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Steven B. Ronsen updated their profile
Sep 15, 2018

Cartoonist Rick London Speaks Out On Sleep Apnea Surgery, And, How It Saved His Life

The apnea group, whom I had the pleasure to meet at Twitter has asked me to discuss my experience with sleep apnea. On November 22, 2008, I had major surgery to treat it.

It all started around 1998. My mother had just died in my rural home in Ms. I had returned there after almost two decades away to take care of her. I was there for four years as a caretaker. She was a trooper, always had lived life to the fullest, and lived way longer than her oncologists had predicted. I still miss her greatly, and think of her generosity and care of people; always thinking of others. She was trained as a school teacher at University of Alabama, later turned housewife. After marrying her college sweetheart, they eventually both returned to her hometown (Hattiesburg, Ms) around 1951, where he took over the reigns of what was becoming a large (her father's) real estate business; now run (nearly 100 years after its beginnings), by my younger brother, Andy. The town was a small rural backwoods timber town when my family moved there with less than 10,000 people. It has now blossomed into a major medical center and retirement community and has received accolades from magazines as "offering a high quality of life at less cost".

During that period of time, I did not allow myself a lot of time for dating or relationships, and slept alone.
I noticed I awakened tired often. This was not the “usual me” as I had always been what one might call "not your typical candidate for sleep apnea".

I was thin, I was a daily jogger, even a marathon runner, I had taught the martial arts, was a vegan, and there was not an ounce of fat on me. I didn't smoke and very rarely drank alcohol. I did not use drugs.

After mom died, I stayed a few more years in my hometown, but knew I was not going to stay there forever. I had worked in large town media for almost two decades and was a “city dweller”, or so I thought.

I decided to take a break, in a part of the country I had visited when I was very young. This was 1999. Hot Springs, Ar is a magical place, and also in the epicenter of what physicists call an "energy vortex"energy vortex">. There are only a few energy vortexes on the planet. Another is Findhorn, Scotland. Allegedly, there is lesser crime rate, divorce rate, higher life expectancy, and vegetation and plants grow three to four times larger than normal size.

"New age" healers of every type have hung out a shingle on every corner. It is the only city in the U.S. which is actually also a federal park and spa. The cost of living and quality of life overshadows what little it lacks. No it is not utopia. It is also not unusual to see famous "household names" walking the sidewalk. Former President Bill Clinton recently bought his uncle's land and moved back (he's here half the year). Numerous Hollywood celebrities have either full time or winter homes here. It is known as a "holistic healing place".

My great aunt, cousins, and several friends had lived here and loved it. All my life they'd tried to recruit me to move here and I hesitated. The town is loaded with beauty, nature, and history. It is like an “enigma/oasis in a desert of a “land without culture”. This is not actually the case, so much, as it was even two decades ago. Arkansas has become a very progressive state and a competitor in the world market.

Within an hour of me is Wal-Mart headquarters. Love Wallyworld or hate it, one cannot help but admire the Sam Walton and family story who started it with zilch, sweat equity, and, possibly living within the epicenter of an energy vortex (of course that is not proven but makes sense the more I read about E.V's)

Also very near me stands President Clinton's childhood home. The modest frame house showcases that he too, started with nothing, and ended up an Oxford scholar and of course later at 1600 Pa. Avenue. Love former President Clinton or not, one cannot help but admire that he took a very wayward national budget, and balanced it. From his rural roots
running the country, starting with nothing.

I look out my living room window at a dead volcano that now spews out “crystal healing thermal-waters" that draws several million tourists annually worldwide. It has been the fastest growing “small arts community” in America for years. It is very progressive in many ways; and I've lived in NYC, LA., D.C and the other “usual cultural suspects”. I do not live in the city but on my own mountain about 25 miles from there in a very remote area.

I could feel myself getting stronger, but I was now middle-aged, and could no longer run marathons. In 2001 I had a major heart attack and near-death experience. I was told I had congestive heart failure and may or may not make it. I was given a cocktail of drugs to control my blood pressure and cholesterol. I took them three months. The side effects were horrendous. I decided to research the Internet to find more holistic approaches. I made yet more changes in my diet and added herbal tinctures. I still awakened tired, but was able to get my work done.

During all this time, I had launched Londons Times Cartoons, which to my surprise, within seven years, broke the Alexa ranking elite top 100,000 sites, and in 2005 became the top-ranked offbeat cartoon on Google where it has remained for three years.

