"Serendipity!" Meir Kryger (05/25/2022)

June 03, 2022

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00:00Tell me what worked, what didn't work,
00:02what I needed to improve,
00:03and that was fantastic.
00:05He taught me the mechanics of
00:07clinical research and he encouraged
00:10me to pursue sleep studies to
00:13actually do stuff with sleep well.
00:18Well, when you have lemons,
00:20you make lemonade.
00:21So here I was in in in Colorado,
00:24my boss John Wilde tells me to
00:27go and do sleep research and and
00:30there there was no device that
00:33was available for acquiring data.
00:35There was nothing out there that could help.
00:39And So what I got interested in
00:41was sleep at high altitude and
00:43this is the city of Leadville, Co.
00:46The highest.
00:47Human habitation in North America.
00:50And there was a mine there,
00:51so there was an actual town,
00:54so I decided to do some some research
00:58in this town and three things aligned.
01:02And this again is serendipity.
01:04So the three things that were
01:07that aligned was I.
01:09I wrote a letter to Helen Grass,
01:12who was she and her husband
01:14were the owners of the grass
01:17company that made a polygraphs.
01:20And I asked for a polygraph
01:21and she sent me one.
01:23And so that's that was one
01:26thing that was important.
01:28Hewlett Packard that year introduced
01:31the fiber optic era oximeter.
01:34This was a revolutionary device.
01:37This was the first medical device
01:39that actually used fiber optics.
01:41It was a brilliant device
01:43and and and when we got it,
01:46I was able to talk to the engineers
01:49and and and get all the information
01:51I needed on how to use it.
01:54The third thing that aligned
01:56was this was the height of NASA,
01:59the NASA space program and working
02:01in Colorado at the Institute
02:04where I was was Gene McCullough,
02:07who was a genius programmer who
02:10developed computerized data
02:12acquisition of all Night studies.
02:14In other words,
02:15we we connected the grass device
02:17to a data acquisition system
02:19that he put together and we were
02:22actually able to gather data.
02:24And to analyze it so my life in
02:28Colorado it was it was productive.
02:31And these are some of the
02:32articles that I wrote then,
02:33but I want to just highlight one of them,
02:35which is this one here.
02:37This was by complete coincidence this
02:41article impaired oxygenation during sleep,
02:44and excessive polycythemia of high altitude.
02:47That was the first article printed
02:50in this new journal called Sleep.
02:53The very first article,
02:55and it was just sort of a crazy coincidence.
02:59So also while I was in Colorado,
03:01I had a chance meeting with this
03:04gentleman here Christian Gemino and
03:06those of you who have ever visited Colorado.
03:09Those are the maroon bells.
03:11That's what it actually looks like.
03:13And Christian Gemino was a
03:16neuropsychiatrist from Stanford
03:18and he was there to to to give a
03:21talk on something I had organized a
03:24symposium on control of breathing.
03:27And we spent Christian and I spent a
03:29lot of time just hiking and talking
03:32and what he kind of pointed out to me
03:35was I knew about sleep and breathing,
03:37but I really needed to get much
03:40more involved in the field of
03:43sleep so that and so the term,
03:45by the way,
03:46the term sleep apnea Christian
03:49actually introduced the term,
03:51but he introduced it with
03:53a the wrong condition.
03:55He called it insomnia.
03:57The sleep apnea. A new syndrome.
03:59In fact, his patients did
04:01not have obstructive apnea.
04:02They had central apnea and
04:04I won't get into that.
04:05But that was my first encounter
04:07with someone from Stanford.
04:09Could you say that again?
04:10Oh my God,
04:12my my my phone is going crazy here.
04:15So Christian convinced me to
04:18go to a sleep meeting which
04:21was held in Palo Alto and and
04:24I was the only I'm pretty sure
04:26I was the only pulmonary guy.
04:28At this meeting and and and that
04:30was the prime of Bill Dement,
04:32a you know professor of psychiatry
04:34and and I did my presentation on
04:37sleep at high altitude and Dement
04:39came over to me later on and he said my God,
04:42you're just a kid and the the reality
04:46is is that at that time I was a kid.
