revenge of the ninja

So to recap,

I had a home sleep study,

results analysed by sleep consultant guy at hospital who wrote a report,

now I want to see the report.

I called the hospital and asked if I could be sent a copy of the report.

No.

I asked why I couldnt see the report.

I was told I needed to make an appointment to see the consultant.

Reluctantly I said OK, when could I have an appointment.

4 months.

Ah, you are having an arabic jest with an unworthy infidel, no really, when could I see the consultant to see my report.

4 months.

OK, can I come down to the hospital and see the report.

No, but the consultant has a open appointments session on Monday, you could try to see him then.

So , Monday comes. I drive 77KM to the hospital and I go straight to the sleep clinic consulting room, not the diseased waiting room. There is a smiling Pakistani lady in a white coat sitting at a computer.

I smiled and said, "Hello, my name is George O'Neill. The consultant has written a report on my home sleep study. Is it possible for me to just read the report?".

The lady looked puzzled and said, "Of course, why should you not see your own report, please sit down.". She did a bit of typing, got up, left the room, came back within 10 seconds and handed me my report.

My experience with the ninjas had left me totally unprepared for meeting someone who genuinely wanted to be helpful. I greedily read my report.

The diagnosis was clear, I definitely had obstructive sleep apnea. I actually felt relieved and was quite emotional.

"OK, what is the next step?" I asked the lady.

"You need to make an appointment to see the consultant and then you need to have a full overnight sleep study. This sleep study will include testing you with a cpap."

"DO I make the appointment with you?", I asked in a please-god-dont-make-me-deal-with-the-ninjas-again voice.

"No, you must go to the reception desk and make an appointment there".

My heart sank, my stomach churned and I felt a great need for a bowel movement. With drooped shoulders I shuffled over to the ninja desk.

"I would like to make an appointment to see Dr Ali please.", I said with a smile to the resident ninja.

Talking to someone wearing a veil is strange for me. You cant see any of the face, not even the eyebrows. There is a very thin slit across the eyes and its hard not to try and read expressions in the face. This can be misconstrued as staring and the whole point of the veil is to stop men staring. You can be jailed for staring at a lady with a veil and I was acutely aware of this.

She looked at me and placed her mobile phone to her ear and started talking. She extended her gloved hand in my direction. I had no idea what to put in the hand so I asked in a very sheepish, please-dont-kill-me voice, what she wanted.

She muttered something on the mobile and made a big show of the fact that I had interrupted he call and she was now very pissed off. Sh waved the mobile in mid-air and said, "Appointment card", her other hand still outstretched.

"I dont have an appointment card", I said, cringing at the thought of the biblical retribution in store for me for my deeply offensive use of words to resolve a situation.

"First appointment?", curious-ninja asked.

"No, I have already seen the consultant, I just need to see him again to discuss the report he has written.", I bleated.

"No appointment.", she said and immediately turned her swivel chair so that she was facing away from me and she loudly resumed her call.

"Why cant I have an appointment?", I asked in a very calm voice.

She ignored me.

"Why cant I have an appointment?", I asked in a very loud hear-me-at-the-back-of-the-room teacher voice.

Call-interrupted-ninja swung round to me and very angrily shouted, "First appointment needs referral letter".

"Its not a first appointment. I have seen the consultant and he has written a report on me and I need to discuss the report with him.", I said in a quieter voice.

I waved the report in the air. "This is the report he wrote about me. My name and his name are at the top of the report. Can I please have an appointment?", I said very, very slowly.

Happy-ninja now just slowly rotated in her chair and completely ignored me. I no longer existed to her. She resumed her call.

So there I was. Diagnosed with an illness but I was not able to progress to get treatment because a grumpy ninja would not give me an appointment. It occurred to me that in the UK a receptionist would, quite rightly, be fired for what the ninja had just done. She was the person assigned the task of making appointments for sick people with doctors so that they could get better and she clearly considered the job as a nuisance. I wondered how many sick people died because she didnt let them have access to doctors. To be honest, it turned my stomach and made me feel very sad for the hundreds of people who needed to rely on this system for medical treatment. It was inhuman.

