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Sleep Apnea Diagnosed Immediately After Heart Attack


Resolve Itself; Delayed or Repeated Sleep Tests May Be Preferable.

Published on


Section 1.

Question. 1. How did this discussion come about?

Answer. 1. The discussion was posted on LinkedIn Chronic Pain Support Group. "Sleep Apnea Diagnosed Immediately After Heart Attack May Resolve Itself; Delayed or Repeated Sleep Tests May Be Preferable."

Question. 2. So why should you show interest, by creating a webpage?

Answer. 2... 

A. The answer to this will be demonstrated towards the end of this page - however, for the, moment it is because an Educated Medical Person was trying to Suppresses my views that you will observe only came as a result of the scientific paper posted.

B. Please accept this paper is not entirely as presented in the original discussion -  in making this web page I have inserted/added many comments and conclusions to make it more readable and to answer unasked or answered question.

Question. 3. If we are understand the suppression - is it not best we review and comment on the discussion paper first?

Answer. 3. Indeed it is, let us start.   


The Discussion. 

Sleep Apnea Diagnosed Immediately After Heart Attack May Resolve Itself; Delayed or Repeated Sleep Tests May Be Preferable.

Section 2.

Question. 1. It is stated; Conducting a diagnostic sleep test shortly after a Heart Attack can help Doctors rule out Sleep Apnea in Patients? What does this mean?

Answer. 1...

A. If one was in possession of the answer to the conundrum. "What came first the Chicken or the Egg, it may well be an answerable - other than that is it just an answer to the old age Medical Sciense adage of; "Watchful waiting."

B. Meaning from a presented symptoms apply a treatment, one already knows cannot as the evidence demonstrates - cure; thus, "watchful waiting" is the time when something waiting for something tangible that can be done, like an operation or following a Heart Attack.

C. In addition; Electric Shock Paddles on the chest of a Heart Attack Victim or a night time Breathing Machine.   

Question. 2. In question 1 there was a mention of Sleep Tests. Is there a value in such tests?

Answer. 2. Tests conducted in the immediate aftermath of a Heart Attack are somewhat unreliable for positively diagnosing Sleep Apnea.

Question. 3. Who created these test results to give such an Opinion?

Answer. 3. The results it appears came from a single-center study scheduled for presentation at the American College of Cardiology’s 66th Annual Scientific Session.

Question. 4. What is the expected outcome?

Answer. 4. As a result, it may be best to repeat the test after a few months or to delay initial testing before making a definitive diagnosis and initiating treatment.

Question. 5. What is the Hypothetical outcome predicted to be? 

Answer. 5.

A. In view of the strong association between Sleep-Disordered Breathing, Heart Attack and the established negative prognostic implications of untreated Sleep Apnea in these Patients, cardiologists are becoming increasingly aware of the importance of screening for Sleep Disorders in their daily practice.”

B. Prognostic = relating to or serving to predict the likely course of a medical condition.

Question. 6.  Just who is the highly educated medical practitioner or scientists who published this - guesswork?

Answer. 6. Jeanette Ting, MB, ChB, senior resident at National University Heart Centre, Singapore and the study’s lead author, in a press release.

Question. 7.  What was the searched for outcome of such study?

Answer. 7.  It appears the aim was to determine if screening should be performed during the acute phase soon after a Heart Attack or after a period of stabilization.”

Question. 8.  If we accept. "Sleep Apnea Diagnosed Immediately After Heart Attack May Resolve Itself" what is the connection?

Answer. 8. Sleep Apnea is thought to contribute to cardiovascular disease by increasing Stress on the Heart and Blood vessels, causing inflammation, reducing available oxygen and affecting hormones.

Question. 9... 

A. I have as always to laugh when a so called Scientifically Proven paper has the word. "Thought," somewhere within?

B. How then, are Doctors no matter how clever or qualified; able to utilise such research findings?

Answer. 9...

A. Yes it is clear; if one, after much detailed scientific study still has to use the word; Thought, it is a clear indication the work is nowhere near completion - therefore not ready for publication unless of course the Funding is running out.

B. Doctors can use questionnaires to identify Patients who might have Sleep Apnea, but the only definitive test is an overnight sleep study, in which a specialist uses electrodes and sensors to monitor how often the Patient stops breathing during sleep and the length of each pause.

Question. 10...

A.  What were the protocols utilised with the. "Over Night Sleep Study," to gather the study participants.

B. And what was the outcome of the statics complied as a result of the study.

Answer. 11...  

A. For the study, researchers performed an overnight sleep test in 397 Patients treated for Heart Attack at Singapore’s National University Heart Center.

B. This initial test was conducted within five days of hospital admission.

C. A subgroup of 102 Patients underwent a second sleep test at home six months later.

D. A total of 52% of Patients tested positive for Sleep Apnea in the initial test.

E. Forty-two percent had Obstructive Sleep Apnea, the most common form of the disorder.

F. Ten percent had Central Sleep Apnea, a less common form in which the Brain fails to properly signal the muscles that control breathing.

G. About a quarter of the Patients underwent a second sleep study after six months.

H. A majority of the Patients initially found to have Sleep Apnea showed a change of status in the follow-up sleep study.

I. Among those initially diagnosed with Obstructive Sleep Apnea, 46% no longer had Sleep Apnea at the 6-month test.

J. Among those initially diagnosed with Central Sleep Apnea, 83% were found to have Obstructive Sleep Apnea at the 6-month test.

K. The vast majority - 93% of those initially found to have no Sleep Apnea, remained Apnea-free at six months.

L. Overall, Patients with Sleep Apnea were older, had a higher body mass index - BMI and more often had High Blood Pressure compared to those without Sleep Apnea.

M. Patients showed no significant change in BMI between the first and second sleep tests.

N. The study bolsters evidence from previous smaller studies suggesting Sleep Apnea diagnosed immediately after a Heart Attack may resolve naturally over time.

O. In addition, because different types of Sleep Apnea may require different treatments, the change in Apnea type observed in this study underscores the need for repeated or delayed testing after the initial hospitalization for a Heart Attack.

P. Finding the optimal timing to screen for Sleep Apnea is important because of the need to avoid unnecessary treatment in People whose Sleep Apnea may resolve over time, while identifying those who truly need to receive treatment to reduce their cardiovascular risk.