04:49So after my training I went off to
04:52Winnipeg for a variety of reasons.
04:55I wanted to go back to Canada
04:57and this is a photograph that
04:59I took actually from the front
05:02porch of our house in.
05:04In in Winnipeg,
05:05and this is the Aurora borealis and
05:07it's just a wonderful thing to see if
05:10you ever have the chance to see it,
05:12but Winnipeg doesn't have
05:13great press because of winters.
05:15So why did I go there, right?
05:17So it had the best pulmonary medicine
05:20section in the country and in Canada.
05:24Who was there?
05:25Ruben Cherniak,
05:26who later on became head of the
05:29National Jewish Hospital for many,
05:30many years.
05:31Nick Antonio says,
05:33so anybody who orders?
05:35Oxygen on a patient might know that
05:38Nick Antonissen was in charge of
05:41the NOT study funded by NIH that
05:44actually documented the benefit
05:46in a double blind study of using
05:49oxygen in patients with COPD.
05:52Larry Wood was there and Larry
05:55eventually wrote one of the great
05:58textbooks of critical care medicine.
06:01So, as I mentioned before,
06:03Nick Antonissen had a lot of.
06:05Had a lot of faith in me and he he
06:08gave me the opportunity to create
06:10the first clinical lab in Canada.
06:13And because there was such a
06:16vibrant pulmonary program,
06:17I was able to do sleep studies and COPD
06:20and there's this your lung disease,
06:23acromegaly,
06:24post polio you know can congestive
06:28heart failure scoliosis you name it?
06:31And the other thing about Winnipeg it's
06:34a great place to raise your family.
06:37OK,
06:37so this is my family so this is from
06:40around that era and a few years later.
06:42So this is my wife Barbara.
06:44This is Shelly this is Michael and
06:47this is Steven and they're all
06:50much bigger now and they're all
06:53successful and this is a typical
06:56picture of a Prairie town with the
06:59grain elevators in the background.
07:02So after I got to Winnipeg before I
07:05had any equipment I had time to kill you,
07:09right grants and then you kind
07:11of waited to get
07:13equipment and I was going to be ultimately
07:15in charge of the second year of pulmonary
07:19program for the medical students.
07:21So I I put a book together and that
07:23was the first book that I did.
07:25Pathophysiology of respiration and I
07:28basically did it for the students.
07:32So after I arrived in Winnipeg,
07:34my role in life changed.
07:38Initially I had these great mentors and
07:42they mentored me and then I became a
07:46mentor and that so my role flipped entirely.
07:50And I had fellows showing up literally from
07:54all over the world from all over the world.
07:58I had fellows who who who appeared
08:01usually with their own funding at
08:04that most of the time there were
08:07no official training programs,
08:09and they came from all sorts of specialties,
08:12neurology, psychiatry, surgery,
08:15ENT, pulmonary cardiology.
08:17And it was really wonderful because all
08:20of a sudden I got to learn from them.
08:22Not just them learning from me.
08:26So my lab became very well known.
08:29This is an so down here.
08:32This is the old Hewlett-Packard
08:34oximetry oximeter.
08:35This is the the grass model 78,
08:39and this guy hears is Prince Phillip.
08:42And so I'm explaining to him how we're
08:47documenting respiratory effort and and
08:49the lab became well known and and.
08:52And there was another fluke
08:54that happened very soon.
08:56After that,
08:57the fluke was that it turned out that
09:00next door to to my lab in in Winnipeg
09:04was something called Manitoba Center
09:06for Health Policy and Evaluation.
09:09Turned out they were the depository
09:13of all the medical data for the
09:16province of over a million people,
09:19so I could obtain data from my
09:21patients and match them to controls.
09:24OK,
09:24and this led to the to a bunch of papers
09:28having to do with healthcare utilization,
09:31and I'll give you just one example of 1.
09:34So this is an example of the are the kind
09:37of data that we were able to to find.
09:39So on this graph,
09:41on the extreme right where
09:43it says evaluation,
09:44that's when I saw my sleep apnea
09:47patients and there were hundreds of them,
09:50and these are female patients,
09:51and I was going to.