I walked back to the room where the smiling Pakistani lady sat. I explained that the ninja would not give me an appointment. I was so angry I could barely speak. She took my report and walked over to the happy-talking-on-her-mobile-ninja herself. There was a lot of arm waving, pointing to the report, upturned palms and eventually, typing on the computer. 15 minutes of verbal ju-jitsu later, I had my appointment with the consultant AND an appointment for the sleep study the day after seeing the consultant. It was in four months, but, it was all that was available.

I still to this day cannot believe how downright nasty that ninja was. She didnt care. I needed to see a doctor and she didnt care. She actually went out of her way to try to prevent me from seeing a doctor. Truly despicable, yet as I have learned, completely consistent in the middle east.

Sleep Apnea and me

So far I have recounted my experiences along the road to getting treatment for my OSA. Here is how I am affected by my condition.

All my life I have been a sound sleeper. All of my sleeping partners have always commented that they have never known anyone who fell asleep so quickly. Some did complain of my snoring but not all. In my bodybuilding days I would normally sleep for at least eleven hours every night. Like most people I never really thought about sleep. I just went to bed and opened my eyes 8 hours later. For me those days are a lifetime ago.

When I moved to the middle east in September 2009 I was in fine health. Three months later I was being fed high blood pressure medication and I was sometimes so tired I clock-watched till it was time to go home and crash. My worst experience has been where I had a sore throat and went to bed dehydrated. I closed my eyes for no more than 10 minutes at a time before I actually felt my throat close and I choked. It was like being slapped in the face every time I was on the verge of falling asleep. I got no sleep at all that night. The following day was a week-end so I got up at 4am as it was pointless staying in bed. I was a wreck. I walked around like a zombie all day and eventually tried to sleep again at 8PM. This time it was worse. I was experiencing a thumping heartbeat, sweating and damn near having panic attacks when I actually felt myself choke. The worst night of my life. I got up at 3am and sat on my couch near in tears until 6:30am when the medical centre opened. I explained what had happened and the doctor gave me anti-histamines, a decongestant and an order to go back to bed. I took the drugs and drank a litre of water. My kids were very worried about me as I was barely making any sense so for their sake I went to my bedroom and lay down. This must have been around 8:30am. I read a book sitting up in bed. The next thing I remember I woke up, book still in my hand at 8PM. My daughter was knocking on my bedroom door. I got up to tell her I was OK, took more drugs, drank a lot of water and then went back to bed and woke up again at 5am for work. I actually felt OK.

I learned something that night. My apnea is made worse by getting any kind of sore throat. If I have a blocked nose from a simple cold my breathing is affected very badly and I get no sleep. The antihistamine from the doc combated the allergic reaction which was giving me the sore throat and blocked nose. The decongestant cleared my airway. I also believe the water was crucial.

Here is how I avoid having another "worst night".

No shouting, chilled drinks, swimming in chlorinated pools or sitting near anyone with a cold.

I drink at least 2 litres of water at room temperature during my waking hours. I constantly sip from a water bottle while I teach. This keeps my throat nice and moist.

I use a humidifier in my bedroom for at least one hour before I go to bed. I have a humidity meter in my room so I know that the humidity must be around 70% to aid my sleep. Anything lower and I get a dry throat and more apneas.

I spend as much time as I can NOT in air-conditioned atmospheres. This is difficult in a very hot climate. I NEVER sleep with my A/C on as this almost guarantees apnea attacks.

I vacuum every day anywhere I sit for any length of time. My classroom is vacuumed by a cleaner. My bedroom is vacuumed everyday and mopped too. So is my living room and beloved couch. Dust is the enemy. Living in a desert, it is impossible to get rid of all of the dust but I try.

If I have a stuffed nose I use a decongestant one hour before I go to bed.

If I feel all bunged up I use a decongestant AND a antihistamine. Dust storms make me feel like I have a cold. This is an allergic reaction to the dust, hence the antihistamine.

I sleep on my side. My strategy is to hug a large pillow when I am on my side and this stops me rolling onto my back.

I sleep regular hours. There is no tv, games console or computer in my bedroom. Just a bed and a book. Bedtime is BED TIME.