Q. Making accurate Sleep Apnea diagnoses also has a bearing on health care costs.

R. It is important to determine if the Patient truly has underlying Sleep-Disordered Breathing,

S. Ting says. A repeat sleep study six months later on those found to have obstructive Sleep Apnea or Central Sleep Apnea should be considered before commencing therapy.

T. Alternatively, deferring the sleep study to six months’ follow-up may be considered.”

U. The study was limited by a small sample size.

V. In addition, the baseline sleep study was conducted at the hospital while the second sleep study was performed at the Patients’ home, which could have influenced the findings.

W. The researchers plan to further analyze the data to assess how Sleep Apnea might affect measures of Heart Function.

X. Ting will present the study, “Prevalence and Evolution of Sleep Disordered Breathing in Acute Myocardial Infarction,” on March 19, at 9:30 AM ET at Poster Hall C at the American College of Cardiology’s 66th Annual Scientific Session in Washington.


A. Lots of numbers and percentages expressed in many different formats - do these numbers really give an accurate analyses of these two sets of symptoms, or are they so complicated even the researchers/writers do not understand them or - is Item W, a perfect demonstration, they do not.

B. Let us accept; to the researchers the numbers do make sense - how does this balance out or equate to anything other than of Novel but not scientific interest in the understandings; when the true cause of either of the listed symptoms remains unknown.

C. Moreover - the understanding of impact of multiple pre existing symptoms, with or without any form of medically approved treatment and the effect the entire body chemistry has as a contraindication  for or against any of the presenting symptoms and medications prescribed, that in reality was an Initiating  or contributing cause to the Heart Attack and the Sleep Apnea.   


Section 3.

Too important to not share;


Section 4.

Julia Worrall RN, CCRN

A. I find this study disturbing.

B. It is likely that undiagnosed, untreated Sleep Apnea led to the Heart Attack in the first place.

C. How accurate are the Harvard Science Technology's in diagnosing adrenergic responses and Heart Rate variability?

D. What medications did the Patient start on that could modulate these responses?

E. Why would they do the initial one with a PSG and then switch to HST?

My concern is that putting this info 'out there' with 'minimal sample size'... and with much more research to be done... and risk minimizing the need to aggressively treat Patients - in order to prevent ANOTHER MI - Myocardial Infarction or CVA - Cerebral Vascular Accident?

Conclusion. Peter Smith.   Is it not fair to suggest any treatment without knowing and treating the true cause is not scientifically proven medicine - it is an opinion.


Section 5.

Tim Mickiewicz, D.D.S.

A. Get your point.

B. But the bigger picture is about awareness by Patients and Doctors.

C. If it stimulates our highest risk patient. white middle aged guy. same demographic as highest Cardiac Risk, it may be enough to stimulate a conversation with their Doctor.

D. We can all fudge data to get the result we want.

E. These posts can be dissected by a top cardio or it could be seen by lay public.

F. We have to hit all markets not cherry pick Smart People only.

Conclusion. Peter Smith. Is it not fair to suggest; as the recent evidence from some of the leading governing bodies and publication so relied on as the foundation Medical Sciense rests on - has published so much of the Scientific Data that is clearly not correct or even in some instances of fraudulent conversion.


Section 6.

Julia Worrall RN, CCRN



Section 7.

Peter SMith


A. I do so have to laugh at items as this as this extract demonstrates. Sleep Apnea is """"thought"""" to contribute to Cardiovascular Disease by increasing Stress on the Heart and Blood vessels, causing inflammation, reducing available Oxygen and affecting Hormones.

Kindest regards and best wishes,

Peter Smith Talking Cures.

Conclusion. Peter Smith.

A. One should look at this information as vexatious or unnecessary criticism of - the Medical Profession and the many front line professionals who dedicate their lives to helping others in desperate need.

B. This is not the intention for the use of the word. "Thought," in any scientific paper - surely means, "we do not know very much, or we have a lot to learn."  



Lynn Hendrickson

Peter will you offer more information please ?


Section 9.

Peter Smith

Dear Lynn,

With pleasure.

May we first look at the word. “Thought,” for any paper with this word in it - in the year 2017 is surely only a demonstration of Nothing is known of anything but Novel yet no Scientific Value.

Thus cannot or should not be so called Scientifically Proven; as it is no more than an opinion.

May we explore a couple of Tim's comments - that are so true…

“We can all fudge data to get the result we want....

We have to hit all markets not cherry pick - smart People only.”
F. When one looks around the world - still today, there is not one definitive cure for one illness and management only lasts a very short-time compared to the effort expended.

G. Therefore we can conclude from Tim's comments - The entire Medical Profession is for Customer provided profit only; thus there are no Smart People to talk too for if there were...
...Someone would have the common sense to ask. “Why,” which of course they are not allowed to as such comments are not Scientifically Proven.

I. May we now address the eloquence of your question.
Still Today; I have never once in 35 years read a Scientifically Proven Paper worthy of reading past the Abstract.

K. If we just take the symptoms, listed in this paper. Heart, Blood problems and pressure, Sleep, Breathing Concerns, Weight Concerns - not only with any one of these symptoms presented on their own, can scientific medicine create a cure, sadly, are only able to improve for a very short-time or until another symptom takes over.

Thus - as a result of this extract from the attached paper. “The researchers plan to further analyze the data to assess how Sleep Apnea might affect measures of Heart Function.”
M. It is clearly defined when symptoms are concomitant with others - they are not only able to do nothing at all about, let alone of true scientific value.

1. Concomitant:
happening at the same time as something else.

N. Only seek further funding for further failure as taught by their University and Medial School.

Kindest regards and best wishes;

Peter Smith Talking Cures.


Section 10.

Lynn Hendrickson

Interesting points.

Thank you for your responses;

A. Are you saying too difficult to isolate factor of change or catalyst for improvement when concomitant disorders are measured?

Conclusion. Peter Smith. It is always such a pleasure to responde to polite questions as yours Lynn.


Section 11.


A. Sadly anything before its initial presentation makes even a Simple Pain symptom far to complicated for Medical Science to comprehend.

B. After that all is lost and for profit only.

C. For once Simple Pain has defied any form of management as it will - if it does not self repair, then only another name will scientifically suffice - say Acute Pain from then on it is all laughable.  

Kindest regards and best wishes,

Peter Smith Talking Cures.


Section 12.

Julia Worrall RN, CCRN

A. The US National Task Force for Preventative Medicine recently concluded that there 'was not enough evidence' to conclude that Patients either should or should not be screened for Sleep Apnea because the studies out there are on People who were referred to providers based on suspicion of high risk factors and not on the general public.

