Thomas Gionis and the TEDx journey

Thomas Gionis 0:00

I had an experience with uh with sleep apnoea that was uh dramatic and uh I I lost temporarily the the memory of the name of my wife, the names of my uh three daughters and three granddaughters. I was lucky to uh to have an opportunity in California where I could finish three and a half years of college in one year. We made them aware of what is called a silent epidemic, but it's really not that silent, is it? Snorting's not silent. Because if we don't, if we don't, we're at a hundred percent higher risk of developing high blood pressure.

Andy Coley 0:42

But it's startling the effect that sleep apnoea can have, not just on tiredness or your partner or you not getting enough quality of sleep.

Thomas Gionis 0:51

I'd like people to to be aware of the problem and to know that it's a warning sign and that they have to do something about it. And most commonly what people think is

Title 1:01

This is the TEDx Northern Quarter Podcast.

Andy Coley 1:06

So, Thomas Gionis, physician surgeon, and future TEDx Northern Quarter speaker. Welcome to the TEDx and Talks podcast.

Thomas Gionis 1:16

Thank you, Andy. It's uh an immense honor to be here.

Andy Coley 1:20

It seems like such a long time ago that we got your application in. And yeah, it was that must have been end of December, January, I think, wasn't it?

Thomas Gionis 1:27

It it does seem like a long time ago, but the amount of work and preparation and updates and practices and rehearsal and speech coach, uh it there was a lot in that past several months. Very, very uh enlightening and uh wonderful experience.

Andy Coley 1:49

It it's so interesting. We're two days away now from wow and a half at the end of the Wednesday where we're opening up the TEDx on the Friday morning, of course. Um to have gone through that whole process. Uh what were you expecting when you applied? Because uh were we the first TEDx you'd applied to, or you you had you apply to others?

Thomas Gionis 2:10

I had applied to uh some others and uh uh had one acceptance and I decided uh uh not to go ahead with it. Some of that, but I had no idea of the uh the amount of coaching I would get. And the what was astonishing to me is that after each coach coaching session, there would you you could self-improve. You would uh I find areas that you yes, you can improve here and you can improve here. And that was continuous. Yeah. Continuous throughout the past uh nine months, I guess.

Andy Coley 2:48

And it's must be really interesting. I'd imagine doing the work that you do. We'll come on to all of that before. Uh you've probably had some kind of training in speaking in public and um speaking to teams. I certainly I know I've coached quite a lot of um healthcare organizations, or we've had consultants or doctors who want to improve their ability to be able to speak to to a group. I would imagine doing a TEDx, or certainly the way we do it, has been a little bit different.

Thomas Gionis 3:14

It's different. It's uh I should say more intense. Uh it's more intense, yet very precise. And what was amazing to me, particularly as a surgeon, is how precise it can be, time after time after time, where the coach, I had a fantastic coach, you know, Elliot, uh, could hone in instantly on whether you might consider this or consider that. And it was uh quite an educational experience.

Andy Coley 3:45

And hopefully when you can take back into other areas of your life as well when it comes to speaking in public. No question about it. No question. So before we we sort of go too much into what you're speaking about and so forth, tell us a little bit about you. I mean, uh the some of the history of you, how you've gotten to where you are, the work, yeah. Because um certainly I know that you're involved in health, but you've also trained as a lawyer, you've been in public health. You have what most people would probably consider several lifetimes of CVs. So go on, give us give us a little precy of who is Thomas, who

Medicine, surgery, law and lifelong learning

Andy Coley 4:20

are you?

Thomas Gionis 4:20

Thank you. Well, you know, I um I've always wanted to become a physician. My parents uh were of Greek heritage, and that was very important. They always instilled education uh into us, and um I always wanted to be a doctor. I worked very hard. There was no one uh in my family who had been to college or uh graduate school or become a doctor. So I was lucky to uh to have an opportunity in California where I could finish three and a half years of college in one year, and I started medical school when I was 17, and I was one of the youngest in the country to ever finish medical school in the United States at 21. So it gave me a big jump and it gave me an opportunity to uh really explore the fields I I enjoyed. And I enjoyed surgery very quickly. I went into cardiovascular surgery and I uh practiced for uh several years. It was immensely rewarding. But it was the kind of occupation you can imagine that occupies just about 24 hours of each of your day. I mean, before you have dinner, you're thinking about everything in every one before you go to sleep, and it's just um a wonderful experience. But I I wanted to take a different path, and so I went into emergency medicine, the trauma, and uh had a wonderful experience. And then, you know, the healthcare industry changes, it changed a lot, and I felt in order for me to keep up with the changes, at that time there were HMOs were coming on, health maintenance organizations and changes in insurance. I got a master's in business so I could understand the language of administration that we were speaking, and and that helped a great deal. And then the industry kept changing, and I obtained a master's in healthcare administration so I could become more aware. So the master's programs that I did and the education that I did, I always saw them as necessary steps to stay competitive. Yeah.

