Season 2: STORIES FROM THE FIELD. Episode 1: PROLOGUE Artwork

Empowered Sleep Apnea

Some podcasts give you INFORMATION. Empowered Sleep Apnea gives you knowledge. Join Sleep Medicine master-clinician Dr. David McCarty and Sleep Neuroscientist Dr. Ellen Stothard as they do a deep conversational dive into one of the most complex, common, and misunderstood disorders on the planet: Sleep Apnea. Using a combination of humor, fictional elements, and--yes--even CARTOONS, Empowered Sleep Apnea takes you where no other Podcast has gone before!

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Empowered Sleep Apnea

Season 2: STORIES FROM THE FIELD. Episode 1: PROLOGUE

March 08, 2023 • David E McCarty, MD FAASM & Ellen Stothard PhD • Season 2 • Episode 1

[For a full PDF Transcript of this episode including cartoons, click HERE!]

Empowered Sleep Apnea is back...and it's time to leave the Island!

Sleep Apnea, as a diagnosis...as a label...means many things to many people. It has a thousand faces. Moreover, it seems like everywhere you go, there's somebody else telling you that they have the answers...and, somehow, it seems like someone is always trying to sell you something...

In this Season 2 PREMIERE, join Dr. Dave McCarty for a balloon ride of a different color, as he chronicles his two-year post-clinical journey through music, time, space, and friendship to try to find a language that ties us all together.

Cartoons featured in today's episode can be viewed on our website! A full PDF transcript of this episode can be downloaded by clicking HERE :)

Our Website: https://www.empoweredsleepapnea.com
Official Blog: "Dave's Notes" : https://www.empoweredsleepapnea.com/daves-notes

To go to the BookBaby bookstore and view the BOOK, click HERE!

Empowered Sleep Apnea: THE PODCAST

Season Two: STORIES FROM THE FIELD

Episode 1: PROLOGUE

Written, illustrated, and performed by David E McCarty, MD, FAASM

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This is a transcription of an audio performance, which itself is adapted from a really long essay:

McCarty DE. Rocket Fuel, OR: The Siloes of Sleep Medicine, The Semmelweis Effect, and the Blue Balloon Solution. In Dave’s Notes (the official blog of Empowered Sleep Apnea), originally posted 23 February 2023

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00:00 “Change the Channel”

00:28 Safe Words!

Empowered Sleep Apnea is an educational podcast, which is a bit different from a medical advice show. Clinical decision-making in Sleep Medicine can be complex, and even EMPOWERED patients need a partner. So…play it smart and make sure you discuss your case with your healthcare provider before making any changes to your medical treatment plan.

And now…on with the show!

00:58 Season Premiere

Empowered Sleep Apnea: THE PODCAST…Season 2…STORIES FROM THE FIELD, Episode 1…PROLOGUE.

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01:07 A Brief Introduction to the Friendship Thing

My name is Dave McCarty. I’m a Sleep Medicine specialist.

When I began the Empowered Sleep Apnea project in May of 2021, I thought I had all the answers.

What I actually discovered was my own ignorance, leading me on a journey that took me through time, space, friendship, music and love, seeking for a way to make the journey of Sleep Apnea feel whole, for both providers and patients. My journey took me to surprising places, including a trip back to Vienna in 1847, to visit the tragic trajectory of one Dr. Ignac Semmelweis, and how his interactions with medicine, innovation, and change landed him in a whole world of hurt.

I’m just getting you started, though. I’ll start at the beginning.

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By 2021, I’d been through a lot, as a clinician. I did three years active duty in the Air Force as a general internist, another three years in civvies doing private practice, followed by a walk-on Sleep Medicine fellowship, leading to a 14-year gig practicing full-time Patient-Centered Sleep Medicine, including a short stint running an academic program.

I had seen a lot of jungle. I’d seen a lot of sky.

The way I saw it, I had seen enough of the Sleep Medicine universe to write a tome that could help put it all into perspective.