B. This is so frustrating and definitely sends the wrong message... so to all you providers out there... Start screening EVERYONE, even those you do not believe have risk factors.

C. We need to gather these numbers too apparently... by The Scientific Method!

Conclusion. Peter Smith.

A. Is there not sufficient evidence in these few words to explain all that is required... 

B. '...Was not enough evidence - therefore - We need to gather these numbers too ... by The Scientific Method!


Section 13.

Kevin Asp
It looks to me like they need to focus on the different findings between the in-lab sleep study vs the home sleep test!

Conclusion. Peter Smith. The sad part about this revelation is - No one in the medical community ever does takes the unwitting message of this and acts on it.


Section 14.

Tim Mickiewicz, D.D.S.

A. It is not a health professional audience, though they need a kick in the pants.

The picture says it all.

The average Person will see the picture and a few key words.

We are so caught up on graphs and stats and, "studies." 

. What about awareness.

Mental pictures may stimulate the Brain to associate with a thought process to perhaps change your lifestyle... agreed Peter???

lose the complicated overthink. make mental associations try a new tack. what we do now is not working.

Written sitting in a hospital.

Conclusion. Peter Smith...

Item D say all that is required and Item G would read so much more interesting if the word Brain - no more than an organ of the Body was changed to Mind - our Master keeper of all life's information and chemical instructions for life.

B. Item F suggests - Mental pictures to stimulate the Brain to associate with a thought process has most serious merit, if indeed one knew how to create such a stimulus and then follow it through via the entire body chemistry by making the connection with the presenting biological symptoms.


Section 15.

My Response. 

Dear Tim.

A. Love this comment of yours. "lose the complicated overthink. make mental associations try a new tack. what we do now is not working - written sitting in a hospital.

B. Sadly for all the effort our dedicated front line clinicians expend - the only outcome is failure, all because the profession, still persists in the Dr Jekyll and Mr Hyde process - the Mind does not exist.

C. Thus, the Medical Profession in everything they write as scientifically proven only demonstrate mostly within the abstract of any Paper; it is designed to fail.

D. Making the profession the only Business in the world ever never once to improve its product outcome.

E. For everything our dedicated physicians do only makes People worse.

F. Thus the system is not broken it has never been fixed.

Once this is incorporated into complicated over scientific thinking and this is recognised, we all will benefit instead of Dying For the Cause as we always do.

Case in point, you cannot call the part of the profession that call themselves Mental Associations when they use drugs that only makes People drugged passive, angry and frustrated so they require putting in a strait jacket.

Are these People so blinded by their lack of knowledge, not to be able to see all this does is confirms the original emotional lead jacket that created Simple Pain and Fatigue in the first instance, that in their efforts, clinicians only converted into Sleep Problems, Sleep Apnoea and Heart conditions - they can only play with symptoms never ever improve.

Kindest regards and best wishes.

Peter Smith Talking Cures.

Conclusion. Peter Smith. Is it not time we all recognised the heady days of Medical Scientific Proof at the hands of the Medical Profession are "over and done with" as still in the year 2017 there are no cures for any illness and all other therapies follow like lambs to the slaughter - for no one will accept the Mind causes all illness on instructions from our Parents. 


Section 16.

Kevin Asp

A. It is not complicated to ask for the specifics before throwing out dangerous misinformation like this.

Conclusion. Peter Smith. Illness is not complicated - only complex made so by medical science writing papers so complicated and ever going around in circles; even they do not understand.


Section 17.

Tim Mickiewicz, D.D.S.

A. Watching a Cardiac Patient struggle to breathe.. diagnosed with Sleep Apnea when I spent the night with him a year ago.

B. 20 years of Cardiac Issues... no one looked at the obvious... Is CPAP a blessing.

C. At 90 years old its quality if life not quantity.

Conclusion. Peter Smith. Item B is a perfect example of Medical Mind Absent Blindness - thus a new symptom; is for the attending Doctors Anxiety relief and nothing to do with the now long suffering Patient at all. 


Section 18.

Julia Worrall RN, CCRN

A. Very Frustrating!

B. I advised a Doctor the other day..."My Patient has Severe Sleep Apnea, he sleeps sitting up in a chair, snores and stops breathing even sitting up!

C. Has not laid down in his bed for a few years now.

D. Doctor says, no, it is not Sleep Apnea, it is Heart Failure. this is a chronic condition.

E. I said, "it became chronic because no one has ever addressed his Sleep Apnea."

F. I see a flash of realization cross his face, but then he decides to 'Stick with his original diagnosis' and discharge the Patient anyway.

G. Good thing his wife was receptive to my education and promised to follow up with FMD.

H. Let us hope they are more receptive.

Conclusion. Peter Smith. Item E goes some way to understand the unfortunate mans plight - yet only ends up hiding the total failure of Medical Sciense to understand Sleep Apnea is like a fruit on a tree - many symptoms; all from a lonely seed.


Section 19.

Robert Dawkins, PhD, MPH

1. Obstructive Sleep Apnea Syndrome is not just a plumbing problem.

2. Respiratory control loop gain is important in Obstructive Sleep Apnea Syndrome and Complex Sleep Apnea Syndrome.

3. OSAS & CSAS and complex SAS and Mixed Apnea constitute a spectrum of sleep related respiratory disturbance.

4. Compromised cardiac function contributes to CSAS  - clearly and well documented and to OSAS.

5. Myocardial Infarction  acutely compromises Cardiac Function.

6. PSG immediately post MI may, therefore, return elevated SAS - whether OSAS or CSAS depends on multiple factors and HST is not appropriate for a post-MI SAS evaluation.

7. Regardless of whether the SAS was preexisting, cardiac treatment & rehab post MI may improve Cardiac Function sufficiently to improve respiratory disturbance to normal.

8. Similarly, we have long found that CABG sometimes correct OSAS and snoring.

9. Which brings us back to OSAS is not just a plumbing problem.

10. Post-MI PSGs should, therefore, be repeated in one year.

Conclusion. Peter Smith...

A. Whether as a Professional one understands this or not; pales into insignificance to a Patient already compromised by, if nothing else lack of sleep quality and their ability to comprehend the message.

B. Is this not a clear and unambiguous demonstration of the revolving door of Scientifically Proven Medicine.

C. Revolving Door of Scientific Medicine = One specialist or Doctor prescribes a treatment - manages with drugs symptoms for a while.

