Sleep Apnea and Your Medical

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Changes in Latitudes
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Sleep Apnea and Your Medical

#1 Post by Changes in Latitudes » Wed Oct 21, 2009 11:48 am

Yes you may have got your 6-8 hours of sleep, but was it quality rest?

If you've got sleep apnea, and I know many of our fellow peers and colleagues do, this may be one of those things to look into ridding yourself of before a medical examiner forces you to (one day). Even if it doesn't become a screened or discussed item, attacking this issue will increase your standard of living dramatically.

It's definitely more prevalent and more dangerous in our line of work than many people realise.


Safety board issues wake-up call on sleep disorder



WASHINGTON (AP) — Safety investigators have sent government agencies a wake-up call about sleep apnea, a disorder that's showing up in a wide range of transportation accidents.

The National Transportation Safety Board said Tuesday that commercial truck and bus drivers and merchant ship pilots should be screened for sleep apnea. The board made similar recommendations for airline pilots and train operators earlier this year.

In letters to the Coast Guard and the Federal Motor Carrier Safety Administration, the board recommended requiring medical examiners to question drivers and ship pilots about the disorder — which involves disruptions in breathing during sleep — and to develop programs to identify the problem.

Sleep apnea denies people the rest they need, and it has been found to be a factor in incidents involving every transportation mode, NTSB Chairman Deborah Hersman said in the letters.

The board has sent similar recommendations to the Federal Aviation Administration and to local transit agencies across the country.

Among the incidents cited in the letters:

In January 2008, a motorcoach carrying passengers returning from a weekend ski trip went too fast around a curve on a rural Utah highway. The bus went careening down a mountainside, killing nine people and injuring 43 others. The driver suffered from sleep apnea and had trouble using a device to regulate his breathing while sleeping in the days before the accident.

_The same month, two go! airlines pilots conked out for at least 18 minutes during a midmorning flight from Honolulu to Hilo, Hawaii, as their plane continued to cruise past its destination and out to sea. Air traffic controllers were finally able to raise the pilots, who turned the plane around with its 40 passengers and landed it safely. The captain was later diagnosed with sleep apnea.

_A trolley train crashed into another train in May 2008 in Newton, Mass. Investigators said the driver probably fell asleep because she suffered from sleep apnea, but it could not be proved because she died.

_In November 2001, a train engineer drove through a stop warning in Clarkston, Mich., striking another train and killing two crew members. He was found to be a very high risk for sleep apnea, but he had not been diagnosed or treated.
_In June 1995, a cruise ship maneuvering through Alaska's Inside Passage was grounded on a submerged but charted and marked rock by a pilot later diagnosed with sleep apnea. The ship was carrying about 2,200 people.

A 2002 study that found 7 percent of adults have at least a moderate form of the disorder, but people often don't know they have it.
The motor carrier administration is already considering a rule to tighten its standards for medical certification of commercial drivers, Transportation Department spokeswoman Sasha Johnson said.

The FAA is also in the process of drafting new rules to broadly address pilot fatigue and will consider the board's recommendations, spokeswoman Laura Brown said.

The Coast Guard is examining the recommendations and will pursue possible safety strategies, spokeswoman Lisa Novak said.

The letters noted the Federal Railroad Administration is also working on drafting new regulations to address the problem.

Mark Rosenker, a former NTSB acting chairman, said the issue has long been a concern of the board, but the go! airlines incident jarred board members.

"Obviously when two pilots fall asleep in the cockpit and they miss their stop, that triggers a lot of interest at NTSB," Rosenker said.



On the Net:

National Transportation Safety Board: http://www.ntsb.gov
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Re: Sleep Apnea and Your Medical

#2 Post by Hedley » Wed Oct 21, 2009 11:55 am

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Re: Sleep Apnea and Your Medical

#3 Post by Pugster » Wed Oct 21, 2009 1:31 pm

Hedley wrote:Is "sleep apnea" like "cognitive dissonance", which is
why Bob Hoover's medical was pulled?
What?