I thought that all I had to do was sit down and write it…which I did. Over and over. And it was terrible. No matter what I did, I couldn’t make the material work the way I wanted it to. I couldn’t make the pieces fit together. I wanted to make a magic key. I wanted to create something that felt safe, for everyone.

Early in the process, I reached out to my old friend Tom Colquitt, DDS. I knew that Tom had been brainskulling his way through a self-education effort in “Airway-Centered Dentistry.” I knew he was keeping up with what was currently happening in the clinical realm, where innovators with an engineering mindset were trying to figure out what works, and why. I wanted him to look over the parts of the book relevant to “dentistry” and make sure it was “accurate”. As I told him then, I wanted the material to contain “no dark clouds.” In my mind, according to my world view, in my silo of thought, my information was all correct.

Mostly, I wanted to avoid saying anything to inadvertently offend anyone in my audience. Mostly, I believed I had all the answers.

At that part of the journey, you see, my vibes were playing mostly defense. I was doing my best to be “brilliant” without making anyone else uncomfortable.

I’m not proud of it, but there I was. Such was the status of my journey.

Silos.

Fortunately, the universe brought me lessons, and the most important lesson for me was my friendship with Tom. As I think of it, our friendship was sort of a fulcrum of my life!

My friendship with Tom began in 2007, when he became my patient, only one month before I ran away from home to “join the circus”—leaving my successful primary care practice to help the great Sleep Medicine pioneer Dr. Andy Chesson turn his apprenticeship-style of training fellows into a fully-fledged ACGME-accredited program. I later encouraged Tom to come to the school to teach our fellows, and I made it a point every year to take my fellows on a field trip to his office, so they could see what kinds of things he was doing.

Our friendship blossomed in our mutual love of music. In 2013, I briefly joined Tom’s rock-n-roll band The Hubcaps as bass player, sometime vocalist, and wiseacre-in-training. Practicing and playing with The Hubcabs were some of the most joyous moments of my adult life.

That kind of thing leaves a mark, as it turns out.

Music is a sort of magic…it’s a language that surpasses other more prosaic forms of communication when it comes to drawing people together. Music is capable of pulling people out of their silos, to enable real transfer of information.

Music is a meta-language.

I’m living proof of that.

It was because of music and friendship that I was able to poke my head out of my silo long enough to taste the waters in other places.

And it’s with the music of friendship that I speak to you now.

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05:50 “Collaboration” and Siloes

I think it’s fitting that I’ll be delivering a keynote address this September at the conference so beautifully named Collaboration Cures. My journey as an artist and a healer has been an existential meditation on the very concept of “collaboration” itself.

What does it mean, finding healing?

What does “collaboration” even mean?

Over the past two years, I’ve had dozens of useful and enlightening conversations with friends and colleagues across the planet. In doing so, I’ve developed a theory about how our environment functions. I’d like to share it with you, because it gives me a way of exploring the harm that’s caused by our fractured environment while not making the fracturing worse, and this helps me focus on how best to provide guidance to individual patients, no matter where they are in their journey.

As usual, this idea first came to me as an image. As usual, I had to write this essay to figure out what the image meant. The image was this:

From the sky, we look down at a scarred and broken landscape, upon which stand enormous silos. Within each of these silos is a whole ecosphere of concourse and discourse with respect to our friend Sleep Apnea. None of the silos has any way of communicating with the others. Individual patients stumble between and amongst the silos, looking for solace. It’s a haunting place, desolate. There is no way to know who to trust. It feels nightmarish. It feels scary.

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07:44 The School of Rock

One thing that I’ve learned, playing in rock-n-roll bands: if you can’t hear the other players in the room, your music is gonna sound terrible! I’ve played with guys who are so stoked to show off their hammer-on Van Halen guitar machismo that they can’t groove with anything anybody else is doing.

All broadcasting…no receiving.

Playing with dudes like that is a drag.

Playing in a rock band teaches you that sometimes the music is made of the empty space, too. The listening is important. There’s a call and response that can begin to vibrate, like love.