09:52I was able to match each patient with four
09:56controls who are either the same weight,
10:00same BMI, or were normal weight
10:03but born roughly on the same date.
10:06OK, so and I was able to look at data.
10:09Going back about 9:00 or 10 years and
10:13what this showed is that the problem
10:16with sleep apnea isn't obesity,
10:19because BMI controls did not have
10:22the same degree of healthcare,
10:25you utilization as the sleep apnea patients.
10:28So that's the kind of research that I did.
10:32And and that was and and.
10:34And that was again because of a
10:37fluke that there was a lab, right?
10:39There was a an office right next to me
10:42that could actually supply that kind of data.
10:46So we're going to go now to 1984.
10:49I was asked to give a talk at the
10:51California Thoracic Society at the Yosemite,
10:55and at that meeting I met Tom Roth.
10:58And and when you're at a place like Yosemite,
11:02you go hiking, you go on.
11:04You have a great time and we
11:06talked and we talked and we talked,
11:09and that led us to work
11:12together on a research project.
11:15Actually, more than one,
11:16and we decided at that meeting
11:19that that a clinical textbook
11:21was needed in the sleep field.
11:23OK, so the study that we collaborated on was
11:27this study here mortality and apnea index,
11:30and obstructive sleep apnea.
11:32So in in the mid 1980s that was
11:36before CPAP was widely available,
11:39or at all in any big numbers.
11:42So at Henry Ford Hospital they had
11:45a large number of untreated apnea
11:47patients that they had been following
11:50for years and years who were not
11:53treated because the only treatment.
11:55At that time,
11:56really was tracheostomy,
11:57which you didn't want to do,
11:59and what this paper showed is that if
12:01you had an apnea index of less than 20,
12:04you didn't die.
12:05If you had an apnea index of more than 20,
12:07you had a pretty good chance of
12:10dying within about 10 years.
12:11Now,
12:12the thing about this paper is
12:14I thought this was really neat
12:15stuff and I submitted it to the
12:17New England Journal of Medicine,
12:19and I got an instantaneous rejection.
12:23It was one of these rejections where
12:26where the the the editor and he
12:28writes me back saying that people are
12:30really not interested in sleep apnea.
12:32Go, you know, go try somewhere else.
12:34So as we resubmitted it to.
12:38To another journal.
12:39So in 1985 we explored the idea of
12:42a textbook and I asked colleagues,
12:45Christian Dimino,
12:46Christian Dimino did not think
12:48there was enough to fill a book,
12:50build them into I.
12:51I I had gone to Stanford and spoke to
12:55Bill and what he said was without a textbook,
12:58you can't have a field.
13:00And so we started to work on the book.
13:04So and and this is really the
13:07last line of of Casablanca.
13:10I think this is the beginning of a
13:13beautiful friendship we worked together
13:15on this book for well over 30 years.
13:18Bill is in the middle and Tom
13:20Roth is on the right and this is
13:22at one of the national meetings,
13:24so the inspiration for the title came so
13:28I've so I mentioned before the library.
13:32So the library at McGill.
13:34Just called the Osler Library.
13:36Osler had been a professor of medicine at
13:40at McGill before he became really famous.
13:43When he moved to the States
13:45and later on went to Oxford.
13:47So the title of the book was going to be
13:50principles and practice of Sleep Medicine.
13:54So this was the 1st edition.
13:56So the 1st edition was broken up
13:59into two parts, normal sleep,
14:02abnormal sleep.
14:03There were a total of about 750
14:08pages and and the book.
14:10Actually it became fairly popular,
14:13came out in about 1989.
14:16So these are all the different
14:18versions of of the book. So
14:238994, 2002, 1005 and and 2011 and.
14:26And show the book changed
14:29it got bigger and bigger.
14:32And and then my family moved to Connecticut.
14:36OK. And I I would have to say so.
14:39First. I was a Gaylord.
14:41I would have to say that
14:43Gale was gutsy to hire me.
14:46I was 64 years old.
14:48And it was sort of gutsy to
14:50hire someone who's 64 years old,
14:52but I guess they saw some value in it
14:55and I worked at the VA where I helped
14:58introduce remote monitoring of CPAP machines,
15:01oral therapy of of sleep apnea and at Yale.