This doesn't make sense to me...

Cognitive dissonance is an attempt to explain behavior, not a clinical diagnosis. AFAIK it's not found in the DSM (the diagnosis handbook for psychologists) - so I can't see how they could yank his medical for this condition. The basic idea of cognitive dissonance is that you may feel you are one way - but behave in a way that is contradictory to those beliefs. An example would be someone who believes they are very health conscious but smokes 2 packs a day. Some psychologists believe that this contradiction can cause issues.

Not calling you out Hedley - but I think you need to check your facts on this one. My guess is that they may have cited cognitive dissonance in diagnosing some other disorder. It would be the diagnosis of that disorder that could have provided the "justification" to pull his medical. If they did indeed pull his medical citing "just" cognitive dissonance, I'd think he'd have a pretty strong legal case...and no shortage of good psychologists willing to come to bat for him.

On another note...

Sleep apnea and fatigue are obviously intertwined. I think you're bang on in suggesting that people get a handle on this before MOT docs start making it a hot button. Make sure you get a family doc you trust - and discuss it with them in confidentiality before it becomes a problem.

I just reread my post and realized I sound like a prick. Sorry - the old academic BS trickling out... :roll:
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Re: Sleep Apnea and Your Medical

#4 Post by chu me » Wed Oct 21, 2009 1:58 pm

Pugster;

Sleep Apnea is reportable to MOT and DOT. So if you dicuss it with your family doctor and you undergo testing and are found to have it, your family doctor is required by law to report it. So, having a nudge nudge wink wink conversation with your family doctor is out. Having said that, I would suggest that anyone who believes that they are suffering from any kind of sleep disorder see their doctor right away, especially if you are a pilot.
As someone who has suffered from sleep apnea, I can honestly say that my life is completely different now that the Apnea is being treated. I never had my medical pulled the whole time and I do not believe that they pull medicals for that reason anymore. If anyone needs more info they should contact Dr Palff in Civil Aviation Medicine at Young St. T.O. He was extremely helpful with me and never I repeat NEVER suggested that T.C. was even looking at my medical. I have not had a problem since and it is going 4 years now. By the way my apnea was diagnosed as severe at 100 episodes/ hr ,some lasting up to 30 secs in length.
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Re: Sleep Apnea and Your Medical

#5 Post by chu me » Wed Oct 21, 2009 2:07 pm

For those of you who are interested here is the contact info for Dr. Jim Pfaff. Hope it helps!!

Employee Information
Name: Jim Pfaff
Telephone: (416) 952-0562
Fax: (416) 952-0569
Position: Senior Consultant, Policy and Standards


Internet
jim.pfaff@tc.gc.ca

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Ontario Regional Office,Joseph Shepard Building
4900 Yonge Street,North York, Ontario
M2N 6A5


Aviation & Marine Medicine
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(613) 990-6623
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Re: Sleep Apnea and Your Medical

#6 Post by ... » Wed Oct 21, 2009 4:05 pm

I don't think TC medical exam standards are concerned with Sleep Apnea in 703 & 702, or the rules would have been written differently.

I really do.
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Re: Sleep Apnea and Your Medical

#7 Post by dashx » Wed Oct 21, 2009 5:16 pm

Got a remstar plus. Hardly use it now. Such a hassle to drag it through airports....

Just train yourself to sleep on your side. No more problems.
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Re: Sleep Apnea and Your Medical

#8 Post by loopa » Wed Oct 21, 2009 9:03 pm

Maybe instead of pulling medicals, transport should regulate commercial air service and flight training with more liberalism. Provide more mandatory rest for pilot's; force airline flying to be reduced in number of hours. Or at least, number of over time hours. Instead of allowing pilot's to have 17 hour days with an extension of 6 hrs rest, limit the pilot's at 12 hour days and open up more positions for other pilot's to fly the 12hour to 17 hour legs.

