Issue: 31


August, the French Have it Right!

When I was hired by Sanofi, the French pharmaceutical giant, I was encouraged to apply for "cultural training." I was surprised to learn how differently we Americans and our French bons amis (good friends) approach life. For example, the French like to "do their homework" before a project to avoid costly mistakes. We Americans believe it is better to get started ASAP and learn from our mistakes along the way. Another major difference is our approach to work. Americans live to work while the French work to live. Never was this more apparent than in August. Even the most ardent French worker takes the month of August to unwind, refresh, vacation, and rekindle their "Joie de vivre" (joy of life). Vive la France!


John A. Schmidt, MD 


Now Hear This! Our Office Will Be Closed August 19-24!

As mentioned in the July newsletter, our dear second daughter, Susan, is to be married on Saturday, August 23, on the glorious Eastern Shore of the Chesapeake Bay. The newlyweds will be honeymooning in Hawaii (They are avid James Michener fans!). The office will therefore be closed except for emergencies from August 19 through August 24. Please plan ahead and submit your refill and other requests as soon as possible. Thank you! (Can't wait to see how the groom, a Californian, deals with the innards of blue claw crabs at the welcoming party. The handles on the mallets will read, "Love, Honor, and Old Bay me." Good luck with the Old-Bay/Obey part!).

The Runkeeper App

Exercise is a great way to enjoy the summer but many of my patients find it difficult to motivate themselves. One way to catch the fever is to download the Runkeeper App onto your smart phone. Using GPS it captures and displays your route whether on land or sea. You can also track the exercise activities of your friends. For example, Rita's nephew was canoeing in the San Juan islands in Puget Sound and we could see his route including the distance paddled! Refusing to be outdistanced by her nephew, Rita proceeded to walk a greater distance on the golf course at Fairway Mews and then proceeded to brag about it on Facebook! Form your own Runkeeper group and challenge yourself and your friends!

Epworth Sleepiness Scale

I recently prescribed a sleep test ("polysomnography") for a patient I suspected of having sleep apnea. The test was rejected by the insurance company because I had not submitted the results of the Epworth Sleepiness Scale. Please complete this simple questionnaire to see if you may have a sleep disorder. Assign 0 points for no chance of dozing, 1 point for slight chance of dozing, 2 points for moderate chance of dozing, and 3 points for high chance of dozing in the following situations:


1) Sitting and reading ______

2) Watching TV         ______

3) Sitting inactive in a public place (e.g., a theater or meeting) _____

4) As a passenger in a car for an hour without a break _____

5) Lying down to rest in the afternoon if time permits _______

6) Sitting and talking to someone ____

7) Sitting quietly after a lunch without alcohol _____

9) In a car, while stopped for a few minutes in traffic ____


If your score is 1-6, you are getting enough sleep; 7-8, your score is average; 9 and up, seek my advice right away!


Complete the STOP-Bang questionnaire to further estimate your risk.

What if I Snore?

Snoring, a frequent symptom in those with sleep apnea, is not included in the Epworth questionnaire because people can't hear themselves snore and because snoring and apnea are two different things. "Apnea" means no air is passing into the lungs. Blood oxygen levels decline, sometimes dramatically. Measuring arterial oxygen levels through the night is therefore a convenient and straightforward approach to detecting apneas. A dramatic fall in oxygen level leads to "arousals" or "startles," which are abrupt sleep-disruptive awakenings as the oxygen starved brain sends a strong signal to wake up and breathe deeply. Once again, many patients have no recollection of arousals but their terrified bed-mates almost always do as they lie awake waiting for their partner to resume breathing.


I will never forget watching my dear mom the night after her knee replacement surgery. She was snoring. When the snoring stopped, her oxygen level began to fall on the bedside monitor. Once the oxygen saturation level declined to about 70 percent, she would startle, sit bolt upright, open her airway, and take a huge breath. My brother, a dentist, who also suffers from sleep apnea, called the respiratory therapist who inserted a simple device into my mother's mouth to keep her airway open. The arousals went away instantly and her blood oxygen level never dipped. It was probably her first good night sleep in years! She now wears a CPAP device and sleeps fitfully. My brother carries his CPAP wherever he goes. He finds that he performs at a higher level (and his patients are happier too!).

Overnight sleep tests are expensive and many of my sleep deprived patients are reluctant to visit a sleep laboratory. Now there is a simple screen to help decide if you need the full-blown test. It involves taping an oxygen sensor to your finger and wearing it while sleeping in your own bed. Your blood oxygen level will be recorded through the night. Turn in the recorder and I can tell you if you should have a more detailed test. The test is inexpensive and can be obtained with a prescription from Breathe Easy on Sylvania Avenue in Neptune. About ten of my patients have had the test in the last few months and several with severe sleep apnea have been identified.


As reviewed in the August 5 issue of the Annals of Internal Medicine, the home test is not perfect. If you have daytime sleepiness and other serious medical conditions (for example, congestive heart failure), you should opt for the full sleep lab test. On the other hand, if you are otherwise well, the portable in-home test is a good place to start. Let me know if you would like to arrange this simple and cost-effective test.

Decision Aids for Advance Care Planning

August hopefully provides you some time to reflect on your long-term goals especially if you, or someone you love, are unwell and approaching the end of your/their life. I agree with the French: planning is important especially when it comes to your health! Here are some on-line decision aids for Advance Care Planning as reviewed in the July 29 issue of the Annals of Internal Medicine.


Helpful Information:

There are also on-line decision aids for persons with serious or advanced illnesses. For example:

Remember, planning is not the end of the process but rather the beginning of an ongoing discussion between you and me to help me better understand your wishes. 

Your Doctor, The Quarterback 

In the August 7 issue of the New England Journal of Medicine there is a timely article written by a general internist who, like me, works hard to coordinate the care of his patients when working with specialists. Like a quarterback, he can see the entire field, size up the defense, and call the best play to advance the ball. The author/doctor recounts the numerous phone calls and emails necessary to make sure his patients receive the best care for a complicated condition. He stresses the importance of already having earned the trust of the specialists so that every minute is spent discussing you, the patient, rather than building rapport with a stranger. Networks constructed by insurance companies often get in the way of trust because they force general internists to refer to specialists they do not know. The risk of delays and communication break-downs naturally increases. With so many new insurance plans and so many doctors, is it any wonder that many specialists have no conception of the patient's overall health status? The solution? Bring me the names of your specialists and I pledge to get to know and work with them as best I can to build a care team dedicated to your health!


Valerie (which means "brave" in French) and I wish you a restful August!

In This Issue
Office Closed August 19-24
The Runkeeper App
Epworth Sleepiness Scale
What if I Snore?
Overnight Pulse Oximetry
Decision Aids for Advanced Care Planning
Your Doctor, The Quarterback


John A. Schmidt Jr., M.D.

 is one of the leading Internists in Monmouth County offering  Medical Home Services  


"Laugh and the world laughs with you,

snore and you sleep alone."

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 
E-Mail:  [email protected] 
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.