15:05I established a real fellowship
15:07program that had funding that actually
15:10participated in the match and so forth.
15:13Continued scholarly stuff and I and
15:16I started to run an undergraduate.
15:18Course called Mystery of Sleep,
15:20which I'll get back to in a minute.
15:23So we had.
15:25Terrific sleep fellows.
15:27They were an incredibly inspiring
15:29group and in the last few years
15:31we've had about 20 of them,
15:33and they've populated academic centers,
15:35both at Yale Mayo Clinic and and and Duke,
15:39and many have established
15:41clinical practices throughout the
15:44US and outstanding centers.
15:47So during the pandemic it's
15:48hard to give a talk these days
15:50and not mention the pandemic,
15:52so this is what it was like
15:55to mentor students.
15:56And through precept our
15:58fellows during the pandemic.
16:00So you can see me up here in the little
16:03tiny window as I'm talking to the
16:05fellow who has just described the case
16:07to me and and that's how we ended up,
16:10sort of for for basically at least one year,
16:14year and a half doing remote teaching.
16:17During the pandemic of our trainees,
16:20so I also have to say that our sleep
16:24attendings are uninspiring group to me,
16:27an incredible group and I just want
16:29to point out that every time you
16:32see a why with a little bulldog
16:34which is sort of the mascot of Yale.
16:37So these are our faculty members
16:40who actually went through our
16:42Sleep fellowship program.
16:44So I'm very proud of the
16:46fact that that some of our.
16:47Fellows have gotten sort of real jobs,
16:50although I don't know how much
16:52they're making compared to if
16:54they went into private practice,
16:56but they're terrific, terrific people.
17:02So this is the last photograph I was
17:04able to take of the people working in the
17:08clinic itself and and the sleep faculty.
17:11And this is from 2019.
17:13We haven't been able to get the
17:16entire group together like this post
17:19COVID and it really does take a
17:22village to to actually train fellows,
17:25train each other and take real
17:28good care of our patients.
17:30So this is the dream.
17:32I mean, I won't go through all
17:34the people who are on this,
17:36but they're what a great group.
17:39So meanwhile,
17:39while all this is going on,
17:41the 7th edition is coming out right?
17:44So the 7th edition is like way bigger
17:47than what I've showed you before the
17:507th edition of the textbook came out.
17:53Actually, about four months ago,
17:55five months ago,
17:57213 chapter chapters over 2000 pages.
18:02And the book looks like this on on the right.
18:05So the 6th edition looks like
18:07this 7th edition looks like that,
18:10and I I'd like to actually mention a
18:13couple of things about the 7th edition.
18:18So so we Kathy Goldstein is became.
18:24One of the terrific sort of
18:28senior editors of the book and and
18:32hopefully she will continue taking
18:34the book forward into the future.
18:38And I I was delighted to learn
18:40that just this week she has been
18:42promoted to full professor at the
18:45University of Michigan.
18:49So during the book, during the creation
18:51of the book, there was a huge.
18:55I'm I'm I'm gonna say the efforts put forth
18:58by by the section editors were phenomenal
19:02and so I listed the all of the editors.
19:06All the section editors there was one for
19:09neurology, one for movement disorders,
19:11one for pulmonary,
19:12one for cardiovascular, and so forth.
19:16They did a tremendous,
19:18tremendous, tremendous job,
19:20and Bill Dement died and Bill Dement died.
19:25I guess it would be about almost
19:28two years ago now and that was
19:30a huge shock and and he wasn't.
19:32I mean, I mean,
19:34he was really the inspiration for me to
19:38start on the books in the first place.
19:41Putting out a book during a pandemic.
19:44I gotta tell you was a real struggle.
19:48There were five authors who died during
19:52during the creation of this book,
19:54who would have contributed to the book.
19:57A Christian demino also died.
20:00And so it it, it was a.
20:02It was a very tough thing to
20:06actually get it done,
20:08but it we had to get it done
20:10and we did get it done.
20:13And and with thanks to all the
20:16section editors and and Kathy.
