Monthly Archives: December 2004

“To sleep, perchance to dream…”Hamlet

“To sleep, perchance to dream…”Hamlet said those words, because he couldn’t sleep. And neither can many Americans, for one reason or another. Some of us just choose not to get enough sleep; we are busy working, we have babies that wake us at night, or we party too hard. Others of us *can’t* sleep; we have insomnia, we snore, we’re depressed, or we quit breathing in our sleep and that wakes us up.

Or it doesn’t. World-famous football player Reggie White died last week in his sleep. Reports say he had a heart attack due to sleep apnea.

According to the Sleep Foundation, Sleep apnea is a serious, potentially life-threatening condition that is far more common than generally understood. First described in 1965, sleep apnea is a breathing disorder characterized by brief interruptions of breathing during sleep.” In Greek, apnea means �want of breath.�

There are two types of sleep apnea: central and obstructive. Central sleep apnea occurs when the brain fails to send signals to the breathing muscles to initiate respirations. Obstructive sleep apnea, far more common, occurs when air cannot flow into or out of the person�s nose or mouth although efforts to breathe continue.

In a given night, the number of involuntary breathing pauses or �apneic events� may be as high as 20 to 60 or more per hour. These breathing pauses are almost always accompanied by snoring between apnea episodes, although not everyone who snores has apnea. Sleep apnea can also be characterized by choking sensations.

The frequent interruptions of deep, restorative sleep often lead to excessive daytime sleepiness and may be associated with an early morning headache.

Early recognition and treatment of sleep apnea is important because it may be associated with irregular heartbeat, high blood pressure, heart attack, and stroke.

Because doctors now realize how dangerous sleep apnea can be, there are sleep test centers in many hospitals, and patients go there for a night of monitored rest.

But who can get a good night’s sleep in a hospital?

Responding to his own need for a sleep test, serial entrepreneur David Kaye decided to fine tune the concept of the sleep test to make it more patient friendly.

And that’s how I came to be spending a night last week in a Mesa hotel, being a beta tester before the launch of the first Sleepwell Diagnostic Center in Arizona.

Kaye has already rolled out similar centers in Oregon in Utah, and is in the process of making a nationwide deal with a hotel chain to roll the company out all over the U.S. For each center, he leases part of a floor in the hotel, and fits it out like a cross between a home and a sleep center. This center opens in January, and it needed a guinea pig or two to test all the systems. I’ll try anything once, especially if it’s for a client and fellow entrepreneur, so I allowed myself to be persuaded to try it.

One thing is certain; it didn’t feel like going to a lab in a hospital.

I showed up at about 8:30 PM, and met a very nice technician who began attaching electrodes to my legs, head, and heart. It took about forty minutes to hook me up. He answered all my questions, and I told him to be aware that I would be up twice during the night processing the two liters of water I drink during the day. Then I went to bed in the hotel room, watching CNN while he went into the data center to watch me.

All night long the monitors recorded information from about twenty-five centers in my brain that are involved with sleep. These tell whether I go through all the stages of sleep during the night, and how much of the night is spent in deep, restorative sleep. They also tell whether I am dreaming, although not WHAT I am dreaming.

At the same time, a monitor across my chest keeps track of my heart and lungs, and one on my face measures whether I breathe in and out regularly, and what the quality of my breathing is while I sleep.

Another set of monitors measures leg movements to see if I have restless leg syndrome, another condition that robs people of sleep.

Did I mention that I am the sleep queen? I can sleep anywhere, under any conditions. So I wasn’t bothered at all by all the wires. I did get up my customary two times, and had to be disconnected from the machines briefly, but reconnecting once you’re hooked in originally only takes a second.

At about 5:30 AM I awoke, as I always do. I took a shower and went downstairs to use the hotel’s fitness center and then eat the hotel’s complimentary breakfast (waffles). That was pretty cool.

And then I drove off into the dawn to go home and explain it all to the dogs.

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What is 602.412.3315?

No, it�s not a Jeopardy answer. It�s the inadvertent new phone number for Stealthmode Partners. By �inadvertent,� I mean we didn�t intend to change office phone numbers; for years, I�ve paid extra to avoid doing so. Still, you had best replace the old phone number (602.331.0997) in your Rolodex with this one.

And here�s why. You know me and my proclivity for early adoption. You may also know that I grew up in New York City, where everyone learns to compete during the first three months of life. You compete for subway seats, pre-school reservations, spaces at Ivy League colleges, and scarce seats for hit shows.

As the Jesuits say, �give me a child for the first five years, and I will have him for the rest of his life.� Or something like that. Moving to Phoenix did little to alter my aggressiveness to be first.