D. Time passes new Symptoms arrive = Another Specialist and now new medications for the presenting symptoms.

E. Time passes a Heart attack arrive appearing to cure an earlier symptoms - Sleep Apnea.

F. No one notices; it is the failure of the seemingly successful treatment of the earlier symptoms that caused the Heart Attack - this being more life threatening and serious than the Sleep Apnea and as we humans by and large are only able to carry out one task at a time. we have no option but to stop the Sleep Apnea as we have been in the background creating a Heart Attack in the vain hope someone will understand.

G. Sadly as one ever does - once the Heart Attack has been stabilized the Patient goes out the door only to be revolved at a later date into another door; with even more and mysterious symptoms. 

H. Lest we forget:- Everything about the body and it ability to function is a Plumbing or an Electrical System - thus if one part fails to function as designed; then all functions cease.


Section 20.

Tim Mickiewicz, D.D.S.

A. So in a few days 600 people will have viewed this. the data is a bit contradictory, note it is to be presented at a cardio meeting.

B. I agree with you Kevin, studies that show no connection of OSO to Cardio, denying oral appliance efficacy.

C. This field is becoming as fragmented as the old/current Temporomandibular joint - TMJ, controversy.

D. I am again trying to raise awareness sometimes devil advocacy is the only option.

E. I must say that I love what you put up.

Conclusion. Peter Smith.

A. Does not Item C say it all or send the correct message to the 600 People and or Medical professionals who will read the many comments in this discussion.

B. Moreover does not Item D confirm not only the validity of Talking Cures comments but the necessity.


Section 21

Kevin Asp



Section 22.

Tim Mickiewicz, D.D.S.

Now 900.... People love a good craic - Irish for chat!


Section. 23.

Tim Mickiewicz, D.D.S.

I must say Kevin, I love your posts and routinely forward to my network and Facebook, with proper credit of course, I appreciate your input.

Best Tim.


Section 24.

Tim Mickiewicz, D.D.S.

A. Peter are you suggesting that your way is a portal to immortality? or at least a life; "disease free"?

Conclusion. Peter Smith. Now I could but will not take this as a Barb for me to get hooked on.


Section. 25.

My response:-

Dear Tim Mickiewicz, D.D.S.

A. Many thanks for your question, which I am delighted to answer.

B. I do try my best not to come over as. “I am right and everyone else is wrong by default, just because I say so.” 

C. For there is no question in my mind everyone is doing their very best with the tools techniques and understandings they have to hand.

D. Thus, I can safely allow the entire medical profession to do this - "they are right and everyone is wrong because they say they have the Scientific Proof" - based on the security of thousands of years of the inability to demonstrate illness is in the slightest understood and as a result, a cure created; with the use of two words. “Symptom Management.”  

E. This to a Patient only panders to the Emotional Phenotype of the Person - The image we show to the world as a result of our entire Memory history.

F. Manage symptoms and the Mind will create sometime in the future; a new set of even more mysterious symptoms.

G. Yet no one ever recognises or owns up to this well documented fact. Symptom management makes People/Patients even more ill.

H. Moreover, the ill Person loves it, because it enables them to sustain the protective wall around the Person(s) that caused the illness by keeping up the pretense the illness is - in the body; when in reality it is only a process of the Mind, thus no more than a projected image on a wall.

I. Even when it can be seen with imaging devises the body is being destroyed.

J. In order to answer your question; “is your way a portal to immortality? Or at least a life "disease free."

K. Let us take a deeper look at the efforts of Medical Science - who collectively and over many thousands of years have only created a Long-Term Medically Assisted Death - or perhaps we may say; many of the “Diseases” you speak of being free from.

L. Since time began, one can accept Mankind has suffered many illnesses that have taken Lives too early and Medical Science has improved the quality and quantity of life.

M. Were that to be really true, we would not be required to have this discussion.    

N. Therefore, there has to be another way at looking at Mankind’s suffering.

O. A problem I solved 35 Years ago and ever since have worked on the protocol. “If a Patient desires symptom  management. I will unreservedly support them with their efforts."

P. However, no matter how much they scream at me to assist in managing symptoms - of which I am very able, not under any circumstance will I. For to do so will only assist in their long-term Mind created Death.

Q. This may appear very barbaric - rest assured; I would not do this if there were another way - which clearly Medical Science on their own; demonstrate all the time; there is not.

R. Working on the principle “All illness even congenital deformities are not in the slightest Genetic - Genes or DNA, are a use once process and life is only a working copy of Genes in constant flux as a result of our thoughts - be they Good, Bad or Indifferent.

S. From this, we are able to see. “Illness is no more no less than an expression of our entire body chemistry - perfectly balanced at ALL times, no matter how ill or close to death we are.

T. Interfere with this chemical process with management techniques - no matter how it is professed are Scientifically Proven; at ones peril.

U. Based on our Individual Perception of how to react to our thoughts and memories. Negative of course; we create illness and disease.


1. It is the efforts of Medical Science and the true creators of illness that seek through their Children -  in a vain attempt for them not to grow up and suffer in the same manner as they did, who in turn maintain the Family and or Traditional Values and Secrets. Parents - that take away our ability of a - disease free long life.

2. Surely if we all were to - if we have to use such a word, Consciously - there in no such thing, accept this, then the future generations will develop the ability of a long-term Disease Free Life.

3. As a fundamental Right - not a gift, for being a good Boy or Girl or thanks to and as a result of very short-term symptom management.

4. As for immortality. Only Fools attempt to predict the future, however as I tell a Patient with many mysterious symptoms tossed aside by many that have tried their best and not succeeded. “We do not know what we can do with that symptom," but that is not going to stop us working toward you being symptom free, living a life until you decide it is time for you to leave this Life and go back to living.

Kindest regards and best wishes,

Peter Smith Talking Cures.


Section. 26.

Reply from:-

Tim Mickiewicz, D.D.S.

A. Interesting take, given that life span has increased with such simple realizations that you should wash your hands...

B. So medical science has some redeeming qualities...

C. No genetics... well your fellow British may disagree,

D. Genome mapping and prevention of gene expression to avoid debilitating and life threatening deformity is worth it...

E. We have one of the top cardio programs in the nation right down the street.. doing valve replacement surgery on a fetus to save it's life...time and money worth spending...