Andy Coley 6:31

It's about evolving from being a manager into a leader, becoming a much more of a visionary, becoming much more of the person who has a little bit of a scope as to where are we heading and how are we going to get there.

Thomas Gionis 6:41

Exactly, because the world was changing. Yeah. The healthcare industry was changing. And I um ultimately uh got a master's in public health from UCLA and and then uh decided to go to law school. And uh law school was a tremendous new experience of a new way of thinking, critical thinking. And all of these fields I could bring in to the practice of medicine, and to my practice of medicine. So they were each uh very informative for me, uh, very critical as far as being competitive, and uh very critical in me being able to make a worthy contribution to my field and to my profession and to um the the society I was trying to help.

Andy Coley 7:33

That's so interesting, isn't it? So I must go back to something you said earlier. Three and a half years worth of degree in one year.

Thomas Gionis 7:40

Yeah.

Andy Coley 7:41

I think you you said that that was a great thing to be. I can't imagine many people thinking that's like an entire school system in one year. It was.

Thomas Gionis 7:49

It was. And I knew, you know, I had no connections in medicine. I had I wasn't political, my family was in political. I had to do something. I had to do something to set myself apart. And so I worked hard. Yeah. I worked hard in the summer before the year I went to college, the summer, the college I took double semester loads, the summer after I I took heavy loads, and I I tried to distinguish myself uh on the uh on an application.

Andy Coley 8:21

Um, what are you doing now within the field of healthcare or or law or wherever your your attention is right now? Where where do you spend most of your time at the moment?

Thomas Gionis 8:32

Well, you know, law intersects in America every day of your life.

Andy Coley 8:37

I'm in healthcare. As does healthcare. Yeah.

Thomas Gionis 8:40

Well, I practice primarily uh emergency medicine now. And uh so I'm the director of an emergency room and chief of staff of out of a hospital, and that entails a lot of interaction with uh patients and physicians and administration that occupies a good deal of my time. I also have a large uh with my wife, a large uh telemedicine practice that we've uh built up over the past three years. We've seen uh over 12,000 uh visits telehealth-wise. Amazing.

Andy Coley 9:10

Is that for organizations to be able to utilize you to be able to get people appointments or to get people speaking to a doctor much quicker? Yeah.

Thomas Gionis 9:20

Yes, quite quick. And uh and I do those practices. I'm licensed in the United States and in California, New York, and Florida. I live in Florida, but that gives me a great deal of flexibility, and it's a change from the um emergency medicine, acute care, critical thinking, high pressure uh environment. Um so it it works well to have a balance.

Andy Coley 9:44

And all of those things, though, are not directly what you're gonna be speaking about on the TEDx stage. You've got another passion or a particular element of medicine that you really want to explore because So you've had some personal history with dealing with sleep apnoea.

Thomas Gionis 9:58

Indeed.

Andy Coley 9:58

Yeah, and that's very much where you're gonna be honing in on your TEDx

The experience that changed everything

Andy Coley 10:02

talk, isn't it?

Thomas Gionis 10:02

Right. And and it fits very much in with the public health interest I've had. And uh I had an experience with uh with sleep apnoea that was uh dramatic, and uh I I lost temporarily the the memory of the name of my wife, the names of my uh three daughters and three granddaughters, and um you can imagine that feeling, and and then as a physician not knowing what it was, but knowing it must be something terrible that happened, and then going on the journey of trying to find out what it was, and ultimately, ultimately finding out it was sleep apnoea. In the interim, my treatment uh, because sleep apnoea involves a lowering of your oxygen, uh, my oxygen was so low that my blood system started to react appropriately and get thicker, make more hemoglobin, and so that subjected me to uh stroke. So I had to donate blood over and over and over. And I tried various treatments, I they didn't quite fit. You have to find the right treatment, like with anything, like with anything in medicine. And and finally I came across uh a laser technique, which I I read about and immediately found the best person I could to do it and had it, and it worked immediately. I was amazed. Um, it changed my biology, it changed my breathing, it changed my life. And I then subsequently became trained in the laser surgery, as did my wife. And um, we began speaking publicly about sleep apnoea, and came to learn that uh the public awareness of sleep apnoea is is quite low. Yeah. Um but the danger is quite high, quite high. Uh, and I thought, my goodness, this we have to do more to educate the public about what the relationship is, for example, between snoring and sleep apnoea and what they are at risk for.