20:19So I mentioned before that I teach
20:22a class and this is a photograph of
20:25the students that I had in in 2018
20:27and mystery of sleep class and I love
20:31teaching the undergraduates why?
20:34Because they're so smart that it's
20:38actually frightening. So that's me.
20:40And the yellow jacket and and Doctor
20:42Suen bottom, who is Co instructors back here.
20:45You can barely see him.
20:47I mean the.
20:49These students were so inspiring I could.
20:52I could take an hour to explain
20:54to you some of their their their
20:57achievements incredible.
20:58So I also did some books for the
21:02public and I won't spend a whole
21:05lot of time talking about them.
21:08But one of the things that that.
21:11I always love to do was to take
21:13care of patients, manage patients.
21:15And it has been an honor for me
21:18to be able to treat probably more
21:21than 50,000 patients in my career.
21:25And a lot of what I have learned about sleep,
21:29about diseases about humanity
21:33have been from my patients.
21:37So I'm gonna end now by talking
21:40about the things that shaped me.
21:43And hopefully there'll be
21:44some time for comments.
21:46Mother,
21:46my mother and and I guess it's
21:50genes genetics, the love of writing.
21:53My father, the love of art.
21:56And and my and I've actually written
21:58a book called Sleep and Art,
22:00and that's again a genetic thing.
22:04I was shaped by my spouse who
22:06really taught me about loving life.
22:09And my children.
22:11Unwavering support, I mean,
22:13during the the the years when they
22:15were young and I was in the basement
22:17working on talks, working on books.
22:19They never ever said.
22:21You know that we need to go
22:23and play baseball or something.
22:25They were incredibly supportive.
22:29So what a career needs
22:32is champions and mentors who believe in you.
22:36Who lets you do what you want to do,
22:39not what they want you to
22:42do and take over their work?
22:44You gotta. They have got to.
22:47Express themselves, you need to have
22:51a passion about what you are doing.
22:52You gotta love what you are doing.
22:55You have to have a supportive family.
22:58You have to have patience because some
23:01of the things that you do may take
23:04a year or 30 years for that matter.
23:08And of course serendipity.
23:11You need serendipity.
23:13So I'm going to end now with
23:16the last part of of a poem that
23:20I love by Robert Frost.
23:24I shall be telling this with a sigh
23:27somewhere ages and ages, hence.
23:28Two roads diverged in a wood and I
23:32I took the one less traveled by.
23:36And that has made all the difference.
23:39Thank you.
23:44Thank you so much, Doctor Krieger,
23:46that was really wonderful and I'm
23:48going to cry now even even as you are.
23:50So I think if we hadn't if the
23:52audience of everyone could hear,
23:54I think we'd have a amazing round
23:56of applause and a standing ovation.
23:58Amazing comments in the chat.
24:00Thanking you for sharing your journey.
24:03I would like to invite people
24:04to ask any questions you have.
24:06Any questions they have so far I'm
24:09just seeing great, great comments and.
24:12Wonderful things, what you know.
24:13I would say you know having a career
24:15like this and you know going back
24:17when you're so young and training.
24:19And then as you move forward in your career,
24:22there are a lot of.
24:23There are a lot of forks in the road
24:24as you mentioned, a lot of changes.
24:26Sometimes they're stumbling blocks.
24:28How do you keep moving forward?
24:30You know some of our mentees will
24:31ask you know, what do you do?
24:34Sometimes things just don't work.
24:35How do you maintain that enthusiasm?
24:37How do you maintain that interest?
24:38How do you maintain that curiosity
24:40in those times that?
24:41Like you said,
24:42there's many rejections right
24:44from these journals, et cetera.
24:45So maybe you can speak to that.
24:48Well, I you know the.
24:51The child of Holocaust survivors.
24:55And what you learn is a sense of resilience.
24:59What you learn is that you don't give up.
25:03You continue on your journey
25:05whatever the journey is and and you.
25:08If you have a destination, you go to it.
25:11In other words,
25:12you know having a paper rejected.
25:15Some people would say it's the worst
25:17thing that can possibly happen.
25:18Sometimes it's the best thing
25:21that can possibly happen.