A lifelong competitor at sports, business, and verbal one-upsmanship, I was in danger of being eclipsed by one of my daughters, who moved to Amsterdam and changed her phone service to VOIP so she could have free long distance.

She got Vonage, and after the first phone call from her, during which she showed no eagerness to end the call (none of the usual �this is very expensive so I�ll make it short� stuff we used to say about the service formerly known as �Long Distance�), I felt my heart sink. I DIDN�T GET THIS FIRST!!!!!

I had to get it. And now you have to get it, too, because it�s awesome.

Here�s how it works. You order the service, which can be both phone and fax lines (yes, our new fax is 602.218.5272). For unlimited calls, no matter where, the service costs $24.95.

A modem arrives in the mail. You connect the modem to an electrical outlet and your computer and your phone. In our case, we also had a wireless network to contend with, but if you send Vonage an email, they send you the instructions for connecting that, as well.

Then you fax a form to Vonage, allowing them to switch your phone number over. This is the same number portability that comes with cell phone providers now.

In the mean time, Vonage gives you a �virtual� number, through which you can send and receive calls and check voicemail. I never told anyone the virtual number, and used it only for outgoing calls. I still got incoming calls on the old number.

A month went by, and my number still hadn�t switched over. Impatient (another one of my legacies from New York), I called Cox Communications and disconnected my old number. I thought if I took matters into my own hands, I could make my number transfer faster.

What a mistake!!!

It turned out that the transfer was in process, and by disconnecting the old number, I lost it. Patience would have been a virtue, but unfortunately I didn�t have it.

So my �virtual� number has become my real number.

I thought my troubles were over. But extension phones don�t work with Vonage either, unless they are the kind that have a base station and wireless handsets. Then you can put the base station near the modem and computer, and distribute handsets all over the office (or in this case, my home). I bought the phone system on EBay; Siemens makes one that many EBayans seem to refurbish and re-sell.

And one last glitch: the other night I was watching Tivo, and a notice came on that I only had a few days of information left before the system would stop recording programs for me. Why? Because Tivo needs a land line! So I had to call Cox and get a basic land line re-connected.

According to my calculations, I will still, after all these escapades, save enough money every month on long distance to make all this worthwhile. And the quality of the calls is indistinguishable from the old technology.

So Merry Christmakah, Hanumas, or whatever it is correct to call it. This year you get two gifts from me: a new phone number and my experience with Vonage so you can avoid my mistakes!

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Every once in a while,

Every once in a while, I am bowled over by the changes made in our lives by the digital revolution. Although health care is universally said to be behind the power curve in its use of technology (I�ve railed about the lack of patient accessible electronic medical records for years), the way in which it has changed recently is truly amazing. And it�s only going to get better.

Last week I went to get an X-Ray of my lumbar spine, something everyone of a certain age can look forward to. Now, I�m not without knowledge about radiology (or diagnostic imaging, as it is now called), being the widow of a radiologist. But just a scant seven years ago, my late husband Gerry took real films in his office, developed them with chemicals, waited for them to dry, read them as quickly as he could, and got a diagnosis faxed to the referring physician. Everything was done by fax.

Kodak was his major supplier for film. Siemens made the equipment.

Gerry also read films for other doctors, who took them in their own offices on their own equipment (some good, some poor) and sent them to him. Those he read in his spare time, often at the beginning or end of the day. Piles of them. God only knows how long those patients waited to get their results.

After thirty-five years in practice, Gerry had a full storage room containing only films, each of which belonged to a patient. A patient who wanted to take his X-rays for a second opinion had to pick up his films and physically transport them to the other doctor�s office, and then physically bring them back (if that was their desire).

Flash forward to 2004, and Francine at the The Orthopedic Center of Arizona in Phoenix, a practice that services the Suns and the Diamondbacks in a fancy facility near the Biltmore.

Although it�s still Siemens, all the equipment is now digital, No film. (Poor Kodak.) I lay on the table, the technician takes the pictures, and they are fed into a computer. They will be emailed to the radiologist who will read them. He�s not in this office, although fortunately he is in this country. If this were an emergency over night, he might easily be in India.

I get up off the table. The tech tells me it will take two or three days for my doctor to get the results. The radiologist is probably reading all the films at the end of the day, as Gerry did. But if I am willing to wait, the technician tells me, she can give me copies of my films. Ten minutes later, I walk out with six large glossy prints of my left hip and lumbar spine.

Unlike the past, in the intervening time I can take my pictures home, search the Internet for sites such as e-spine.com, and see informational pictures of conditions similar to mine. I can learn how to �read� my own X-rays and make my own preliminary diagnosis. I already know the name of my condition, spondylolisthesis; I am trying to see if it has gotten worse. In ten minutes, I have an answer. It has not. I compare my print to the one on the computer � still Grade 1 or 2.