Of course, with attacking the core of the problem, there will be more money that has to be put into play. Since the guys in the suits need to be paid half a million to fart around, this problem is not going to be attacked at the core but rather affecting the victims.

This doesn't just apply to aviation; the transportation industry as a whole is a corrupt one in which ever sector you operate. We all know it and operate within it.

We all know that it's no longer about safety but rather about money. If they can save money by medicaling out pilots, they will find some method to do it. Heck, they should make the medicals more like Europe. I bet more than a good chunk of us on these boards would fail a medical as strict as Europe's.

I honestly don't see this sleep apnea being something that will be tested because I guarantee you that there will be MANY people who WILL medical out. Maybe then we can promote the "shortage of pilots" cheer :P
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Re: Sleep Apnea and Your Medical

#9 Post by Stevo226 » Thu Oct 22, 2009 7:21 am

Anybody have any alternatives to getting the snoring machine? I make an Instructor's wage :(
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Re: Sleep Apnea and Your Medical

#10 Post by Driving Rain » Thu Oct 22, 2009 8:58 am

Stevo226 wrote:Anybody have any alternatives to getting the snoring machine? I make an Instructor's wage :(
Check out ebay Stevo. They can be found pretty cheap there.

However....
Most of the CPAP machines cost is covered by OHIP in Ontario. The problem with a used machine is the pressure setting might not be right for you. Only a sleep apnea study can determine what pressure is correct for you. If you do buy a used machine take it to an authorized dealer and have it adjusted to your setting.
The study is covered under OHIP too.
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Re: Sleep Apnea and Your Medical

#11 Post by The Old Fogducker » Thu Oct 22, 2009 9:09 am

Stevo ... at one time, I was also a struggling young pilot with dreams of greater things ... mainly a better pay cheque, so I understand your dilemma and feel your pain .... the best non-CPAP sleep apnea alternative I was able to find on the net was this mouthpiece, similar to that made by dentists to prevent grinding your teeth in your sleep.


http://puresleep.com/PureSleepSite/cont ... 5QodPz9qAg

Something you should look into though ... pilots and truck drivers ... people that operate equipment for a living ... go to the top of the list for appointments and fitting for CPAP machines, and the equipment is paid for by Medicare, or in most private health insurance programs too.

Do some more research, and don't take no for an answer.

In a manner similar to the effects of allergic reactions, Sleep Apnea comes in widely varying degrees depending on several contributing factors for different people. For some, it is a super-serious matter and is life threatening. Some are affected by the episodes of stopping breathing 40 or more times per hour, some people to a lesser degree. For some persons, it takes something unusual or out of the ordinary routine to trigger it ... like changing to a hotel bed from your home bed, changing schedules, eating or drinking before bed ... the list of things which may trigger onset is quite long.

Your first indication that you may have a sleep disorder is your partner comments on how loud and disruptive your snoring is.

I've spoken to several pilots with varying degrees of Sleep Apnea, and each one has said they were highly grateful for the difference a CPAP machine made to their lives after the problem was properly diagnosed. One friend in Saskatoon had his medical "popped" due to the effects of Sleep Apnea. He was unable to remain awake in an airplane for a full flight, and was napping or feeling super-sucked out for energy and mental alertness almost every leg. He was also just not "at his best" (or even normal) at almost any time.

I recall him telling me the first night he slept on the CPAP machine, he knew they had found the instant cure for him. His physical strength, and mental acuity returned to normal, and he quickly regained his medical. He struck me as being genuinely happy that his problems had been found, diagnosed correctly, and treated because the difference it had made for him was substantial.

If you have Sleep Apnea, even long periods of sleep don't result in a one to one restorative factor for rest and reduction of Sleep Debt. You can sleep for a solid 8 hours, but because of frequent interruptions, you may only obtain the restorative equivalent of perhaps 2 hours sleep quality. After many years of this, you are in a constant state of oxygen deficient sleep debt and damage to your body by a long term state of anoxia. Regardless of time away on vacation, or hours slept, you never recover your former "vim & vigor."