F. So sorry not all disease is a somatization disorder.

G. Yes I read your floral prose, metaphysical discussion from a scientist trained in a great books curriculum is certainly a fun exercise over tea.

H. But, I need to defer to some of the others that are sharing their experience with dissection of the science presented pro’s and con’s...

I. And I can take the con arguments with grace and appreciation...

J. By the way; this post will hit well over 1000 people in several days’ time...

K. So you are getting lots of press.

Your welcome...

Best to you, cheers,


Conclusion. Peter Smith. A Person with somatic symptom disorder (SSD) is not faking his or her ... Somatic symptom and related disorders - they are almost exclusively caused by Symptom Management.


Section. 27.

Peter Smith Talking Cures

Dear Tim

1. May I take the above comment or yours as posted on LinkedIn discussion you posted, as it had no polite salutations it was indeed intended for myself?

2. Thus, I am content as always to respond politely and in detail to the question you posed me however; this passive approach - must not be considered, a weakness.

3. For this post could well reach every Medical Professional and their allied associations in the world, not only would I be delighted, moreover would stand my ground against all of them.

4. I found your use of the word; “somatization disorder,” quite intriguing, leading me to update my understanding to this current meaning behind the words.

5. I feel quite sad for any medical professional and it confirmed my opinions are more worthy than all the science currently available.

6. On the sound bases Talking Cures is a completely New Science - that not only understands the Mind and its Chemical Electrical Activity via the Organ called the Brain, through to the entire Body; that, if of a negative nature will cause all illness.

7. More importantly guides a Person often with many disorders of Mind and Body tossed aside by many Professors consultants and specialist Doctors and Therapists as no longer interesting or even novel - just another Heart Sink revolving door Patient.

8. May we review the current understandings of:-

A. Somatization disorder - also cutely renamed Briquet's syndrome, which, “was” a “mental disorder,” characterized by recurring, multiple and current, clinically significant complaints about somatic symptoms.

B. Although it is no longer considered a clinical diagnosis.

C. It was recognized in the DSM-IV-TR classification system, but in the latest version DSM-5, it was combined with undifferentiated Somatoform Disorder to become Somatic Symptom Disorder, a diagnosis which no longer requires a specific number of somatic symptoms.

9. ICD-10, the latest version of the International Statistical Classification of Diseases and Related Health Problems, still includes Somatization syndrome.

10. Is this confused or just Scientific Guesswork - worthy of a fresh amalgam filling.

11. If not please show me a Scientific paper on any disorder  that will make me change my Mind.

12. In addition, “somatization disorders”  are clear description - all illness is not only Mind created but the then ensuing biological illnesses are in fact Scientific Medicine created, yet hidden by ever changing names.

13. Therefore one could consider the words, “somatization disorder” Scientific guesswork or perhaps we should be Posh and say “Hypotheses.”

14. Interestingly No British Medical Professor or Professional, ever challenges me - is this because they have no answers or real scientific proof and use discretion is the better part of valour as a defense.

15. Or better said - they have the wisdom and Integrity to know I am speaking a truth that they have never once been allowed too.

16. There can be no question the skill of our dedicated Doctors and Surgeons not only in the USA but all over the world are doing a Stirling job that sadly your use of this. “We have one of the top cardio programs in the nation right down the street.. doing valve replacement surgery on a “fetus” to save it's life... time and money worth spending..."

17. Only seeks to confirm my argument the Item in discussion is no more than a“somatization disorder,” if indeed we have to use such useless meaningless words.

18. To justify this one has to have a secure understanding of the Mind and Body Chemistry to make sense or start to understand this. Sadly, Medical Science will destroy itself before this happens.

19. Moreover, as you suggest. “Genome mapping and prevention of gene expression to avoid debilitating and life threatening deformity is worth it...”

20. Continual failure to understand the Human Mind that cannot speak any animal talk will only confirm this procedure as exciting as it may sound - is only for the researchers funding and perhaps a Noble Prize.

21. Thus of short-term novel but no long-term scientific value; if the ensuing health of the Person throughout their life is not considered - a consequence of the brilliance of interfering with the Use Once Genetic Structure of Humans and indeed Animals.

22. All confirmed if one is unable to comprehend ...In illness even congenital... 

...The Mind/Brain/Body is not in the slightest doing something wrong, it is desperately trying to right a serious and terrible wrong?

23. May I in conclusion refer to your comments:-

A. And I can take the “con” arguments with grace and appreciation...

B. Yes I read your floral prose.

C. Certainly a fun exercise over tea.

24. It is always a pleasure to debate with a Professional and debate we must; for. “We all have a lot to teach and a lot to learn and learn we must.”

25. Sadly, the professionalism is somewhat lost with the Dr Jekyll and Mr Hyde comment as contained in items 2 and 3.

26. Am I supposed to apologise and crawl away self-worth in tatters - being the foundation the entire medical profession stands on.

27. Thus in so doing hiding up the long-term miserable failure this discussion. “Sleep Apnea Diagnosed Immediately After Heart Attack May Resolve Itself,” clearly demonstrates.

28. There are no medical books ever written or scientifically proven peer reviewed and published papers worthy of reading - as there are more People ill today than ever, even taking into consideration the rise in population.

29. People in Pain alone. It is reported there are 100 million American who suffer.

30. In addition there are 100,000 illnesses recognised and diagnosed in the world and not one of them is the true cause known and not one of them has a definitive cure = no more illness and no more medications.

31. One does not require to be a Mathematician to work out the Numbers of People profitably ill.

32. Including close family members and loved ones of those that deem suppression of new and innovative ways of understanding and treating illness by Floral Threats is acceptable in the year 2017.

33. This is my truth now tell me yours - change someone's Mind.

Kindest regards and best wishes,

Peter Smith Talking Cures.


Section. 28.

Tim Mickiewicz, D.D.S.

Dearest Peter.

Indeed your amazing sense of perception discerned the comments were meant for you.

B. Not sure if I am the only medical professional that you love to challenge directly.

Sad there is not a single doc in the United Kingdom that will take on your unconventional take on disease.

Serious question here, is that due to them being forced to provide service in a rationed nationalized health system?

E. For the record my introduction to the Pain world started 35 years ago.

Thrust upon me as I became a Doctor of last resort in a public health setting and I am sure this saddens you.

I have always practiced surrounded by physicians an thoroughly enjoy the access to some great minds and compassionate People.