That’s when the magic happens.

My friendship with Tom taught me that it was going to take a lot more than just a desire “not to offend.”

I was going to have to open my ears. I was going to have to open my eyes. I was going to have to open my heart.

I was going to have to leave my silo.

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08:48 Steam Trains, Deafness, and Rock-Throwing

By the way, I can always tell when I’m sinking into my silo when I feel the steam start to exit my ears.

It’s when I’m in a conversation with someone who just doesn’t get it. I know I’m in my silo when I just stop listening. I know I’m in my silo when I experience a stomach-wrenching urge to tell someone exactly how wrong they are.

Like when we were kids--sometimes you throw dirt clods…sometimes you throw rocks. When you’re joking around, you throw dirt clods. When you really mean it, you throw rocks.

Psst! I know I’m in my silo when I want to start throwing rocks.

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9:37 The Empathy Spy

In the two years I’ve been away from clinical practice, I’ve been traveling across time and space. I’ve been reading history and I’ve been making friends. I’ve gotten to explore the different silos in Sleep Medicine, talk to the people in them, find out what makes them tick. Most importantly, though, I’ve gone to the different silos to learn.

In my explorations, I’m imagining I’m in my own spy-balloon, though mine is a beautiful blue hot-air balloon more like a Jules Verne story than the bus-carrying spy balloon made famous by recent events. In the image in my mind, my balloon is flying in between the silos, looking in windows. In the image in my mind, I’m riding the balloon as an explorer, an adventurer, a seeker of knowledge.

(A Balloon of Different Color)

My spy balloon is equipped with special sensors, because I’m not spying for military gain or financial leverage. I’m spying with my heart. I’m spying to feel what silo members are feeling.

I wanted to understand the stirrings of people’s hearts in silos different from mine, because my intuition kept telling me that the trauma of navigating the silos was one of the biggest sources of heartbreak for our patients out there, and no one was talking about it.

I realized I wanted to talk about it.

That’s how I became an empathy spy.

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11:28 The Siloes of Sleep Medicine

For the following section, imagine that you are reading about players in a play. After all,
“All the world’s a stage”, aren’t I right, Brother William?

For now, anyway, read about the silos, see if any of them sound familiar. And hey: wouldn’t you know? You might find that you fit into more than one silo!

The Silos of Sleep Medicine: Dramatis Personae

The Medical Establishment

Providers in this silo align with AASM guidance and like to recite diagnostic criteria from the ICSD-3. Patients in this silo must follow rules created by their insurance companies.

Strengths: Strong science in good journals. Infrastructure of Western Medical Complex.

Weakness: Infrastructure of Western Medical Complex. Algorithmic, rule-based approach lends itself to a disease-based and treatment-based strategy, which is dissatisfying for many patients.

Natural Enemies: The Outlaws

The Dental Establishment

Providers in this silo align with AADSM guidance. Treatment is typically limited to mandibular advancement-type oral appliance devices. Patients in this silo must follow rules created by their insurance companies, or else they must pay out of pocket.

Strengths: strong science in good journals. Infrastructure of Dentistry.

Weakness: Algorithmic, rule-based approach lends itself to a disease-based and treatment-based strategy, which is dissatisfying for many patients.

Natural Enemies: The Outlaws

The Outlaws

Providers in this silo have “dropped out” of The Establishment, and are playing by their own rules. They are vocal about how “healthcare” is actually “disease-care” and talk a lot about how broken the system is, and how it harms people. Outlaws tend to throw rocks.

Patients in this silo have become disenchanted with the “standard of care” and are usually vocal about how corrupt and unfeeling the entire system is. In casual conversations, they say “Big Pharma” a lot, and they believe that most doctors and dentists are in it for the money.

Strengths: Bonding between provider and patient by virtue of identifying The Establishment as a mutual enemy.

Weakness: Hard to know if your provider is getting it right.

Natural Enemies: The Medical Establishment and The Dental Establishment

The Silos of Provider Personalities: Dramatis Personae

The Engineers

Engineers are always angry about the limitations of currently available diagnostic and treatment strategies, so they are always trying to figure out a better way to do things.

Engineers can found anywhere, in Establishment or Outlaw practices, but they tend to become Outlaws once they sense that the Establishment holds them back from where they need to go. Engineers clearly see the limitations imposed by an algorithmic black-or-white rule-following approach, and they have a hard time understanding how anyone could practice that way.

Engineers, as a result, tend to throw big rocks.

Strength: Innovation

Weakness: Field-engineered innovations garner anecdotal reports of success, but few peer-reviewed publications are available. This creates rock-throwing opportunities from silos of the Establishment. The desire to innovate is also closely linked with the desire for recognition, leading to jealousies, patent wars, and alignment with The Profiteers.

Natural Enemies: The Medical Establishment and The Dental Establishment

The Profiteers

Providers in this silo are comfortable with the notion that healthcare is a business, the goods we sell being visits, procedures, and treatments. Profiteers can be found in any practice silo, Establishment or Outlaw.

For Profiteers, efficiency in the diagnostic process and a streamlined process for initiating treatment and billing for it are foundational goals.

A profiteering practice is typically advertised in a fashion that feels similar to marketing for other consumable products, which feels kinda wrong to Healers, which I’ll talk more about below, and this creating a “natural enemy” situation.

Strength: Efficiency and profitability can certainly increase the reach of care, and that’s good…

Weakness: when efficiency and profitability are the primary goals, an algorithmic treatment-based approach is the rule. Patients and providers become demoralized when they sense that profits matter more than individual patients.

Natural Enemies: The Healers

The Healers

Providers in this silo see their role as a proponent for the overall health and well-being of their patients.

Healers can be found in any practice style, Establishment or Outlaw. Healers instinctively reject the reductionist approach of caring for a disease, or speaking only for one part of the body, and instead wish to help their patients find solutions that feel more holistic.

Healers speak of their job in the same language as a teacher or a minister: they’ll say it’s a calling. Patients instinctively seek out Healers when they don’t feel listened to by providers practicing with a reductionist disease-specific strategy, or if they are overlooked by an algorithmic approach.

Strength: Humane care for individual patients

Weakness: Professional burnout & demoralization

Natural enemies: The Profiteers

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17:32 How Silos Behave

Inside each practice silo, there is a culture and a language. Within each provider silo, there are different expectations as to what the rules of the game should be. It’s fun to see how each silo talks about the others!

There is a sense of “otherness” with regard to silos we don’t belong to. Our tragic tale of Ignac Semmelweis will get to that, in a minute. I promise you. We will get there.

Inside our silo “here” is “normal.” “There” is strange.

Inside our silo, we may judge other silos harshly. Other silos are not to be believed, because they’re wrong. That’s not “normal.” That’s not how “we” think.

Silos have a way of self-selecting their inhabitants. People won’t stay in a silo, if it’s making them too uncomfortable. On the other hand, if the water feels OK, people stick around. This is how silos start to represent different realities.

Fun fact: folks can receive inhumane treatment in any practice silo, and when that happens, they drift to another one, so they can spin their tale of woe.

Hope springs eternal.

This serves to reinforce any preexisting toxicity there may have been, between the silo you’re in and the silo your patient came from. The abuse of our patient is just the proof we needed to confirm that those guys are idiots.

For example, Mary goes to her ENT with a chief complaint of snoring. The very first thing he offers her is a UPPP—a uvulo-palato-pharyngeoplasty…a complex surgery where soft tissues from the back of the throat are removed, sometimes with unfavorable downstream consequences. It’s a brutal surgery…it’s really rare for this to be the right first choice for anybody!

When Mary stumbles into my office as a new patient four years later with continued Sleep Apnea, now complicated by nasopharyngeal reflux and a requirement for an oronasal mask, all I want to do is throw rocks at the idiot who did this to her!

