Issue: 54

July: No Apocalypse! Build Our Country Now!
Congratulations if you were able to survive the apocalyptic speeches from Cleveland. If Spiro T. Agnew were still alive, he would no doubt say, "nattering nabobs of negativism." I was left with the same eerie feelings evoked by Joseph Conrad's Heart of Darkness and Frances Ford Coppolla's Apocalypse Now.  In the City of Brotherly Love, hope, not despair, will prevail.  The selection of Senator Tim Kaine, who served in the Jesuit Volunteer Corps in Honduras, and speaks Spanish, is auspicious. 
One of the chief mantras of the Judeo-Christion-Muslim faiths is to build a Kingdom of God where all lives matter.  This ideology has been horribly warped by ISIS, which is bent on the formation of a caliphate where "infidels," even Shia Muslims, have no right to live and are summarily executed in cold blood.
How we react will be a defining moment in American History. Guns and Butter rhetoric is clearly not the answer. The road will be difficult and we must be strong-together!
One recent, albeit modest, example of how we can build our country comes from, of all places, the United States Congress where a new bill to support drug treatment and recovery was unanimously passed by both houses and promptly signed into law by our President on July 22. More young lives are tragically lost to heroin than guns. Addicts' lives matter too and it is heartening that our leaders have unified to do something constructive to save them!  Visit the website of the Substance Abuse and Mental Health Services Administration ( www.samhsa.gov ) to find a treatment center or call SAMHSA's national helpline at 1-800-662-HELP (4357).