H. Of interest on your Mind Body connection there was an older study at the multidisciplinary Pain Center that I did a residency that studied; "cryptotrauma," we would get the unsolvable, there were ancillary providers, psych, biofeedback, patient etc on staff and there was an amazing proportion of sexually abused patients that presented...

I. The info came out in the psych interviews and us admittedly tunnel vision Doctors thought we could manage their Pain with a piece of plastic.

So I wish I had more time to debate.

I have a slammed schedule of brain induced orthodontic crowding I need to deal with.

If I ruffled your feathers, good.

M. You can take on the whole medical profession and dismiss them as charlatans lacking any sense of brain power, creativity and compassion.

N. Guess I am speaking for at least a few of them...

By the way we are at 1600 views... glad I can help spread your message.

To be continued.

Best wishes.



Section. 29.

Robert Dawkins, PhD, MPH

You have more patience than most, Tim Mickiewicz, D.D.S.!

Comment. Peter Smith. I have to consider this was in intended for Talking Cures appearing to try Peoples Patience. 


Section 30.

Tim Mickiewicz, D.D.S.

A. We all have our cross to bear Robert... I have been trading commentary with Peter for some time.

B. Hard to get your head around the metaphysical, Cartesian window to the soul...

C. Not claiming I have that magic ability..yet...

D. I am sure Peter will educate me.

E. Follow his links for fun.


Conclusion. Peter Smith.


A. Pertaining to or of the nature of metaphysics.

B. Is a Philosophy concerned with abstract thought or subjects, as existence, causality, truth or with first principles and ultimate grounds, as being, time, or substance.

C. Is therefor highly abstract, subtle, or abstruse - designating or pertaining to poetry of an early group of 17th-century English poets,  whose characteristic style is highly intellectual and philosophical and features intensive use of ingenious conceits and turns of wit.

D. Thus when introduced into the medical field of Mind created illness is Archaic. imaginary and fanciful.


Section. 32.

My response:- 

Peter Smith Talking Cures

Dear Tim

A. No Tim; you are not the only dedicated professional I share my erudite knowledge with - of the interaction of our Mind and its Negative Thoughts, via the Brain into the rest of the Body to cause what Medical Science terms as Medically Mysterious Illnesses all with unknown cause and with no known cure.

B. I write and share in such a way as to bring my findings to the World - all puppy-eyed looking to their Dedicated Doctors looking for the cure or even long-term-relief that; strangely never comes.

C. This I do willingly and all free of an upfront or hidden Fee - money only corrupts the Mind and the outcomes of treatment studies.

D. To respond to your. "Serious question."

E. It is the Medical Profession that has an Unconventional View on illness.

F. For No One ever becomes fully well from the efforts of the dedicated Doctors only carrying out instructions from Medicals Science who say the only way to cure you is with a piece of Plastic - I call that a credit Card or an unrestricted insurance policy...

...Thus Patients become CUSTOMERS -VICTIMS.

G. Being Mind and Body Well equals - No more illness and no more medications.

H. Surely Tim.  Being a Doctor of last resort should put you fair and square on my side - as with your comments you demonstrate"the medical profession is seriously ill."

I. Whilst I can make serious side splitting fun of this. "Cryptotrauma;" a study where researchers  would get People with unsolvable - symptoms.

J. Is it not a confirmation within the comment you made this was shelved - or not pursued;  for it demonstrated the truth behind illness at the expense of the well health of the study participants...

K. Such intelligence defies logic. 

Cryptotrauma and "Accident Neurosis."

L. Accidents may often have been far more traumatic psychologically and emotionally than appears to be the case at first sight.

M. Attention is drawn to such "Cryptotrauma" and illustrated with three clinical vignettes.

1. Vignette = a brief evocative description, account, or episode, demonstrating a small illustration or portrait photograph which fades into its background without a definite border.

N. Emphasis is placed on the need for painstaking analysis of the accident in all its details.

O. Without such careful investigation "Post traumatic stress disorders" can easily be overlooked, since Patients tend not to offer the information spontaneously.

P. Tim you do not have the integrity nor wisdom to ruffle my Feathers.

Q. As the main thrust of my education is clear. "It is Medical Science that very cleverly makes all practitioners into what you describe as Charlatans.

R. Surely it is this as Robert suggested; should try ones patients.

S. If there were 7 Billion Views this could still not ruffle my feathers nor shake me of the sound knowledge...

T. "The Mind and its store of Memories if Negative vie the entire Body Chemistry - creates all illness."

U. I find this comment of yours"Hard to get your head around the metaphysical, Cartesian window to the soul." Quite amusing and extremely sad.

V. With all the intelligence you accuse me of dismissing - no one in the medical field has worked out; this is a demonstration of the generations of back to Front thinking perhaps created by Rene Descartes and if I read you correctly his still practiced.  "Cartesian window to the Soul."  

W. For he was not correct then and anyone that follows this doctrine is committed to Symptom management of short-term duration aided and abetted by the use of the word. "Soul," an organ of the Body that even with the very latest imaging devices; medical science would find impossible to find - thus is for Philosophers and metaphysical Dreamers FUN.

X. Speaking of the word Fun in this context - I would take this discussion you posted as being for fun only - and nothing to do with many People that have Heart Conditions Myocardial Infarctions and following the dreaming their Medically Created Apnea will self resolve; when there is no known cure for Sleep conditions at all; let alone Sleep Apnea.

Y. For clarity - May I explain. - You nor anyone else not even myself - have now or ever will have, the Integrity and Wisdom required; as many have demonstrated so admirably this last Thirty Five  years - to destroy my last Thirty-Five and indeed Seventy Three near Years constructing  as I have; the understanding of The Human Mind and its daily activities.

Z. Tim I really do appreciate you are very busy - thus, this webpage is for the world of sufferers and practitioners to view. And make of it as fits their desire.

Kindest regards and best wishes,

Peter Smith Talking Cures.



Tim Mickiewicz, D.D.S.

Dear Peter,

A. kindly delete from your blog your feelings regarding my lack of integrity and wisdom because i wont blindly follow your philosophical musing.

B. It is slanderous and arrogant.

C. Stop hiding behind pretty words.

D. I have yet to see any "proof" offered by you besides your opinion. yet you demean well meaning providers for their lack of evidence.

E. I Thank you for a quick response,


Conclusion. Peter Smith.