25:23You know, you know, as an example,
25:26I have reviewed papers written by
25:29colleagues of mine, which were terrible.
25:33And I rejected them and and
25:34why did I reject them?
25:36Because they the papers.
25:38If they had published,
25:40would have made the authors look bad.
25:43In other words,
25:44you try to help people.
25:46And sometimes the best way to help
25:48people is to tell them you can do better.
25:51You can do better and and that
25:54I think is is an important,
25:56very important lesson that that you learn
26:00something every time you you have been.
26:03Told that it's not good enough and and
26:06the other thing I I'd like to mention
26:09is that in in in I mean people in
26:11medicine generally are good folks.
26:13They have a heart and don't ever be
26:16afraid of going to like the most famous
26:19guy in the world and and contacting
26:22them with a question or or or if you
26:25have some concern about something,
26:27they will respond to you and
26:29with the Internet it's it's.
26:31It's crazy easy.
26:33To actually develop a relationship with
26:36someone because you never know where
26:39that relationship is going to take you,
26:41it might take you nowhere,
26:43but it may take you somewhere terrific,
26:46so so resilience and and and you know,
26:51keeping the destination insight and
26:53and I'll tell you there are times when
26:56people realize that the course that
26:59they're taking is the wrong one for them.
27:03In other words,
27:04very early in in life I I,
27:06I suddenly realized that I'm never
27:09going to be a neurosurgeon.
27:12I could have gone into neurosurgery
27:14and sort of failed at it or
27:16not be very good at it,
27:17but I I corrected my course
27:20for whatever that's worth.
27:23That's terrific, yeah.
27:24If you can't build a house right?
27:26You can't become a neurosurgeon.
27:27So you obviously learned we do have a
27:30question about what's next for you.
27:31If you're comfortable sharing that,
27:33well, I mean, what's next for me
27:36is I'm doing is I'm going to being
27:38an emeritus at Yale, allows you to
27:41to teach to teach undergraduates,
27:43so I'm going to continue to teach
27:46the mystery of sleep course and and,
27:49and that is extremely gratifying.
27:52The number of students is gonna
27:55this year is gonna be about 70
27:58and and between 60 and 70.
28:01I'm going to love doing that and there are
28:04a few books that are brewing in my head.
28:07As we speak there,
28:08there are a couple of books that are
28:10in the final stages of production.
28:12I see doctor Steven Sheldon is
28:14is on here and Steve,
28:16Steven and and I are are shepherding.
28:19Actually mostly Steven are shepherding
28:22a pediatric sleep textbook,
28:24which I think is sort of almost finished
28:27and and so that's one of the projects.
28:30There's a.
28:31There's a an Atlas of Sleep Medicine
28:33that I'm working on that's going
28:35to be finished in the next year.
28:37And I'm still interested in art and
28:40and I'm gonna try to recover all
28:42the time lost during the pandemic.
28:44There are a lot of people I
28:46haven't seen sort of in in, in,
28:49in person and I need to reestablish them.
28:53Some of that relatives in in in Europe
28:58and and and elsewhere you know,
29:01until about a month ago I hadn't seen my
29:03own sister in in more than two years.
29:06Hadn't seen her in 2 1/2 years.
29:08And so I'm going to try to kind
29:10of recover some of the lost time.
29:15Alright, that's that's wonderful.
29:16Wonderful for you again.
29:18A lot of great comments.
29:19A lot of this has been fabulous,
29:21inspirational and everybody
29:24appreciates what you're sharing.
29:25If anyone would like to either
29:26put a message in the chat,
29:28or if you would like to
29:30unmute yourself I can give you
29:32permission to do that and then
29:34ask any questions that you have.
29:36I'd be I'd be happy to do that.
29:39You have permission if you'd like.
29:42I think Naftali just raised his
29:43hand or somebody raised their hand.
29:47Yeah, so of course. Thank you mayor, it's.
29:54Really amazing talk and
29:56inspiring and as always,
29:58also just interesting and and the book.
30:04Umm? I haven't opened the book.
30:08But I do enjoy looking at the cover.
30:10It's so beautiful and I
30:12promise also to look inside.
