Enrollment standard with Sleep Apnea

[estoguy]

Well, the wind was taken out my sails today.  I received a letter from the RMO saying that because I have sleep apnea and use a CPAP that I do not meet the "common enrollment medical standard" for the CF.  Which I find rather hard to believe, considering that I'm fairly confident that I could report for Basic right now and do well.

According to the letter I can do the following: submit "new pertinent medical information through your local Canadian Forces Recruiting Center medical section; or to forward a request for secondary review of your existing file to the Director of Medical Policy through your local CFRC medical section being sure to outline the aspect(s) of the decision with which you disagree and the reasons why."

So, to the medical minds of army.ca - any suggestions/advice?

I know more than one doctor has remarked that my tonsils are quite large, and even the doctor who gave the original diagnosis said that removing them and any excess tissue  could have an effect, but it was not offered as a treatment option. I'm totally prepared to go under the knife for this, if that is what it will take.  I've come too far and worked too hard to give up now.

Any thoughts would be welcome.  Thanks!

 

[Blackadder1916]

So, to the medical minds of army.ca - any suggestions/advice?

Yes, there is something you can do.  You can "submit new pertinent medical information through your local Canadian Forces Recruiting Center medical section; or to forward a request for secondary review of your existing file to the Director of Medical Policy through your local CFRC medical section being sure to outline the aspect(s) of the decision with which you disagree and the reasons why."

. . . . Which I find rather hard to believe, considering that I'm fairly confident that I could report for Basic right now and do well.

What you believe, and occasionally what civilian physicians (particularly if they are unfamiliar with the CF CEMS) believe, are not pertinent to decisions concerning medically suitability for enrolment.  Any official objection to the decision of the RMO would have to be based on providing clinical evidence that refutes the RMO's opinion.

 

[estoguy]

I understood what the letter meant about submitting information... in terms of advice, what I meant was does anyone here have any experience with sleep apnea and suggestions how to not have this be a barrier to joining? 

 

[AGD]

I can see why the RMO would not want to enrol somebody as a pilot who has a condition which contributes to fatigue and sleep deprivation. Anyway...

in terms of advice, what I meant was does anyone here have any experience with sleep apnea and suggestions how to not have this be a barrier to joining?

It's certainly not a permanent condition...I know an individual who had terrible sleep apnea; lost 50 lbs. and it completely went away.

A tonsillectomy, as you have suggested, might work. I'm wondering why this wasn't offered as a treatment option. It's so common that it's like a trip to the dentist...

I believe the problem is the CPAP machine...if you can demonstrate that you no longer need it, that might be enough "new pertinent medical information" to see you through.

 

[estoguy]

I have lost some weight since my physical, but I don't believe my weight is not a terrible factor. I'm 6'2" and right now about 235 lbs.  So, technically overweight (if you go by BMI), but certainly not morbidly obese.

When I was originally diagnosed, the doctor did discuss having a tonsillectomy, but really pushed the CPAP.  Doing some further reading, they can also reduce other tissue while they are in there, so I'll definitely be talking to my GP about it and see what his opinion is.

 

[aesop081]

  Which I find rather hard to believe,

Well, believe it.

considering that I'm fairly confident that I could report for Basic right now and do well.

You know there is more to life in the military than basic, right ?

 

[estoguy]

Thanks for the input guys... and yes, I do understand where its coming from.  *I* just find it hard to believe.  I know that has very little bearing on the rest of the world! LOL

Have an appointment with the GP on Thursday, so we'll see what happens. Wish me luck!

 

[Good2Golf]

...So, to the medical minds of army.ca - any suggestions/advice?

Embark on a fitness and dietary plan that sees you eating well and exercising to lose the extra weight.

There really isn't anything that any of us can reasonably provide as input to you that will help you other than the above advice.  There might be procedural "solutions", however, that is for medically-trained persons to counsel you.


Regards
G2G

 

[medicineman]

A tonsillectomy, as you have suggested, might work. I'm wondering why this wasn't offered as a treatment option. It's so common that it's like a trip to the dentist...

Ever seen how long it takes for a 35 year old to recover from a tonsillectomy?  No?  I think you know where I'm going with that then right  :nod: ?. 

