Replies to This Discussion

Permalink Reply by RockRpsgt on February 15, 2010 at 9:41am

Thanks Dr. Mack. It sounds much better your way.

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Permalink Reply by assholes showing my profile when on February 15, 2010 at 9:45am

Dr Jones I would like to kindly request where the report of this COD is located and where I can find it. I instruct classes at a local college in the PA program and had included this discussion on sleep apnea. Not one of my students have been ablre to find a case where sleep apnea caused cardiac arrest. I believe it is critical that we include some sort of data with our comments that suggests anything other than what medical evidence over time has suggested. In my opinion and in many other physician opinions at the hospital where i reside advising that sleep apnea is the casue of cardiac arrest would be misleading at this time unless there can be complete medical evidence to suggest other wise. I also polled at least 30 physicians who do not agree that sleep apnea causes morbidity thats its the underlying condition that causes morbidity. Please if you can forward me any report or medical evidence documenting heart disease as the secondary result of sleep apnea. you can forward this to my email so I can also take into consideration the report. I advise numerous patients to look for alternative means than weraing a Cpap and treat the underlying condition. I also took the time to review medical record DC's of all morbidity in Erie County and not one catagory was defined Sleep Apnea. I am also here to learn so this subject has intrigued me since others I have recommended to resign their Cpap have yet to die of cardiac arrest, usually a complication of heart disease. Another big question, did you find any other supportive documentation of Reggie Whites history as inclusive with these supposed diagnosis of death by sleep apnea? Like Heavy Steroid use for years? His neck size and circumfrence and being overweight, Diabetes, Any history of heart disease to which I have learned he had?? Again I challenge anyone who pounds away at the fact that sleep apnea caused the death of Reggie White. Just like all other athletes and the lies, deception etc about drug and steroid use. These are usually the two major causes of morbidity in athletes. The steroids damages the heart and thats what reggiw white died of in my opinion. e sometimes never learn of them until autopsy and toxicology reports reveal otherwise. I will warn professionally that going with a Cpap and undiagnosed heart disease will cause morbidity. I strongly suggest anyone with a Cpap find out what the underlying causes of their sleep apnea may be whether, heart, addisons disease, diabetes, endocrin, drugs whether prescription or illegal, steroids, sodium and potassium inbalances etc. Continuing with a Cpap can also lead to morbidity if the underlying condition is not detected, evaluated and corrected.

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Permalink Reply by assholes showing my profile when on February 15, 2010 at 10:15am

Rock I do not doubt the report, There are so many mis-diagnoses out there. See even at autopsy and depending on who it is the area the skill of the physician there may be an error in their report. I do not know how many positions i have been in where I had to witness a re-evauation of autopsy. Meaning the body had been in plain words, "dug back up" and an autoposy was performed AGAIN! Usually they are performed due to an intorduction of more evidence. I am sure that if a complete autopsy was performed, and toxicology reports appropriately performed, there may be more to this fatality than once assumed. I am going to review the repost if i can and really look into what was missed. As you can see I treat like an OD. I fully treat casue and efffect and patients as a whole. I look beyond and not into the obvious. As you can see I am a PA out of the box. And my physician and hospital love me for that. I specialize in dignostic medicine. If this autospy just looked at the assumed cause and did not further evaluation of the brain, heart, liver, taking blood, enzyme levels etc, then in my opinion, this autopsy was flawed. Again just my opinion because I have seen so many. I n fact there are so many rare diseases that ten years ago would have been left undiagnosed and the death stated as unknown causes or natural death or even sleep apnea if that is what this person had, that is all they knew at the time and know what, it was the easy diagnosis becasue the morgue have have been backed up and the physician was pressed to complete. Who knows but I would tend not to agree with this detrmination based on current medical evidence and what we currently know today about the human bodies casue and effect. Do you know how many people die annually from Addison disease, the reason I became a PA. and it goes undiagnosed even at autopsy. History also has a lot to do with diagnosis of an individual. If a patient lies like they do in 50% of the cases that come my way then its a difficult road to diagnosis. I do not know how many times I asked a patient that presents ill, were you out of the country ever or ever traveled inside the US?? They say no. Then you find out either when its too late or when its a critical time in their care that the say or someone says, oh yeh, Ive been to Canada, or Mexico. Then its crisis moder to find the disease commonly associated with those areas which their are several. So again get the underlying condition diagosed and work on that not the sleep apnea. Again its up the patient whether they take the hard way out or easy way out. Again thank Gid i also had these experiences because it has helped me to understand what others are going through unlike others who have not. Honesty is another part of treating. A patient needs to be not only honest with the physician but honest with themselves. One miss, One lie about a drug or steroid can mean morbidity. Thanks for all your great input and help in understanding this dynamic medical issue.

