Why UARS is Harder to To Treat Than Sleep Apnea

November 24, 2015 by  

Almost routinely, I see patients who repeatedly stop breathing at night but don’t have any significant apneas on sleep studies. Jennifer was told by her husband that she choked multiple times at night with frequent arousals. But her apnea hypopnea index (AHI) on her in-lab sleep study was 1.0, well below the 5.0 threshold needed for an obstructive sleep apnea diagnosis. She underwent every possible test, including an MRI to rule out a brain tumor, but everything came back normal.
Eventually, drug induced sleep endoscopy (DISE) revealed severe tongue base and soft palate obstruction. Essentially, people with upper airway resistance syndrome (UARS) obstruct often but wake up to light sleep too quickly, less than the 10 seconds that are needed to be scored as an apnea or hypopnea.
Here are 5 reasons why UARS is harder to treat than obstructive sleep apnea:
1. If your AHI is less than 5, you’re told by sleep doctors that you don’t have sleep apnea. Your severe fatigue and various other conditions are often blamed on hormonal (pre-menstrual, menopause), neurologic (multiple sclerosis), infectious (Lyme, mononucleosis), rheumatologic (chronic fatigue, fibromyalgia), food/environmental allergies, mold sensitivities, or nutritional/vitamin deficiencies. As a result, treatment for a sleep-breathing problems is not even considered. 
2. If you’ve already been diagnosed with one of the above conditions in #1, then it’s very unlikely that you or your doctor will consider an alternative explanation, especially if you’ve already invested so much time, energy and resources.
3. If your doctor wants to treat you for UARS with continuous positive airway pressure (CPAP) or a dental appliance (that pulls your tongue forward), insurance won’t usually cover it, since your AHI is less than 5.
4. Most people with upper airway resistance syndrome also have various degrees of nasal congestion. Having a small mouth with dental crowding also leads to narrow nasal passageways, making it more likely that you’ll have a deviated nasal septum, enlarged or over-reactive turbinates, or flimsy nostrils. Having a stuffy nose will prevent you from being able to use CPAP or dental appliances. 
5. UARS is a structural problem caused by smaller-than-normal jaw structures, leading to narrowed air-passageways that lead to severe breathing problems at night. All the truly effective solutions involve using gadgets, devices or surgery. With few exceptions that can lead to temporary relief, you can’t treat it with a pill. 
The most common manifestations of UARS are severe chronic fatigue and exhaustion (not sleepiness), anxiety/depression, headaches, nasal congestion, TMJ problems, cold hands/feet, low blood pressure, diarrhea/constipation/bloating, frequent nighttime urination, and hypothyroidism. The typical exam findings include a high arched hard palate, narrow dental arches, crooked teeth, bite problems, head forward posture, and a relatively large tongue (due to a small mouth). 
If you fit some or all of the features described above, you may have upper airway resistance syndrome. For a more detailed description of UARS, you can read an article by clicking here. Please note that you can have UARS and various other conditions. But not being able to breathe and sleep properly can significantly aggravate any other condition that you already have. In addition, you can have obstructive sleep apnea and UARS overlap to various degrees.
Unfortunately, many mainstream sleep physicians will be resistant to acknowledging that UARS exists. If you do your research, you should be able to find a sleep physician that will be willing to treat your UARS even if you don’t have sleep apnea. Other specialists such as otolaryngologists and dentists may be more receptive to UARS, but even then, they are in the minority. A good place to start looking is to listen to some of my past expert interviews, particularly the episodes with Doctors Guilleminault, Krakow, Gold, Lawler, Palmer, Silkman, Belfor and Singh.

