7 Ways to Speed Up Aging

If you don't know Steven Park yet, now's a good time to get familiar with him.  An ENT who focuses on sleep and breathing issues, he authored "Sleep Interrupted" here, runs a biweekly webinar on sleep issues, teaches at Montefiore, and wrote this clever article last year that should be read by all.

7 Ways to Speed Up Aging | Doctor Steven Y. Park, MD | New York, NY | Integrative Solutions for Obstructive Sleep Apnea, Upper Airway Resistance Syndrome, and Snoring

On Early Treatment and Sleep Apnea

Here is a Letter to the Editor of the AJODO (orthodontic's premier journal) about two articles on sleep apnea. One article extolled the virtues of using appliances to treat sleep apnea and the other jaw surgery.  While both have their place, both miss the point, as you shall see...

Point/CounterCounterpoint: 

Treating obstructive sleep apnea:  The case for early treatment.

by Dr. Barry Raphael, Clifton, NJ

I was thrilled to see sleep apnea being discussed in the October 2012 (142:4) issue.  This is a timely topic that needs to be seriously considered by all orthodontists.  Many of our patients are victims of sleep disordered breathing.

We know that the underdeveloped maxilla  is a primary risk factor for obstructive issues (Dempsey, et.al., 2002), and that a majority of malocclusions, including Class II’s, have an underdeveloped maxilla (McNamara, 1981).

Connect the dots backward from the adult sleep apneic to the growing child to see the connection:  if a child’s face grows poorly from the beginning, s/he will be more susceptible to airway restriction as an adult.

While Drs. Jacobson and Schendel drew appropriate recognition to this issue by recognizing the importance of maxillomandibular advancement to relieve the airway in children, they quickly jumped to discussing surgery in craniofacial anomalies completely skipping over the vast majority of children with similar but less severe problems.  They were completely on target, however, in stipulating that “the orthodontist can play a major role” with interceptive therapy at early ages.

I would like to propose two issues that bear immediate discussion in our profession :

1. We need  the diagnosis of Bimaxillary Retrusion in our thinking.  Most Class II malocclusions are maxillary retrusive.  And just because the dentition is Class I doesn’t mean it is properly placed in the face.
2. There are approaches to orthopedically correcting bimaxillary retrusion in the growing child, but they must be started EARLY.  Waiting for the facial skeleton to be 90% grown before we commence therapy, as the ongoing discussion on early treatment is leading many of us to, is much too late.  By then, the maxilla has collapsed transversely, vertically and sagitally and the mandible has compensated for its partner’s limitation.  Dental compensation doesn’t help (and may hinder)...only orthognathics does.

The American Academy of Pediatrics (Marcus, et.al. 2012) issued guidelines regarding OSA in children.  Though T&A is now (finally) the first line of defense in children with OSA, at least one of the panel members (Sheldon, 2012) has stated publicly that dentofacial orthopedics (in his case, Biobloc Orthotropics) will likely be the future of pediatric sleep medicine.

I urge all of us to take a second look at these issues in light of the coming epidemic of sleep disordered breathing.  The children require it.  And we need to be the ones treating it. 

References:

Dempsey, Jerome, et.al, Anatomic Determinants of SleepDisordered Breathing.  CHEST 2002;122(3), 840-851.

Marcus, Carol, et.al, Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome -Clinical Guidelines. Published at http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1672 

McNamara, James,  Components of Class II Malocclusion in Children 8-10 Years of Age, Angle Orthodontist, 1981;51(3):177-202.

Sheldon, Stephen, Children and Airway: Issues and Interventions,  at NYU, October 6, 2012

Getting Healthier

I just started a "Detoxification Diet". Why? Just 'cause it's another step I want to take toward healthy.  Here is my first post on the CleanProgram.com blog.... Thought I would share.

I'm Day 3, but this feels like I've been doing this all along....

I'm here because I'm going through "professional" changes.  Not really a new job, but a revitalization of something I've loved all along.  I'm just taking things to a new level.  

I'm asking my patients to become healthier.  Here I am, over a year ago,  lecturing.  Notice my belly?  I realized I'd be a poor role model for health if I looked like that and was on BP meds and was out of breath from walking stairs.

Then one of my colleagues (Thanks, Gwen!) gave me Dr. Junger's book.  I started the Elimination Diet right away....Slowly right away.  I'd known from multiple attempts at losing weight that if the effort stressed me out it either wouldn't work or wouldn't last.  

So I took it slow.  I ate only foods from the Elimination Diet (Whole foods. No sugar. No wheat. No dairy. No red meat)  that I liked and ate as much of them as I wanted.  It was a qualitative diet instead of a quantitative diet.  And it began to work.

Then I saw "Forks over Knives", and read "The Omnivore's Dilemma", and William Davis' "Wheat Belly", and studied Joel Furman's "Eat to Live" program.  Each time, I picked up on something new, maybe dropped something off my menu.  I got a Health-master blender for my birthday.

And little by little, I lost 30 lbs over 9 months.  Here's me in August.  Better right? And over the summer I maintained just by eating good food - real food- only.  I also started lifting ("The Power of 10") and walking Casper, my white lab.

But now it's time to take my eating to the next level.  And that's why I'm here. 

Day 3: It's been pretty easy.  Actually, I'm kinda stuffed after lunch.  I've been pretty much eating this way all along.

Come 21 (days on the whole program), I hope to feel like I know what I'm talking about when I tell the kids that they need to make a change in the way they eat (and breathe and stand and sleep...) and they CAN do it. 

Wish me luck!

Dr. Barry Raphael