Andy Coley 12:18

So some people will be listening won't know what sleep apnoea is. So do you want to describe, would you want to tell people what what is sleep apnoea for people who have an awareness, or maybe they won't know somebody's got a machine to help them at night, or surely they sleep with a heavy snorer next to them, or they are a heavy snorer themselves. Like what is sleep apnoea?

What actually is sleep apnoea?

Thomas Gionis 12:37

So um sleep apnoea is a condition where when you sleep, you stop breathing. Um or your volume of breathing decreases 30% or greater. So as a result, your body goes through these drastic changes. Now, we identify different severities of this stopping of breathing, but the most common type is that people stop breathing, stop, between 15 and 30 times an hour. Now you can imagine having your oxygen go to near zero and you stop breathing, that has profound metabolic changes and puts you at profound risk. So what happens is there's a transition. The warning sign to sleep apnoea is snoring. And everybody thinks, well, snoring, you snore, you know, that's horrible, I guess. I mean, what am I gonna do? No, I don't really snore, and you know, you everyone denies it, and um, and they kind of passed.

Andy Coley 13:46

And then your partner plays the recording in the middle of the night.

Thomas Gionis 13:49

Your partner records you, and then uh perhaps may ask, you know, this is a little disturbing. Do you want to maybe spend the night in the guest room? And uh and because I so we can both, so we can both get a good night's sleep. That's called a sleep divorce. That sleep divorce, legally, I can tell you, uh, leads to a high number of actual divorces. The problem is we we don't uh recognize snoring as a warning sign. Yeah, it's a big yellow flag. It's a warning sign we have to listen to. It's loud enough, isn't it? It's loud enough, it's telling everyone, but we have to listen to it and do something about it. Because if we don't, if we don't, we're at a hundred percent higher risk of developing high blood pressure, we're at a hundred and eighty-six percent higher risk of developing Alzheimer's, a two hundred and eighty-six percent higher risk of having a stroke, and a well-documented increase in death rate of three hundred percent. That's the group that's unaware. And it's the group that tried some treatments and then stopped. They become untreated. So the unaware group and the untreated group are at high risk for mob morbidity and mortality. And that's the public awareness we need to bring out there. That snoring is a warning sign. You need to do something about it.

Andy Coley 15:37

Um and snoring isn't the only warning sign for

Snoring is a warning sign

Andy Coley 15:40

sleep out in the air.

Thomas Gionis 15:41

No, it's not. It's the loudest we have. The other ones can be a bit um uh generalized. Yeah. Fatigue in the morning, many causes. Um not feeling clear thinking in the morning, um, gasping at night for air, uh, and of course making loud noises at night, uh, interrupting your sleep. Many people say, you know, yeah, I snore. I I can feel it when I go to sleep. I snore a little bit and then I stop. Well, they don't stop. They keep snoring, and they have this fatigue and poor mental concentration in the morning.

Andy Coley 16:19

And how's the s stopping breathing in effect at night the same or different to holding your breath? We're choosing to not breathe at that moment in time.

Thomas Gionis 16:29

Um Well, you know, a good question. You can hold your breath for a short period of time, but the stopping of breathing uh you hold for such a degree of time that your oxygen drops down and stays down. Okay, you can hold your breath once. But will you be holding your breath 15 to 30 times an hour every hour while you're sleeping? So that's a tremendous metabolic um impact. Yeah. Yeah.

Andy Coley 17:07

Every two to four minutes for four, six, seven hours. It's it's incredible. So you got diagnosed? Was that easy? Finding out that you had it, you did you self-diagnose or did you uh go to sp- I don't think you went specialist for the laser treatment, but how how did you get your diagnosis of sleep out there? I'm uh asking the question of somebody who has had tests recently myself to see whether or not it's something I've had. So this is also another reason why I was so curious about your your talk from a very personal perspective. Of course. We would like to be uh absolutely um, you know, um yeah, how did how did you find out about having it other than the snoring?