I exercise when I can. Any exercise is better than none and it definitely helps me sleep.

Following these rules has given me a better quality of sleep and I feel better for it.

I need to clarify a few things here. My new job required me to get up at 5am. I have never had to rise at that time before and, frankly, I hate it. Everybody gets tired if they get up at 5am so I assumed my fatigue was just related to getting up early. It is very hot where I now live. Daytime temp can regularly be 45 centigrade, thats 113F in old money. It is also very windy and I live in a desert so the air is always full of dust. I live near oil fields so I can see gas being burnt off all around me sometimes leading to weird smells in the air. All of this, I believe, has made my apnea worse. Before moving here I believe I had mild apnea. I feel confident in saying this because I have never experienced fatigue before. My own hypothesis is that I am experiencing some sort of intermittent allergic reaction to something which cause me to have sore throats, mild throat infections and other relatively mild upper respiratory issues which really make my apnea worse and lead to terrible sleepless nights. I have gone for a month where I have the energy to exercise every day and never wake up during the night. Sometimes I have a whole week where I never get a full night's sleep. Sleep is now my major concern.

I am due to get a cpap on August 3rd 2010. I am hoping it will resolve a lot of my sleep-related problems. The science geek in me has doubts. Time will tell. And then I will tell you on my blog, here.

Till next time.

George

How I found out part 2

So there I was. A succession of doctors telling me I had high blood pressure and my weight was to blame and I was going to burst like a dead frog on a hot day if I didnt take the many-coloured chemicals they prescribed.

I am a bit of a science nerd and a computer geek. The scientist in me was raging against the conclusions reached by my highly qualified physicians. The only evidence of high blood pressure was the readings from the machine in the medical centre. There was a stack of anecdotal evidence to suggest that the readings of that machine had to be called into question. I needed hard evidence and providence provided it.

My next visit to the medical centre was to ask the doctor about obstructive sleep apnea. My brother has OSA and has had a cpap machine for years. I spoke to him about my situation and he explained that it was high blood pressure which had eventually led his physicians to diagnose and treat him for OSA. So I suggested OSA as a possible cause to my doctor. He grumbled a bit and then, without speaking , typed into his computer for 5 minutes, left the room and came back with a printout which he signed and stamped. He handed me the printout. It was a referral to the sleep unit at a local hospital. I was stunned. So stunned I just got up and walked out of the consulting room without thanking the doctor. He hadnt actually spoken to me so I didnt feel discourteous.

I called the hospital, arranged an appointment and booked a day off work. The whole experience of going to a public hospital in the middle east is worthy of a book in itself. The whole concept of a hospital is turned on its head. Let me explain my attempt to attend my pre-arranged appointment with the sleep consultant.

I arrived at the hospital in a taxi benevolently provided by my employer. The idea was that I would get back to work quicker if I wasnt driving. My appointment was for mid-day, I arrived at 11:45. I go to the outpatients building and there is a guy in a booth with a big sign above it saying "Please ask me for help". So I asked him where I went to see the sleep consultant. The guy looked at my referral letter, mumbled something in arabic, shouted to a friend, lots of upraised palms and shrugs and he told me he didnt know. He then dismissed me by asking an arabic lady behind me if he could help her. OK, new country, lets try again. So I asked him where I went. He gestured to a sign which read "Main Building" and said "Main Building". SO I followed the sign for "Main Building". This led to another sign and another and another and finally the signs stopped and I was standing in front of a door with a sign saying this next door led to a ward exclusively for ladies and if you go through this door you better have ovaries. So I made my way back to "Please ask me for help" guy and got lost. I found another "Please ask me for help" guy who gave me a bewildering set of directions which sounded like a memory test they give spies. Anyway, I ended up, completely by accident back at the out-patients reception.

I had a vague memory of reading something on the internet about the sleep clinic being directly above the reception of the out-patients. So, with nothing to lose, I walked up the first set of stairs I found and looked for a sleep clinic. What I found was a massive waiting room. Actually, two massive waiting rooms, one male the other female. I walked over to the male waiting room and spoke to the lady at the desk.

