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



The apnea group Sleepguide.com, 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 Judy on February 28, 2009 at 2:15pm
Each complete sleep cycle takes from 90 to 110 minutes. The first sleep cycle has a shorter phase of REM sleep. Toward morning, the time spent in REM sleep increases and the deep sleep stages decrease. REM sleep accounts for 20–25% of total sleep time in normal human adults. REM sleep begins about 70 to 90 minutes after you fall asleep. Older adults spend progressively less time in REM sleep.

Stage 2 sleep occupies 45 to 55% of total sleep in adults. Stages 1, 3 & 4 sleep occupy the other 25%-30% of sleep. Stage 1 is light sleep where you drift in and out of sleep and can be awakened easily. If aroused from this stage of sleep, a person may feel as if he or she has not slept. This is why we usually think we slept less than we actually did during a sleep evaluation.
Comment by Rick London on February 28, 2009 at 12:41pm
Thanks for your comment Judy. From the first study, I did not bother to get a copy of the graph. I knew
(just common sense) it was a farce; so I felt "why bother"; I was and am too busy to mess with it. However
the second ENT DID ask for it, so of course I had it forwarded to him. Though I only slept about 4-5 hours
during the "new improved" Little Rock sleep study, I was shown the graph to that test. Only about 2 hours of
that sleep was REM. I averaged about 20 or so apnea attacks per hour. The problem was that (the new ENT told me) my passages were so blocked, both nasally and in my mouth, the pain was air building up in the mask and pushing hard against my face. Of COURSE it was squeezing my face (half to death); the air had no place to go but build up a vacuum and begin pulling. I even figured that out before the second ENT told me how ridiculous the first ENT had been not to have seen such a MAJOR blockage. Now, I will do a 3rd sleep study (using the CPAP) to see if it might improve even more; that is my option; I don't have to do any further
procedures for it to have been "a success". I woke up today refreshed after 7 hours sleep and dreamed much of it. Life is pretty dam good, and I have no problem now getting the CPAP (if needed) as, I have a feeling it will not hurt in the least. Why should it. The air now has a place to flow; through my nostrils and mouth. The
second ENT asked me if I ever "sighed deeply" during the day. I did and told him so. He was not surprised and said most likely i used to have trouble breathing throughout the day as well, with that much blockage.
SO CAVEAT: Again, if you feel you didn't sleep during a study, and they told you you did, and rush in
with CPAPs for sale, and it hurts like hell to wear one, please get a second opinion. That is the point of my story. If I had not, I wouldn't be here now, am sure of that. Thanks for reading.
Comment by Judy on February 28, 2009 at 12:16pm
I would say the tip-off was the PAIN - from a CPAP??? Pain from the mask eventually digging into the bridge of the nose, yes. But pain just putting the mask on and turning the CPAP on?? This is the FIRST I've ever read of that and thus was a BIG clue something wasn't kosher! But one would then expect that the problem was in the nasal passages, not the entire airway. INTERESTING tale, Rick, very interesting. Thank you for sharing it w/us.

Did you ever bother to get a copy of the full scored data summary report w/condensed graphs from that first ENT's ordered sleep study as well as his dictated results?

Did you ever bother to get a copy of the full scored data summary report w/condensed graphs from the sleep study that Dr Welch ordered before your surgery as well as the dictated results?

Did you get a copy of the full scored data summary report w/condensed graphs and doctors' dictated results from your sleep study since your surgery?

They should be interesting reading as you compare them!!! Do be sure to let us know what you decided to do as far as whether to opt for CPAP therapy now since your surgery and how you do w/it! Yours is a fascinating story and we'd like to know how you fare.

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