How sleep apnoea is tested

Thomas Gionis 17:46

You know, after these thousands of blood tests, I was walking out of the room and uh they said, you know, all your blood tests are normal. We really can't tell what's what's going on, which I was not particularly thrilled with as a physician. Um and in passing, in leaving the room, somebody said you probably have sleep apnoea. So I was speaking to my wife, who's also a doctor, and I said, I don't have sleep apnoea. And she says, No, you you probably do. I said, I don't have sleep apnoea. And she says, You got to get tested. Well, there's two kinds of tests that we do. One is a very simple test that you can download a program on your phone, and it simply records the snoring, and it records it as a sound wave. So you can see the sound waves and you can see how often that happens. So, first we have an indication that there is snoring, which is an obstruction. Yep. Means the the parts of your throat and tongue have fallen back and have caused an obstruction, and that obstruction is making the noise. So, first we have indication from uh a test uh from your phone that there's a noise, and then we do a uh sleep apnoea test, which measures how many times you actually stop breathing and for how long. In the old days, if I can say, that used to be a very complicated test. You'd have to go to the hospital, go in the sleep lab, they'd hook you up with all sorts of electrodes, and then you would try to sleep comfortably. Hard to do. Nowadays, uh there are hundreds of devices throughout the world that you can uh wrap around your finger. Again, uh goes to your phone through a Wi-Fi system and actually measures rather accurately, rather accurately, that we can depend on um how many times you stop breathing and for how long, and and how low does your oxygen get. So we can get a very sophisticated marker that you have it and to what degree you have it. And that's what I did. I did both of those tests.

Andy Coley 19:49

Yeah, I said you had to I tried the one uh they put something on your Adam's apple, and then you get sleep with that one, and then that one was inconclusive, and then another one where more the tubes and and and and a little bit more, you know, like a pack to wear. Right. Again, apparently that came back without as well. Right, right. Um but it's interesting, isn't it? When you're when you're wearing these devices, you're not getting a quite a normal point in time because you're aware of this thing that you're wearing um in and of itself. So it's like the the whole thing of testing is isn't the normal that you would be used to as well. Exactly. But it's startling the effect that sleep apnoea can have, not just on tiredness or your partner or you not getting enough quality of sleep, but actually all the other things that if there was anything else going on, like the increase in Alzheimer's, the increase in you know death, would be getting headlines, and we'd be getting a lot of money spent on helping sort this thing out. Like why why is it so not talked about about the fact that this is is is it's such a problem that could be what sounds like relatively easily

Why are we still overlooking it?

Andy Coley 21:00

solved?

Thomas Gionis 21:00

I I think Andy, because it's come upon us in such a huge way. The it it it sounds as if in the past few years, my goodness, sleep apnoea has become this epidemic. And and it a lot of that is increased awareness. But what's happened is is that as that oxygen level drops and uh it affects so many metabolic changes in your system, that the sleep apnoea can make worse the existing uh heart disease you have, the existing renal disease, the existing neurogenerative diseases. And so we've seen an increase in the severity of those metabolic illnesses, which the doctors are incredibly busy taking care of. We've also learned that there's a mutuality that those people who do have heart disease. And kidney disease and obesity and neurodegenerative changes. If they don't have sleep apnoea, those comorbidities can serve as a precipitating independent factor in the development of sleep apnoea. So one potentiates the other. So we've seen in medicine this huge increased burden of disease globally. We've seen it increase in morbidity and mortality. And it's as if we are all just trying to keep up managing the disease. It's so overburdening. And sleep apnoea is one of those things that the patient has to have a conversation with the doctor, and the doctor needs to really kind of seriously think about it.

Andy Coley 22:52

And so with your talk, obviously you're going to be talking about sleep apnoea. What is sleep apnoea, the signs of sleep apnoea, and so forth? What do you want people to take away and take action on when they get to one watch the talk in a couple of days' time, but and two, you know, come across it on YouTube or on the TED channel. What is it you would like people to take action on or get from your talk when you're sharing

Diagnosis doesn't automatically mean CPAP

Andy Coley 23:18

about?

Thomas Gionis 23:18

I I'd like people to be aware of the problem and to know that it's a warning sign and that they have to do something about it. And most commonly what people think is, oh, I have sleep apnea. I have to wear one of those masks. CPAP. Those CPAP masks. And I can't do that, and I'm not going to do that. In reality, there are many different types of treatment. And patients may require certainly require different treatments. Different patients require different treatments. And they may require different treatments along the course of their history of sleep apnea. So I want them to be aware that it's a warning sign. They can't ignore it. They need to do something. And there are many things to do. There are many treatments, many treatments. And I mentioned several of them and I show some examples. And I want them to feel comfortable that although if they don't do anything and ignore it, there's a high risk, I want them to know that there are things they can do. They should do it. They're simple. It's simple to do the testing, simple to get the treatment, and they can improve and improve their health.