All I can think is that he cared about doing that procedure more than he cared about that woman.

I fill with rage, as I go fill my bucket with rocks.

Or how about this: Joe feels shamed by his Establishment physician for being unable to use CPAP, telling him to keep practicing, that it’s the only “real” solution. Joe ditches his silo and joins up with an Airway Centered Dentistry Outlaw Engineer, who slowly, methodically, carefully guides him to a workable integrated dental solution.

What’s our Outlaw going to say about the Establishment, going forward?

Let the rockfight begin!

There’s an important point to understand about stone-throwing between silos, though.

As soon as you cast your first stone, the intended target becomes stone-cold deaf! That’s right, y’all. Stone-throwing induces pathologic deafness! Stone-throwing makes the silo you’re chucking rocks at get deeper and more impenetrable. Moreover, the deafness, being infuriating to behold, leads one to hurl more stones, this time directed at the gaping and ongoing willful stupidity that must explain their inexplicable inability to hear you.

That kind of deafness has a way of becoming permanent. It’s how silos stay silos.

20:50 In Between the Silos

It’s hard to see outside our own silo, so it’s easy to come to the conclusion that our reality is the universal truth. We think the things we’ve seen should generalize to everybody. We are confident of this. It’s why so many of the rocks we throw are aimed at someone else’s intelligence or moral bearing.

We believe that people who can’t see what we’ve seen must have something wrong with them.

But there is nothing wrong with their intelligence. They can’t see what we’ve seen, because they’re in a different silo. The water is different there. The silo is different. They are deaf to our experience, because of the stone-throwing.

21:32 The Tragic Tale of Ignac Semmelweis

Gold Medalist, Rock-Thrower, 1847-1865

If we had to place Ignac Semmelweis--the man who is now known as the “father of modern handwashing” and “savoir of mothers”—into a silo, I think he would have started as an Establishment Engineer.

Along the way, he turned into a very fiesty Outlaw Engineer, and possibly the most epic world-champion rock-thrower the planet has ever known.

This tale does not end well for our hero, but we’ll get to that.

For now, let’s ride our beautiful blue balloon back in time…back to 1847…back to Vienna.

Cue harp glissando as time travels backwards…

In 1847, puerperal fever—also known as childbed fever--was a nightmarish, horrible, painful mode of exit, and it was caused by a bacterial infection of the uterus gone wild—and killed as many as 30% of new mothers, and no one knew what caused it.

At that time, The Establishment prized scientific study, and you counted yourself amongst the enlightened if you learned autopsy science from the physicians in Vienna, the biggest brains in the business.

The new science looked down with disdain on the fairy-dust sensitivities of prior generations, intent on discovering disease with a previously unknown precision. New physicians were learning an anatomic basis of disease, and they were on top of the world, describing what they saw, during their ritualistically precise anatomic dissections in the “Death Room”. The “new knowledge” was that the body was a machine. Doctors were discovering how it was put together, and what the different parts looked like, when it died.

The intellectual atmosphere reeked of condescension for those who had not mastered the new science of anatomic pathologic correlation.

Psst! Silos!

Autopsies at Vienna’s birthing ward were performed on yesterday’s dead, first thing in the morning, by physicians with scalpels and bare-hands. In the delivery area, you could smell the stench of death.

After finishing their rounds on the dead, doctors would walk directly from the death room, the smell of putrescence still on their hands, and then serially examine every woman on the maternity ward.

Did I mention they were bare-handed? Yes, I did.

Let’s think about that again. Close your eyes, if you have to, and imagine it. The horror is unspeakable.

Physicians walked straight from the autopsy room to the ward, with the smell of death literally wafting from their hands, and then methodically, serially, put their death-stench fingers into the vaginas of every woman under their care. By the way, it was a teaching hospital, so the women would also be probed by a medical student or two, also with bare hands.

By current standards, it’s beyond unspeakable. It’s a horror movie.

And it was the best that science had to offer.

