metabolized by a particular P450 known as "CYP2C19" before it can protect your heart. Patients who have two defective CYP2C19 genes fail to adequately metabolize clopidogrel and are inadequately protected.  A new study in the February 18 issue of the Annals of Internal Medicine makes the case for pharmacogenetic testing of patients who take clopidogrel.  If the test shows that both of your copies of CYP2C19 are defective, a newer, more costly medicine (ticagrelor, Brilinta�) should be prescribed because it does not depend on CYP2C19 to be protective.

TAVR at Jersey Shore University Medical Center!

Aortic stenosis is the most common form of valvular heart disease in older Americans. It prevents the flow of blood from the left ventricle (the major pumping chamber) into the aorta and, when severe, carries a significant risk of congestive heart failure, heart attack, and sudden death.  Open heart surgery was the only option and is still the standard of care for patients who can tolerate the operation. 

But what if a patient is too frail?  For such patients there is now TAVR (TransArterial Valve Replacement).  With TAVR, an artificial valve is passed from the leg or through the chest wall and expanded inside the stenotic aortic valve, thereby restoring normal function.  More than sixty of these procedures have been safely performed at Jersey Shore University Medical Center. I have one such patient in my practice and the improvement was dramatic. Now, as reported in the February 18 issue of the Annals of Internal Medicine,TAVR has been demonstrated across multiple studies to be comparable to open heart surgery in terms of improvement of functional status for up to 23 months. Longer term studies are ongoing.

US Preventive Services Task Force (USPSTF) Recommendation for BRCA-Related Cancer in Women

Readers of this newsletter will recall my discussion of Angelina Jolie's decision to have bilateral mastectomies following her testing positive for mutations in the genes known as BRCA1 and BRCA2.  Her mother had died of breast cancer. When should women be screened for BRCA mutations?  

Keep in mind that (1) most breast and ovarian cancers occur in women who do not have BRCA mutations, (2) that most women with breast cancer do not have a first degree relative with breast cancer and that (3) digital screening mammography every other year in women of average risk is the best way to detect early breast cancer. The U.S. Preventive Services Task Force (USPSTF) recommends the following: if someone in your family had breast cancer before the age of 50, had cancer in both breasts, had breast and ovarian cancer, was a male with breast cancer, and/or was a person of Ashkenazi Jewish ethnicity, then you should complete an easy six step questionnaire known as the Referral Screening Tool at www.breastcancergenescreen.org which can also be found on the Healthy Links page of my website under Calculators. If the questionnaire is positive, the USPSTF recommends you meet with a Genetic Counselor before deciding to proceed with BRCA testing.  The same site will help you identify a Counselor in your area.  I can help as well.

Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults

In a study published online in Journal of the American Medical Association (JAMA) Internal Medicine on February 3, investigators from the Centers for Disease Control and Prevention found that persons who consumed more than 25% of their calories from added sugar (sucrose) were 2.75 times more likely to die of cardiovascular causes than those who consumed less than 10% of their calories in the form of sugar. These results suggest that we would all be wise to avoid concentrated sweets and eat complex carbohydrates, such as fruits and vegetables, instead.

Fecal Immunochemical Tests (FIT) to Screen for Colorectal Cancer

As reported in the Annals of Internal Medicine on February 4, FITs are more sensitive at detecting both colorectal cancers and adenomas than the older card based Fecal Occult Blood Tests (FOBTs).  A single FIT had similar sensitivity and specificity as several, independent of FIT brand. I have been offering FOBTs to my patients between colonoscopies. Based on the latest results, I will now add the FIT to your annual testing at Labcorps and no longer offer the FOBT.  Your insurance company will pay for the test and you will be able to view the results in the Patient Portal.

New Treatment for Restless Legs Syndrome (RLS)

Dopamine agonists such as pramipexole (Mirapex�) and ropinirole (Requip�) have been the mainstay of RLS treatment but are sometimes associated with augmentation which means the symptoms may become more bothersome with time, especially during the daytime.  As reported in the February 13 issue of the New England Journal of Medicine, pregabalin (Lyrica�) taken once daily was at least as effective as pramipexole with a two-thirds reduction in the rate of augmentation for up to 52 weeks. These results suggest that pregabalin be considered for long term treatment of RLS.  I remind my patients that RLS can be a manifestation of sleep apnea and that a sleep test (polysomnography) is indicated in patients with RLS.

Valerie and I wish you a pleasant March and the promise of a spectacular Spring!