Rock Hinkle said:

To date I believe that there has been only one death that could be directly attributed to Apnea. this pt died at iowa University hospital under the care of Dr. Mark Dyken. I have seen the video of the PSG with my own eyes. The only way to 100% diagnose a death of apnea is to have the pt hooked up to a PSG at the time of death. Since most people do not know when they are going to die this becomes problematic in blaiming apnea as the direct cause of. If a person dies in there sleep more than likely it was due to a complication of their sleep.

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Permalink Reply by RockRpsgt on February 15, 2010 at 10:54am

Welcome back Richard. How are ya?

You argue your points like a politician running for office. Lots of promises, opinions, and he said she said arguments. I have not seen you offer any validity other than "the mayo clinic said" or " I have read in many medical books". Where are your links supporting your findings? Other than the ones that I found for you. I believe that the I am the only one that has offered support to my opinions in either one of our debates. I also provided you with the knowledge needed to actually see an apneac death with your own eyes. You must have missed it so here it is again. Dr. Mark Dyken at the University of Iowa


i do agree with you that no matter what your disorder is you need to find the underlying cause and treat it. This is not some new medical treatment that you have just figured out. I do not agree with you on the fact that treating the underlying disorder will always cure the apnea. Nor will losing weight. With all the talk of underlying disorders you have left out 2 very important facts about CPAP. No matter what underlying disorder you have if you need CPAP it will improve your sleep efficiency. Sleep efficiency will improve your ability to heal. Healing will help your underlying disorder. Do you see where this is going yet? Can or will you deny the healing power of PAP therapy? As a well read medical professional surely you have looked at all of the studies supporting PAP therapy as way to help treat numurous medical conditions. hypertension, diabetes, CHF, nocturia, and gerd just to name a few. they are easy to find just search CPAP and (insert any medical condition here). You will find something I promise.

i also question you on this statement: Not one of my students have been ablre to find a case where sleep apnea caused cardiac arrest.

I highly suggest that in the course of your studies that you spend some time in a sleep lab.

or this one: I also polled at least 30 physicians who do not agree that sleep apnea causes morbidity thats its the underlying condition that causes morbidity.

If apnea is the cause of the underlying condition then would apnea not be the cause of the morbity? Were any of these docs sleep certified? 30 out of how many? Enquiring minds you know? I find this statement to have about as much credit as being told that "4 out of 5 dentist chose crest in a national survey". I still use mentident.

I also am curious as to know how many of the pts you "advised" to get off of PAP had PSGs to determine if it was safe. As a PA who obviously does not work for a sleep physician what gives you that right? I hope that you understand that taking a person off of PAP that has an AHI>5 could be a death sentence.

Just my opinion though. Let me know if you need the link.

I am sorry that PAP therapy did not work for you. However there are 14 million people that it is working for, and another 35 million that could really use it. Don't knock it without all of the facts man!

Drugs and athletes! I am not going to touch that one. I would call a lawyer and check your liability on that opinion. Athletes and musicians can be some sue happy mo-foes.