These doctors did these things not because they were sadistic, not because they were stupid.

They did these things, because they did not yet know that bacteria existed.

They did these things, because they were proud of the knowledge that they had, and they had never considered the possibility that one human being could spread a disease to another this way.

They did these things because they were so cocooned in their silo, from where they stood, things appeared to be just fine.

1847 was the year everything changed for our pal Semmelweis, the year he saw something that couldn’t be unseen. That’s the year that one of his beloved autopsy science mentors got nicked by a scalpel during an autopsy of a woman who’d died of puerperal fever.

Tragically, the physician succumbed to sepsis and death days later, in a pattern that eerily looked exactly like puerperal sepsis. The insight was like a bolt of lightning to Semmelweis, and it changed his core: something deadly was transmitted by the scalpel.

He fastened onto the knowledge that the same thing must be happening with provider’s hands, and he never, ever let go.

Semmelweis held a post at the hospital similar to that of a chief resident today, and he used his post to immediately institute a mandate of rinsing hands in a chlorine-lime solution, “until the death smell was no longer present,” before going into the maternity ward.

It was that simple.

All he did was make people wash their hands until they didn’t smell like death anymore.

And you know what? It totally worked!

The mortality rate from puerperal fever dropped, at times nearing zero! Holy smokes! Semmelweis was right! In a world where justice is served, Semmelweis should be carried around on shoulders, while young girls cry and grown men beam.

Semmelweis was a hero!

But that’s not how it went down, for our pal, in real life. In real life, Semmelweis got the shaft. Our universe, as we know, is not always just.

Instead of a hero’s welcome, Semmelweis received disdain. Instead of a celebration, Semmelweis received banishment. Instead of many happy returns, he perished in terror.

So, what happened? I’ll tell you what happened.

Silos.

Semmelweis’ idea of handwashing predated any understanding of germs. He had no idea why washing hands would work. He reasoned that there was something in the “death particles” that caused disease, but he didn’t know what! His starchcoated colleages twirled their fingers around their temples every time he brought it up. They thought he was a looney. They made fun of his intelligence.

They threw rocks.

The implications of his idea were serious, which explains the pushback. If he was right, then doctors would have to square off with the idea that THEY were the cause of a heck of a lot of trouble, and THEY were the vector for a lot of misery and death.

That’s a lot of blood on people’s hands, in addition to the “death particles”.

That’s a paradigm shift that no one wanted to accept, especially not from a weirdo like Semmelweis.

Despite his stroke of genius, Semmelweis never published anything in the academic literature to showcase his work. He never designed a randomized controlled trial to prove his plan was sound. Microscopy was available, he just didn’t think to use it. If he had, he possibly would have beat Lister to the punch and would have been the first to see bacteria.

Had he learned about silos, and how to navigate them, he might have been a hero.

But he didn’t.

Instead, he collected his rage and his violated pride, and wrote a book that most experts say is meandering, circuitous, and chock full of grievances against his foes. Not surprisingly, few people read it, and he would die before his ideas were widely accepted.

He would die believing he was surrounded by idiots, a silo of one.

In the decade before his death, Semmelweis became a pariah. He had personally written to every major player in academic medicine in Europe, lambasting each by name, saying how history will mark their murderous deeds, illustrating how God would punish them. He lost his standing in the community. He lost his friends. He gradually lost his sanity.

As I said, his rock-throwing was legendary.

Semmelweis died at the age of 47, alone and friendless, in a lunatic asylum, 14 days post-admission, after first being brutally beaten by his guards. One of the injuries found during a modern examination of his remains disclosed thoracic trauma that could only have come from a boot stomp. His mode of death was both tragic and ironic: an infection on his right hand turned septic.

One wonders if the guards mocked him, as he begged in a fever-dream of lunatic desperation to be allowed to wash his hands.