Podcast #14: Your Sleep Apnea Questions Answered

November 17, 2015 by  

In this episode, I answer 13 of your questions that I get through my blog, email, and contact me page. This is completely live and unscripted. I have no ideal what Kathy will ask me. See below for a list of the questions.
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1. How much do you charge for a office visit or procedure? 
2. How can I make an appointment to see you?
3. Various questions about specific medical issues.
4. What’s the difference between upper airway resistance syndrome (UARS) and obstructive sleep apnea (OSA)?
5. Will sleeping pills work for upper airway resistance syndrome?
6. Does sleep apnea cause brain damage? 
7. Are apneas more damaging on the brain than hypopneas?
8. What’s the relationship between depression and sleep apnea?
9. How do dental extractions affect sleep apnea?
10. Can nasal surgery cause sleep apnea later in life?
11. What’s the link between reflux and sleep apnea?
12. Can sleep apnea cause dizziness?
13. What questions should I be asking my doctor?
Show Notes:
Podcast 13: Which surgeon do  you recommend?
Sleep, Interrupted
How to Unstuffy Your Stuffy Nose e-book
Contact Dr. Park
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An Out-Of-The Box Explanation For Chronic Stress

November 12, 2015 by  

Here’s a very good story about one of my past guest interviewees, Dr. Avram Gold. Sleep Review Magazine published an interesting article that reviews Dr. Gold’s controversial work on functional somatic syndromes (depression, anxiety, chronic fatigue syndrome, fibromyalgia, insomnia, Raynaud’s syndrome, RLS, hypothyroidism, IBS, etc.) and upper airway resistance syndrome. 

It’s a fascinating discussion about how patients with “mild” or no obstructive sleep apnea (OSA) can often be worse off than OSA. My sleep-breathing paradigm is completely in agreement with Dr. Gold’s basic premise, that frequent partial resistance to breathing at night with repeated arousals from deep sleep can cause or aggravate many of the the conditions listed above. What I describe has more anatomy-based descriptors, due to the fact that modern Western humans have shrinking jaws, leading to more narrow upper airways. 

I, too have had patient with many of the various functional somatic syndromes feel significantly better or get better completely after treating their narrowed upper airway anatomy, using CPAP, dental appliances, or surgery. In fact, most of these patients had no significant apneas or very mild levels of OSA on sleep studies. In all cases, upper airway evaluation using a flexible camera showed very narrowed airways. 

If you have or had any of the above conditions improve or resolve completely by using CPAP, dental devices or surgery, please tell us your story in the box below.