A.   There is nothing you could say or even threaten me with - that would make me remove my comments regarding your Integrity and Wisdom - for if I did I would be agreeing with the constant stream of Scientific Proof that comes out of the medical profession - where the reality is they could not cover a piece of confetti with it, without leaving room for a big Magnum Opus body of work.

B. Ignorance of the law is no defence slander only occurs when the information published written or spoken is not the truth. However I forgive you for what may well be construed as Slander - these Published words of yours; apparently aimed at myself: floral prose, metaphysical discussion, a fun exercise over tea. ETC.

C. If we accept; I hide behind Pretty Words as you suggest. What does than make of the words of Medical Sciense that never once demonstrates - although it says with great eloquence. "It has the Scientific proof."

D. Yet in the abstract of every written paper or within the introduction or main body it always says; "The cause is not known or well known and more research has to be done to establish the cause and a cure is not available for any illness.

E. Or this last part better said. "There is no known Cure for any illness." These really are Pretty Words.

F. I am of a sound belief there are Scientifically Proven some Seven Billion People on this Planet and every one of them has a different Genetic Fingerprint and Body Chemistry and - although we must pursue treatments to cure instead of as the evidence proof you speak of makes People more Diseased, it is a necessity we all recognise all illness is Unique.

G. Any reply I make to such a demands as you make  - will be in a time representative of a reasoned response. Thus not as a Ruffled Feathers activity.   


Section. 34.

Peter Smith Talking Cures

Dear Tim and Robert.

A. I do appreciate you are both very busy - Yet I can find NOTHING, "Funny" in this or any ill health, thus I have responded for the world to share in the discussion.

I have recently been requested to write, demonstrate and answer as yet unanswered questions on the Link between Narcolepsy and Anesthesia by an Anesthesiologist.

Kindest regards and best wishes,

Peter Smith Talking Cures.

Conclusion. Peter Smith... 

1. It is interesting to note at the time of including this information 28th March 2017.

2. Not only has there been no input from the Anesthesiologist who requested I write the Paper as mentioned - also I sent out a request to some Ten Thousand Anesthesiologists and Pain management specialists - to date not one of them has proffered a question.

Leaving one to consider Medical Sciense does not require answers - only profit from failure and more Customer-Victims.   


Section 35.

Robert Dawkins, PhD, MPH

Here is some help with your Narcolepsy essay, Peter Smith Talking Cures.

Edgar Allan Poe in Eleonora, 1841, described Narcolepsy before the medical community did, 1877:

“They who dream by day are cognizant of many things which escape those who dream only by night.”

And on this one, you are right when you tell someone...

"...It's all in your head."

Conclusion. Peter Smith. It is always a delight to receive information as this.


Section. 36.

Peter Smith Talking Cures


Well thank you kind Sir.

A. I will if possible enter the information you have provided into the paper.

For Poe had it correct and Scientific Medicine would be all the better today - had he been listened to and indeed he understood what he was saying.

May I correct you Sir; You will never ever read or hear of my saying...

 "its all in your head."

D. This is Nonsense or better said Esoteric (Only we know) Claptrap, used in the early days of medicine and still in use today, as a way of dismissing a Person simply because the attending clinicians do not know what caused the presenting symptoms and disorders; Never had - nor have any remedy to even sooth illness symptoms for a while.

E. Thus the correct and perhaps my Unique term is.

F. All illness even Congenital is.

“A Process of the Mind."

Kindest regards and best wishes,

Peter Smith Talking Cures.

Conclusion. Peter Smith.  

Leaving one to consider - if the true cause of congenital illness was known and addressed the huge numbers of Children having to be operated on in the womb or their early years may well drop to near Zero.

H. Or was it Vaccines or the management of symptoms in the Mother, or growing pre teenager Mother to be, responsible for causing the Congenital illness, if this is so how many other illness Children develop from birth to Motherhood are medical created.  


Section 37.

Tim Mickiewicz, D.D.S.

Oh Peter,

A. Learning is fun..
few People will take the time to go to the links you provide.

B. If they are to better appreciate your philosophy, they can do as I have and spend time perusing your philosophical musings.

C. I was merely suggesting that the good Dr. Dawkins may glean some positive information and indeed he did. 

As previously stated I was not educated in faceless classrooms and had the joy of a challenging Great Books approach steeped in the Socratic Method of learning.

We science geeks though a double major in Biology and Chem. did not just fill in bubbles on a scantron, we were taught to think critically and write all answers in essay form.

F. You may think it an oxymoron that I still cling to my values in Medicine and do not blindly embrace your constant barrage against the medical community.


Section 38.

Sara Barrett.

Too bad they did not go to the trouble of controlling the testing methods, environment, or obtain a statistically significant sample size. Interesting hypothesis.

Conclusion Peter Smith.
If we change the words Interesting Hypotheses into Interesting Guesswork, we see through to the truth - it is the final published papers so called scientific proof where the control is required.


Section 39.

Peter Smith.

Dear Tim,

A. Sadly I do not demean well meaning providers - quite the reverse; Medical Science does this very eloquently and constantly and scientifically proves it as this discussion demonstrates.

B. With all of the Might of Medical Science over thousands of years - never once has it produced any studies that Scientifically Prove the cause of an illness in known and there is a cure = No more illness and no more medications.

C. Please do not respond with Vaccinations - these are meant to be Disease avoidance medications; yet the evidence is now suggesting they cause many more illnesses than they avoid.

D. These valid points leaves the way open for a New Science that you will not find in the books you refer too - that are only the foundation of the failure of Scientific Medicine, continued blindly today as the Gold Standard.

E. At all times I do my utmost to show People the highest respect especially if they are unsure on a subject and yes give my Hard to Fathom Opinion view on a subject as you will have observed in this discussion.

F. May I repeat no one has the Integrity And Wisdom whether they use clever words or Medical Obfuscation nonsense - Not even myself, to suppress Talking Cures Truth.

Did not Thomas Wakley creator of the medical bible The Lancet say.

"This is my truth Now tell us yours"  

G. If the truth hurts so be it; Lies like. "We have the Scientific Proof" that our many dedicated doctors dream of but never can poses, as they only see Long-Term Medical assisted Death as the outcome of their dedicated efforts. Are always suppressed from publications.

H. Only to be University or Medical School educated to respond with...

"...The Person died of an unrelated disorder."

I. Suppression techniques from your recent posting - such as "Oh Peter,"  "Learning is fun"  and few people will take the time to go to the links you provide.  Only go to demonstrate the Low Self Worth Scientific Medicine has empowered you with and contributes nothing to the discussion at all.