Call it fate, or luck of the draw, who knows for sure. I have never been a real religious man, but am a believer, and
tend to give credit upstairs, if, for the bit of talent with which I have been blessed. It didn't hurt, I do not believe, to
have been (again luck of the draw) born into a maternal family in which poetess Emma Lazarus was my direct
ancestor. I can write a little poetry, certainly not in her league, and tend to communicate with humorous writing and cartoons. For those unfamiliar with Emma, the last verse of her most well-known poem "The New Colossus" is at the base of the Statue Of Liberty ("Give us your tired, your poor, huddled masses.. etc"). And she was mentored by Ralph Waldo Emerson; so I had what I guess you might call the "big footstep syndrome", in that I always felt "more than the usual" was expected from me.

I went back to college (online) and learned to open E-stores and license my cartoon images. Within a few years I had almost 150,000 funny gift items bearing my cartoon images on them.

In 2004, I decided maybe I should try dating again. It had been a long time. After a few negative experiences I tried “one more time” and it turned out to be the right person (for that time in my life). Of course, as relationships continue, a couple becomes more intimate. We did. She advised me on the second night of our “relationship honeymoon” that I had the worst case of sleep apnea she had ever experienced.

I thought she was joking. She told me to get tested.

First I had to call my G.P to refer me to an ENT specialist. He checked me out and saw nothing unusual, maybe tonsils a bit large but not that big, and no other real obstructions. He did not even look in my nostrils to my memory. He scheduled a night for a sleep study.

I went to a sleep study clinic in Hot Springs but could not sleep due to all the wiring. Around 5 a.m. I was told to “wake up” by an incoming nurse (of course I was awake, as I knew I had not slept throughout the night). Within
ten minutes two salespersons dressed neatly in starched shirts dragged in a machine with a mask attached for me to try on. One told me I would even learn to “love it”.

I tried on the mask for about one minute and that was torturous. I had no idea why it hurt so bad. They were sure it must be the size of the mask so they brought another. The same horrific pain. I could tell what was happening, and, I assured them I felt like I was choking and my face was being squeezed to death. They assured me I was wrong, and, since they'd talked to my ENT specialist, they knew it was simply a very mild case.

Something felt very fishy. I asked the nurse how much I'd slept (knowing I'd not slept a wink), and she said “around four hours”. I told her that was not so, that I know when or if I've been asleep, when I awaken, and that I remember every minute of tossing and turning that night. She assured me “all her patients” say that, and simply don't remember the sleep parts. I was not convinced.

I left and went back to the Internet. I found all sorts of information on the various types of sleep apnea. My then girlfriend told me I was waking up every five minutes, choking and gasping for air; much worse than just snoring. She had no reason to lie to me; and, even though I felt confused I asked her to tape me one night. She did and the sound was so frightening, I'd wondered how she had stayed with me that long. By then she was sleeping wearing earplugs. I could now see why.

After a few month's more research, and by now a very strained relationship, I decided I better try something fast. I went back to the same ENT and asked him about the surgery options. He declared my sleep apnea was not severe enough for surgery. I had heard it by now, on tape, and knew he was not leveling with me. I was so angry by then I wanted to ask him, “Yeah, and where do you bury your mistakes”?

I talked my G.P into a referral to a well-known ENT surgeon, Dr. Welch, at UAMS in Little Rock, Ar. One might think, “Could that be better”? Oddly enough, UAMS (University of Arkansas Medical School) has remained one of the top-ten hospitals in the country (in numerous departments including
ENT) for 11 straight years (along with Johns Hopkins, Cedar Sinai, et al). It is odd to think but somehow this small university created one of the best medical schools (and hospitals) in the U.S.

Dr. Welch was very friendly and generous with his knowledge. I was told he does not do as much surgery anymore, as, much of his time is traveling giving lectures at other hospitals and medical schools on certain new procedures. He is considered one of the top experts in sleep apnea. I got very lucky. It took him fifteen minutes to look into my respiratory system. It was almost completely blocked.

He had no problem telling me the other sleep study was faulty, and the doctor who examined me was incorrect and could even talk to him if need be (doctors very rarely criticize their fellow brethren).So I knew this man was pulling no punches. I was easily at death's door. He even called in a young intern and said “What do you see”? The intern examined me and echoed his same diagnosis. Almost no room to breath (mouth or nose). I needed not only my tonsils, uvula etc removed, but entire respiratory system restructured.

I had to wait 6 more weeks before he could fit me in for surgery. I did not know if I was going to make it that long. He asked me if I wanted it, knowing it could be very painful (the recovery). I told him I was a man who had survived a major heart attack and angioplasty, then a near-death appendicitis in which it had about three hours left before exploding, and one of the few thousand patients who has
received a vagus nerve stimulator for treatment resistant depression. I felt I could survive just about anything.