Tom Hanks, Spies, and My Dilemma As A Sleep Apnea Surgeon

November 10, 2015 by  

One of my greatest challenges as a sleep apnea surgeon is what to do when patients require additional surgery because the first one didn’t work. With all surgical options for sleep apnea, there is always a small but significant number of patients when surgery helps partially or not at all. 
Patients know this before going into surgery. Rarely, you can also have complications. There are a number of technical reasons why this may happen, but the remainder of this discussion will focus on the dilemma that the patient and I face when presented with the possible need of more surgery. When initial operation didn’t work, I can’t help but to feel a sense of remorse as their surgeon feeling like I’ve let them down somehow. By all accounts, I did everything by the book. 
In a recent movie I saw called “Bridge of Spies,” Tom Hanks plays James Donovan, a high powered New York lawyer, who unsuccessfully defends a Russian accused of spying during the cold war. He escalates the case to the Supreme Court, arguing successfully that the accused should not be executed in case they need a bargaining chip with the Soviets. Sure enough, an American pilot gets shot down and stands trial in Russia for spying. 
The American government is contacted by the Soviets through someone in East Berlin to inquire about a possible trade. About the same time, an American student is captured and detained in East Berlin. Donovan is determined to negotiate the release of both captives in exchange for the convicted soviet spy.
Ultimately, Donovan easily wins the freedom of the American pilot. In everyone’s eye, this was a fair and equitable trade and something that was more than anyone could have asked for. But he couldn’t let this go. He kept pushing for the East Germans to free the American student at the risk of jeopardizing the deal he made with the Soviets for the American pilot’s freedom if not at the risk of his own life. He was accused of being an extremist. He fought with a dilemma of feeling like maybe he’s doing this to stroke his own ego or because he knew this is the right thing to do no matter what the cost.
My Dilemma as a Surgeon
Throat surgery is usually considered only after trying everything else for sleep apnea patients, including CPAP, dental devices, nasal surgery, diet and lifestyle modifications. Whenever the first surgery doesn’t help, patients will sometimes initiate the discussion, asking about the possibility of further surgery. In most cases secondary surgery helps. 
But what about patients who undergo multiple procedures without success? Some patients go through 3, 5 or even 10 surgical procedures before coming to see me. Whenever I ask my sleep colleagues, the general response is to avoid doing any more surgery on these type of patients. 
Is the Patient Crazy?
Whenever I see a long list of past surgical procedures, I admit that my first reaction is to recommend not doing any more surgery. What more can I possibly offer when even some of the top sleep surgeons in the country can’t help? Whenever I run these situations by my colleagues, I’m told consistently to avoid doing any more surgery, but I can see from the tone of their voice and facial expressions that they think the patient is addicted to surgery.
One way I’ve dealt with this situation is to recommend a second opinion. Some people end up going for two, or even three opinions. Invariably, they get conflicting recommendations and comes back even more confused and frustrated.
This brings up the question that all surgeons have to face: How far do you go to help your patients? Is there ever a limit to the number of surgical procedures, especially if you have a reasonably good idea what the problem is? Does having undergone ten operations automatically disqualify you from further surgery? Is it unrealistic to expect surgeons and patients to expect a “cure” after the first procedure?
Addicted to Surgery?
I thought that I could find all the answers since we are the “experts.” Patients are looking to us as their last hope. We as a profession should to able to help patients who have exhausted all their other options. But what should I do when my own profession tells me to withdraw care on certain patients that are “addicted” to surgery?
I searched amongst my colleagues, the research literature, and Google for some answers, but was unable to find any helpful suggestions. However, over the years, I began to see some insight from an unexpected source: my patients.
Something Besides Brain Damage
I began to see a pattern with certain patients that seem to be “addicted” to surgery. These people were relentless in their pursuit of a great nights’ sleep. Some patients were able to localize where the blockage was happening, but were oftentimes dismissed by their  doctors. In other cases, sleep physicians were puzzled when the AHI dropped from 60 to 1, but they didn’t feel any better. One common explanation by sleep doctors is that there may have been some brain damage or nerve damage in the throat that can’t be cured with surgery. 
However, whenever I examine these patients in the office or under general anesthesia, I see obvious persistent obstruction behind the soft palate, tongue base, or both. The previous procedure wasn’t strong enough. Sometimes, the epiglottis falls back or the soft palate flips back up in the nose during nasal exhalation. The latter mentioned conditions can’t be picked up by sleep studies. You can also see complete obstruction to breathing, but the pauses are so short that the sleep study doesn’t register any apneas or hypopnea. Oftentimes these patients are told that they don’t have any more sleep apnea and that their symptoms are either due to brain damage for some other unknown problem.
The Possible Difference Between Success and Failure
Whenever these patients decide to go on for more surgery, many patients end up finding the holy grail: a great night’s sleep. It may not be perfect, but it’s so significant, that some patients are in tears. Not all patients will ever reach this point, but in general, the more aggressively the patient pursues more surgery, the better the result.
Contrary to what’s generally believed by the sleep medicine community, in my experience, surgical failure does not lead to lessening the chances that you can use CPAP. Oftentimes, suboptimal surgery will allow patients to better benefit from CPAP and/or dental appliances. Extremely high CPAP pressures can be lower, making it more comfortable to use, and oral appliances may help better since there’s more space behind the throat structures. 
Sleep Apnea Surgery Is Not A One Time Deal
Patients and doctors still have the mentality that you need one good option to treat your sleep apnea. This is what ultimately breeds unnecessary competition between the various sleep professionals. What I’m finding is that for best long-term results, you need to consider mixing and matching multiple options, with periodic adjustments and even switching primary treatment options every few years. 
For obstructive sleep apnea, most patients can do well with only one procedure, but some patients will require more than one surgical procedure. One way of looking at this is to consider surgery for cleft palate, reconstructive procedures for children born with no ears, or patients with severe facial burns. In each of these situations, you start off with the knowledge that you’ll most likely need multiple surgical procedures, mixed along with physical therapy, hearing tests, psychologists, and various other supportive options that are usually needed.
If your initial surgery was successful but stopped working after a few weeks, most people will say that the surgery didn’t work. However, the fact that it did help significantly, even if only temporarily, means that you addressed the right area of blockade, but the surgery was not aggressive enough. At this point, an examination in the office or sleep endoscopy usually reveals what more needs to be done.
Questioning My True Motives
Tom Hank’s character struggled with whether or not to “go for it” placing both captives and even his own life at risk. He could have taken the easy way out and settled for only the pilot. In the same way, the easiest and safest option for me is to tell the patient that I don’t think anything more can be done. But if I know that there’s persistent obstruction behind the soft palate and there’s a chance that more surgery can help, what’s the right thing to do? Settle for good enough and go back to CPAP, or agree to further surgery with no guarantees of success? Am I offering further surgery because it’s in the patient’s best interests, or to boost my own ego as a sleep apnea surgeon?
Granted most patients won’t ever have to face this dilemma. But this situation happens often enough for me to question my own motives every time it happens. Unfortunately, there are no textbooks, research studies, experts or other resources to help me with this particular issue. Until something comes along, the only resource I have to to develop a strong relationship with my patients, and come to an individual decision based on the available evidence and mutual trust.
If you are faced with this situation as a patient, would you rather that your surgeon play it safe or would you rather that he or she did everything possible? What do you think?

