The Michelin Man
Photo: Michelin in France, official
Mr. Jeff Jenkins 2008
Preface
This article was originally published 20081220, but has had various revisions. It seems to me that I deleted much of the original text and left the entry with images primarily.
According to official Blogger statistics, this article presently ranks #4 on this website's present and very modest, All-Time Most Pageviews list. I have revised and placed versions on academia.edu for the other nine articles in the top ten. I accept the intellectual challenge, of God-willing, making this an academic article that can also be reasonably placed on academia.edu. According to Blogger this article since 2008, has had 7.17 K pageviews. I will leave the fine artwork from Mr. Jeff Jenkins. Revised for an entry on academia.edu 20240528.
The Michelin Man
Back in December 2008, I named myself Michelin Man, as I sort of looked like Michelin Man in my Wilson winter jacket, which I still own. I think it is over 20 years old and still looks new. It has had some repairs. In my humble opinion, I have always been fit. But looking fit, according to modern western standards has been a problem.
When I was young adult, I soon began to put on weight. This despite the fact, I have always exercised regularly and have never consumed large calorie meals. I had played street/ball hockey since I was four years old. I did and still do martial arts. I have been trained by an MMA trainer online, and have used weapons for over twenty years. I walk long distances and barely show any signs of fatigue. For example, I did this for five hours a day in my recent British Isles trip.
Again, as I was a fairly new young adult, when I looked in the mirror, I seemed fine. When I worked out, I seemed fine. But when I saw photos of myself, I was very discouraged as I looked unhealthy. I also soon developed significant fatigue during working on my two academic, course work degrees. Eventually I was diagnosed with sleep apnea which explained issues I had with slower metabolism and weight gain, at least to an extent.
My seven key approaches at countering the effects of sleep apnea.
1 CPAP
For treatment, with medical advice, I first tried CPAP, but that gave me a suffocating feeling and was abandoned within six months, seems to me. Besides the suffocating feeling, I am frankly, also a very particular sleeper in regards to anything on my face while trying to sleep. It worked horribly for me.
Cited
'CPAP Machine
A CPAP (continuous positive airway pressure) machine is one of the most common treatments for sleep apnea. It keeps your airways open while you sleep so you can receive the oxygen you need for optimal function. CPAP machines can significantly improve sleep quality and reduce your risk for a number of health issues, including heart disease and stroke.'
Cited
'What is a CPAP machine?
A CPAP (continuous positive airway pressure) machine is used in the treatment of sleep apnea. This device delivers continuous pressurized air through tubing into a mask that you wear while you sleep.
What is a CPAP machine used for?
CPAP machines are used to treat both obstructive and central sleep apnea. In both disorders, your breathing is interrupted during the sleep cycle. This can occur hundreds of times in a single night, leading to a lack of oxygen and a higher risk for high blood pressure, heart disease, stroke, diabetes and other health concerns. A CPAP machine helps keep your airways open by delivering continuous air through your nose and mouth.'
References from this referenced website
Bloch KE. Alternatives to CPAP in the treatment of the obstructive sleep apnea syndrome (https://pubmed.ncbi.nlm.nih.gov/16741848/). Swiss Medicine Weekly. 2006 Apr 29;136(17-18):261-7. Accessed 11/09/2021.
Bodington R, Johnson O, Carveth-Johnson P, Faruqi S. Travel with CPAP machines: how frequent and what are the problems (https://pubmed.ncbi.nlm.nih.gov/29232460/)? Journal of Travel Medicine. 2018 Jan 1;25(1). Accessed 11/09/2021.
Iftikhar IH, Bittencourt L, Youngstedt SD, et al. Comparative efficacy of CPAP, MADs, exercise-training, and dietary weight loss for sleep apnea: a network meta-analysis (https://pubmed.ncbi.nlm.nih.gov/28215266/). Sleep Medicine. 2017 Feb;30:7-14. Accessed 11/09/2021.
Lim DC, Pack AI. Obstructive Sleep Apnea: Update and Future (https://pubmed.ncbi.nlm.nih.gov/27732789/). Annual Review of Medicine. 2017 Jan 14;68:99-112. Accessed 11/09/2021.
Sánchez AI, Martínez P, Miró E, Bardwell WA, Buela-Casal G. CPAP and behavioral therapies in patients with obstructive sleep apnea: effects on daytime sleepiness, mood, and cognitive function (https://pubmed.ncbi.nlm.nih.gov/19201228/). Sleep Medicine Review. 2009 Jun;13(3):223-33. Accessed 11/09/2021.