The lady was wearing a full veil so I could only see a tiny portion of her face. I couldnt help but think she looked like a ninja and I inadvertently giggled and then I quickly made it appear like a cough. I asked the lady if I was in the correct place to attend my appointment with a sleep consultant.

She turned her head in my direction and said "Paper".

"What paper?", I replied.

"Paper, paper", she said in a harsh tone and she slapped her hand on the counter.

"I dont have any paper", I said innocently, feeling guilty about my paperless situation.

She expelled air and looked up at the ceiling. Its amazing that even through a full veil she conveyed utter contempt for me very effectively.

"Is it first?", she barked, still looking at the ceiling.

I pondered this for a moment. I didnt want to offend her again as I was genuinely afraid that she would slap me instead of the counter. so I ventured, "First appointment?", in a hesitant please-dont-slap-me questioning voice.

There was a pause of a few seconds. She was still looking at the ceiling but she was motionless and obviously contemplating my violent demise. The pause made me sweat, heart pounding. Then she looked at me for a whole second and then said something which brought me immeasurable joy.

She said, "Referral letter" and the universe made sense and old people and children slept securely in their beds.

Grinning like an idiot, I handed ninja-killer-receptionist the referral letter which I brought with me purely by chance.

She took the letter, did some typing, ripped a printout from an ancient dot-matrix printer like she was ripping the head from an insolent sick-person and then slammed the printout and the referral letter on the counter.

"Go there and pay" she commanded in the same way as Henry VIII ordered beheadings.

"Go where?", I asked by reflex and immediately regretted the words. I was merely offering ninja-decapitator the golden opportunity to publicly display her disgust at having to deal with a stinking, offensive trouble-maker like me.

She made a grunt noise and gestured with the back of her hand to one corner of the massive waiting room.

I bit my tongue and looked in the general direction of the gesture. I had no idea I was going to be asked for money but I was willing to pay a massive wad just to get away from the ninja-testicle-crusher. I walked off in the direction of what looked like a queue of people.

There was a loose collection of men in front of two tiny windows which were at my eye level. I stood at the back of the collection of men and moved forward as men walked forward, handed over paperwork and money, received paperwork and walked away. I got to the front and I was quite excited. I guessed that the printout was needed here so I handed it over to another ninja-payment-taker. She tapped on a keyboard and then put out her hand. I had no idea how much to pay her so I handed over the biggest note I had. More tapping and the hand reappeared with printout, money and a new pink card. I gratefully gathered this and walked away feeling like someone who had just taken delivery of a really great Christmas present. I did not hear one word spoken in the whole time I was in that queue.

I had no idea what to do now. I stood there for a few minutes observing the room. This was my first chance to really notice how truly disgusting the room was. There were about one hundred grey plastic seats packed tightly together. They werent individual chairs. It looked like plastic seats were welded onto a very spindly metal frame which looked unlikely to bear the weight of three sparrows. On the seats were a collection of men from various nationalities all coughing like hags and gargling on enough phlegm to collectively drown an elephant. Coughing doesnt really describe what they were doing. It looked like they were participating in a "First to expel a lung" contest. Hands wiped away dribbles of white foam from corners of mouths, hands were then wiped on clothing to deposit said foam and create white stains on dark cloth. There were Herculean sneezes which shook the building unhindered in their germ-spreading glory by any attempt to cover mouths. My observation revealed that most of the plague victims had a ticket with a number on it. I looked around for a machine but there wasnt one. My heart sank and my stomach churned as I caught sight of the first ninja handing a ticket with a number to a walking corpse who had light blue skin and purple lips. I gathered my courage and walked up to ninja-number-dispenser and just before I asked for a number I stopped still, thought for a second and I handed over the pink card. It seemed logical captain and I fully expected sudden, violent death. Without looking at me, ninja-happy-now-he-stopped-using-words handed me a numbered ticket. It said, room 219, 201. Now all I had to do was wait.

There was a digital display hanging from the ceiling facing the seats. Different numbers flashed up every 5 seconds which I now understood to be room numbers and the number of the next patient. A clue of some sort would have been good. My appointment was for mid-day. It was now 12:05. I hoped I hadnt missed my appointment. I would be happy to face open-heart surgery without anaesthetic rather than try to get another appointment. SO I resolved to sit and watch for my number. I spied a seat with the greatest number of free seats round it in the whole room and walked towards it. Then I caught the stench. If body-odour was an olympic event, I was in a roomfull of potential gold medal winners. I literally gagged and decided standing was better than vomiting.

