Narcolepsy

Dr. Errol B Cahoon has passed away on Monday July 5, 2004
This site will be kept up in his memory.
Dr. Errol B Cahoon M.D.,D.Psych.,F.R.C.P.C
June 5, 1917 - July 5, 2004

Definition on Narcolepsy, ADD, Comorbidism, SOREMPS, Classification of Sleep Disorders, Effects of Narcolepsy on Sex, and Some of my writings.

"I fled the tigers, I fled the fleas, but what got me in the end was the Mediocrates."
by Spanish Philosopher Santanna

Too much emphasis on standards is a cause of decay; often it is a psychological defense mechanism set up by persons no longer productive.
The Organizations which become more and more exclusive tend to die of dry rot.
by Isaac Starr

The BMO TV Advertising states that "On the surface people appear quite similar, but we realize that everyone is truly unique.
Perhaps the regulators and guideline writers should think of this before insisting on "Standard Treatment" for these "unique" patients.!

Every child with ADD, Obesity, Abused mentally or physically, or bullied are made to feel different, which depresses them, and this lasts all their lives. In my opinion this is the source of many of the patients who get diagnosed as Dysthymic. Since these people have never learned how or are afraid of expressing their feelings, they are unable to assess the reactions of others, and misinterpret the motives of others, and get into great difficulties.
by E. B Cahoon, 1990

"It is our vocation to save life. It involves risk, but when we serve with love, that is when the risk does not matter so much. When we believe our mission is to save lives, we have to do our work"
by Dr. Marrhew Lukwiya, (Uganda)

This gentleman set up a hospital to care for the Ebola victims and one day he did not put on his protective gloves to examine a patient, and he contracted the Ebola virus and died 1 week later.

I have been harassed for 16 years re the diagnosis of Narcolepsy. In 1966 Dement et al. decided in their article "The nature of the Narcoleptic attack" that :

Apparently it was agreed unanimously (?) at a meeting in France in 1975, and since that time the Sleep Disorders Researchers have all been obsessively using it and stating that any other of the symptoms of Narcolepsy were different diseases, e.g. They have therefore removed Sleep Paralysis from the Tetrad of symptoms as a different disease.

The testing consisted of an all night Polysomnography using the EEG all night to find out if the patient had the onset of SOREMPS in the first ½ -1 hour of going to sleep. Since that time the researchers have added the MSLT test (Multiple Sleep Latency Test). In this the patient is connected to the EEG machine for 4-5 20- minute periods every 2 hours. The patient is supposed to try to go to sleep during the 20 minutes, and if he/she succeeds, in less than 14 minutes, and this onset is accompanied by SOREMPS 2-3 times out of the 4-5 attempts, then the patient is proved to have Narcolepsy.

In the early 1940's it was common knowledge that Syphilis was known as the Great Imitator, and last year the advertising for donations for Lupus Erythematosus was stated to be the disease of 1000 faces. I suppose that AIDS has only one presentation so the diagnosis can be DEFINITE.

It is my opinion that the sleep researchers could not get control of the American EEG Society, and so set up their own Sleep Disorders Groups. This allows them to brain wash themselves and keep every member in line believing the same things. This sounds like the psychoanalytical societies.

Talking to one of my classmates a couple of years ago, he stated that the members of my class in Medicine did not understand me, and a few months ago he stated that I never believed what I was told during my years in Medical School. I replied that most things changed every 6 months or so, and why should I believe it? I had the impression that he believed me. He said (pounding his forehead) that he believed all the professors said, and what was wrong with him. I did not tell him that he did not think for himself, which seems to be a common difficulty in many people.

In 1945 while taking a 6 month course to become an army psychiatrist here in Toronto, I read some of Freud’s works for the 6 months. At the end of that time I decided that Freud’s theories illogical, and thereafter paid little attention to them. Stating this to others did not make me very popular in Toronto, where about 40 psychoanalysts had been imported and given all the good jobs.

I went to Montreal to the Queen Mary Veterans Hospital with Dr. John Kershman, and to the Montreal Neurological Institute with Dr. Herbert Jasper to learn to read Electroencephalograms (EEGs or brain waves) in 1947 for 2 months. During that time I saw Dr. Wilder Penfield operate on a patient with intractable epilepsy under local anaesthesia, while Dr. H. Jasper recorded an EEG. Penfield stimulated the brain and put little squares of numbered cotton on the cortex. He was able to localize areas where the epilepsy started, and other areas of function which he did not want to remove, as they were necessary to living and working, hearing and seeing, etc. I also concluded that if one's memories were not localized, one would never find them to use them again.