Other surgical options like a UPPP are great in that they work, but are quite nasty and take a long time to recover from...and then they tend to only buy people time.

My advice, ask your GP for a new formal sleep study (PSG) and a sleep latency test thereafter (which will likely take forever to get incidentally, depending on where you are) without your CPAP to see how where you're at...it'll either refute things or reinforce it.  You can also see if an ENT surgeon will entertain either a tonsillectomy or a UPPP and discuss it with you.  Be prepared for a wait , and then you'll have to be prepared for a fair recovery period as well after the surgery.  You'll then need evidence (ie a formal sleep study without CPAP and sleep latency test) that your OSA has resolved.

The reason I say a formal PSG vice home overnight oximetry is it's done in a lab or at home with witnesses to ensure you're not hooking yourself up to your CPAP at night to fool the pulse oximeter...unless your hospital can admit you overnight to do the overnight oximetry...either way, you'll need convincing evidence you're good to go without the CPAP.

One way or the other, be prepared for a long process.

Cheers.

MM

 

[estoguy]

Thanks so much MM! 

I know that I least have some direction anyway... and I'm willing to put up with some discomfort to make this happen.

Why did you say that the tonsillectomy/UPPP only "buys time"?  Just curious what you meant by that.  I take that as meaning that the problem can come back?

 

[PrettyMaggie63]

The tonsillectomy can be very hard on an older person. I've seen patients in their 20's have extremely long recovery periods, or even end up with lifelong problems because of the surgery. Both a tonsillectomy and a UPPP (or UP3) are surgical procedures and have risks and should only be considered as a last resort. My advice to you is follow medicineman's  advice, do the official sleep studies first, see an ENT for a consult, and prepare for a bit of a long haul.

 

[cupper]

Speaking from personal experience (after my military career) it's not just the current medical state, but also the long term potential problems from having sleep apnea.

Additionally, the need for the machine limits your deployment readiness, as there may not be electric trees to plug into where you get sent. Being off the machine for even one sleep cycle can cause the symptoms to return until you can get back on the machine, and some studies have shown that the symptoms can be more problematic when you've been on CPAP for any length of time.

Losing the weight will definitely help, and ironically the CPAP will help with losing the weight.

If you are a candidate for the surgery, it may be a better option, but I can't really speak to that. But having the tonsils removed will make a huge difference, and could reduce chances of other possible problems (infections etc)

 

[estoguy]

Cupper - yeah, I totally get where you are coming from and I understand those issues. If I had of known sooner that this would be an issue, I would have taken steps before now.  Oh well, can't cry over spilled milk, right?  I've been working on the weight loss since my physical.  I'm down about 10 lbs from that time.  Going to ramp up things even more on the cardio side to help shuck those pounds.

I've been doing some reading about some of the possible treatments, including the tonsillectomy, and it seems that the adult experience of recovery can be varied.  Some people older than myself breezed through it, others had a hell of a time.  Knowing myself, I think it could go easy if it happens, as I do tend to heal quickly and there were some common threads in the comments from people who didn't have a rough time - keeping hydrated post-op was the big one, and several articles pointed that out as well.

As the popular saying goes around here, "Hurry up and wait"... looks like some more waiting.

I certainly appreciate all the advice and viewpoints! 

 

[medicineman]

Why did you say that the tonsillectomy/UPPP only "buys time"?  Just curious what you meant by that.  I take that as meaning that the problem can come back?

Yeah, essentially - alot of people lapse back to having some of the tissue/weight replace what's taken out.  A friend of mine had it done, and still needed a CPAP in the end.  He did lose 35lbs as a direct result of the UPPP though...since he was gacking up blood and could barely swallow for 3 weeks.

Something else I forgot to mention was to ask about a mandibular advancement device - kind of a bite splint that shown some promise with some folks as far as tempering their OSA or better. 

Fact is, most people I treat with OSA (and alot of humans for that matter) are inherently lazy and would prefer what they think is the silver bullet like surgery or CPAP as opposed the real silver bullet - actually loooking after themselves.  I have one person that's having every issue you can think of as a result of their OSA, but still won't stop shovelling crap into themselves.  Maybe a UPPP will help them with that.  Granted, there are those of us that have been cursed with tonsilar infections throughout our lives that have left them big and in the way, but alot of folks are content to live out their lives under the adage of what my supervising doc says "Modern medicine allows people to live their lives longer in the [shoddy] manner they've become accustomed to".  I feel a rant coming on so I'll stop here  ;D.