Wickwire EM, Bailey MD, Somers VK, Srivastava MC, Scharf SM, Johnson AM, et al. CPAP adherence reduces cardiovascular risk among older adults with obstructive sleep apnea (https://pubmed.ncbi.nlm.nih.gov/33141315/). Sleep and Breathing. 2020 Nov 3. Accessed 11/09/2021.
End of References
Result:
The machine kept me from sleeping.
CPAP was out...a legal form of torture and sleep deprivation.
2 Dental appliance
Next I tried a dental appliance from Klearway.
Cited
'Klearway™ is a fully-adjustable oral appliance used for the treatment or snoring and mild to moderate Obstructive Sleep Apnea. Fabricated of thermoactive acrylic, KlearwayTM becomes pliable for easy insertion and confirms securely to the dentition for an excellent fit while significantly decreasing soft tissue and tooth discomfort. Small increments of forward lower jaw advancement are initiated by the patient under the direction of a dentist and this helps avoid rapid jaw movements that can cause significant patient discomfort. Once warmed under hot water and inserted, the acrylic resin hardens as it cools to body temperature and firmly affixes itself to both arches. Lateral and vertical jaw movement is permitted which enables the patent to yawn, swallow, and drink water without dislodging the appliance. THE KLEARWAY™ APPLIANCE FOR THE TREATMENT OF SNORING AND OBSTRUCTIVE SLEEP APNEA'
References from this referenced website
UBC SLEEP APNEA DENTAL CLINIC 2199 Wesbrook Mall Vancouver, BC V6T 1Z3 Canada Phone: (604) 822-5775 Fax: (604) 822-3562 This clinic was established by Dr. Alan A. Lowe but all patient care is overseen by Dr. F. Almeida. Specialty Clinic located in Room 161 on the Ground Floor of the Faculty of Dentistry, J B MacDonald building, 2199 Wesbrook Mall adjacent to the University Hospital. Clinic Hours: The clinic is held only on selected bi-monthly Wednesday afternoons. Tuan Le, Clinical Research Manager, can be reached at 604-822-3750 for further information and to arrange appointments. (E-mail: tuan.le@ubc.ca )
End of References
Result:
I could not sleep with the dental appliance, and I would spit the appliance out of my mouth several times during sleep. The device kept me from sleeping.
The dental appliance was out...
Note, that I did try the appliance through the UBC, Sleep apnea dental clinic.
3 UPPP
I have had my tonsils and uvula removed with the UPPP surgery.
Cited
'Uvulopalatopharyngoplasty (UPPP) is surgery to open the upper airways by taking out extra tissue in the throat. It may be done alone to treat mild obstructive sleep apnea or snoring or with other procedures to treat moderate obstructive sleep apnea (OSA).
Description
UPPP removes soft tissue at the back of the throat. This includes: All or part of the uvula (the soft flap of tissue that hangs down at the back of the mouth). Parts of the soft palate and tissue at the sides of the throat. Tonsils and adenoids, if they are still there. Why the Procedure Is Performed Your health care provider may recommend this surgery if you have mild OSA. Try lifestyle changes first, such as weight loss or changing your sleep position. Most experts recommend trying to use CPAP, nasal expanding strips, or an oral device to treat OSA first, before considering surgery. Your provider may recommend this surgery to treat severe snoring, even if you do not have OSA. Before you decide about this surgery: See if weight loss helps your snoring. Consider how important it is to you to treat snoring. The surgery does not work for everyone. Make sure your insurance will pay for this surgery. If you do not also have OSA, your insurance may not cover the surgery. Sometimes, UPPP is done along with other more invasive surgeries to treat severe OSA.'
References from this referenced website
Katsantonis GP. Classic uvulopalatopharyngoplasty. In: Friedman M, Jacobowitz O, eds. Sleep Apnea and Snoring. 2nd ed. Philadelphia, PA: Elsevier; 2020:chap 32.
Qaseem A, Holty JE, Owens DK, et al; Clinical Guidelines Committee of the American College of Physicians. Management of obstructive sleep apnea in adults: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2013;159(7):471-483. PMID: 24061345 pubmed.ncbi.nlm.nih.gov/24061345/.