1pm came and went. No-one seemed to be leaving the waiting room. I recognised many of the diseased lepers with open running sores had been waiting longer than me. 1:45 arrived and I was getting edgy. I needed to leave at 2PM so I could be home in time to pick up my children from school. I went to the desk and risked a ninja question. "When will I see the consultant?" I asked. She completely blanked me and dialled a number on her mobile and spoke quite loudly to her friend. I was pondering my next move when I heard a very arabic version of my name being called by a tiny ninja-nurse. I walked over to the ninja-nurse and before I could check that it was me she was looking for she walked off and gestured for me to follow. In the next millisecond she had taken my weight and blood-pressure and I was being sent back to the flesh-eating-disease incubation unit.

I stood for about 30 seconds and another arabic voice called my name. I couldnt see the source of the voice so I went looking. At the opposite end of the corridor a woman was calling my name from a doorway, facing away from me. I walked up to her, and , again, before I could check that she was looking for me she placed her hand in the small of my back and ushered me into the room. There were about ten people in the room. About half were wearing some sort of uniform. The other half seemed like members of the public who werent willing to risk sitting in the anthrax-laden atmosphere outside and had simply found a place to sit. Behind the desk sat a venerable Arab gentleman who smiled at me and very politely asked me to sit.

There were many conversations going on in the room. The Arab gentleman spoke and I didnt think he was speaking to me. He looked me straight in the eye and asked if I had been waiting long. There was a lot of talking going on in the room and I really didnt want to participate in a consultation with half of the middle east listening in. But, it was 1:55 and I needed to leave in 5 minutes. The whole conversation took 2 minutes. I was booked in for a home sleep study. As I was leaving the Arab gentleman asked me what motivated me to have a sleep study. I mentioned the blood pressure. He squinted at his notes. "133/85 today. No blood pressure issue here", he scoffed. Then it dawned on me. I wasnt stressed because it was done so quickly. Also, the cuff was huge and easily fitted around my arm. I asked him to write it down and I have kept that piece of paper to this day.

My taxi whisked me home and I asked to be dropped off at the medical centre. I walked straight into the blood pressure room and asked for my blood pressure to be taken. It was 158/90. All I had done was sit in a car for 40 minutes, not run a marathon. Yet here was my clear, quantitative evidence that the medical centre machine was wrong. The nurses and doctors all completely ignored my evidence and forever lost any belief I had in them.

In my next post I will describe how I personally have been affected by OSA.

Until next time.

How I found out...

This is my story about how I came to be diagnosed with obstructive sleep apnea.

I moved to a new country, actually a new continent. I had a very thorough medical at my interview and then another medical 4 months later when I started the job. Both medicals found me fighting fit. Blood tests all came back negative, blood pressure fine and lungs the size of Nebraska. I have been a weightlifter for over thirty years.

After a few months I went to my new medical centre complaining of a headache which didnt go away after I took some paracetamol. The nurse took my blood pressure. This wasnt simple because I have huge muscular arms and he had to really pull on the cuff to get the velcro to overlap. He eventually managed this and got a blood pressure of 210/120. This is a really, really bad blood pressure. The nurse went into a panic and started shouting, literally, for a doctor. The doctor came running, again literally. I was sitting in a chair perfectly calm, reading a pamphlet about quitting smoking and feeling fine except for this light headache which would not go away.