Its very important to understand that medicals aren't "popped" due to merely having been diagnosed with Sleep Apnea, medicals are sometimes ... rarely ... taken away because the pilot can no longer function properly due to long-term lack of rest and chronic fatigue which has come about so slowly, the person doesn't realize just how bad things have become.

The Docs at TC may ask for some additional information from a specialist, but frankly ... so what. If you've got a condition which may result in sudden or subtle incapacitation in the cockpit, do you really think you should be flying?

Although a different medical condition, you can appreciate the serious nature of Sleep Apnea by watching someone on the extreme end of sleep disorders ... those with Narcolepsy. These individuals fall into a temporary deep sleep for awhile and then awake immediately .... sitting at a stop sign for example, or having a conversation and then they freeze for a few seconds and are asleep.

Here's a video of someone with Narcolepsy. Imagine this poor fellow doing an approach with you in the other seat, and you can see why some medical conditions are disqualifying or require a more in-depth bit of investigation.

If you watch part 2 of this series, you can see the trouble he has waking up in the morning ... this is similar to persons with advanced cases of Sleep Apnea when they wake up in the morning. You might be able to identify with this after a long period of stressful operational flying.....where you wake up just as tired as when you went to bed, and have another 14 hour day to look forward to.

http://www.youtube.com/watch?v=l2x14qETS7E

Here is a short, but concise description of Sleep Apnea and its long term effects.

http://www.youtube.com/watch?v=Vlep63RY12Q

I have Sleep Apnea and am super-glad it was found and now is being treated.

I recall the first morning I woke up after only 5 hours sleep and knew we were onto something positive. I felt like I'd drunk 4 Tim Horton's iced cappocino about 5 minutes before waking up.....I hadn't felt that awake in many years. That state only lasted 45 minutes before I slipped back into my pretreatment state, but I knew what it felt like, and it was a good thing.

In the days that followed, it was like somebody had taken my brain out and bolted on an extra 30 IQ points, then reinstalled it while I was asleep. Each day, the beneficial effects of the CPAP machine became longer, but alternated by periods where I was just whipped and need several afternoon and evening naps. When I was "up" I felt like I was about 25 years old again ... I just couldn't believe what a difference it made. It was like a medical miracle had been performed on me.

Physically, I feel like I'm 15 years younger and now am enthusiastic about going out and doing something rather than being glued to the couch in my down time.

I encourage anyone who thinks they may suffer from a sleep disorder to seek treatment, because it could be a fountain of youth for you, just waiting in the form of an "overnight cure."

Thinking back at how long I may have unknowingly suffered from sleep apnea or its time of onset, I think my so-called "mild case" of sleep apnea was somewhere around 10 to 13 years.

Its only been a few weeks since I've gone on the machine, and think its a great thing, although I gotta say, I look like a real dolt in the mask ... like sleeping with a pressure breathing, demand O2 system on your schonz while in bed. I'm sure its a real attractor for babes. My wife says I need an air force flight suit to sleep in so I really look the part.

I hope you have found this informative and encouraging.

Regards to all from a revitalized, but still,

Old Fogducker
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Re: Sleep Apnea and Your Medical

#12 Post by Driving Rain » Thu Oct 22, 2009 10:46 am

Great info and first person testimonial there TOFdr

I feel the same way as you. I can't believe what a life changing event it's been for me and it's only been 3 weeks since I got my iron lung.

My wife and I both wear the mask and look like two Borg in stasis when we sleep.

I've had my machine for only 3 weeks now and lost 12 pound and the wife has lost 13 though she's had hers longer. We both feel getting this machine was a life changing experience. My energy levels prior to the machine were near zero. I felt like an 80 year old man. The flight deck of a 415 was the last place I wanted to be. Since the machine I'm walking 5 k a day just for fun and can hardly wait for next spring when I can again strap the tanker to my ass.

