Issue: 39


The Invasion Has Begun!

An informal survey of persons wearing sunglasses on Main Street in Belmar confirms that the annual influx of summer visitors has begun.  Welcome!


John A. Schmidt, MD 


American College of Physicians (ACP) Publishes Position Paper on Electronic Nicotine Delivery Systems (ENDS)

The ACP, the professional association for internists to which I belong, has stated its long-awaited position on e-cigarettes.  As reported in the April 21 issue of the Annals of Internal Medicine, the ACP recommends that 1) FDA extend its authority to regulate ENDS; 2) flavors be banned from all tobacco products; 3) taxes be levied at the federal, state, and local level to discourage use among children and adolescents; 4) restrict advertising including a prohibition of television advertising and include ENDS in anti-smoking media campaigns and school-based interventions designed to discourage use of tobacco products; 5) extend indoor and public place clean air laws to include ENDS; and 6) empower the Centers for Disease Control (CDC) to thoroughly study the health effects of ENDS.  As previously reported in this newsletter, some ENDS generate formaldehyde, a potent carcinogen.  ENDS may also serve as a gateway to cigarettes and other tobacco products.  I strongly agree with the ACP!

Close-up Of Person Hand Holding Electronic Cigarette

Efficacy of Commercial Weight-Loss Programs

As stated in the April 7 issue of the Annals of Internal Medicine, obesity is a leading health problem in the United States because of its high prevalence and role in many chronic conditions such as diabetes. More than one third of U.S. adults are obese (Body Mass Index (BMI) greater than 30; calculate your BMI on the Healthy Links page at www.SchmidtMD.com). Direct health care costs associated with obesity were estimated at $147 billion in 2008.  Nutrition and physical activity remain the cornerstones of obesity treatment. In the same issue, 32 commercial weight-loss programs were reviewed.  Only 11 had published clinical trial data and only Weight Watchers® and Jenny Craig® reported significantly more weight loss than controls at 12 months (2.6-4.9 percent). Nutrisystem® had similar results at 6 months. Among the crash diet programs, Health Management Resources (HMR) showed the largest weight losses (8-22 percent at three months). Attrition for HMR was surprisingly low but associated with a 6.3 percent risk of gall stone-related complications. Other crash diet programs, including Medifast® and Optifast® resulted in substantially less weight loss, approximately 5 percent. Self-directed programs (Atkins™ and Slimfast) resulted in negligible to modest weight loss. Three trials involving Internet based programs (The Biggest Loser Club, eDiets, and Lose It!) were ineffective.  The authors, who appropriately focused on long term results, concluded that clinicians could consider referring patients who were overweight or obese to Weight Watchers® or Jenny Craig®. Nutrisystem® holds promise if longer-term weight loss can be documented in future studies. Weight Watchers® and Jenny Craig® topped the U.S. News and World Report commercial diet plans list published on January 6, 2015.


Surgery versus Nonsurgical Treatment of Lumbar Spinal Stenosis

Lumbar spinal stenosis is common in my practice.  The hallmark symptom is back pain on prolonged standing relieved by sitting down.  Many patients seek MRIs and surgery.  Now comes a study published in the April 7 issue of the Annals of Internal Medicine showing that surgery and physical therapy gave similar improvement at 24 months of follow-up, including those who "crossed over" to surgery during the study period. The accompanying editorial reviewed this and several previous trials and notes that the general observation across trials is that patients randomized to surgical decompression surgery often did better initially but that the benefit waned with time; that is, the benefits of surgery were not durable and some patients required additional surgery. The editorial reminds us of other recent trials (MeTeOR and KANON)) where patients with a degenerative meniscal tear or ruptured anterior cruciate ligament achieved similar functional improvement whether treated with surgery or physical therapy. The editorial concludes "that patients with lumbar spinal stenosis should be offered a rigorous, standardized physical therapy regimen. Those who do not improve and ultimately consider surgery should be informed that the benefits are likely to diminish over time."


We have all experienced it at one time or another.  As reported in the April 7 issue of the Annals of Internal Medicine, features of constipation include having to strain, lumpy or hard stools, having to resort to digital maneuvers to remove impactions, and less than three defecations per week. Abdominal pain, nausea, vomiting, weight loss, bloody stools, and a reduction in stool caliber are NOT typical features of constipation and deserve further diagnostic evaluation.  Risk factors for constipation include increased age, decreased mobility and physical activity, consumption of a low-fiber diet, and inadequate hydration. Certain medications such as narcotic pain relievers, calcium channel blockers, and diuretics may predispose to constipation and should be stopped if no longer indicated. Other helpful tips include taking advantage of the gastrocolic reflex after your morning coffee, more fluid intake, fiber supplements (psyllium/Metamucil®, prune juice, and raisins), bulk laxatives (Miralax®), and safe stimulant laxatives (bisacodyl/Dulcolax®).  Some will find Fleets enemas to be helpful. Milk of Magnesia can be used if renal function is normal. Colace®, a widely prescribed stool softener, is less useful than Metamucil®. If these OTC remedies are unsuccessful, there are safe prescription remedies such as lactulose, Amitiza®, and Linzess®. Let me know if I can help you get regular!

Preoperative Medical Testing in Patients Undergoing Cataract Surgery

Cataract surgery is common.  As reported in the April 16 issue of the New England Journal of Medicine, 1.7 million procedures are performed annually. The surgery is very safe. Furthermore, routine preoperative testing neither decreases the incidence of adverse events nor improves the outcomes of cataract surgery. Since 2002, guidelines from multiple specialty societies have deemed routine preoperative testing unnecessary. 

Now Hear This! Now Hear This!

If we have your email address (and I hope we do!), you should have recently received an on-line questionnaire.  The purpose of this anonymous survey is to help me serve you better. Please respond candidly. Thank you!


If you haven't already, please sign up for a Follow My Health Patient Portal account! You will be glad you did!  Contact Morgan at MorganRich@SchmidtMD.com to get started. Those who signed up before June, 2014, need to sign up again to benefit from this exciting new feature.  It's free and secure and puts you in touch with me with just a few key strokes! Watch our Follow My Health Patient Portal video to learn more about the many benefits of using the portal.


Valerie, Morgan, and I look forward to meeting you on the boards of Asbury Park, Ocean Grove, Bradley Beach, Avon, Belmar (yeah!), Spring Lake, Sea Girt, Manasquan and Point Pleasant Beach this glorious summer! Start walking, cycling, swimming, and boarding and safely enjoy our priceless stretch of the Jersey Shore! We have a unique community and we are fortunate to be part of it. As my pastor says, "Welcome to Paradise!"

In This Issue
ACP's Position on Electronic Nicotine Delivery Systems
Efficacy of Common Weight-Loss Programs
Surgery versus Nonsurgical Treatment of Lumbar Spinal Stenosis
Cataract Surgery
Now Hear This!


John A. Schmidt Jr., M.D.


Dr. Schmidt is one of the leading internists in Monmouth County offering Medical Home services.     Dr. Schmidt is an Associate Attending in the Department of Medicine, Jersey Shore University Medical Center, and  Clinical Assistant Professor in the Department of Medicine at Rutgers Robert Wood Johnson Medical School.



"And so with the sunshine and the great bursts of leaves growing on the trees, just as things grow in fast movies, I had that familiar conviction that life was beginning over again with the summer." 

- F. Scott Fitzgerald



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Conceptual view of digestive problems like constipation or diarrhea.
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.