Anyway, the doctor looked at me quite puzzled and asked me how I felt. A blood pressure of 210/120 is about the same as a truck tyre and blood should have been spouting out of my eye sockets. He hummed a bit and then decided to take my blood pressure again. This was after he told me that I was probably about to have a heart attack or at least a stroke. He actually could not get the blood pressure monitor cuff to fit around my arm. It was one of those all digital things. The cuff goes around your arm, the nurse hits a button and the display shows the blood pressure. Simple. In theory. The doctor asked me to go to a different part of the medical centre where there was another machine with a bigger cuff. The bigger cuff was still too small but it did just about fit round my arm. This time the reading was 170/85. Much more reasonable but still too high for a normal person. The doctor made me lie down on a bed for 15 minutes and took my blood pressure again with the machine with the bigger cuff. My reading was 200/100 and he was back to the "You are about to die ...." speech. I kept telling him I felt fine but he clearly wasnt listening to a word I was saying. He kept asking me if I felt dizzy had neck pain and a whole host of other questions which I answered no to. He took another couple of blood pressure readings, all in the "imminent death" quartile and decided to prescribe me some drugs which he assured me would make me feel better. I had to take the drugs and come back in one hour. So I did and I did feel better. My blood pressure reading was still in the red but the doctor seemed happy to send me home. I had to report twice a day to have my blood pressure taken. The medical centre was close to where I worked so this was not a problem.

My next day at work was interesting. The school nurse asked me to come to her to have my blood pressure taken. She had a fully equipped emergency room and a blood pressure machine which I later discovered costs over one hundred thousand dollars. It also had a micro cuff which would barely fit around the arm of a barbie doll. But she persevered, took my blood pressure and recorded my highest ever reading of 220/120. I actually watched the blood drain from her face and heard her call for an ambulance. I asked her if it was normal that the velcro of the bp meter cuff came apart but she was beyond listening and was obviously terrified to be the first school nurse to have a death by heart attack in her beautifully equipped room. I am a teacher, by the way.

The ambulance arrived, I heard the nurse, in hushed terrified tones, explain to the ambulance guys that my blood pressure was 220/120 and I could already be in cardiac arrest. So they walked into the treatment room serious-faced expecting to find an ashen-faced near-corpse. Instead they found me sitting calm, relaxed, pink with life and reading a pamphlet about post-natal incontinence. The two ambulance guys looked at each other, made a huff noise and then looked at the nurse and made the same huff noise. They asked me if I could get into the wheelchair they had brought for me. I said yes, I was able but wouldnt it be easier if I just walked down to the medical centre which was literally a 2 minute walk away. It would have taken longer to drive. They asked me lots of questions about how I felt, dizzy etc..... to which I replied I felt absolutely fine. They insisted I walk to the ambulance and then they drove me to the medical centre where I was seen in the emergency room by the attending doctor. He took my blood pressure again, 170/85, asked me the dizzy questions again, prescribed me more drugs and told me to come back in two hours. This I did. He took my blood pressure again, 170/75 and said it was still to high but the 75 was good. I forgot to tell him that I had spent over an hour in the gym lifting weights but he didnt seem to be interested in anything I said.

This went on for three months. I never had a blood pressure reading below 170/80 despite a variety of chemicals being applied. One doctor used the expression "aggressive" hypertension and used this to justify even more chemicals. These ones made me feel dizzy. I told the doctor this but he simply ignored me.

I had had enough. I then spent a few days looking up the whole blood pressure issue. My findings were that taking blood pressure is actually a bit of a lottery. Basing a diagnosis on a single reading is ludicrous. Taking blood pressure is also very prone to inaccuracy if the cuff is too small, too big or not placed correctly on the arm. Other factors which can affect accuracy include taking exercise before the reading, being very hot, having a full bladder and having muscular arms.

The cuff of the digital blood pressure machine works by inflating to a point where a sensor detects that the blood has stopped flowing in the arm. This is the first number in the blood pressure reading. The cuff then deflates to a point where the blood starts to flow again and this gives you the second number. The digital blood pressure meters are not infallible. They can be wrong, especially if the cuff is too small. A cuff generally has to overlap about 50% otherwise the velcro cannot get a good grip and the reading is likely to be incorrectly high. In my case, the velcro hardly overlapped at all making an accurate blood pressure reading impossible.

The classic hand operated blood pressure meters are basically infallible. They cant go wrong. A trained person will use a stethoscope to listen to the arterial flow of blood and will use the hand pump to inflate the cuff until the pulse in the arm disappears. They will then slowly release the pressure in the cuff until the sound of blood rushing back into the arm is heard. This is the first bp number. The pressure is then released until the sound of blood flowing disappears, this is the second number. They had one of the old style blood pressure meters in my medical centre but the cuff physically would not go around my arm so I have had all of my blood pressure readings taken on the same digital machine using the same cuff.