Sarber KM, Lam DJ, Ishman SL. Sleep apnea and sleep disorders. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 15.
Version Info
Last reviewed on: 6/4/2023 Reviewed by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
End of references
Results:
The UPPP surgery has likely significantly, declined the results of sleep apnea, improved my weight loss and overall health.
4 Rhinoplasty
Cited
'Rhinoplasty (RIE-no-plas-tee) is surgery that changes the shape of the nose. The reason for rhinoplasty may be to change the appearance of the nose, improve breathing or both.
The upper part of the structure of the nose is bone. The lower part is cartilage. Rhinoplasty can change bone, cartilage, skin or all three. Talk with your surgeon about whether rhinoplasty is appropriate for you and what it can achieve.
Your other facial features, the skin on your nose and what you would like to change are considered when planning the procedure. If you're a candidate for rhinoplasty, the surgeon will develop a personal plan for you.'
References from this referenced website
Rhinoplasty: Nose surgery. American Society of Plastic Surgeons. https://www.plasticsurgery.org/cosmetic-procedures/rhinoplasty. Accessed Dec. 4, 2022. Nasal surgery: Fixing form and function. American Academy of Otolaryngology-Head and Neck Surgery. https://www.enthealth.org/be_ent_smart/nasal-surgery-fixing-form-and-function/. Accessed Dec. 4, 2022.
Septoplasty: Deviated septum correction. American Society of Plastic Surgeons. https://www.plasticsurgery.org/reconstructive-procedures/septoplasty. Accessed Dec. 4, 2022.
Flint PW, et al., eds. Rhinoplasty. In: Cummings Otolaryngology: Head & Neck Surgery. 7th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed Dec. 4, 2022.
Nose surgery. The Aesthetic Society. https://www.theaestheticsociety.org/procedures/head-face/nose-surgery. Accessed Dec. 6, 2022.
Townsend CM Jr, et al. Plastic surgery. In: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 21st ed. Elsevier; 2022. https://www.clinicalkey.com. Accessed Dec. 6, 2022.
AskMayoExpert. Rhinoplasty. Mayo Clinic; 2021.
Rubin JP, et al. Open technique rhinoplasty. In: Plastic Surgery, Volume 2: Aesthetic Surgery. 4th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Dec. 6, 2022.
End of references
Results:
The Rhinoplasty surgery has likely significantly, declined the results of sleep apnea, improved my weight loss and overall health.
5 CoolSculpting
Cited
'CoolSculpting is the brand name for a fat-freezing method that aims to get rid of stubborn fat in certain parts of your body. The method is called cryolipolysis. The FDA approved it in 2010. Scientists came up with the idea for cryolipolysis by studying what happens to fat during frostbite. Fat freezes at a higher temperature than skin. The cryolipolysis device cools your fat to a temperature that destroys it while leaving your skin and other tissues unharmed.'
References from referenced website
American Society of Aesthetic Plastic Surgery: "Does fat freezing yield results similar to liposuction?"
Mayo Clinic: "New fat-reduction treatment leads to positive results,” “Liposuction.”
American Society of Plastic Surgeons: "Nonsurgical Fat Reduction: What is Cryolipolysis?"
Coolsculpting.com: "Clinical Information." “You’ve Got Questions? We’ve Got Answers.” Plastic and Reconstructive Surgery: "Cryolipolysis for fat reduction and body contouring: safety and efficacy of current treatment paradigms."
Elase: “How Much Does CoolSculpting Cost?”
MedlinePlus: “Deoxycholic acid injection.”
Advanced Dermatology: “CoolSculpting Fat Freezing Procedure.”
Cleveland Clinic: “Does Fat Freezing and Non-Surgical Body Sculpting Work,” “Abdominoplasty (Tummy Tuck),” Fat Freezing (Cryolipolysis)
JAMA Dermatology: “Paradoxical Adipose Hyperplasia After Cryolipolysis.”
Wolters Kluwer Health: “Complication of 'fat freezing' procedure may be more common than thought.”
Aesthetic Surgery Journal: “A Multicenter Evaluation of Paradoxical Adipose Hyperplasia Following Cryolipolysis for Fat Reduction and Body Contouring: A Review of 8658 Cycles in 2114 Patients.”
End of references
Result:
After I had the procedure (s), two nurses and the administrator told me I actually did not have much stomach fat. As I was told by my GP years earlier, I have a lot of stomach muscle. But, I will take what I can get as far as any improvements to health and appearance.