The moment I woke up from the operation, I felt I was in hell. I do not remember a pain and discomfort (and fear) like that. It was relentless and I kept calling to tell them the pain was too much.

I could not swallow solid foods for a week. I did not desire any food for several weeks post surgery. I drank water when I could get it down. I could not drive. I could not exercise. I was told to rest but I didn't. I worked (at the computer). It was the only thing that kept me sane in the midst of a pain so intense, one cannot describe. I could barely swallow for almost two weeks. I was given liquid hydrocodone which relieved the pain only slightly.

I didn't believe them when they told me the pain would, in time, subside. Two weeks later I started feeling a bit of the intensity lessening, and my appetite was returning. I also noticed I was dreaming.

I had forgotten, but I had, for the most part, stopped dreaming almost twenty years ago. The reason is, because they learned in the second study (of which I did not talk about; there was a study done in Little Rock before the actual surgery), I had most likely, they felt, never gotten more than 2 hours of R.E.M sleep, (at the most) any night for two decades. It was amazing I was alive, much less taking two mile walks, mountain climbing, biking, walking working, going to school full time etc.

I can only think that it was diet and exercise, and a “magic” concoction of herbs such as cat's claw, cayenne, flax seed, hawthorn berry, and many others, all tinctures (never pills as they have very little if any medicinal value), that kept me alive, and gave me some energy, plus, making certain the majority of my diet was live foods, and organic if possible. I had stopped, for the most part, eating meat a long time ago. My life as a vegan has been sporadic. Occasionally I will eat fish or chicken. Very rarely meat.

It is now 3 months since the surgery. Last Thursday I returned to Little Rock for yet another sleep study. My condition had improved app. 70% since the surgery (it is rarely 100% effective) but, given the odds, and how fast untreated apnea can kill or cause other health issues, most ENT surgeons feel that if it is as much as 40% effective, it is a success.

That still does not mean the CPAP would not be helpful. I have a letter coming giving me the options available to me and that is one of them (if I want 100% improvement). The difference is, now, I could wear it without the pain, as there is passage in my throat and nostrils for which the air to go; and not stay on my face causing horrific pain.

So, I tell this story as I feel I may not be the only one to which this has happened. If you have sleep apnea, and the cpap fits and works fine and is not uncomfortable, then your ENT most likely made the right diagnosis and you're good to go.

On the other hand, if something wasn't right, and you knew it, please don't stop with one doctor. If I had not gotten a second opinion, there is no doubt, I would not be here typing. In only three months, I sleep, I dream, I wake up not tired. My life is coming back. Would I go through this procedure again if needed? In a Dallas minute. Life is for the living. It's time to live it.

Rick London is a freelance writer/cartoonist and E-entrepreneur. He is also an inventor and return to school
adult student. London founded Londons Times Cartoons, the Internet's highest ranking offbeat cartoon since
2005. He also founded the world's only famous love quote shoes at Shoes That Amuse. London's most
notable patent is the world's first and only fully-automated computerized medical alert device, Insert Alert.
He was born and raised in Hattiesburg, Ms and now lives in the Ouachita Mts of Arkansas

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Comment by Mark Douglas on July 3, 2010 at 4:34pm
Im stunnned that one doctor would find nothing wrong -- but others would see quickly that you had near total blockage of an airway for sleep. So troubling to know how unreliable a doctor's exam and findings can be.

Im very curious -- with all these problems -- what was your overnight O2 readings? Did anyone bother to check them? Isn't that what matters -- or one of the big things? I mean, if your oxygen level is good overnight, aren't you " good to go"

Oh I know sleep is more than oxygen levels -- but I hear these very scary stories, and no mention of oxygen levels. Whats up with that. Isn't that what all the fuss is about? Isnt oxygen level the very thing you are trying to get right? Isnt that why you get a CPAP or have surgery, to get your 02 levels right overnight??

Did the ENT guy who missed your obstruction even bother to hand you a meter and have your 02 levels measured overnight? If not, why not?