Blood pressure is measured in the number of millimeters of mercury. So the perfect blood pressure of 100/80 means that 100 millimeters of mercury is the highest the blood pressure gets and the 80 is the lowest the blood pressure gets. There are two numbers because your heart sends blood around your body in one big squeeze. The pressure at the very beginning of the squeeze is highest and gradually goes down until the heart beats again. 100/80 means that the pressure at the very beginning of the heart contraction, or heartbeat, is 100mm of mercury and just before the next heartbeat it is 80mm of mercury.

I read many cases of misdiagnosed high blood pressure where medication has been prescribed unnecessarily and to the harm of the patient. I also read about "white coat" syndrome. This is where a patient presents high blood pressure only in the doctors surgery. Home readings can be as much as 20 or 30 mm of mercury lower.

I went back to my doctor and asked some questions. I made this case:

Firstly, I feel fine.

Second, I exercise regularly and perform feats of weightlifting which send my heart rate to over 160 beats per minute. I regularly spend 2 hours lifting weights in this manner and I have never died of a stroke so far. If I had high blood pressure surely I would now be dead.

Thirdly, my blood pressure was fine in my two medicals so why would it suddenly jump.

My doctor got really pissed off at my questions and refused to speak to me. Instead he sent me to have a barrage of blood tests. They all came back negative. I have low cholesterol, low sodium, perfect blood sugar, normal thyroid, liver and kidney function. Not bad for a 46 year old fat guy. I am overweight. OK I admit that. I have never been thin but I have always been fit. I spent a lot of my youth in gyms and when I was 27 I got over a broken heart by becoming a bodybuilder. I was huge. Even at my current advanced state of decrepitude I can still bench press a bar, not a cursed machine, weighing 60KG 25 times. I can still do cleans with a 50kg bar in sets of 5 and I can generally lift any woman I please above my head. Women dont like that and I havent done it since I was 30 and then it was my wife, sorry, ex-wife. I digress. My doctors' response to all of this anecdotal evidence was to prescribe different chemicals which made me even dizzier.

A clear pattern was emerging. Up till this point I had rarely ever been to see a doctor. My naive view of these omniscient, caring professionals was largely formed by watching tv hospital soaps. My reality was that they were arrogant pill-pushers whose main responsibility was to get you out of the consulting room with a bag of chemicals which they could justify and asking questions merely annoyed them.

One doctor sticks out in my mind. Imagine the stereotypical fat guy. The one you see in many silent black and white movies. This doctor was him. His every breath was like listening to someone suck molasses through a straw. His jowls drooped down to the middle of his chest and his fingers were so fat he could barely use a pen. My first consultation with doctor Fat would not be out of place in a tv comedy. He looked at my history on the computer, looked at me and then gave me the following advice, without asking me anything. He suggested that I stop eating junk food, cut down on the alcohol, start to take exercise, like walking for 10 minutes every evening and get my weight down as this was causing my high blood pressure which was now in danger of killing me. He actually used the words "killing me". I guess I had reached bullshit saturation point cos I could not take any more. I informed him, in a very sarcastic tone which my students are very familiar with, that he was totally wrong in all of the many assumptions he had made based on no actual evidence whatsoever. I am practically a vegetarian and I never eat any form of fast food. I am a foodie and a pretty good cook. I dont drink alcohol. I spend 2 hours at least three times a week in the gym and I swim. I weigh less now than when I had my medical three months ago and apparently my blood pressure was fine then so weight is not causing the alleged high blood pressure which I still doubt is actually real. His wee fat face went red and he started shouting at me. The bits I understood had words like "denial" and "sorry state". I was tempted to say something about the pot calling the kettle fat but I didnt. I got up and walked out. My view of doctors forever changed by doctor Fat.

When I started typing this I expected it to take 10 minutes. This is way too long but I feel a cathartic need to get all of this down. I will continue tomorrow.