Andy Coley 24:29

And ultimately, what will that legacy be then of that education that you're putting out there? Because obviously you've decided to double down and hone in on this particular aspect. It's what you've trained to do and trained support, and you and your wife, and you're running, you know, I'm sure lots of sessions supporting people in this. But ultimately, what do you want that legacy to

The (not so) silent epidemic

Andy Coley 24:51

be?

Thomas Gionis 24:52

I want the legacy to be that we made a significant contribution to the improvement of people's health, and that we made them aware. We made them aware of what is called a silent epidemic, but it's really not that silent, is it? Snorting's not silent. Yeah. We made them aware of this uh epidemic type problem. And we've we've made them comfortable in being tested and knowing that there's many options of treatment, and there's things that we can do that will certainly, certainly improve their life in longevity as it has with me.

Andy Coley 25:39

And who wouldn't want that for themselves and for the others in their life?

Thomas Gionis 25:42

And for their loved ones, absolutely.

Andy Coley 25:44

Absolutely. And so obviously, you've been working on honing this talk down. I have a sense when we when we first got your application and that we started working with it, you could probably talk for many hours on the subject. What's it like being honing it down to 15 minutes? So getting it down to that kind of level of of specificity for the topic. And what have you learned about yourself through that process?

Thomas Gionis 26:13

Well, I I've I learned immense uh immense uh about myself and immense amount uh through the help of the coach and Elliot, and that you can be very refined in a large subject. And you know, we're always asking ourselves as speakers in this TEDx program, do I do I really need this? Do I really need to say this? Is this really helping the message? Yeah. And that process of self-reflection and self-deprecation, we do occasionally, we do it a lot in preparation for the TEDx. And so I learned that refinement process. And um it's very gratifying and knowing that in a 15-minute period, you can significantly impact the opportunity for improvement in the health of many individuals. Yeah, it's a wonderful feeling, Andy.

Andy Coley 27:20

Yeah, it's not very long, and it's also quite long. We're up there on stage as well. Has there ever been any um TED Talks or TEDx talks that have inspired you in the past?

Thomas Gionis 27:31

Many. Many. Um I I don't remember their names, but I I remember even from the beginning of my MBA graduate studies, uh I started listening to uh TED speakers, TEDx speakers, economists from uh uh Norway, I believe it was, and and and other public health specialists, which were phenomenal. Yeah. I I can't begin to express the degree of excellence, clear thinking, and their ability to bring a complex subject to clarity and to transmit that clarity to me as a student and to others. Um I have listened to many, many um TEDx and TED Talks, and always uh was amazed at their ability and their their brilliance.

Andy Coley 28:31

Let's hope somebody one day will add your talk to their list of those very same topic areas and well.

Thomas Gionis 28:36

I'd be honored. I

The Red Journal: a Greek dance-off

Thomas Gionis 28:38

can only hope so.

Andy Coley 28:39

Um so we have a little tradition here on the TEDx and Talks podcast about um the Red Journal, and the previous speaker, uh who happens to be your speaker coach, has left you um a question he would like you to answer. Okay. So hello, says Elliot. If you could have a dance off with someone, who would it be and why? If I had a what? A dance off. So where you do a dance, they do a dance, and you try and do the best dance possible.

Thomas Gionis 29:09

A dance.

Andy Coley 29:10

A dance. If you could have a dance off with somebody, who would it be and why?

Thomas Gionis 29:17

Um you know, being Greek, we um we have many dances that we do. Some are in groups, some are singular, and they are internally inspiring because in order to do the dance, you have to be passionate about listening to the music. I would have it with my wife because she's also Greek, and uh in doing the dance with each other, posing each other with each other, uh, it would be mutually inspiring, enlightening, and exciting.

Andy Coley 29:52

I love that answer. Uh Thomas, thank you so much for joining us on the TEDx and Talks podcast from TEDx Northern Quarter. It's been a delight to meet you in person, finally, after all these months of virtual sessions, um, and to be able to hear you in day and a half time, take to that red dot and inspire us all about how we can improve our health and our sleep.

Thomas Gionis 30:13

Thank you, Andy. I'm I'm profoundly honored. I'm truly honored to meet you, and I thank you for all your help and your staff and Simran and everyone. It's a it's a profound honor to be here, and I hope to make a worthwhile contribution and be worthy of your selection. Thank you. Thank you.