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Permalink Reply by RockRpsgt on February 15, 2010 at 11:33am

http://www.umm.edu/patiented/articles/who_has_sleep_apnea_000065_4.htm

http://www.reuters.com/article/idUSTRE57H0CP20090818

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Permalink Reply by RL on February 15, 2010 at 1:22pm

http://yourtotalhealth.ivillage.com/sleep-apnea-therapy-fights-hear...

article: Sleep apnea therapy fights heart disease via iVillage Total Health newswire

http://www.webmd.com/sleep-disorders/sleep-apnea/news/20030326/trea...

article: Treating Sleep Apnea Helps Heart Failure - CPAP May Improve Both Conditions at Once
" The authors say there needs to be a greater awareness among doctors about the role obstructive sleep apnea plays in congestive heart failure, and the sleep disorder should be treated in these patients.
SOURCE: The New England Journal of Medicine, March 27, 2003."

http://health.dailynewscentral.com/content/view/1046/63

article: Sleep Therapy May Prevent Death from Heart Disease Contributed by Tom Harrison| 14 June, 2005 00:58 GMT
"OSA patients who were treated with CPAP had significantly fewer cardiovascular disease-related deaths and cardiovascular-related events than untreated patients in a study published in the June issue of Chest, the peer-reviewed journal of the American College of Chest Physicians."

As a patient diagnosed by PSG with OSA & CSA, and not presenting with any underlying conditions per additional medical testing, I prefer to use CPAP therapy now, rather than wait until my lack of oxygen and sleep quality progress to diabetes and CHF, causing physical damage that would inherently affect my quality of life, not to mention length of life. I would encourage anyone who has symptoms of OSA to be tested, and if determined to have OSA and or CSA, to work with xPAP therapy to the best of their ability, at the same time as seeking out and treating any underlying conditions as appropriate. If you encounter medical professionals who discourage you from seeking this type of therapy, make the effort to get second and third opinions from sleep certified doctors to make sure what is the best therapy for you. Your own quality and quantity of life may depend on it.

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Permalink Reply by Mack D Jones, MD, SAAN on February 15, 2010 at 4:33pm

I think Rock an RL have said it very well. I admire your out of the box attitude, but you would do much better if you had learned more about the pathophysiology of OSA and cardiovascular disease before stepping out of the box. I recommend starting with 'The Principles and Practice of Sleep Medicine' by Kryger, Roth and Dement, fourth edition (the fifth edition is due in June and will be even better).

It is worth reading the entire volume not just the chapters on cardiovascular disease, because understanding sleep disorders in general gives a better understanding of OSA and it's complications. I would like to point out the large number of references that are in the book at the end of each chapter to research for answers to specific questions.

Am I correct in thinking you have OSA, but are not treating it? If that is so, I recommend your treating it with all due diligence.

BTW, why don't you attend the annual AASM meeting? As far as I know there is no problem with PAs attending. I believe you would enjoy the exchange of ideas immensely.


richard rydza said:

Rock I do not doubt the report, There are so many mis-diagnoses out there. See even at autopsy and depending on who it is the area the skill of the physician there may be an error in their report. I do not know how many positions i have been in where I had to witness a re-evauation of autopsy. Meaning the body had been in plain words, "dug back up" and an autoposy was performed AGAIN! Usually they are performed due to an intorduction of more evidence. I am sure that if a complete autopsy was performed, and toxicology reports appropriately performed, there may be more to this fatality than once assumed. I am going to review the repost if i can and really look into what was missed. As you can see I treat like an OD. I fully treat casue and efffect and patients as a whole. I look beyond and not into the obvious. As you can see I am a PA out of the box. And my physician and hospital love me for that. I specialize in dignostic medicine. If this autospy just looked at the assumed cause and did not further evaluation of the brain, heart, liver, taking blood, enzyme levels etc, then in my opinion, this autopsy was flawed. Again just my opinion because I have seen so many. I n fact there are so many rare diseases that ten years ago would have been left undiagnosed and the death stated as unknown causes or natural death or even sleep apnea if that is what this person had, that is all they knew at the time and know what, it was the easy diagnosis becasue the morgue have have been backed up and the physician was pressed to complete. Who knows but I would tend not to agree with this detrmination based on current medical evidence and what we currently know today about the human bodies casue and effect. Do you know how many people die annually from Addison disease, the reason I became a PA. and it goes undiagnosed even at autopsy. History also has a lot to do with diagnosis of an individual. If a patient lies like they do in 50% of the cases that come my way then its a difficult road to diagnosis. I do not know how many times I asked a patient that presents ill, were you out of the country ever or ever traveled inside the US?? They say no. Then you find out either when its too late or when its a critical time in their care that the say or someone says, oh yeh, Ive been to Canada, or Mexico. Then its crisis moder to find the disease commonly associated with those areas which their are several. So again get the underlying condition diagosed and work on that not the sleep apnea. Again its up the patient whether they take the hard way out or easy way out. Again thank Gid i also had these experiences because it has helped me to understand what others are going through unlike others who have not. Honesty is another part of treating. A patient needs to be not only honest with the physician but honest with themselves. One miss, One lie about a drug or steroid can mean morbidity. Thanks for all your great input and help in understanding this dynamic medical issue.