Why Interrupted Sleep Is Worse Than Short Sleep

November 5, 2015 by  

Everyone has experienced interrupted sleep. From having a new child, to car alarms or a barking dog, it’s a given that our sleep will be interrupted as a part of life. However, some people are awakened every few hours, even every few minutes during sleep due to breathing pauses. Obstructive sleep apnea can cause this, but you can also have frequent breathing  pauses without having apneas. This is called upper airway resistance syndrome, which I describe in my book, Sleep, Interrupted. The main premise is that all modern Western humans have various degrees of dental crowding and upper airway narrowing, leading to interrupted sleep.

Here’s a Time Magazine article which supports the main point of my book and everything I write on my blog. They cite a Johns Hopkins University study which found that interrupted sleep and short sleep lead to drops in positive mood ratings compared with controls. However, on subsequent nights, interrupted sleepers had continued declines in positive mood, whereas the short sleepers stayed the same. 

Furthermore, the researchers found that interrupted sleepers had significantly lower levels of slow-wave sleep, or deep sleep. About the study, the lead researcher commented, “We saw a drop in slow wave sleep so large and sudden, and it was associated with a striking drop in positive mood that was significantly different than in the other group.” We know that deep sleep is needed for your body to heal and regenerate.

There are lots of studies showing that prolonged interrupted sleep also lead to a major chronic stress response, which alters your mood, energy levels, and your hormones. A great book to read about stress is “Why Zebras Don’t Get Ulcers,” by Dr. Robert Sapolsky.

Another known consequence of interrupted sleep due to frequent breathing pauses is nighttime urination. Obstructed breathing stretches the heart muscles, which makes atrial natriuretic peptide, a hormone that makes your kidneys make more urine. People who get up to go in the middle of the night do it on a regular time interval, anywhere from 1.5 to 2 hours, which is one sleep cycle. Whenever you cycle through to deeper levels of sleep, your muscles relax to the point of obstructed breathing severe enough to wake you up completely. Oftentimes, there won’t be too much urine.

Many people with interrupted sleep get by with drinking lots of coffee or exercising intensely. Some even resort to taking prescription stimulants or anti-depression/anti-anxiety medications. The possibility of a sleep-breathing problems is not often considered, even by most physicians. 

You may be asking how can you know if you have this, and what can you do about it? One simple clue is to look at your sleep position. If you prefer to sleep on your side or your tummy, that means that it may be harder for you to breathe on your back, due to your tongue falling back more often due to having a mouth that’s too small, and due to gravity. Many people will also have chronic nasal congestion. You may also suffer from fatigue, headaches, anxiety, TMJ, digestive problems, cold hands. Snoring is helpful but you don’t have to snore to have sleep apnea or upper airway resistance syndrome. Being overweight or obese is also not a requirement. Most people with upper airway resistance syndrome are usually young and thin, and don’t snore.