After thinking about the fact of these functions being localized. I, in the next 5 years, decided that all mental illness had chemical and electrical representation in the brain. Making this statement to other doctors made me even less popular. I did not practise medicine to be popular, but to treat patients well and help their suffering to be relieved.

This latter is suggested by the history of Hypnagogic Hallucinations at that time after going to sleep, and was suggested by Dr. Gelineau in 1880.

It is my opinion that this is a much too restrictive criteria for the diagnosis of Narcolepsy. I am of the opinion that the present title "The Classification of Sleep Disorders" should be discontinued and replaced by The Narcolepsy Family". The listing of Narcolepsy under this should be Narcolepsy-SOREMPS type.

This would allow the remainder of the list of 84 items in the present classification to be included as part of the diagnosis of Narcolepsy.

If further proof of this is needed look at my web site, and the charts of the article that I am sending to the Canadian Neurological Journal.

2. The present criteria for diagnosis.
The presence of Sleep Attacks, Cataplexy, SOREMPS (Sleep Onset Rhythmic Eye Movement Periods) must occur 100%, or the patient has some other diagnosis.

3. The questions I personally ask of each patient.
I do not give questionnaires for the patient to answer, as I found the patient did not always understand the questions, the qualifying numbers, and when I ask and explain things, they seem to understand and give answers to suit them. I have a discussion about lying, and explain that: if they lie to me then they force me to make a mistake in their diagnosis, and also in their treatment which then is no help to them. They understand this extremely well.

4. The relation to ADD (Attention Deficit Disorder).
I have had 36% of 1340 patients who have a history of ADHD. ADWOH (fantasy). There were a number of patients with practicably no memory for their childhood, so this percentage is probably too small.

5. The effects of Narcolepsy on sexual behaviour.
58% of the patients have had sleep attacks during sexual intercourse, and one couple who both went to sleep at this time.

6. What should be included in my classification of Narcolepsy.
It is my opinion the Classification of Sleep Disorders name should be changed to;
The Classification of Narcolepsy!

I consider that the 83 other diagnoses of the Classification of Sleep Disorders, are really subsections of the Classification of Narcolepsy, and in this last the listing of Narcolepsy should be changed to Narcolepsy-SOREMP producers.

7. A Simple Theory of Mental Illness.
Fifty plus years of interviewing patients, I noted that each patient made many decisions daily in their lives, leading to changes in their thinking and behaviour. This led me to note that they made different decisions at increasing age. Of course I have not been alone in this and there are many books on the market stating this. The psychiatric literature seems to not mention it very much at all.

8. Scenarios of Behaviour in Narcolepsy.
This appears to me to describe the onset of varying decisions and resulting behaviour in young ADD patients, and which leads to much difficulty for the rest of their lives.

9. 2SD (2 Standard Deviations).
This is a result of the ease of finding something occurring more or less that 2SD than an average of a survey study. It is of little use to any patient who does not think he/she is a statistic, but rather the most important person to him/her self. It also does not relate to considerable individual differences in the different patients reaction to any medication or dosage of same. My old teacher Dr. George Lucas, professor of pharmacology at the University of Toronto, who said that "The dose of a pill that works is the dose that works!"

10. Ethics.
This use of the above 2SD to stop doctors from giving medication, just because they are giving more of a medication than the average of their group of doctors. Can you imagine just what my 2SD just be as a result of 3171 patients, 1340 of whom have Narcolepsy? That must have been 100SD possibly, and given the regulators a terrible mental shock. The result of this is that the regulators then decide that one gives too much of a medication, and it is decided that this must be stopped. At this point, the regulators do not ask the patient any questions as to whether the medication hindered or helped; but just stopped the doctor from prescribing this pill which was given too frequently. Is this an investigation or just a decision without information?

11. Placebos.
I think that over the 57 years since I graduated from Medicine, I have used a placebo injection 3 times.

I never thought that I learned anything from using a placebo.

Perhaps the only history of a placebo effect was a lady who told me that she had to be very careful when she took her one Seconal capsule on going to bed. When asked why, she replied that, "When she took it standing up she fell on the floor asleep immediately, and had to sit on the bed to take it." I replied that she should sit on the edge of the bed.

12. Comorbidism.
This seems to be a new frightening fad. When I was in lectures in medical school the patient being presented only had one illness, but when interning I immediately discovered that he/she had several diagnoses. When dealing with the veterans of WW II, I found an even longer list of illnesses, both past and present. This file shows the listing of diagnoses of both the 2500 patients seen and the additional 1340 patients with Narcolepsy. I only listed in the first database 4 diagnoses, and latterly 7. Therefore it misses many other diagnoses.