30:14I'm sure it's amazing.
30:15I do want to mention that this
30:17doesn't get you off the hook.
30:19You will have to return to Yale.
30:20Give a talk in person,
30:22go through a reception and all the
30:25people on this talk are invited,
30:27so make sure that you stay tuned
30:30because it's going to be hybrid
30:32so you don't have to come.
30:33But again,
30:34we'll be glad to come and and I
30:37also will take this advantage
30:39to mention the June 1st.
30:41We have a sort of another
30:43farewell to a local giant.
30:45Vahid Mossanen will give a pulmonary
30:47grand rounds and we'll have a reception.
30:49So again, everybody's invited.
30:53This is sort of a change in.
30:55Of.
30:56I literally understand now the verse of
30:59standing on the shoulders of giants.
31:01You know,
31:02because when you get to meet giants?
31:05And recognize it you understand we are
31:07all of us are really on your shoulders.
31:09So thank you,
31:10mayor.
31:12So I see that Jill Lavine so Gil
31:17was the Dean of of a dental school
31:22in Montreal University Of Montreal.
31:24So digital. Through here mirror
31:28I have. I hope, now that
31:29two challenging question,
31:30but with all your background experience and
31:32the vision you always add in the future,
31:35what is the biggest challenge for
31:37our student for our young doctor?
31:40Young dentist in Sleep Medicine?
31:42Do you see something which should
31:45work to as a group to improve?
31:49Challenge the defeat.
31:51Yeah, I think the major challenge
31:55for the field going forward
31:57that there are two challenges.
31:59One of the challenges is really access.
32:02There there is so much inequity in
32:06in medicine still that only certain
32:09you know that there are so many
32:13disadvantaged people who never
32:15have their sleep problem diagnosed
32:18properly and treated properly.
32:20So access is a huge huge issue and the
32:24other thing that I think is going to become.
32:27Very big in the future is combining
32:30some of the newer technologies,
32:32maybe genetic testing and and
32:34and so forth in in, in the in,
32:38in the management of patients with sleep
32:41disorders and and in terms of dentistry.
32:45I think whenever someone sees a patient
32:48in the clinic you got to ask them about
32:53their children because of very large
32:56percentage of the patients that we see.
32:59With sleep apnea,
33:00who are like 50 years old will have a
33:03child who's like 10 or 11 and if that
33:05child snores or has a sleep problem,
33:08they need to be treated in order
33:10to avoid them developing the
33:12sleep disorder later on in life.
33:15So I think those are some of
33:17the big challenges.
33:19Mercy vocal, thank you very
33:21much ma'am. You're welcome.
33:25Anyone asking any comments?
33:28So Adrian from London
33:30yes, mayor again like everyone's sentiment.
33:35How absolutely wonderful.
33:38I guess some of us of a similar age would
33:41been through similar things, but uh,
33:44can't put them together quite so eloquently.
33:46But then you graced us in London
33:49with your time and the sabbatical,
33:52but a small center called
33:54guys and Saint Thomas.
33:56So do you think there's stuff that
33:59can be done in other places that would
34:02help this journey to understand sleep
34:06well? Who knows that maybe I'll return to.
34:09To to? I mean, you're being very
34:11modest guys in the Saint Thomas,
34:14I think together are like,
34:16aren't they like the biggest
34:18Medical Center in Europe?
34:20And sleep center your ideas.
34:21OK, so you're you're overly modest and
34:25the sleep clinic in London was wonderful.
34:29The staff was was just wonderful and the
34:32research going on there was was terrific.
34:34And you know, maybe one day I'll go back
34:37and and hang out with you guys again.
34:40We'll look forward
34:41to that. Thank you mayor again,
34:42and wonderful lovely thank you.
34:45Thank you everyone so much for coming.
34:47I think mayor this has
34:49been absolutely wonderful.
34:50I appreciate everyone for attending
34:53and all of your comments.
34:54Hopefully we can save the chat
34:56so that way you can see it.
34:58Thank you everyone mayor.
34:59Thank you so much for sharing your story.
35:02Thank you.
35:03Have a wonderful day everyone.