The first step in addressing this problem is to improve your sleep hygiene: make sure you’re sleeping long enough, don’t eat or drink alcohol within 3-4 hours of bedtime, and don’t use anything with an electronic screen before bedtime. Improve your nasal breathing the best that you can. Start with nasal saline irrigation, breathe right strips, allergy medications. If this isn’t helpful, see your doctor for more definitive options.

The above tips will help some of you, but many will need additional help from a doctor that understands what’s going on. The first step is to determine if you have obstructive sleep apnea. Even if you don’t officially have sleep apnea on a sleep study, don’t rule out upper airway resistance syndrome. It’s important to find an otolaryngologist (ENT) who can look at your airway to see what’s going on. 

If you have interrupted sleep, it’s important to look beyond the typical things that keep waking you up. Sleep-related breathing disorders can be a good explanation, whether or not it’s due to obstructive sleep apnea. 









Podcast #13: How To Find A Good Sleep Apnea Surgeon

November 3, 2015 by  

In this episode, I answer one of the most common questions I get, which is: “Can You refer me to a good sleep apnea surgeon in my area?”

Kathy and I will provide 4 questions you should be asking your surgeon, as well as 4 that you shouldn’t. 

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Show Notes

The Truth About Sleep Apnea Surgery free report

Getting to Yes: Negotiating Agreement Without Giving In (BATNA concept: best alternative to a negotiated agreement)

Sleep, Interrupted: A Physician Reveals the #1 Reason Why So Many Of Us Are Sick And Tired

If you found this podcast helpful, please share with others by using any of the social media icons below.

Winston Churchill and Sleep Apnea

October 27, 2015 by  

You’re probably guessing that I’m going to suggest that Winston Churchill had obstructive sleep apnea. He probably did, but that’s not the focus of this blog post. One of his more famous quotes, is “Never, never, never give up.” Unfortunately, many people with obstructive sleep apnea give up much too early. But time and time again, I see that people who are relentless usually find something that works. It can be one option after trying 10 different options. Or they may need to layer on two or 3 different options. 
John was one such patient. He came to me after struggling with 3 different types of positive airway pressure machines (CPAP, APAP, bilevel), 4 different masks, and an oral appliance. We ended up doing palate and tongue base surgery. Surprisingly, he wasn’t disappointed when surgery didn’t help that much. His plan was to go back to trying his dental appliance again, which he preferred to CPAP. After a few weeks, he was happy to report that the dental appliance was working much better compared to before surgery. He tried CPAP as well, and was able to use it better after his pressure was lowered.
Jaime is a fashion designer that was struggling with APAP for the past 3 months. The machine reported perfect compliance, with no leaks, minimal apneas and 7 hours of use every night. She tried 3 different masks, without any success. Her DME (CPAP equipment company) suggested that she try a constant pressure rather than an automatic setting. Within 3 days of starting, Jaime called to say that she’s sleeping much better. This is in line with studies showing that some patients prefer APAP (automatic) over CPAP (constant) pressures, and some prefer CPAP over APAP. 
Peter is a 60 year old man who came to see me with a list of 10 surgical procedures for obstructive sleep apnea, including 2 nasal procedures, 3 soft palate procedures, 3 tongue base and epiglottic procedures, and 2 jaw operations. I didn’t see any obvious areas of persistent obstruction on exam, so I was reluctant to offer any more procedures. However, sleep endoscopy showed severe collapse behind the soft palate. He underwent further soft palate surgery by another surgeon, with much improved sleep quality. 
These are examples of patients that did not give up. I bet there are many more sleep apnea sufferers that have tried multiple options, but give up just before they find something that works for them.
Napoleon Hill, in his book, “Think and Grow Rich,” tells a story about a man who invested everything he had to mine for gold in colorado. He found a small vein, but it stopped all of a sudden. He kept drilling and drilling, but to no avail. Eventually he gave up and sold all his mining equipment to a junk man for a few hundred dollars. The junk man called in a mining engineer who determined that they should drill 3 more feet. Sure enough, there it was.
I’m not here to say that everyone who persists and never give up will be successful in overcoming sleep apnea. What I see is that more more persistent you are, the more likely that you’ll be able to find something that works for you. In addition to persistence, expert counsel is also needed at the right times. I realize that the above examples are on the extreme side, but  I see this happening far too often for it to be a coincidence. 
If you have a similar success story, I’d like to hear from you. How much did you have to persist, and how did seeking expert advice help you?