My brother passed away 12 years ago from undiagnosed heart disease. A major factor in that was undiagnosed sleep apnea. Sleep apenea accelerates heart disease and aging.

My wife had many symptoms of other disorders. She thought her lack of energy and sleeping at work was because of an iron deficiency. She had a very serious operation this spring and when she wouldn't breath while in recovery they put her on a CPAP and bingo in one night she knew what was wrong all this time.

It's like drugs without all the harmful side effects.
Cheers
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Re: Sleep Apnea and Your Medical

#13 Post by PPpilot » Tue Nov 14, 2017 2:15 pm

Bumping this to see if there is any new information on keeping your medical and being diagnosed with sleep apnea. I am scheduled to go for testing in a few weeks. I am worried about losing my medical. I am not someone who falls asleep during the day or really has to take naps but sometimes I definitely feel like I haven't gotten a full nights sleep and my wife constantly wakes me for snoring or from me stopping breathing.
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Re: Sleep Apnea and Your Medical

#14 Post by hydro » Thu Nov 16, 2017 9:57 am

If you are doing something about your sleep apnea (e.g. CPAP machine) there should be no problem. There are a handful of people at work with Sleep Apnea with no issue on the medical (ATC, Category 2 medical). I declare it on the form, the CAME asks if I use a machine, I say yes, every night (True), we move on the next item on the questionnaire.
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Re: Sleep Apnea and Your Medical

#15 Post by Heliian » Thu Nov 16, 2017 4:47 pm

^ easy as that. I hope you're using the machine, it is life altering for some.
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Re: Sleep Apnea and Your Medical

#16 Post by PPpilot » Fri Nov 17, 2017 7:30 pm

Thanks, that eases my worries.
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Re: Sleep Apnea and Your Medical

#17 Post by mantogasrsrwy » Sun Nov 19, 2017 5:15 pm

I don't think anyone is losing their medical for it if it's treated, but I bet Transport will have you jumping through some hoops when then find out.
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Re: Sleep Apnea and Your Medical

#18 Post by cncpc » Mon Nov 20, 2017 9:52 pm

Pugster wrote:
Wed Oct 21, 2009 1:31 pm
Hedley wrote:Is "sleep apnea" like "cognitive dissonance", which is
why Bob Hoover's medical was pulled?
What?

This doesn't make sense to me...

Cognitive dissonance is an attempt to explain behavior, not a clinical diagnosis. AFAIK it's not found in the DSM (the diagnosis handbook for psychologists) - so I can't see how they could yank his medical for this condition. The basic idea of cognitive dissonance is that you may feel you are one way - but behave in a way that is contradictory to those beliefs. An example would be someone who believes they are very health conscious but smokes 2 packs a day. Some psychologists believe that this contradiction can cause issues.

Not calling you out Hedley - but I think you need to check your facts on this one. My guess is that they may have cited cognitive dissonance in diagnosing some other disorder. It would be the diagnosis of that disorder that could have provided the "justification" to pull his medical. If they did indeed pull his medical citing "just" cognitive dissonance, I'd think he'd have a pretty strong legal case...and no shortage of good psychologists willing to come to bat for him.

On another note...

Sleep apnea and fatigue are obviously intertwined. I think you're bang on in suggesting that people get a handle on this before MOT docs start making it a hot button. Make sure you get a family doc you trust - and discuss it with them in confidentiality before it becomes a problem.

I just reread my post and realized I sound like a prick. Sorry - the old academic BS trickling out... :roll:
No, cognitive dissonance is not an attempt to explain behaviour. Cognitive dissonance manifests as a mental discomfort at having stongly held beliefs or attitudes challenged by facts and evidence that seriously dispute those closely held beliefs. The countervailing evidence is sufficient to result in holding two opposite beliefs at the same time, i.e. creationism v. evolution. It leads to a change of positions in order to reduce the mental tension that has arisen.