Rock Hinkle said:

To date I believe that there has been only one death that could be directly attributed to Apnea. this pt died at iowa University hospital under the care of Dr. Mark Dyken. I have seen the video of the PSG with my own eyes. The only way to 100% diagnose a death of apnea is to have the pt hooked up to a PSG at the time of death. Since most people do not know when they are going to die this becomes problematic in blaiming apnea as the direct cause of. If a person dies in there sleep more than likely it was due to a complication of their sleep.

• ▶ Reply

Permalink Reply by RockRpsgt on February 15, 2010 at 5:30pm

Rchard do not get me wrong. I applaud and respect what you do. Had I started my healthcare career earlier diagnostic medicine would have been my route. Your out of the box ideas are truly thought provoking. please embrace PAP therapy and sleep education for your pts sake. Treating any underlying cause is the answer to most medical disorders. Sometimes that underlying cause is bad sleep. No matter what is going on with you bad sleep will limit the healing process.

I would suggest that you read the sleep bible that Dr. Mack suggested. the promise of sleep is another great book for sleep basics. Learn about the circadian rythm, biological clock and how they pertain to hormone production and distribution. In my opinion most underlying conditions begin with a hormonal imbalance of same nature. Our circadain rythm controls hormone production. Sleep is one of the biggest factors in circadian rythm function. i would love to be able to talk to you about how our 2 fields could help one another. it is my opinion that no matter waht medical practice you are in you should always start your pt conversation with three questions:

What brings you to see me today?

How do you feel right now?

How are you sleeping?

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Permalink Reply by assholes showing my profile when on February 15, 2010 at 6:52pm