Podcast 12: 7 Good Reasons to Consider Surgery for Your Sleep Apnea

October 12, 2015 by  

There comes a time when you have to say, “enough is enough.” You’ve gone through 3 different masks, CPAP, APAP and 2 dental appliances. You also tried chin straps to keep your mouth closed along with your oral appliance and CPAP, all together. Some of you can’t even keep CPAP on for more than one hour. And there are some of you that are able to use CPAP for 8 hours straight for 3 months and your machine is telling you that your AHI level is 0.1, but you still feel terrible. You’ve also tried every trouble shooting step mentioned on every sleep apnea support site. At a certain point, you have to consider the possibility of undergoing surgery.

Granted not everyone who struggles with CPAP has tried all this, but many of you have already gone through many, if not most of the above steps. Some people will be better candidates for surgery than others. 

In this podcast, Kathy and I will go over the 7 good reasons why you may want to consider surgery for your obstructive sleep apnea.

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Here’s a quick summary along with the resources and links mentioned in the podcast:

1. CPAP is not working
      Podcast on troubleshooting CPAP problems (Podcast #9)
2. Oral appliance is not helping
      Podcast #59 on oral appliances
3. You have a stuffy nose
      E-book on how to unstuffy your stuffy nose
4. You have large tonsils or adenoids
5. Previous surgery didn’t work
6. If you can’t breathe out through your nose or feel a flap close suddenly during inhalation
7. You’ve tried everything.
If you liked or found helpful what you heard on this podcast, please leave a review on iTunes. Please also share this post by using the links below.

A Matter Of Life And Death: Dr. Borelli’s Wake Up Call

October 8, 2015 by  

There’s been a lot more studies recently linking untreated obstructive sleep apnea with brain damage. One study out of UCLA showed how obstructive sleep apnea can damage the brain. One of my past guests for my Expert Interviews, Dr. Joseph Borelli, talked about how often he sees brain damage in patients with severe untreated sleep apnea (iTunes Podcast #14). Here’s a recent article featuring Dr. Borelli on Discover

I’ve had many patients tell me that their memory became better after being treated for obstructive sleep apnea. This is in line with a 2010 study showing that damaged areas of the hippocampus can regenerate partially after being on CPAP. 

If you have obstructive sleep apnea, did treatment using CPAP, dental appliances or surgery help your memory? Please enter your comments in the text area below.