J. Moreover your comment, "we were taught to think critically and write all answers in essay form." Only goes to demonstrate this is not the truth; were it to be so, you would be able to take my critiques and make sensible discussion from the many points I make.  

K. Leaving me to conclude; As I will not tolerate any form of suppression from any one Medically Educated or not;  I am at the moment creating a webpage that contains all of this discussion including the Nonsense paper it started with - someone has to make some sense of illness; if Medical Science and the dedicated front Line staff are not going to kill all of its Patients in its daily efforts.

L. Please be advised. I will not remove any data from my website or blog - I placed you on notice as with everyone else on this discussion. "I place the information on a Blog to ensure; the no nothing editor of a group or discussion is not in control of what is or not in the semi or public domain."

M. It is of no concern at all if People do not read my contributions to ill health - You screaming at 1600 and many more People does that very well for me.

Kindest regards and Best wishes,

Peter Smith Talking Cures.

Conclusion. Peter Smith. Reference item L.

N. For far too long People in the Medical Profession as agents for Medical Sciense and Editors - whether appointed by the medical profession or not - deem they know all about illness.

O. Moreover have the right to "censor" contributions from People either with better knowledge or information or seeking answer to previously unanswered questions.

P. This time is now Over and Done with - it stops on my watch. 


Section 40.

Tim Mickiewicz, D.D.S.

Dear Peter....

A. This "know nothing" editor is too much of a gentleman to participate in your trading of insults and barbs.

B. If you have something to share pertinent to the greater collective on this thread, feel free.

C. If you want to engage me personally, you have my direct contact info.

Kindest regards...


Peace out in California vernacular..... 

Conclusion. Peter Smith.

A. Gentleman is out for later discussion. 

B. Always I share my unique knowledge of the understanding of the complexities of illness and the ever changing face of symptoms made worse by the very medications designed or advertised to make a Person better.

C. As much as it would be nice to debate in depth with you - I have to accept there are Seven Billion People in the world most of whom may well be ill in some form or another, all desperately trying to understand why they or their loved ones are ill or dying to early in their life.

D. Therefore, I have to consider - Illness waits for no Person, so I must speak too as many as these type of discussions allow.

E. And then let them spread the word if only with raised jugular veins.


Section 42.

Robert Dawkins, PhD, MPH

Damn, I must have missed a post. :-(

Conclusion. Peter Smith. Robert - the beast is yet to come.   


Section 43.


Dear Tim

A. Had you truly been a gentleman we would never have arrived at this position in the first place.

Again may I place you and all of your highly qualified Doctors and Medical Scientists on NOTICE.

Your days of demeaning anyone that has an opinion different to that of the Medially Qualified are over and done with. 

D. The reason for this is clear - Never once has Medical Science truly demonstrated it has a worth by creating a Cure for one illness – thus it has only gained its pathetic superiority and is no more than of a Strawman opinion, by Suppression or Oppression.

Thus, those heady days of the so called Medical Science activity are by my hand and knowledge – whether I am right or wrong, is of no importance; Are Over and Done With.

Therefor, if you are as you say a Gentleman or desire to be one – then be one by following the example of a True Gentleman. That has a most serious ability and a nasty aggression of which you have seen nothing I assure you.

G. Always I seek to add to the discussion and do so in the most polite manner – only do I turn aggressive by the stupidity of the medical profession having created clones that in real terms know very little at all, with the Floral Snide Gestures to name but one.

H. Let us now return to the discussion at hand – for I feel sure there is many a mile to go before we reach a Medically Understood reason for any illness and then have the skill Integrity and Wisdom to create cures, instead of Blindly Emotional and Financial profits neither of which can be
spent when dead.

Kindest regards and best wishes,

Peter Smith Talking Cures.

Tim Mickiewicz, D.D.S.
Tim Mickiewicz, D.D.S.

Tom Rem....? read your latest diatribe when posted on your blog.

Glad you put us technically in the same lack of wisdom, lack of proof schools, same conclusions yet diametrically opposed.

It is a healthy exchange,

kindest regards,

your pen pal...

Tim Mickiewicz, D.D.S.
Tim Mickiewicz, D.D.S.

Despite the naysayers this post just hit 2500 views.

It has been interesting to see the pro and con discussion.

If we spur one patient into action, whatever the treatment modality, then it is time well spent.

keep it up.



Conclusion. Peter Smith:

A. If we may accept the story line of many of the films and television programs - we all consume some of our spare or relaxing time watching.

B. Should we not observe; so often when the town villain or village bully is intent on gaining control - do they not always; having first gathered the necessary information, gain the upper hand by saying. "If you do not do as we say we will make your family go away."

C. Working on the lifetime fact the one thing Medical Sciense has proven.

D. "We all are Children of Parents or in the main Parents of Children - even the villain and village bully fit into this concept."

E. Thus themselves have family members - therefore we must surly accept this information is bullying in reverse and is to ensure in the future all of our Loved Family Members, Close friends and associates live a Long Happy Healthy life.

F. Instead of one of illness so highly medicated as to no longer be the Person they were or should have been.        

...The Mind/Brain/Body in illness is not in the slightest doing something wrong, it is desperately trying to right a serious and terrible wrong?

The reality is; there is no such thing as Medical Science if there were; surely there would be at least one definitive cure for one illness, are we really to consider - a life time of ever increasing medication is to be considered a cure, does medication not clearly demonstrate itself as just short-term management of symptoms.

Leaving me no option but to accept Talking Cures if is only an, "opinion" is No different than the Scientifically Proven without any known illness understanding or treatment - without definitive cures is the main, thus is just for profit...

...Talking Cures with no financial gain desired - is for education of us as a race of People, blinded by so much Science.

Whilst it must be recognised, the framework - part of the content, for this paper is in the public domain and credit given to the authors;

Peter Smith Talking Cures asserts the right to be recognised as author and Intellectual ©Copyright holder of his contribution to this document

"Sleep Apnea Diagnosed Immediately After Heart Attack." Author Peter Smith Talking Cures Copyright 28th March 2017.

Thus, in keeping with the generosity of many contributors - this document is free to use as an Education or Patient led assistance - in its entirety.

Talking Cures is a Twenty First Century Medicine... to treat multiple symptoms of Mind and Body in a Person.

Via Telephone 01702 603030 or Skype. Talking.Cures

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