MM

 

[cupper]

Fact is, most people I treat with OSA (and alot of humans for that matter) are inherently lazy and would prefer what they think is the silver bullet like surgery or CPAP as opposed the real silver bullet - actually loooking after themselves.  I have one person that's having every issue you can think of as a result of their OSA, but still won't stop shovelling crap into themselves.  Maybe a UPPP will help them with that.  Granted, there are those of us that have been cursed with tonsilar infections throughout our lives that have left them big and in the way, but alot of folks are content to live out their lives under the adage of what my supervising doc says "Modern medicine allows people to live their lives longer in the [shoddy] manner they've become accustomed to".  I feel a rant coming on so I'll stop here  ;D.

MM

We don't know each other do we?
You don't happen to practice in Virginia do you?  ;D

 

[medicineman]

We don't know each other do we?
You don't happen to practice in Virginia do you?  ;D

(1) - Possibly.

(2) - Fraid not...Manitoba...could just be a colder version of it though  ;D

MM

 

[estoguy]

Yeah, essentially - alot of people lapse back to having some of the tissue/weight replace what's taken out.  A friend of mine had it done, and still needed a CPAP in the end.  He did lose 35lbs as a direct result of the UPPP though...since he was gacking up blood and could barely swallow for 3 weeks.

Something else I forgot to mention was to ask about a mandibular advancement device - kind of a bite splint that shown some promise with some folks as far as tempering their OSA or better. 

Fact is, most people I treat with OSA (and alot of humans for that matter) are inherently lazy and would prefer what they think is the silver bullet like surgery or CPAP as opposed the real silver bullet - actually loooking after themselves.  I have one person that's having every issue you can think of as a result of their OSA, but still won't stop shovelling crap into themselves.  Maybe a UPPP will help them with that.  Granted, there are those of us that have been cursed with tonsilar infections throughout our lives that have left them big and in the way, but alot of folks are content to live out their lives under the adage of what my supervising doc says "Modern medicine allows people to live their lives longer in the [shoddy] manner they've become accustomed to".  I feel a rant coming on so I'll stop here  ;D.

Again, thanks so much for chiming in on this thread.  Its been very enlighting and helpful.

I've wondered about those mouth devices as well.  Haven't heard much on possible effectiveness, but that will be something I'll bring up too!

I can certainly see the point and the "danger" you made in your "rant". Can't speak for others, but I've never been terribly overweight, probably at my heaviest, 25 pounds over where I should be.  I enjoy food, but I'm not shovelling it in.  I've also been working out much more regularly since even before I applied to the CF.  Just work and other commitments do get in the way.  I'd be really happy getting myself back to around 220 for starters and see how it goes.  If anything, the application process has given me a goal to shoot for and *possible* reward for doing so.

I'm not just going to run off half-cocked on this.  Going to see my doctor next week and see what he recommends.  As I said in your MP comment, I'll definitely be taking your advice along to help keep me on track when I talk to him.

 

[PrettyMaggie63]

Estoguy, you have the right attitude and that will get you places. Until you get an actual letter stating it's the end of the road, then it's not the end of the road. So don't give up, you have several options to consider.
All the best to you, I am really hoping it all works out.

 

[estoguy]

Thanks Maggie!  I hope so.  When I got the news last night, I was down for about 10-15 minutes, but I also know that despairing is not constructive.  So I put it aside, refocused and started looking for answers and asking questions.

I knew starting out it was going to be a long and winding road... but the eyes are still on the prize.  Its moved farther away, but I'll keep on after it until its out of reach.  [mountie]

 

[estoguy]

OK, had appointment with my Doc today.  He's definitely supportive in helping me.  He's arranged for a new sleep test, a consult with a specialist and has encouraged to keep at my workout programme.  Ideally he'd like to see me around 200 lbs, and has some hope that the weight loss could help sidestep surgery.  Since its going to be at least 6-8 weeks before gettign the test or the specialist appointment, I got work to do!

Wish me luck!  :nod: