... or "if the patient wants to live, medicine is powerless ..."

All stories are authentic and instructive, from my own practice. I have selected cases that may be interesting in terms of logic. However, I do not publish the names of the participants for ethical reasons. These are just examples of the lack of logic or strange logic in both doctors and patients and their relatives ...

My first cured patient with severe back pain, which I remembered by the green color of his buttocks:

... I finished studying at a medical institute and was fond of Chinese medicine for several years. On crutches a man came to me a little over 20 years old with a huge and heavy photo bag on his shoulder. He was driven on crutches by severe pain in his lower back. By the time we met, he had been treated in an elite clinic for several weeks. The poor man’s entire ass was blue-green in color from a large number of injections of reopirin and B vitamins. To bring him to a normal state, several acupuncture sessions and a bit of manual therapy were enough (I didn’t even have a table for this then). It was enough to release the segment blocked by muscle protection and improve microcirculation around the affected root using acupuncture. For what he suffered from meaningless drug therapy at that moment, I did not understand. We have been friends since then and occasionally with a laugh we recall this story.

My friend and classmate after hospitalization in the cardiocenter:

A young medical student at the end of training in a difficult and nervous situation for himself felt chest pain. An ambulance quickly took him to a cardiology clinic, where a future colleague received an examination in which no cardiac pathology was detected, and the diagnosis was cardiopathy of an unclear etiology. As a result, he was sent for outpatient treatment with a complex of drugs in a very frightened state. This was our last year of study and by that time I was already engaged in manual therapy and acupuncture constantly. That was my hobby. He came to me with all this and suggested trying to figure out together what to do next. Pain periodically appeared, but he did not want to take this set of drugs, including for some reason prescribed prolonged nitro. I proposed to consider this problem as intercostal neuralgia with radiating pain for the sternum along 4-6 intercostal spaces, because found on his back a painful area and a compressed muscle block at the level of 4-6 thoracic vertebra on the left. Total: acupuncture and manual therapy of the thoracic spine solved this problem for many years to come. In the future, he periodically underwent massage courses for prevention. Unfortunately, he recently left us not yet an old man, but the cause of his departure was an oncological disease. I always remember him, and he became an example of a very common condition in men - chest pain, which is similar to an attack of angina pectoris. This is more common in men of "square" physique with a massive chest. In these cases, a cardiological examination is mandatory and monitoring just in case, too, preferably several days, the risk of an angina attack and the possibility of myocardial infarction should be excluded in the first place. But if the cardiac pathology is not detected during the examination, start treating the back in order to quickly achieve relief for the patient. After the institute, working as an ambulance doctor, I met this condition many times.

Good helpers:

This is just an incident on ambulance duty. We had a hard day and not a minute to have lunch. Such days are when the whole team is tired and exhausted. The driver is angry, the paramedic takes time for coffee, and I'm trying to temper them. And then a walkie-talkie gets a call to the grocery store, where the store worker "cut his hand", no clarifications. Cursing everything in the world because of the inability to take a lunch break, we are turning in that direction. As a result: a ghostly pale man in an inadequate condition sits on a chair in the store’s warehouse, his right hand is wrapped in towels that are soaked with blood and is still visible about half a liter of blood in a puddle on the floor, blood loss is visible about a liter. Two saleswomen help him sit, because the person is already almost swooning from blood loss. Women say that he is an alcoholic and an epileptic, in a convulsive seizure, he fell and broke the inner glass of the window with his hand, which cut him. On a quick inspection, I see on his hand 3 medical braid harnesses and 2 twists! They tried to stop the bleeding !!! I quickly take off my towels and see a couple of superficial cuts on forearm. Dark venous blood continues to flow from them. Quickly cut the twist and remove the harness to the indignation of women: "... doctor, what are you doing!" and the bleeding stops before our eyes for a few seconds. Poor things tried as best they could, but hemostatic plaits were applied immediately after the armpit, just above and just below the elbow joint, and the zookrut was simply wrong. Therefore, they squeezed only the veins, and the arteries regularly continued to drive blood into this arm, so simple venous bleeding, which could have stopped itself, almost killed the poor fellow. We put a dropper to fill the volume of fluid, performed routine routine in that case, and took him to the intensive care unit. This is a good example of stupid help. The presence of a first-aid kit at the workplace is not enough, people need to know how to use it! A haemostatic tourniquet was not needed, but it could have helped if it had been applied correctly and the helping person had been convinced that the bleeding had completely stopped. Although in this case, a pressure bandage would have been enough, for which there were gauze bandages and a dressing bag in the medicine cabinet.

A chance meeting in Moscow:

I flew south with a one-day stop in Moscow. My close friends asked for a meeting for their relative, who by the age of 60 had a lot of problems with back pain and was already very limited in movement. I agreed. but he explained that in one day I could not apparently help anything seriously. The patient turned out to be a nice person with a sad smile and a bunch of X-ray images that terrified me, significant pathological changes and evidence of the rapidly developing process of osteoarthrosis - the disc height is small, osteophytes are everywhere, the intervertebral joints are with obvious changes. Everything is bad. Put it on the dining table, because there was no other and worked a little with his back with his hands, trying not to harm. after which we tried with him several exercises of the Tii yoga asanas. I showed him the technique of working with static loads and tried to describe the methodology and boundaries of application. He explained how to use yoga books (at that time in the Soviet Union there were only a few books with descriptions of the complexes and several articles in the journal "Science and Life"). The patient prescribed everything in detail, he was a scientist and he was interested. After a couple of years, we accidentally met him again and I was very embarrassed by his great gratitude, I did not perceive that day as work and did not expect anything, least of all I expected a positive result, I just tried to tell him a little about my views on this problem. And he showed the surrounding how standing kneels his forehead and bends perfectly in all directions. This is an example of an ideal patient, who is motivated very strongly and intelligently uses every opportunity for his own benefit. His patient talent was much higher than my doctor. I was glad to accidentally or casually get in his way, and I probably learned more from him. than I have it.

Finnish girl with severe migraine:

Young 21 year old girl. A real northern beauty, just "blood with milk", everything is very feminine and round. Just the triumph of flourishing female nature! Severe pains in the neck and in the back of the head, and in addition to everything once a month, a week of bed rest due to severe migraine from the age of 15 with visual impairment, vomiting, etc. After a course of acupuncture and manipulations on the cervical spine, the first part of the ball problem was solved, and the second remained unchanged. When the girl came to me about the actual migraine, I realized that the problem was serious, it worked only half a day, and the medicines that I had to buy were not compensated by the social system and were very expensive. I asked her to keep a diary for a month and note the days of the cycle, moon phases and well-being. When she appeared again with notes from her diary, she offered to talk about her personal life. As a result, here are the conclusions: he lives with a young friend, he is a regular partner and has no other partners, he has been taking hormonal birth control pills since he was 15 years old, migraine attacks almost exactly coincide with the middle of the cycle, i.e. around ovulation. I suggested that she consult with her beloved man and temporarily change her birth control pills to trivial remedies for an undesirable pregnancy. In the first month, when they refused oral contraception, the migraine attack was short and easy, in the second it was not. Here is the logic. For six years, the girl pays for a contraceptive drug and for a drug against migraine, this happens every month, the logic is obvious. I do not consider oral contraceptives to be evil, just there are girls whose violent hormonal system tolerates these drugs poorly. You need to either look for another drug, or change the systematic approach. This applies to hormone-dependent migraines only.

Girl 12 years old with fainting, daughter of a close friend:

This case has not been treated, but is well acquainted with it. The girl grew strongly during the year and began to lose consciousness with each attempt to bend her head back. Parents got alarmed and ran to consultants. During the examination, nothing really was found. The panic was strong. because one of the consultants was thinking out loud about a possible brain tumor. A non-poor family urgently asked them to find a consultation in Finland with a pediatric neurosurgeon. MRI put everything in its place - vertebral artery syndrome (which was squeezed with such an excess in the neck) in adolescence due to the uneven development of the bony system of the spine. They promised that it will pass. Everything has passed. Now she is a pretty young woman who does not have these problems. This is a good example of the right consultation and reasonable decision. It makes no sense to build theoretical assumptions without sufficient evidence.

Finnish young woman with a "long back":

Among all the others, a young woman of about 25 years old appeared with constant work on her legs. The work is not hard. But the back after work hurts all the time. She sought help from a local Finnish clinic and a doctor in the workplace. She finally got the answer: your back is too long, get used to living with it (apparently getting used to it was necessary to live with pain). Take painkillers. The question is how much to take, the next 60 years every day? Well, I looked at her, indeed the girl is quite tall, and her legs are not long at all, posture is poor, the upper back is hunched over already flat, and with a hunched top it is even worse. Those. there is a violation of posture and suboptimal load of the spine and back muscles. In a couple of her visits, he relieved pain and taught her to do the necessary therapeutic exercises. He proposed a technique for tracking and correcting posture. Explained that if this does not make the pain continue. The woman turned out to be with a good level of self-organization, saw each other after that, smiled, there were no complaints, I understood how to cope and help myself completely independently. By the way, the Finnish clinic is not worth blaming. There, as elsewhere, there are 15 minutes per patient, but there is no rehabilitation medicine. This is their school and their tradition. Go to the paid physical therapist. Maybe lucky. But this is not a fact.

"Big boss" with radiculitis, or the next story about the "green buttocks":

I was asked to see and, if possible, treat one official who was severely tormented by back pain and could not move independently. For the rest, he was an active person, hunter and lover of the forest. In his apartment, I was hurt by the smell of the finalgon, apizatron, and something else that his wife, the local pharmacist, rubbed on the unfortunate. He could only stand leaning on the back of a chair. On examination, I saw an old acquaintance - the "blue-green male ass" is all bruised from the countless injections of rheopirin and vitamins with which the unfortunate wife treated him. A well-built male body had one problem that I have known for a long time - “wide in the shoulders, but narrow in the belt”, this is a constitution with a very developed shoulder girdle and chest and a disproportionately small pelvis with skinny buttocks. Such men, unfortunately, are doomed to pain in the zone 4-5 of the lumbar vertebra and in the sacral region, where the muscles of the back to the pelvis are attached. Although they look very aesthetically pleasing - like guardsmen. Therefore, experienced weightlifting coaches never take such folded guys to train, there is a lot of strength in their arms and back, but they will suffer greatly soon in this kind of sport, even better if they ski. In general, one session with this patient was enough, sorry for his wife, then she got a lot of unflattering words from this strong man.

The funny thing is that the story did not end there. They called me in the car and asked to urgently come, because he cannot get out of his chair at work. I came to work for him, the benefit was not far, a free day and good relations with everyone around, because it is almost a village situation. Immediately at the entrance to the office I felt a strong strange smell with an admixture of turpentine. My patient reclined in a wide leather chair and groaned in pain. After the interviews, the result became clear: a friend of the hunter brought him a miraculous balm according to the prescription of some kind of folk revolt "for prevention". This is a terribly smelly ointment based on turpentine, in which tar, bear bile, badger fat, honey, pepper, some cones and some kind of pickled crap are dissolved. In general, he lowered his trousers, put a thick layer on his lower back and lower it, sat back in a chair, in which he fell asleep. In a couple of hours of sleep, a very strong warming started in such a “compress”, which led to severe edema in the lumbar region and a severe pain reaction from the lumbar roots and muscle attachment points. The situation is anecdotal: I could barely lift it to feet and tumble it onto desk, calling the secretary to help indecently - pants were lowered and the patient in the “doggy” position was lying on the table, I took all the paper and napkins from two neighboring tolets, and then half an hour with a knife for postal envelopes grabbed this nightmare from his long-suffering back and that below the back. Then, with rapeseed oil (this rubbish did not dissolve with water, I had to send a secretary to the store), I managed to wash off and wipe off the remnants and traces of this miraculous ointment from the skin. The patient recovered and after an acupuncture session was able to move independently. Two hours of extreme effort. I certainly deserved his ardent appreciation. But then he drove his hunter friend around the village, he did not kill well. Here is a sketch about traditional medicine in the hands of a fool and its stupid use. Funny and very painful, well that worked out.

Pianist with crepitating tenosynovitis:

My old acquaintance (a wonderful otolaryngologist, to whom I am very grateful for the help of my friends and patients) sent me a friend in the early 2000s. A pianist virtuoso who could not play, the so-called "replayed hands." They practically refused to treat him, because Finnish polyclinic didn’t succeed and suggested that they contact Helsinki with an association of musicians with disabilities and prepare to abandon the profession. I treated him with acupuncture and microphysiotherapy, an IR laser, and also developed him therapeutic gymnastics and a self-massage scheme. He warned that the matter was long and difficult. This patient told me simply: "... I will do everything I need .... I do not know how to do anything except what I do ... if I have to leave the profession I can only fry kebabs ...". He traveled to me for 70 km for procedures. After a month, we achieved a good improvement, and after three he played freely. Then we left only preventive therapeutic exercises for the hand in the program. We made friends, he continues his creative life, teaches the piano and gives concerts for the joy of everyone. He owes this success primarily to himself, his unbending motivation and love of music. I still call him the most talented patient of mine! And about this is the next story with him.

Dislocation of the interphalangeal joint of the middle finger:

A few years after I moved to another city, the distance between us increased to 230 km. He called and said that he played football a couple of weeks ago and fell on the right hand with his fingers in the lawn, while the middle finger was dislocated in the opposite direction 90 degrees between the second and third phalanges. He instantly twisted it back, because I realized that in a state of mild shock, I could do it quickly. But unfortunately the injury was significant and the joint was very swollen. The clinic gave a cold bag and put the tire. The condition does not improve; the joint is doubled in thickness; the finger moves between 90 and 120 degrees. The funny thing is that the second proposal came to apply to the Association of Disabled Musicians and prepare to abandon the profession. He came to me, the condition of the finger was terrible even for a carpenter or welder, and for a musician it was scary to think, a swollen hard and painful joint, the sclerosing process in the subperiosteal hematoma around was obvious - the tumor was hard as a stone, contracture after an injury with limited extension. I told him: "... there may be options, but it will take a lot of work from you, but you have already gone through all this ... if you do nothing, it will remain as it is, over time, the size of the swollen joint may decrease, but mobility will not improve " He gave home methods of microphysiotherapy, showed linear self-massage and acupressure with a round probe. He also offered him a "mechanism", which he invented on the go, he was quickly made of a plank, a soft rope and a pencil. "The loop and stick method", as in the comedy about Khoja Nasreddin. A finger on the plank, under the finger there are two holes through which the rope passes. We tie it with a free loop on the other hand. Now pencil inside the loop and twist. The pressure on the straightening of the finger can be easily regulated by turns and act very gradually and carefully. At the same time, the duration of the forced extension procedure can be any, with such a “typewriter” on your finger you can even walk, drive a car, etc. The main thing is to act often and not force through pain, moving forward with minimal pain. As a result, after a month the finger straightened completely, and after two the pianist played freely. It took more time to completely restore and return the joint to its previous shape, but the result was again excellent - complete recovery, we know with it which finger was injured, but no one else sees it. No traces left. And for all this he owes himself much more than me. A talented musician and a talented patient. I am very grateful to him for his willpower and success. We are friends of families so far.

Children with strange neurodermatitis:

One of my Finnish patients, to whom I stopped exacerbating exzema with acupuncture, asked me to see the child of my relative with a severe form of dermatitis or neurodermatitis / eczema, he did not know the exact diagnosis. Later in the fall, a child was brought to me for acupuncture treatment. the baby was a little over 2 years old. After the inspection, I myself was horrified, an attack of lightheadedness: the little one was 80% covered, if not more, with scratches and dried crusts that broke during movement and oozed from them. The head also, while there was practically no hair. The child was severely inhibited, apparently beyond the limit inhibition came from constant pain. The mother of the child said that this is the sixth child in the family, the rest are healthy, which puts him to sleep on the terrace and correctly feeds on the advice of a pediatrician, the child is observed at the pediatrician and hospitalization is planned for intravenous administration of hydrocortisone, as everything else has already been tried. Other children do not play with him - their parents are afraid that he is contagious.

It was impossible to treat it with acupuncture, in the first age, in the second almost complete absence of whole skin. Fortunately, I had an infrared laser for acupuncture, with which I began to work with him. Over the course of a few sessions, there seemed to be some improvement, although it was all very sad every time. The little one calmly endured the procedures, quietly and sadly, he obviously had little strength. he was accustomed to his nightmarish state, but transcendent inhibition was obvious. And then a very interesting event happened - a sharp cooling to minus 20. They again came to the procedure, but the child changed terribly: a terrible hysteria, a constant cry, fights when trying to undress him, his face and hands are purple-burgundy. I asked his mother how the boy reacts to a dream on the terrace, which they still practiced on the advice of a pediatrician. Mom answered: " - just like now, she is all burgundy and screams after waking up, and this happens every time. " It was a really visible syndrome of exposure to PBKE - pathological bioclimatic energy. This is the terminology of classical Chinese medicine, Western medicine does not use these categories of concepts. I asked how it was with him in the south - they had never been there, with a big family there was not enough money, I asked how it was in the summer - obviously better. As a result, the diagnosis is "damage by aggressive cold", the genes of this finnish little boy were formed, the previous five children did not have this problem. I told to boy´s parents that we would seriously change the regime from “build south for him inthe house”, we will experiment. They agreed, because future droppers with hydrocortisone scared them more. As a result: to exclude sleeping on the terrace, warm under an infrared lamp, very briefly do procedures with a low-power UV lamp (30-45 seconds on the front and back, safety glasses), a half-hour daily non-hot sauna. They had a lot of questions, especially about sleeping on the terrace. "THIS SAME THE DOCTOR SAID USEFUL !!! " My question is why the little one screams so much after sleeping on the terrace that has puzzled them. We finally agreed and started. A week later, they again brought him to my procedure: the skin became lighter, there were no new scratches, no swollen spots, the crust was much softer, and the baby himself was more active. I continued to build him the south: take a baby bath, half a pack of coarse sea salt from the store at a time, dissolve it and bring the temperature to 35 degrees. And let him sit in it as much as he wants with toys. Parents were horrified - how to sit in salt water with such skin, it will hurt him. I replied: "... it will hurt to take out ... call me as you will for the first time." In the evening, his father called: "... the baby in the bath fell apart, relaxed and fell asleep ... held him sleeping by the head for more than an hour ...". Then they blotted without washing with fresh water and put to sleep. He slept until morning and smiled all morning. So we continued, once a week, to the procedure to me and every day according to the program of protection from the cold and the obligatory "personal warm south with bathing in a bath with sea salt." By March, the skin recovered almost everywhere. Only white scars remained in place of the old crusts and tears, but it didn’t matter anymore, they would disappear in a couple of years, especially if the child was sunbathing. Hair on the head began to grow over the entire surface. I was just happy, Finnish parents are not very emotional people, but they were very happy. They had little money, I didn’t invoice, but I didn’t care, this success was much more expensive. The kid's father repaired me a crack on the deck of my an acoustic guitar that was memorable for me, guitar lived for several more years.

The story is not over. We moved, they no longer contacted, apparently everything was fine. And suddenly the mother of this baby called me and reminded herself. Again the same thing! I asked what happened to the boy during this time. YES NOT WITH THAT BOY, that is fine. Here with the next child, again, all over again. I ask how he reacts to the cold, whether he sleeps on the terrace and how he wakes up after this dream - EVERYTHING ALSO AS IN THE PREVIOUS CASE! I enumerate everything that needs to be done in a row and ask again - what the hell are you putting to sleep on the street if the child is so sick, the open face and head take a cold hit, the hands freeze in mittens. Mumble: "Well, we are Finns, well they say it is useful, the rest is useful ..." I answered firmly: "Yes to the others - YES, and this - NO, and despite the fact that this is a northern boy! He is different! It so happened! with its genes! Just think, you have a brain for this .... " Well, mom, so many births and breastfeeding, a big family, .. but dad also forgot everything, how he managed to save the previous baby, and in just a couple of years. I offered to immediately start and call me back on the result. A week later they reported - it became much better, we give everything ... 

They didn’t call anymore, maybe they wrote down my advice on the wall or stopped growing the family. Strange people, like the Ladadiolans, are such a rare Protestantism that is found in Finland, they don’t watch TV, only their videos and antenna jack should be plugged in ... contraception is prohibided, children give birth a lot. It seems nothing bad.

"Grandfather athlete" and diagnostician:

This is my patient, although the story is not related to my own actions. A strong, sympathetic and completely gray-haired Finnish man came to me firmly in seventy years. It’s impossible to call such an old man, active with a very smart and lively look and a great sense of humor. He had pain in his lower back for several sessions and learned a lot of interesting things about him. He was in the country's national ski team, received a compression fracture of the spine and went, as far as I remember his story, into rowing and again fell into the national team. Aged, began to engage in forestry, loves it and spends a lot of time there. He was careless with a chainsaw and cut his hip, sewed up a wound for himself, then sewed up his pants and finished work, then went to the emergency room. Here is such an iron man! I called him "grandfather" for myself, although I had no family ties with him.

The second time he appeared a few years later, along the midline of his abdomen he had a long postoperative scar. By that time he was already over 80 years old, the problem is the same - a slight back pain. I cured the pain, improved the mobility of the vertebrae and listened to a very instructive story.

A couple of years ago, he began to have a strong intermittent claudication (this is an athlete who never smoked with a healthy heart). "Grandfather" at first blamed this lower back, but quickly realized that this was not a limitation. He could walk without stopping no more than 150 meters, and the forest continued to love and wanted to spend a lot of time in it. He went to doctors a lot and listened about old age, about the spine, about joints and so on to infinity. There were no reasons for prosthetics of the joints - there is nothing to do, "... the old man’s business, sit in the sun, bask ...". But the "grandfather" was stubborn, did not want to stay at home and he climbed onto the Internet to search and study topics. A month later, he went to the doctors and asked for aortography with an examination of the iliac arteries and the main arteries of his legs. In his opinion, it was an atherosclerotic narrowing of the apparently iliac artery, or even at the level of aortic bifurcation. He was reassured and did not listen - old age! How to understand this without education, "... you don’t even understand the terminology." "Grandpa" listened to all this, thought it over and went to a private clinic, where he directly told this story to an angiosurgeon, asked a direct question - could he have such a problem or not? Got an answer - maybe. Then we do diagnostics for money (this is more than 1000 euros), because the district doctor from the healthcare system did not give a referral. After the examination, it became clear that he was right, a significant atherosclerotic narrowing took place. He was operated on, the narrowing was eliminated, a vascular endoprosthesis was sewn. He stopped limping. The social system returned something to him for the examination and operation, although such a "model citizen and taxpayer" with 55 years of experience should have received everything in the first place, first of all, for free. He did not sue. Good and kind person. These are old people, and no dementia!

Novice hypertension and treatment tactics of hypertension:

One of my close friends, around the age of 50, noticed a regular increase in blood pressure and went to the doctor as a “young” hypertensive patient listened to a lecture on risks and received a set of drugs. Then he came to me for comments. I suggested first to determine the details and do a detailed examination with a determination of heart risks. Biochemical analysis of blood, Doppler examination of the adequacy of blood flow in the coronary arteries, etc. Everything has been done. Sugar at the upper limit of normal, cholesterol and triglycerides, too, did not find blood flow disorders. I suggested measuring pressure immediately in the morning, afternoon at rest in the middle of the day and in the evening before going to bed. The schedule was strange - the worst results are always in the morning, and not after nervous work. In this case, there was a constant tension in the neck area behind and in the back of the head. He also complained of neck stiffness in the morning and periodic pain in it. I suggested doing an MRI and examining the vessels of the neck, because cervical osteochondrosis at this age is common. As a result, there was a narrowing of one vertebral artery (the development of osteochondrosis) and congenital insufficiency of another. Logic of events: an uncomfortable position of the neck at night leads to a decrease in blood flow => therefore hypoxia during the night => the vasomotor center gives a command to increase the pressure, because the brain needs oxygen. Further, taking a hypotensive drug again reduces the amount of oxygen entering the brain => the vasomotor center again commands the rise, and so on in a circle. Thus, the natural mechanism for regulating blood pressure is destroyed. After a year of such therapy, it remains only to raise and change antihypertensive drugs for the rest of their lives. I suggested working with the neck, starting traction therapy, picking up a pillow and mattress and seeing what would happen over the course of a month, while constantly measuring blood pressure and having a quick-acting antihypertensive drug on hand for insurance. As a result, everything fell into place. Of course, cervical osteochondrosis cannot be cured in 50 years, but the quality of life can be significantly improved and hypotensive therapy can be postponed for many years.

By the way, an interesting observation of the patient himself (he now goes to the gym to train): after a light workout on the track with a step and on a bicycle ergometer (looks down so as not to strain the neck), the pressure drops! And this is quite logical, because blood flow becomes intense and brain hypoxia decreases. Similarly, a good walk affects it.

A similar mechanism has the problem of nocturnal apnea, when the accumulating hypoxia of the brain leads to hypertension and tiredness in the morning. Fortunately, somnological testing has now become the norm. And the use of SIPAP devices helps to solve this problem.