John A. Schmidt, MD 
Antidotes to What Ails Us!
Ken Griffey Jr. and Mike Piazza have become the 311th and 312th players inducted into the Hall of Fame in Cooperstown!!  One has to marvel at the enormity of their accomplishments. Piazza, a catcher with the Mets for a good part of his career, and only the second Met to be so honored, was the lowest round draft pick (62nd round, 1,390th pick overall in 1988) ever to be elected to the Hall!  Catch the emotional highlights of their moving acceptance speeches and you will feel much better, I promise!  Other antidotes: view the Norman Rockwell painting entitled, " Runaway."  It shows a police officer and a runaway little boy sitting side-by-side at a soda fountain counter. God bless our men and women in blue who keep us and our children safe! And, as you prepare for the Olympic Games, read "The Boys in the Boat" and watch the video of their gold medal race!  Ahhhh...I am feeling better now...at least for the moment!
LGBTQ Youth: Ending Conversion Therapy
If you are like me, the terrible events in Orlando were a wakeup call to better understand the challenges facing the LGBTQ community.  A good place to start is an important October report entitled, "Ending Conversion Therapy: Supporting and Affirming LGBTQ Youth."  As stated in the executive summary: "Lesbian, gay, bisexual, and transgender youth, and those questioning their sexual orientation or gender identity (LGBTQ) experience significant health and behavioral health disparities....(and) efforts to change an individual's sexual orientation, gender identity, or gender expression is a practice that is not supported by credible evidence and has been disavowed by behavioral health experts and associations....(and) may put young people at risk of serious harm." Conversion therapy is an attempt to interfere with an adolescent's natural path to choosing a sexual identity and orientation or, worse, compelling an adolescent to conform to a gender.  Please don't do it!
Zika Update
As reported by the Centers for Disease Control and Prevention (CDC) on July 20, the number of Zika virus cases nationwide was 1,404. All but one had traveled from endemic areas or been in sexual contact with a person from an endemic area. Fifty cases have been reported in New Jersey. In the U.S. Caribbean territories (American Samoa, Puerto Rico, and the U.S. Virgin Islands) 3,827 cases have been reported, all but twelve of which were the result of local infections. Five of those diagnosed on the mainland have developed the paralytic syndrome known as Guillain-Barre.
As of July 14, 400 and 378 pregnant women have been diagnosed with Zika on the U.S. mainland and in the U.S. Caribbean territories, respectively. 
The CDC has concluded that Zika causes microcephaly and other birth defects. So far, 12 babies have been born in the U.S. with Zika related birth defects including one in New Jersey and one in New York City. All of the mothers had traveled out of the country.
Prevention of Mosquito and Tick Borne Illnesses
As reported in the July 12 issue of the Annals of Internal Medicine, here are several steps you can take to prevent transmission of Zika and other mosquito borne illnesses, such as chikungunya and dengue.
First, restrict or avoid travel to endemic areas. Travel recommendations are available at the Centers for Disease Control and Prevention (CDC) ( www.cdc.gov). Pregnant women should not travel to Zika endemic areas ( wwwnc.cdc.gov/travel/page/zika-information). Further resources for minimizing illness while traveling abroad can be found at www.HeadingHomeHealthy.org. Because many with Zika are asymptomatic, those returning from endemic areas should take care to avoid mosquito bites to prevent becoming a domestic reservoir for the disease. Condoms or abstinence should be used for three weeks to prevent sexual transmission.
Second, exposure to mosquitoes should be limited, especially during peak biting times (morning and evening). Persons should wear long-sleeved shirts, long pants and cover their feet when outside. The use of window screens and air conditioning can minimize mosquito exposure while indoors. Use bed nets at night. The correct and consistent use of insect repellents is essential. The CDC recommends DEET, picaridin, IR3535, oil of lemon eucalyptus, or para-menthane-3,8-diol ( www.cdc.gov/zika/prevention/index.html). You can compare these products at the Environmental Protection Agency website ( www.epa.gov/insect-repellents/find-insect-repellant-right-you). Apply sunscreen before applying repellant. Clothing impregnated with permethrin is very useful. EPA registered repellants may be used by pregnant and breast feeding women. 
Third, measures should be taken to control mosquitoes in and around the home ( www.cdc.gov/zika/prevention/contolling-mosquitoes-at-home.html).
Immunotherapy for Cancer. A Medical Breakthrough!
It has long been suspected that the immune system has the ability to seek out and destroy cancer cells. For instance, a tumor transplanted from one mouse to another with a different tissue type is promptly rejected in a matter of 8-10 days. Why then doesn't our immune system recognize and destroy tumor cells in the same way that it destroys viruses, bacteria, and organ grafts?
It turns out that some tumors are expert at inactivating our immune defenses. White blood cells, the storm troopers dispatched by the immune system to destroy invaders, are often found inside the tumor completely disarmed. The tumor proteins responsible for this pacification have now been identified.  They engage receptors on the surface of the invading white blood cells and render the would-be killers impotent. The new therapies, all of which are engineered monoclonal antibodies, block this interaction so that the white blood cells can go about their protective mission with a vengeance.
Former President Jimmy Carter is one of a growing number of beneficiaries whose life has been saved by this new therapeutic approach. The antibody, called Keytruda® ( pembrolizumab) targets a protein expressed on white blood cells known as PD-1. Once PD-1 is coated with Keytruda, tumor cells are no longer able to deactivate the white blood cells. President Carter's brain tumor, a malignant melanoma, disappeared completely!
As with all treatments, there are possible side effects and complications. As you might imagine, unleashing the immune system can sometimes lead to collateral damage. However, because antibodies are more specific than most medications, the side effects tend to be manageable, making it possible to use them in elderly patients. President Carter remains tumor free at 91 years of age! A patient of mine also experienced a complete remission of her malignant melanoma after eight infusions of Keytruda. She was 84 at the time and treated at the Abramson Family Cancer Center at the Hospital of the University of Pennsylvania in Philadelphia.
Now Hear This!
Our second daughter is expecting her first child and our third grandchild in September! The mother and father and the little bundle are doing very well. The baby is due on my birthday!!  Sharing my birthday with my special new grandchild would be just...grand!!! I predict the baby will have red hair - I could tell from the ultrasound!
I am also happy to report that Ms. Corrine DeSevo, a nurse practitioner student from Monmouth University that many of you had the pleasure of meeting, passed her qualifying examination! An oncology nurse navigator at Riverview Hospital and the mother of two, she has helped countless patients and taught me more than I ever taught her.  She will go far!  Congratulations, Corrine!!! We are very proud of you!!!
Valerie, Morgan, Ms. Clark and I wish you a restful summer full of memories to be cherished for a lifetime! 
In This Issue
July: No Apocalypse! Build Our Country Now!
Antidotes to What Ails Us!
LGBTQ Youth: Ending Conversion Therapy
Zika Update
Immunotherapy for Cancer. A Medical Breakthrough!
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 Associate Attending in the Department of Medicine, Jersey Shore University Medical Center, and  Clinical Assistant Professor in the Department of Medicine, Rutgers Robert Wood Johnson Medical School.

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always the best of 
what  might be." 

Charles Bowden


John A. Schmidt Jr., MD
Meaningful Medicine in Your Medical Home
709 Seventh Avenue
Belmar, NJ 07719
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.