Meet a Specialist: John M. Dobrowski, M.D., FACS
As the son of a general surgeon and registered nurse, Dr. John Dobrowski was exposed to medicine from an early age. “Medicine was a huge part of my family while I was growing up. Both of my parents dedicated their professional lives to providing compassionate care for patients. It was truly inspiring to witness,” Dr. Dobrowski recalls. Although Dr. Dobrowski was drawn toward building and working with his hands, his greatest strengths were in math and the sciences. He explains, “My exposure to healthcare as a child, along with my interests in science and working with my hands, led me to pursue a career in a surgical field of medicine.” Becoming a surgeon was a natural progression, allowing Dr. Dobrowski to combine his technical and mechanical skills with his knowledge base. “ENT is such an intricate and complex area of study, yet it also provides the opportunity to build meaningful relationships with patients. I immediately gravitated toward that specialty in medical school,” Dr. Dobrowski remarks.
As both a Certified Sleep Specialist and an Otolaryngologist at Massachusetts Eye and Ear, Dr. Dobrowski treats adult patients primarily for sleep-related breathing problems and obstructive sleep apnea (a condition in which the flow of air pauses or decreases while breathing, during sleep). Dr. Dobrowski says, “Many patients first make an appointment with me because they have been suffering from snoring. Other patients may be experiencing daytime tiredness or difficulty concentrating.” Although many of Dr. Dobrowski’s patients are self-referrals, primary care physicians in the community and specialists from within Mass. Eye and Ear and Mass General Hospital and its affiliates, also refer patients to Dr. Dobrowski. “Patients suffer from sleeping conditions for a variety of reasons, and obstruction can exist in different locations in the head and neck region, such as the tonsils, palate, tongue, nasal passage or windpipe. Because of this complexity, referrals come from a variety of sources,” he explains.
Once a patient has been referred to Dr. Dobrowski, he first determines where obstruction is occurring. “Typically my first course of action is to order a sleep study for my patients,” Dr. Dobrowski notes. Sleep studies can occur in a sleep lab or patients may take part in a home sleep study. Although home sleep studies are gaining in popularity, in-lab studies are more controlled and provide more in-depth information about the patient. Dr. Dobrowski mentions, “In a sleep center, sleep technologists work to provide an in-depth recording of the patient during various stages of sleep. In-lab tests also provide information about a patient’s brain activity during sleep, which helps determine if the cause of sleep disruption is not related to apnea, but another condition such as narcolepsy.”
Once a sleep study has been conducted, and if the patient is suffering from obstructive sleep apnea, Dr. Dobrowski begins working with the patient on a treatment program. Managing sleep apnea often requires several different forms of treatment. Continuous Positive Airway Pressure machines (CPAP), are often the first method of treatment. Patients wear the CPAP mask at night, which provides positive air pressure to stint or open the patient’s airway and allow uninterrupted breathing to occur. If a patient is suffering from severe sleep apnea, Dr. Dobrowski occasionally suggests a CPAP before a sleep study has been performed, to reduce the immediate danger from the obstruction. Depending on a patient’s specific diagnosis, other forms of treatment may be prescribed. “Oral appliances such as a specifically manufactured sleep night guard, reposition the patient’s jaw forward, which in turn, brings the tongue forward, and stops obstruction from occurring,” Dr. Dobrowski explains.
Certain patients also require surgical intervention to effectively manage their sleep apnea. Dr. Dobrowski notes that surgery is not the primary treatment method for sleep apnea, and that he prefers to treat patients using devices such as the CPAP or by suggesting lifestyle changes. If surgery is needed, however, the timing of surgery and type of procedure performed differs greatly from patient to patient. To receive the most favorable outcomes, surgery might be performed to enhance the function of the CPAP, or after the CPAP has been determined as ineffective for the patient. Oral surgeons perform maxillomandibular advancement (a surgical procedure which moves the upper and lower jaw forward), or an otolaryngologist might perform nasal surgery, a tonsillectomy or an adjustment to the soft palate to assist with air flow from the nose into the throat. Because obstruction can occur in a variety of areas, surgery and other treatment options depend on the patients’ specific condition.
One of Dr. Dobrowski’s major initiatives involves bringing a team of doctors together from Mass. Eye and Ear and Massachusetts General Hospital to collaborate on patient care. “Currently, the group consists of oral surgeons, sleep specialists, neurologists, sleep dentists and ENT specialists,” Dr. Dobrowski explains. Dr. BuSaba and Dr. Dobrowski provide expertise to patients from a structural and surgical, ENT perspective. Their colleagues from Mass General provide expertise in a variety of other psychological and neurological areas. Dr. Dobrowski concludes, “So far, the collaboration has been incredibly helpful for our patients. We are able to provide care across all aspects of sleep medicine, and are constantly striving to improve patients’ qualities of lives. I truly believe our new collaboration will help achieve that goal.”
Contact Dr. Dobrowski’s office at 617-573-4104.
View Dr. Dobrowski’s online bio for more information.
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