6 Neck Liposuction
Cited
'Neck contouring creates a firmer, smoother and more refined appearance to the neck and chin. Even without making any other changes to the face, improving a thick, wrinkled or sagging neck can dramatically improve one’s appearance, helping a patient look years younger or even as though he or she has lost weight. Neck contouring can also help restore balance to facial features by providing a better-defined jawline that frames the rest of the face.'
References with this referenced website
Quatela V, Montague A, Manning JP, Antunes M. Extended Superficial Musculoaponeurotic System Flap Rhytidectomy. Facial Plastic Surgery Clinics of North America. 2020. doi: 10.1016/j.fsc.2020.03.007.
Giampapa VC, Mesa JM. Neck rejuvenation with suture suspension platysmaplasty technique: a minimally invasive neck lift technique that addresses all patients’ anatomic needs. Clinics in Plastic Surgery. 2014. doi: 10.1016/j.cps.2013.09.005.
Gerecci D, Floyd EM, Perkins SW. Incorporating Midline Platysmaplasty with Lateral Superficial Muscular Aponeurotic System Facelifting. Facial Plastic Surgery Clinics of North America. 2020. doi: 10.1016/j.fsc.2020.03.003.
Gonzalez R. Composite platysmaplasty and closed percutaneous platysma myotomy: a simple way to treat deformities of the neck caused by aging. Aesthetic Surgery Journal. 2009. doi: 10.1016/j.asj.2009.04.007.
Fedok FG. Another Look at Platysmaplasty in Facelifting. Facial Plastic Surgery. 2020. doi: 10.1055/s-0040-1714062.
Choi J, Hwang K. Modified Medial and Lateral Platysmaplasty. Journal of Craniofacial Surgery. 2020. doi: 10.1097/SCS.0000000000006515.
Robenpour M, Fuchs Orenbach S, Hadash-Bengad R, Robenpour O, Heller L. The Wide Suture Suspension Platysmaplasty, a revised technique for neck rejuvenation: A retrospective cohort study. Journal of Cosmetic Dermatology. 2021. doi: 10.1111/jocd.14001.
Gonzalez R. Composite platysmaplasty and closed percutaneous platysma myotomy: a simple way to treat deformities of the neck caused by aging. Aesthetic Surgery Journal. 2009. doi: 10.1016/j.asj.2009.04.007.
Robenpour M, Fuchs Orenbach S, Hadash-Bengad R, Robenpour O, Heller L. The Wide Suture Suspension Platysmaplasty, a revised technique for neck rejuvenation: A retrospective cohort study. Journal of Cosmetic Dermatology. 2021. doi: 10.1111/jocd.14001.
End of references
Result:
My surgeon stated that (unlike what I was told in regards to my stomach in that case), my neck actually had a fair amount of fat. I deduced there was roughly a ten percent size reduction, and my surgeon agreed. I now have a significant jawline. The surgeon stated the results were quote 'Fantastic!'. A smaller neck means less effects of sleep apnea as well, and therefore my surgeon stated that I should continue to lose weight.
7 Diet
Result:
The very low carb, no potatoes, no pasta, diet, helps immensely with weight loss. Without the diet, all those medical procedures would not, on their own, diminish the effects of sleep apnea and slower metabolism, enough. The neck surgery being a possible exception, in my humble opinion as a large neck does put pressure on breathing. I suggested this over ten years ago to another Metro Vancouver neck surgeon and was dismissed, in my humble opinion, as a deceived, dishonest, overeater. The one point this surgeon had half right was that I was eating too many potatoes. The truth being that I should not have been digesting the few potatoes I was eating!
Exercise on its own would not work. Diet is key. I walked for example, as noted, 5 hours a day in the British Isles on my recent vacation, and I digest, as always, low calorie amounts, but for whatever reasons, as one of the CoolSculpting nurses suggested, my body has a very negative reaction to certain food. Through my GP and a dietitian, I have figured out that I need to avoid starchy carbohydrates, especially potatoes and traditional pasta. This way I can remain closer to 200 pounds than 300 pounds. I am very muscular, so fit does not equal thin, but God-willing, I aim for as fit looking as possible.
By God's grace and mercy, I appear to be winning on this issue now...
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Mr. Jeff Jenkins 2008
Fine images from Mr. Jeff Jenkins, a friend and fine artist from Florida, USA.
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