Hello World - Lets Talk Sleep Apnea

Hello, my name is George O'Neill. I usually never put any personal information on the internet but this is a special occasion.

The reason I have created this blog is to put some information out there about a condition/illness I have recently been diagnosed with. Obstructive Sleep Apnea (OSA). The spelling of apnea is much debated but I will stick with the simplest form. OSA is where a person chokes in their sleep, wakes up and then goes back to sleep. The soft tissue at the back of the throat falls down blocking the airway. Why this happens is a mystery as far as I have read. Skinny people, fat people, fit people, white and black people all suffer from OSA. People with OSA are usually not aware this is happening as they never completely wake up. The sleeping partners, in the literal sense, of OSA sufferers are usually the ones who notice that their partner stops breathing for anything between 2 and 10 seconds while they are sleeping. There is usually some sort of snort, a resumption of breathing and the apneac goes back to sleep. Some people with OSA stop breathing every minute. The result of this is that the OSA sufferer doesnt really sleep.

The classic symptoms of OSA are constant fatigue, waking up with a sore throat, headaches, using the words "I feel hungover" most mornings, lack of energy, lack of concentration and in my case being clumsy. There are much more serious effects of OSA. The body of an OSA sufferer is constantly struggling for oxygen during sleep. The heart and lungs are working very hard to manage on a limited supply of oxygen. OSA sufferers often report waking up in the middle of the night heart pounding, out of breath and generally feeling dead from the neck up. I write this description from experience. OSA isnt just a lack of sleep, its a massive strain on almost all elements of health. The strain on the heart means that after a few years of OSA, a heart scan shows damage to the heart which is directly attributable to OSA. The damage will get worse over time and will kill the OSA sufferer. The headline will say "Unexpected death from heart attack" but this is not accurate. The death is caused by OSA.

The lack of sleep means that the OSA sufferer will usually have lousy concentration. Driving a vehicle while suffering from OSA is a crap shoot. Many OSA sufferers will fall asleep any time their body identifies an opportunity. People have been known to fall asleep in mid-sentence. OSA sufferers sometimes report "micro sleeps". They could be sitting in a car at a set of lights and they find themselves waking up at the wheel with no idea how long they have been asleep. It may have been seconds or even minutes. Again, headlines will say "Man kills family of three after falling asleep at wheel". Again, this is not accurate, the root cause here is OSA.

Other proven medical symptoms of OSA include raised blood pressure (very common) and sexual dysfunction. My reading has revealed many other conditions are currently being investigated to see if there is a link to OSA. OSA sufferers are many times more likely to suffer from heart attacks and stroke. I have read about studies to see if there is a link between OSA and diabetes.

The treatment of OSA comes down to surgery or a CPAP machine or both. CPAP stands for Continuous Positive Airway Pressure. This is where an OSA sufferer wears a mask which is connected to a machine which blows air at a constant pressure down the back of the throat. This constant pressure keeps the airway open. Many OSA sufferers report almost miraculous results of using a cpap machine. Lives are changed by cpap. Quality of life can be improved beyond all measure. Some OSA sufferers, however, do not feel the instant benefits of cpap but get them over a period of weeks or months.

Surgery can also be an option. The tonsils and adenoids are the tissues which droop down at the back of the throat causing the airway to be blocked. Surgery removes the tonsils and/or adenoids. My reading suggests that opinions are at best mixed about the effectiveness of surgery.

I am not a doctor. I am just an average guy with a natural desire to find out about the condition I have been diagnosed with. I have felt the effects of this condition, experienced the woeful attempts of many physicians to treat my condition and witnessed first hand the knee-jerk diagnoses of pill pushers. I had to take control of my health as I could not trust my doctors to do it. OSA is a potentially fatal condition. I have two children who I want to watch grow up. My experiences unfortunately have made me realise that you cannot leave it all up to the doctors. Good doctors, doctors you can place your trust in, are very rare.

I will begin to detail my own personal journey of discovery about the condition called Obstructive Sleep Apnea in my next blog entry. OSA right now dominates my thinking and I have found my way to treatment and I have seen what amazing results the treatment can have. Its been a long journey. I hope others will find this blog at least informative.

Till next time.

George