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31:04 Dishing the Tragic

I see Semmelweis’ story as a cautionary tale of the dangers of siloed thinking. It doesn’t matter how good your idea, or how right you are—our pal Semmelweis was clearly right, no question about that!—silos can be hard to penetrate! If you don’t know and understand the culture and the language of the silo you’re addressing, you’re likely to be ignored at best, vilified at worst.

In the Establishment silo, Semmelweis was an outsider, a weird Hungarian who spoke accented German and boasted only mediocre writing skills. He simply was not able to speak his truth in a voice that could be heard by his Establishment colleagues. The Establishment was deaf to his experience because he couldn’t speak their language.

31:57 The Frankenstein Cartoon

Recently, I drew a cartoon for another essay, and it depicted the diagnosis of Sleep Apnea as a Frankenstein’s monster, having risen from his platform and broken free from his manacles.

A group of scientists in the room shouts out suggestions for what to do…each coming from a different silo, each ignoring the others, before deciding it’s a free-for-all.

The image troubled me, I think because I sense that our patients are in danger in ways we can’t see, because the action is happening outside our silo.

Out there in the wild, our patients are trying to navigate an increasing array of choices as to how they obtain services for Sleep Apnea, who provides that service, and how that service is paid for. They must explore and navigate the different silos before they find an answer.

They have no idea who to trust, and (let’s not forget this) The Profiteers are rubbing their hands together.

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Here’s this: The mother of Mary Shelly, author of Frankenstein, died within days of young Mary’s birth. The cause of death? Puerperal fever.

Isn’t that something?

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33:39 The Blue Balloon Solution

In my view, the solution to our evolution requires a balloon of a different color.

Our balloon needs to fly above and between silos, to discover the language that binds all of them together. It must include a way of teaching patients and their providers how to navigate this complex problem in a way that makes humane sense to the person going through it. It must include a toolkit that teaches patients to self-advocate, to give them guidance to self-protect, as they walk amongst The Profiteers.

The goal of the balloon ride is to give patients and their providers a map as for how to deliver patient-centered care that’s easy for everybody to read and understand, no matter what silo you happen to be in.

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I was thrilled last month, when our book received its first critical review—a rave one at that—in the legendary peer-reviewed journal CRANIO®! I was buoyed (of course) by the external validation, but mostly I was overjoyed by the concept that my invention works, as designed. I felt like I’d built a rocket ship, and I’d just gotten to find out that the darn thing actually flies.

The meta-language functioned!

Here’s what I mean: Dr. Krasowski, the author of the review, is a dentist who doesn’t know me from a hole in his shoe. This lowers the chance of silo-spillover by friendly encounters. Our silos are as different as they get!

Yet, Krasowski’s response to the book was the opposite of the “Semmelweis effect.” In truth, it’s about as full-throated of an endorsement as any newbie booksmith could hope for:

“I wish I had read this book first, before all the lectures, articles, and books throughout my career, as I tried to figure out my journey in Dental Sleep Medicine. “Empowered Sleep Apnea” is a must read...”

Krasowski JA. Book Review: Empowered Sleep Apnea. Featured in:

CRANIO ®, 41:1,92-92. Published online 4 Jan 202DOI: 10.1080/08869634.2022.2161161

I mean…if the Establishment gave Semmelweis the stiff-arm, I’d call this a hug! This is somebody who not only listened, he wants to share this new information with…well, everybody!

The rocket flies!

~ ~ ~ ~ ~

35:51 A Patient-Empowering Meta-Language

Now I can finally get to the reason why I’m talking about silos and Semmelweis and rock-throwing and deafness.

Currently, there’s no accepted strategy to universally guide patients through an increasingly fragmented system. Silo-specific algorithms just won’t cut it. What we all really need is a map.

The Empowered Sleep Apnea curriculum strategically orchestrates a self-correcting process of patient-centered care, with the patient acting as an active navigator for the journey. The strategy can be used no matter who you are, or what silo you happen to be in. This is a very good thing.

Currently, our patients feel shamed if they question the dogma of the silo they happen to be in. Patients need to be taught how to advocate for themselves. The Empowered Sleep Apnea curriculum gives patients the knowledge to self-advocate.