So what was your oxygen levels before the surgery, and then after?
Comment by denise exhausted on September 19, 2009 at 3:04pm
I too have had surgery to reconstruct my airway. different than yours but none the less...trying to correct a lifelong problem ( my lower mandible was removed at age 2) Amazingly the OSA did not appear to be an issue where it interfered with my life until I was 50. I am an artist ,married to a childrens book illustrator and a mother.My story is long and I would someday like to share it . Now however... now I need help with this devastating health issue...not being able to breathe and sleep. I use a cpap/bipap at the moment. but still have a problem and it is like a pothole that just gets worse until it is fixed.
Comment by Lisa Marie Cardillo on June 30, 2009 at 11:51am
Hi Rick, your story has helped me, I've decided to go for the surgery as well, but i'm not sure I feel secure enough with the ENT, surgeon I met with, do you or anyone else know of a top surgeon in the Philadelphia or surrounding area, and surrounding states?
Comment by Rick London on March 6, 2009 at 12:31am
Michael and Randy. Thanks so much for posting, and Randy, it truly appears ihat we went through
similar circumstances. Took me 4 years to finally (get the right type of apnea diagnosed); THEN they
could work on it. When I hear someone has apnea now, with what I've learned, and a CPAP is immedately
put on the face, it makes me want to get sick. There are too many types, like mine (hereditary in which
throat and respiatary is totally closed); requires surgery. To treat it only with a cpap mask is like putting
the mask against a brick wall. It will do nothing. If treated first, via surgery, works fine; or often, as in my
case, simply not needed.
Comment by Randy Bray on March 1, 2009 at 7:38am
Hi Rick, I can indentify with part but not all of your comments. I'm a post surgical correction Sleep Apnea patient. For me the CPAP helped immensely and was relatively comfortable from the very beginning. Probably the one irritation was that the mask would blow air on my wife if I was laying in her direction. I can't say I've ever heard of a CPAP device being painful unless there was a gross mismatch of the mask to your face. I agree in that it sounds like the first sleep study experience was done very poorly. I'm glad you got a second opinion and that you found relief. When I was forst diagnosed with Sleep Apnea I was in the Air Force and was discharged due to it. I was told initially that "There is no surgical correction that can be done that would eliminate the need to use a CPAP for the rest of my life." I resigned myself to using it. It did help immensely, I too began to dream, something I had not done for many years. I used the CPAP for 7 years going through 2 CPAP Machines and using a REMStarSeries M which worked very well. About a year ago I was having problems with nosebleeds and I had to go to see an ENT. Not having liked the first guy I went to, I asked for a different referral. I was sent to see Dr. Ryan Stevens in Corvallis Oregon just a few blocks fomr my home. He took care of the issues causing the nosebleeds and talked to me about some allergy issues and about my sleep apnea. He asked if I minded an exam to see if there was any surgery that would help me. I was skeptical but agreed. (I Travel a LOT both personally and for business and the TSA were demonic when I had to put my CPAP through the Xray Machine, they swabbed it for explosive residue and treated me like a terrorist, I was so over it I could scream. So I welcomed any ideas that could help me dispense with it) He said there are about 5 different things that can be done. He examined me and said Ahhh, I think your problem is your tongue (I was saying Ahhh too while he had an endoscope down my throat.) Turns out that the Base of my Tongue where it faces the throat had a lot of excess tissue and when I would sleep it would collapse back against my throat. My sleep study had identified me as having Severe Chronic Obstructive Sleep Apnea. We arranged a surgery and had initially considered doing a "Snoreplasty" where injections into the palate stiffen it and help with the OSA. The only issue I had with those is that they often had to be repeated. On the morning of the surgery I consulted with the doctor and asked him if he would consider doing a UPPP as long as he only took about 1/3 the amount of Palate. He was delighted to to hear me request this and said that would be his preference, but that it would take me an entire 2 weeks to recover. He performed A UPPP, Removed my Tonsils, Adenoids, Uvula and also did what's called a "Lingual Tonsillectomy" Where excess tissue is removed from the base of the tongue. He told me it was obvious I had had OSA my entire life. We did the surgery and I too had a miserable first day and night, I was salivating almost uncontrollably and because of "drooling" it would wake me up. He had put a loop of suture through the underside of my tongue in case I had a breathing emergeny they could rapidly pull my tongue forward (none of that happened at all) He removed the suture 24 hours after surgery and things improved rapidly. Yes there was extreme pain, I called it Strep Throat x10. I too was on liquid Oxycontin, it took care of most but not all of the pain. They gave me a lidocaine gel to swallow and while it helped it increased the salivation so I gave up on it. I WAS able to eat solid foods before I left the hospital, I had an Omlette prior to being discharged. Eating was a challenge, not so much with the