13. Book pages denoting the variation of my and sleep labs listing of each patient’s symptoms.

My father graduated from the University of Toronto in 1898 with the silver medal. He has in his files some drafts of a letter to the Medical faculty, asking why he did not get the prize in Surgery, as the person who got it must had had 160 out of 100 on the last exam to get more marks than my father.

He became ill when I was 9 years old, and he would not wait for the surgeon from Belleville to come in 1/2 hour to operate, but had a local G.P. operate. 3days later he had a fecal fistula. The family were all at his bedside one night. He wanted me to kiss him goodby. I did so, and he told me to look after my mother. I said yes. I think that this is when I took responsibility for my actions.

I went to public school in Bloomfield, Ont., and then to high school at the Picton Collegiate Institute in Picton, Ont. I had to repeat the fifth year due to difficulty in exams in English & French. I had written a composition about a local murder, and it was read out to the class as the best one in the class, and I got 68 marks for it. How then can one get into the 75 club. My average marks for the last year was 68%. I applied and entered Medicine at the University of Toronto in Sept. 1936. I had a supplemental exam that year in "The History of Civilization". The second year I failed, and repeated it. The third year I got -40 out of 100 on the first exam in biochemistry. So I bought 5 years of final exam papers, in Jan and answered 1 question every night till I could answer them without the book. I passed the exam. 40 of my classmates had supplemental exams, and the medical staff said that the exam was for the 4th instead of he third year. I could see no difference after my practicing writing the answers to the previous 5 years of exams. The war arrived in 1939, and an arrangement was made for us to become officer cadets in the army, as our course was speeded up, and there was no time to work in the summer. I did not join in May 1941 with the rest of the class, as I wanted to get married in August 1941, and I did not think I wanted to get permission from the army to do so. I joined the officer cadets in Sept 1941. I went to the Medical office and announced I was getting married, and the lady secretary asked in a rather hostile voice, "if I had enough money?". I said I thought so.

Following this fortunate happening I had no more supplemental exams, and graduated from Medicine in Jan 1943.

We were allowed 2 weeks holiday and then sent to various places. I went to the military Trafalgar hospital in Oakville for 2 weeks, where my biggest job was to initial the diet charts for 72 patients every day. Following this we went for a 6 week course at A22 Training Center at Camp Borden, to learn military medicine, and then were sent to various Regimental Aid posts to help look after the military trainees.

I was sent to A33 Armoured Corps to work in the Regimental Aid Post. Here I was under a Major.... and was sent to Meaford range for one week a month to look after the Armoured Corps unit where they used live ammunition. About a year later I was put in charge of the RAP at #1 Armoured Corps Training Regiment, and looked after the members of the Engineers (RCEME and the Dental Corps), with 2 other doctors to help me. In 1944 I had got wondering why many of the men had Atlantic fever, and did not want to go to England, and heard that in England many also had Channel Fever and did not want to go to France. My army examiner (a psychologist) introduced me to Major Hobbs, psychiatrist, and I mentioned the above to him, and he said that if I applied for a course in Psychiatry, he would see that I got it as soon as he got back from his Xmas leave in 1944. I did not tell my wife at Xmas that this might happen, and the camp Medical office called me Jan 6/45, and said I had a course in Psychiatry starting Jan 1, and 6 days made no difference in a 6 month course. I went back to Toronto and stayed with my wife and daughter, during my course at the Toronto Psychiatric Hospital, the Toronto General Hospital (on the Neurolo-Psychiatric service) and Christie St Hospital for 2 months each. The war ended while I was a Christie St. under Dr. Wm. Baillie, and several of us there were kept on as residents in Neuropsychiatry to look after the returning ill veterans. The chief of medicine got jealous of there being 5 residents of Neuropsychiatry and only one in Medicine. So the retired Dean of Medicine Dr. D. Graham said that if they hired him to get rid of us then they could hire senior interns and it would be cheaper, and this saving would be more than his salary. So he came and said that we had to go to the Toronto General Hospital and The Psychiatric Hospital and spend some time in training to be able to write out specialist examinations for the Royal College of Physicians & Surgeons of Ottawa.

We all wrote the exams in 1950, and I failed, as I did not give them their answers on the written exam, and I did not give answers to the psychoanalytical questions to suit. This meant I had to spend another year and rewrite the exams. I read all the writings of the examiners, and gave their answers back to them and passed. This made me conclude that exams were worthless to find out what a person knows, as it only find out what the examiners want you to know, and leads to cookbook medicine. I have seen nothing since to change my mind re this conclusion.