Currently, our patients feel lost and confused when they lose faith in their silo, and they don’t know where to turn. The Empowered Sleep Apnea curriculum helps patients understand how the silos fit together, and how to navigate between them.

Currently, Healers out there already intuit that an algorithmic diagnosis-based approach lacks humanity, but they don’t know any other way to think about the problem. The Empowered Sleep Apnea curriculum gives Healers a patient-centered alternative to the algorithmic approach, no matter where they happen to be practicing.

~ ~ ~ ~ ~

Now, I confess: I’m a Healer-Engineer. I think my Healer’s heart led me to a weird understanding of how this problem is experienced, on an individual level. In my Healer’s heart, I feel much suffering, coming from the damaged, siloed landscape. It haunts me.

My Engineer’s unrest made me do something about it.

Importantly, the Empowered Sleep Apnea curriculum knowledge is available, free, to everyone with internet access, by listening to Empowered Sleep Apnea: THE PODCAST (Season One). The most important parts of the curriculum—the Five Reasons to Treat, and the Five Finger Approach, are all in there, and it’s free for everybody.

My Healer’s heart made me do that, too.

~ ~ ~ ~ ~

37:56 Rocket Fuel

Viewed through the lens of the land of silos, I’ve come to believe that the reason our rocket flew is because it’s based on what connects us, not what separates us. It flew because it’s not silo-specific, and there’s no rock-throwing allowed. It flew because Empowered Sleep Apnea is a language that providers and patients can all share and enjoy, a structure for charting out the magnificent complexity of this leviathan, for all to see, in a nonthreatening way.

The rocket flew because on the Isle, all are welcome, and all are valued.

~ ~ ~ ~ ~

All of this brings me back to my original point, which was a meditation on the concept of collaboration itself. Music, the meta-language, taught me the importance of friendship. Friendship opened my ears and allowed me to peer outside my silo long enough to understand how our fractured system creates new casualties.

Friendship instructed me how to create a language of humanity, care, and love for a field that so desperately needs these things.

Above all, friendship taught me that the fuel of our beautiful rocket isn’t brains.

It’s not what you know.

It’s love.

And how RAD is that? :)

My name is Dave McCarty. And this is my story of EMPOWERMENT

39:24 Cue Rad Theme Music and Closing Credits

Empowered Sleep Apnea: THE PODCAST is a production of Empowered Sleep Apnea, LLC.

Today’s show was written and performed by David E McCarty MD, FAASM. If you enjoyed today’s program, consider leaving a positive review, so that other seekers are more likely to find us.

Check us out on the interwebs at www.EmpoweredSleepApnea.com where you can sign up for our newsletter by clicking SUBSCRIBE. Our beautiful blue book is available on BookBaby in both hardback and Apple eBook formulations, and we also have a Kindle version on Amazon.

This is Dr. David McCarty signing off for today.

Dr. Ellen Stothard and I will be back next time, when we take our beautiful blue balloon away from the Isle of Sleep Apnea, destined for adventure, next time…destination: Toronto, where we’ll look in on a case of Sleep Apnea hiding behind an endless sinus infection…

…and a most unusual treatment creates the transformation of a lifetime…

…you shouldn’t miss it.

Coming up next…

…your Sleep Medicine Dad Joke.

40:50 Sleep Medicine Dad Joke

Dad: Hey, you know, what? I had a dream last night?

Not-Dad: Oh yeah, Daddy-O, what’d you dream?

Dad: Yep, I dreamed I was swimming in an Orange Ocean.

Not-Dad: Oh, is that right? An Orange Ocean, eh? How was it?

Dad: Oh, it was wonderful, wonderful. A real Fanta-Sea! Get it? Fanta. Sea? Like Fanta is an orange drink?

Not-Dad: Oh! Ha! Ha! Like the orange drink, Fanta? Ha! Ha! That’s hilarious!

41:15 Change the Channel