I have some medical conditions, I bought the pillow to help manage mostly the pain and discomfort.The pillow is soft enough for my fibro and comfortable enough for me to lie on it for an extended amount of time.The cooling gel pad is a small square in the center of the pillow where you rest your head and isn't that great. Initially, I thought the pillow didn't come with the gel pad. I misunderstood and thought the gel was a filling in the pillow itself like other cooling pillows. This pillow instead has a pocket with a square gel pad that can be removed. The cooling it gives off isn't great, it works slightly better if you remove it and place it in the fridge for a bit. The pillow case is a little thick which is what makes the pillow more comfortable but doesn't really allow the cooling feeling to come through as well.The pillow comes already in the pillow case with an extra pillow case, I guess to use while you wash the other one. The foam pillow, itself, comes in zipped in a much thinner cloth case that has the pocket with the cooling gel pad.The pillow has a grid of holes in the center of the pillow, I guess for the "breathable" part but with the two pillowcases (the thinner one that holds the gel pad and the actual softer but thicker exterior case) it doesn't feel very "breathy"... which may or may not be another reason the cooling gel pad doesn't come through that well.For orthopedic uses, I think the pillow works well. I've been using it since it arrived and find it to be very comfortable despite my severe case of fibromyalgia. The foam is formed in such a way that allows me to rest both my head and hands as I like to raise my hands near my head and there are dip spots to rest your hands there. I enjoy this design feature.The pillow so far hasn't deflated much at all over every day use since it arrived. The foam seems to be fairly firm but has just the "right" amount of give to not be uncomfortable or stiff.I would recommend this pillow if you're looking for an comfortable orthopedic pillow but maybe not if you're looking for a cooling pillow.