pain, but with the fact that your throat has to stretch to move food down it and that was difficult. I used my CPAP for 2 weeks until the swelling and inflamation was pretty much gone. At the 2 week point trying to use my CPAP was like standing in a NASA Wind tunnel, the airways, nose and mouth were capable of moving so much more air that I quit using the CPAP altogether. I am one of the lucky ones. I never had a heart attack but physical activity was difficult my whole life, I was contstantly tired, grouchy and didn't get along with people very well. I am 6 months post surgery and the 3 post op checkups have been very encouraging. They did an oxygen saturation test and said I have "very slight" sleep apnea and not enough to even bother with a CPAP anymore. It's probably fixed 90-95% Needless to say the doctors are elated. They want me to lose a bit more weight, (I lost 20 post surgery) and then my Oxygen saturation would improve. Dreams!, I dream several dreams every time I sleep, I too had not had many dreams for the last 25 years or so (until CPAP) I dream even more now. I wake up rested, energetic, in a good mood, my relations with others have improved. My boss says I'm more productive. I'm glad you had similar success with your treatment, I definately feel even better after the surgery than I ever did using CPAP. This surgery was likely one of the very best things I did in my adult life. I highly recommend it.
Comment by Michael F. O'Brien on February 28, 2009 at 11:19pm
Rick, I found your article and the blog very interesting. I feel I leaved a lot about myself from reading it. I am 69 and been on the CPAP for not quite eleven months. My wife sees better than I do just how effective it is. I have not missed a night and sleep well for about seven hours each night. I used to have to go to bed around ten and got up early, my favorite time of the day. Now, I am not tired until one, two or three in the morning and sleep to 8:00, 9:00 or 10:00 in the morning. That is a downside for me, but if I go to bed when I am not tired I do not sleep. My wife said it the past that I was asleep before I hit the pillow.! One huge benefit for me it that not once have I had to get up to pee for almost eleven months! Previously it was at least one or twice, somethings three and four!!! I, too, must have had a poor sleep clinic the first time. Thank you for your article.
Comment by Rick London on February 28, 2009 at 4:04pm
Judy, not sure I understand your last post, but in any case, as I mentioned, this is 'NOT A ONE SIZE TREATMENT FITS ALL DISEASE" as, there are so many types of apnea. Though my was obstructive, it was also a more rare hereditary kind (the closed nasal passages and respiratory system) which is VERY OFTEN MISSED, hence my plea for a second opinion to all if one cannot wear the CPAP immediately. UPDATE: Just recieved an email from the research evaluating ENT who told me the CPAP still could be helpful for 100% sleep; now getting a bit less. I may go ahead and try. He adds he does not feel with the significan improvement due to the surgery that I am at any risk for heart attack or stroke anymore. But I still may get it, and he says insurance will easily cover it, for 100% sleep; something I've not experienced since I was a child. In addition, another thing I forgot to add was that during my apnea attacks; I had been losing 80% oxygen to my brain. This has been going on for 20 years. They were amazed I could even function. I do believe the
healthy living, may have (in the end) kept me going in spite of that. Sadly many die much younger from this; and I am now 54. Hope this helps others. Thanks for your comments and interest.
Comment by Judy on February 28, 2009 at 3:54pm
By the way, interesting to learn you have to have FIVE stents w/this surgery. You hadn't mentioned them or I missed it in reading your earlier accounts. You must have had a pin hole for breathing thru before those stents!!!
Comment by Judy on February 28, 2009 at 3:51pm
Yes, you WERE very lucky to find such a good surgeon!. I understand a Dr Li out at Stanford in CA is also one of the tops in the field too. Fortunately, I've not needed such drastic "repairs" for which I am eternally grateful. I'm a real wusp when it comes to surgery!! :-D My son moved out to AR about 5 years ago and we've been thrilled and impressed w/the medical care he has found there. He's in Bald Knob but travels to Little Rock for most of his care. I was w/in 10 minutes of the time I estimated I slept w/my sleep evaluations as well but I've been told repeatedly that we are in the vast minority. I don't know if that counts as a good thing or bad. :-)
Comment by Rick London on February 28, 2009 at 2:32pm
True Judy by many people; but, I knew I had not slept, and when asked in the second study how many hours I felt I slept, I marked down (within 5 minutes) the precise time. So I tend to be fully aware of my environment, even if I am not in REM state (which at that time, I generally was not); Keep in mind, I rarely made it anyone one night for decades to that 70-90 minutes for complete REM, so how could I NOT know. The second MD figured that out within the first test he evaluated. So I was very aware. And..the two tests were diametrically opposed to each other as to the severity of the disease; the first ENT found NO nasal obstruction, the second MD, Dr. Welch, found almost no breathing canal (in fact had to open it with 5 stints during this major surgery). I was just dam lucky, to find the right surgeon.

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