Every few years, I would pick up The Alchemist by Paulo Coelho, and read it from the beginning to the end. After giving it as a gift to another friend this year, I opened it again.
I have always felt there is a Personal Legend - being reflective.
I remember the first time to write down a life long goal in 2007 --- to bring a medical technology to the market that has substantial impact to improve patient care. The omen is still good.
The Inspire project on obstructive sleep apnea has been good. The entire project is so focused, and let me keep the most important thing the most important thing over the last 5 years.
“The only way to do great work is to love what you do. If you haven't found it yet, keep looking. Don't settle. As with all matters of the heart, You'll know when you find it.” - Steve Jobs.
It was exciting to hear the iPhone ECG was approved by the FDA early this month. This device has two electrodes that are built in a case for an iPhone, which can then record, display and also transmit ECG over a mobile network.
Mobile ECG or telephonic ECG are not new. There was a Nokia phone with ECG recording that was tested more than 10 years ago in a clinical study to see if EMR service can save time and improve outcome for heart attack. These studies later supported the current guideline from AHA that requires pre-hospital ECG for emergency services in patients with symptoms of heart attack. It makes sense when signs for ischemia can be identified from ECG, the information can save precious time in getting patients to a hospital that can provide treatment immediately.
I am more excited about the possibility of having an over-the-counter version of the iPhone ECG, which is not available now, but may become available next year. It is not immediately clear yet how the iPhone ECG will be used. Here are some thoughts …
I used to attend the international electrocardiography society conference when I was a graduate student in the late 90s. For several years, the theme for the conference has been “Was ECG still relevant?”. It was an irony for an ECG expert society to ask that question, but in reality, the ECG has become obsolete in most of cardiac services. Echocardiography, CT and MRI provide much more precise diagnostic information for treatment. I don’t expect the iPhone ECG to improve the diagnostic capability over the existing 12-lead ECG systems. That’s not the future.
The future of iPhone ECG is in its potential to provide services to empower us as a consumer for healthcare. In an early post, I argue that one of the reasons we cannot leave health care to a free market is because we are not equipped with enough knowledge to choose doctors or care providers freely. The health equipment shelf at Walgreen today has very few items, thermometer, glucose meter, blood pressure cuff, and none comes with a service. When we get sick today, there is very little choice but going to see a doctor. The trend of rising healthcare cost is not stopping. Recently, we have seen a new trend in the US for consolidation of large hospital systems that integrate diagnostics and treatment. That’s bad news for consumers.
iPhone ECG by itself will be limited to provide diagnostic value, but I see a future that a slew of health equipments that are available in consumer products. There will be independent diagnostic services that can help you become more knowledgeable about your conditions, and when you do decide to go to see a doctor, instead of waiting in the lobby for an hour, your doctor can't wait to see your iPhone.
I like to ask people “Where are you from?”. Living in the twin cities in the last 12 years, I have learned about lives in Somalia in many of the taxi rides between home and the airport than I’ve ever had from books or internet.
It is an easy question to start a conversation, but for many of us, there is no easy answer.
In China, we used to ask “Where are you originally from?”, “老家在哪?”. There is a consistent residence registration system that is in use today, called Hukou, 户口, which goes back for 2,000 years.
I began to answer the question when I went to Shanghai for college, and the answer became a little complicated already. My family originally came from Haimen, 海门, a place I had never been to and could tell very little about. By then, my family had moved from the northeast part of China to Wuhu, 芜湖, in Anhui province. In China, one of the first reasons for asking the question is to find out if you speak the same dialect. I would earnestly put on a little twist of the northeast dialect, whenever encounter someone from the three provinces of Northeast China.
I love the answers I heard when we lived in Antwerp Belgium for half a year. One of the colleagues from the University Hospital told me that he had a big move when he got married. He had to move from the north of the city to the south of the city to be close to his wife’s family. So he has a very specific answer, “I am from South of Antwerp”.
My answer has been getting more hopeless as we move around in the US over the years. Sometimes when I was being asked the question, I can also tell the question includes “Where are you originally from?”, which is not to find out my dialect. I would go through the places I have lived in China. “Shanghai” usually is the satisfactory answer, “Yes, my sister was there last year”, although I have lost most of my dialect from Shanghai.
I am making up my mind though, right now, “I am from Minneapolis”. This is home for the longest so far in my life. We are having the first big snow of the year, the city is beautiful.
Obstructive sleep apnea is a condition that airway narrows or closes many times during sleep, which causes reduced air exchange, frequent arousals and poor sleep. This is a common condition that occur in 2 percent women and 4 percent men.
The typically perception of OSA is that it is a nuisance. That people snore is a fact of life, at least that is what we try to tell our spouses. We are used to being tired during the day for a loss of a few hours of sleep the night before.Who wants to miss the World Cup Final just because it was 2 AM.
Mark Twain once said “Don’t go to sleep, so many die there”. Now we seem to support him with some data.
Gami and Somers at Mayo Clinic first showed that people with OSA had a peak in sudden death from cardiac causes in the sleeping hours, which contrasted strikingly with the low rate of death during sleep in people without sleep apnea or in the general population.
Last month, scientists from Spain reported their findings of after following 939 elderly patients for 10 years [1]. They showed that the chance of death over 5 years from stroke, heart failure, or myocardial infarction was doubled in subjects with severe obstructive sleep apnea (apnea hypopnea index greater than 30 events/hr sleep) without treatment when compared with subjects with AHI less than 15 or subjects treated with CPAP (4 hours/day of use). A pretty amazing fact of the impact of sleep apnea that kill and effect effect of sleep apnea treatment that save lives.
This report was similar to another large-scale population-based study from Wisconsin of 1,522 subjects followed over 18 years, which showed 3 times of all cause mortality in subjects with severe OSA.
Both studies showed the relative increased risk of mortality remain associated with sleep apnea after fully adjusted for age, gender, BMI and many other confounding factors. The evidence from randomized-controlled trial will be coming from the SAVE study (www.savetrial.org) that is studying the effect of CPAP to prevent cardiovascular risks in 5,000 subjects.
Don’t wait for the SAVE study though, if anyone tells you that you stop breathing during sleep, go see a sleep doctor, just to be safe.
[1] Martinez-Garcia MA et al. Cardiovascular mortality in obstructive sleep apnea in the elderly: role of long-term continuous airway pressure treatment. Am J Respir Crit Care Med 2012.