Cognitive dissonance would be a condition that affects a considerable number of Trump supporters in the higher intelligence band of that cohort of Americans. Very few of them ever come to accept that they participated in the election of a sexual predator and a traitor, and the unusual result in what is called escalation of committment, sticking even harder to what they suspect is a very wrong personal choice.
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Re: Sleep Apnea and Your Medical

#19 Post by confusedalot » Tue Nov 21, 2017 2:21 am

cncpc wrote:
Mon Nov 20, 2017 9:52 pm
Pugster wrote:
Wed Oct 21, 2009 1:31 pm
Hedley wrote:Is "sleep apnea" like "cognitive dissonance", which is
why Bob Hoover's medical was pulled?
What?

This doesn't make sense to me...

Cognitive dissonance is an attempt to explain behavior, not a clinical diagnosis. AFAIK it's not found in the DSM (the diagnosis handbook for psychologists) - so I can't see how they could yank his medical for this condition. The basic idea of cognitive dissonance is that you may feel you are one way - but behave in a way that is contradictory to those beliefs. An example would be someone who believes they are very health conscious but smokes 2 packs a day. Some psychologists believe that this contradiction can cause issues.

Not calling you out Hedley - but I think you need to check your facts on this one. My guess is that they may have cited cognitive dissonance in diagnosing some other disorder. It would be the diagnosis of that disorder that could have provided the "justification" to pull his medical. If they did indeed pull his medical citing "just" cognitive dissonance, I'd think he'd have a pretty strong legal case...and no shortage of good psychologists willing to come to bat for him.

On another note...

Sleep apnea and fatigue are obviously intertwined. I think you're bang on in suggesting that people get a handle on this before MOT docs start making it a hot button. Make sure you get a family doc you trust - and discuss it with them in confidentiality before it becomes a problem.

I just reread my post and realized I sound like a prick. Sorry - the old academic BS trickling out... :roll:
No, cognitive dissonance is not an attempt to explain behaviour. Cognitive dissonance manifests as a mental discomfort at having stongly held beliefs or attitudes challenged by facts and evidence that seriously dispute those closely held beliefs. The countervailing evidence is sufficient to result in holding two opposite beliefs at the same time, i.e. creationism v. evolution. It leads to a change of positions in order to reduce the mental tension that has arisen.

Cognitive dissonance would be a condition that affects a considerable number of Trump supporters in the higher intelligence band of that cohort of Americans. Very few of them ever come to accept that they participated in the election of a sexual predator and a traitor, and the unusual result in what is called escalation of committment, sticking even harder to what they suspect is a very wrong personal choice.
Don't know how cognitive dissonance ended up on a sleep apnea thread but anyways....Sounds like an awful lot of medicals should be pulled since many poor sods voted for trump.....
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Re: Sleep Apnea and Your Medical

#20 Post by cncpc » Tue Nov 21, 2017 10:46 am

confusedalot wrote:
Tue Nov 21, 2017 2:21 am
cncpc wrote:
Mon Nov 20, 2017 9:52 pm
Pugster wrote:
Wed Oct 21, 2009 1:31 pm


No, cognitive dissonance is not an attempt to explain behaviour. Cognitive dissonance manifests as a mental discomfort at having stongly held beliefs or attitudes challenged by facts and evidence that seriously dispute those closely held beliefs. The countervailing evidence is sufficient to result in holding two opposite beliefs at the same time, i.e. creationism v. evolution. It leads to a change of positions in order to reduce the mental tension that has arisen.

Cognitive dissonance would be a condition that affects a considerable number of Trump supporters in the higher intelligence band of that cohort of Americans. Very few of them ever come to accept that they participated in the election of a sexual predator and a traitor, and the unusual result in what is called escalation of committment, sticking even harder to what they suspect is a very wrong personal choice.
Don't know how cognitive dissonance ended up on a sleep apnea thread but anyways....Sounds like an awful lot of medicals should be pulled since many poor sods voted for trump.....
Exactly. Or at least carefully reviewed.

I was trying to figure out where cognitive dissonance came in as well, but can't see where.
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