7 Annoying Distractions in the Operating Room, and How It’s Detrimental to Patient Care

October 6, 2015 by  

People used to joke that in the 1970s and 1980s, only doctors and drug dealers had pagers. Drug dealers have moved on to more sophisticated technology, and doctors are probably the only profession using pagers. In our academic institution, residents still use pagers for consults and emergencies.
I’m reminded of this every time I’m in the operating room (OR), with the resident’s pager going off with the old-style shrieking, high-pitched ringer multiple times throughout the day. People in the OR don’t seem to mind at all, expect for me. Perhaps they’ve all been desensitized to all the technology-related noise and distractions that are so common today.
Besides pager noise pollution, there are a number of other distractions that can potentially lead to less than ideal surgical results. Here are 7 annoying distractions in the OR that can be detrimental to patient care:
1. Pagers
Most of the modern pagers have more pleasing ringtones, and even a vibrate option, but it seems that most doctors continue to use the most annoying ringtone to get their attention. It’s not just the bothersome ringtone—it also causes my assistant to get distracted and ends up having the circulating nurse call back the page and relay messages back to the person who initiated the page. Sometimes, the resident scrubs out to talk on the phone or gets called to the floor or ER to handle any emergency situations. Needless to say, this can be very distracting.
2. Chatter
Contrary to the old days when the OR was thought to be an operating theater, conversations start up between various non-surgical staff. Many are for reasons related to the surgical procedure, but often times, it’s just chi-chat. When I was in medical school, these conversions used to be in hushed tones, but now it’s at regular conversation levels. You can sometimes have two pairs of people having conversations.
3. Music
Every surgeon has preferences for whether or not they want music playing at all, and if they like music, will have very different tastes. My personal preference is to have no music at all. I take surgery seriously, as if I’m taking a test. Having music in the background may be soothing or relaxing to some people, but it can definitely have conscious or subconscious detrimental effects on test-taking or even surgery. Also, not every one will like the kind of music that’s chosen to be played. Studies have shown conflicting results on whether music in the OR can alter outcomes. 
If we’re at the end of a case and closing and if someone requests, music, I insist on classical, jazz, or instrumental music only with no words.
3. Too many screens
This may only apply to some of the newer operating rooms. In my hospital with new operating rooms, there are literally 4 LCD monitors, usually hooked up to the camera that I’m using for the patent. Anesthesia has their own 2 to 3 monitors. The problem is that I can usually see 2 or three others in my direct line of sight or peripheral field of vision. Having the camera attached and not holding it steady will make the image shake or move around, making everyone in the room dizzy. Having two extra large LCD monitors make things much worse. Oftentimes, I go around to turn off one or two monitors, and switch the third monitor to the anesthesia machine, keeping only one for myself.
4. Screen savers
One really annoying thing that my hospital has done in the name of patient safety is to install screen savers that animate different messages, like wash your hands often, check the patient’s ID multiple times, get your flu shot, or don’t recap needles. The problem is that the animation is really distracting, in addition to being reminded of things that we’re already doing anyway. Now imagine seeing 4 monitors transitioning to a different screen every minute, like what you would see at a flat screen TV wall at Best Buy.
What I usually do is to turn off the screen savers at the beginning of each case. I do the same thing when seeing patients in the office, as it detracts from the doctor-patient experience. 
5. Instrument noise
There can be dozens of medical equipment in a modern operating room. Some of these machines can beep, hum, buzz, screech or hiss at extremely loud noise levels. Alarm sounds can be even louder. These distractions can occur repeatedly throughout the case. Many studies have shown that sound levels in the OR can routinely exceed 100 dB, sometimes as high as 131 dB. 100 dB is as loud as a lawnmower or a motorcycle. 
6. Too hot or cold temperature
The OR is intentionally kept somewhat cool, but oftentimes, it’s much too cold. Being dressed in scrubs in low 60 degree temperatures can be quite uncomfortable. Putting on surgical gowns makes things much more tolerable, but the circulating nurse and anesthesia staff are frequently shivering. The patient is always comfortable, with a warming blanket throughout the case. Rarely, it can get uncomfortably hot. In most cases the temperature can be adjusted, but not always.
7. No place to write
With more modern ORs, it’s expected that everything will be documented in the computer. However, the vast majority of paperwork that’s done in the OR is still done on paper. Since the one desk/table is being used by the circulating nurse, the only place for me to write my notes and discharge paperwork is on a trash bin, or small light source box. As you can imagine, these are not the most ideal surfaces to write on.
These 7 annoying distractions may be unique to my particular situation, but I’m sure that most surgeons will experience some, if not most of these same issues. 
Some of these distractions may not be a big deal. But if added together, especially if they occur simultaneously at critical times during surgery, you can imagine it can potentially lead to less than optimal medical or surgical results. Here’s an article summarizing these potential dangers. Bare minimum, it can lead to miscommunication or misunderstandings amongst the staff.
In this age of high-technology and multitasking, we assume that we can handle multiple tasks at the same time. However, it’s been shown that we can focus on only one thing at a time. Various distractions can divert our attention away from our main area of focus. It doesn’t take a brain surgeon to know that these distractions do not provide the ideal situation for good patient care.
If you’ve undergone surgery recently, have you noticed any of the issues that I mentioned in this blog? Please enter your responses in the text box below.

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The material on this website is for educational and informational purposes only and is not and should not be relied upon or construed as medical, surgical, psychological, or nutritional advice. Please consult your doctor before making any changes to your medical regimen, exercise or diet program. Some links may go to products on Amazon.com, for which Jodev Press is an associate member.

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