Yesterday I went to see my new family doctor, a man I have met only twice (he is on my new health plan). He has no clue about my past; he looked at the report and had nothing to compare it to. He said, �your back is a wreck.�

I said, �it hasn�t changed in six years.� I had had all my medical records from the old doctor copied and mailed to me. I brought him the radiologist�s report from my last X-ray, six years ago, that said I had grade 2 spondylolisthesis. He looked at it and refined his earlier suggestion that I have my back fused immediately.

This time he told me I needed a hip replacement. �How much pain are you in?� he asked. �Almost none,� I replied. �Oh well, then,� he said. �They won�t do it.�

This was almost a comedy, trying to educate this nice man. But in six more years, I won�t have to do this; he will be able to go on line and see my medical history no matter who my former physician was � as long as I give him permission to do so.

As for me, I feel empowered. Although I am technically still the �patient,� and although I would never presume to recommend treatment to myself or anyone else, I now have information.

I know why people who go to doctors used to be called �patients;� it�s because of all the waiting they had to do in order to get information. Once you don�t have to wait, you should be called something else. The client? The customer? The partner? The collaborator? Your suggestion here____________.

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We are in a taxi

We are in a taxi on the way to the Amsterdam airport, heading home after a week of visits to the Rijksmuseum and the Anna Frank House, the Van Gogh museum and the Vondelpark, the cafes and coffee houses. I warn Amanda and Greg to make sure they are not carrying any drugs. My daughter Sam, who lives in Amsterdam, tells them about all the questions the airlines ask at the check-in for international flights: what was your purpose in Amsterdam? Are you a family? What are you bringing back? She says there are two or three security checks. The government has laid the job of screening for terrorists off on the airlines, and Europeans who value their own privacy but work for airlines flying to America are now forced to ask Americans questions that may violate that of the Americans.

The taxi driver, who has been silent up until now, suddenly exclaims, �Excuse me. I don�t mean to interfere, but…� and goes on to tell us it�s no one�s business what we were doing in Amsterdam. By �no one�, he means the American government. He says nobody in Europe would put up with the kinds of questions Americans have to answer from their government.

�You have already been searched and screened,� he says passionately.� What right do they have also to ask you why you have been here and what you are bringing back? This is the mark of a dictatorial country.�

�How many people are in America,� he asks. �Two hundred million? What if you all said no? Refused to answer the questions.�

I thought for a moment. We wouldn�t say no, I answered. Most of the country just voted for Bush, the President who instituted these screening procedures. This means it would be difficult to get many people to say no, especially if the consequence was not to board the airplane.

The taxi driver couldn�t understand it. Turkish by descent, he was born in Holland and was proud of its track record for human rights.

�Americans must not go anywhere,� he said. �They must not know the difference. It�s like in Turkey. In Turkey, everyone thinks the living is okay, but when they get out and go somewhere else, they find out it�s not.�

This strikes me as a very illuminating point. When I try to defend the government by mentioning the fear we have as a nation since 9/11, he doesn�t bite. Clearly, he doesn�t think terrorists are the �big deal� we think they are. Europe has always had them, and people take them in stride. Just before we arrived in Amsterdam, the Dutch filmmaker Theo van Gogh had been brutally murdered by a young Muslim, presumably for making the documentary �Submission,� a metaphorical portrait of the way Muslims treat women. (If you haven�t already seen this film, a snippet of it is at http://www.ifilm.com).

The Dutch are aware that it was a brutal murder, and that there is a danger of religious war between Muslims and Christians in the country. They are not unconcerned, but they seem to be able to draw a distinction that we (so far) cannot: terrorists don�t just come from without, They also come from within. Therefore, all the screening devices in the world can�t stop them; indeed, some of terrorists are our own citizens. Think of Oklahoma City. Remember the Mad Bomber? Terrorists, perhaps by different names, have always been with us.

I�m not scared of them. Three thousand people died on 9/11, and yes, that was horrific. However, on the anniversary of the death of my children�s father, cancer seems much more terrifying to me personally. Last year we lost him, and I also lost another good friend, both to cancer. And while I was in Amsterdam, I learned that yet another dear friend has been stricken.

To me, this is true terrorism � something with the power to frighten everyone. Something from within. Something likely to hit the people in the Red States as well as those in the Blue States. Something deadly that we�ve been fighting a war against for thirty years.

If I were president, which clearly I will never be, because my views reflect only my fears and not the nation�s, I would be using the homeland security money to fight cancer. My home will not be secure until we have won that war.

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