Thanks, One topic I had to study was the sleep pattern. I worked in Occupational health for 20 years dealing with the workplace environment including every physical and environmental impact the workpace has on the body. This included chemical exposure, airborne contaminents, and all the bodies routes of entry. I even had to focus on the topic you discuss, the acute and chronic effects on those employees who perform shift work and who work combined shifts including midnight shifts. These employees definitely never received the appropriate sleep supposedly. I understand the circadian rhythm process completely since it is a one year study including research in several occupational settings. I had procured numerous data for NIOSH reagarding a population in a selected occupational setting. Even timing for certain medical treaments use the circaian rhythm process in order for treatment to be successful, one being certain horomone therapies. Now you are going in the right direction when ones has OSA and their sleep is disrupted, yes, I agree that a good night sleep without interruption is important. You are good and the response I was waiting for! Great thinking. Someone is thinking out there!!!! Usually melatonin markers are used in conjunction with core temperature rectal preferably when determining rhythms. Remember this disorder , the circadium rhythm disorders are caused by, Shift work, what i talked about in the reasearch I did for NIOSH, Jet lag when one travles in time zones, medication especially, like opiads, how about sleep disorders like waking from normal sleep rhythms or patterns. . I agree that sleep pattern is important and if their is a disruption from the pattern, a disorder is likely to occur. These events are recoverable sometimes though. We also found that those who work night shift from the population in the NIOSH study, those who were born with a circadium rhythm, eastern time zone, normal sleep time, found that over 50% morbidity rate before the age of 60 years old and numerous health conditions including heart disease and obesity. Great job on your thought process. Are you familiar with Chronotherapy??? Chronotherapy is a behavioral technique in which the bedtime is gradually and systematically adjusted until a desired bedtime is achieved. Bright light therapy is designed to reset a persons circadian rhythm to a desired pattern. When combined, these therapies may produce significant results in people with circadian rhythm disorders.
These are the type of out of the box therapies I look at and it appears you do the same. Koodos to you! As you know providing medical advise on site like this is compromising to current positions one might retain with contract either with a hospital or private practice so that is a big reason why personal disclosure is not a good idea for me at this time. Any physician or even medical provider must be extremely careful when posting imput on any medical site. In fact my employer requires knowledge a release signed and usually it is forbidden. I again just hopes the comments we make assist others in making better decisions about their health. I like to raise questions and even be professionally combative not just to prove a point but to make people think about thier care. Is it the best care, Is the current diagnosis correct or is their something else they missed, and believe me it happens alot especially in smaller area hospitals where the pick of the medical providers is limited. Everyone makes mistakes. I make mistakes, you make mistakes but i am sure as you know when decisions we make, can make the difference in someones life, I am ANAL and need to be right. I strive to be right, I need to be right and mostly I want to be right so I can do the best I can for patients. A recent poll conducted by a local HMO suggested patient, provider relationships are compromised. The answers most stated were: the doctor mis-diagnosed me, doctor refused to listen to me, when I told the doctor I read something about my conditon he refused to listen. Thanks again! You are good!!!
Rock Hinkle said:

Rchard do not get me wrong. I applaud and respect what you do. Had I started my healthcare career earlier diagnostic medicine would have been my route. Your out of the box ideas are truly thought provoking. please embrace PAP therapy and sleep education for your pts sake. Treating any underlying cause is the answer to most medical disorders. Sometimes that underlying cause is bad sleep. No matter what is going on with you bad sleep will limit the healing process.

I would suggest that you read the sleep bible that Dr. Mack suggested. the promise of sleep is another great book for sleep basics. Learn about the circadian rythm, biological clock and how they pertain to hormone production and distribution. In my opinion most underlying conditions begin with a hormonal imbalance of same nature. Our circadain rythm controls hormone production. Sleep is one of the biggest factors in circadian rythm function. i would love to be able to talk to you about how our 2 fields could help one another. it is my opinion that no matter waht medical practice you are in you should always start your pt conversation with three questions:

What brings you to see me today?

How do you feel right now?

How are you sleeping?

• ▶ Reply

Permalink Reply by Mary Z on February 15, 2010 at 7:12pm

Another thought on sleep disruption. I have chronic moderate- severe pain, especially at night from what so far is diagnosed as trocanteric bursitis of the hip, or L-5 Nerve route disruption. I take 50 mg of tramodol and two aleve at bedtime and the pain wakes me about four hours later. As I try to keep the pain meds down the pain causes fitful sleep from the early hours on. I'm trying to get a referral to a pain clinic as neither my PCP, not my arthritis doc are willing to prescribe anything longer acting or stronger. The pain control clinic is the recommendation of the arthritis doc. But the whole point is that chronic pain can cause disruption of sleep.

Mary Z.

richard rydza said:

.... Now you are going in the right direction when ones has OSA and their sleep is disrupted, yes, I agree that a good night sleep without interruption is important. You are good and the response I was waiting for! Great thinking. Someone is thinking out there!!!! Usually melatonin markers are used in conjunction with core temperature rectal preferably when determining rhythms. Remember this disorder , the circadium rhythm disorders are caused by, Shift work, what i talked about in the reasearch I did for NIOSH, Jet lag when one travles in time zones, medication especially, like opiads, how about sleep disorders like waking from normal sleep rhythms or patterns. . I agree that sleep pattern is important and if their is a disruption from the pattern, a disorder is likely to occur.

• ▶ Reply

Permalink Reply by Mack D Jones, MD, SAAN on February 15, 2010 at 9:49pm

richard, I Googgled "Obstructive sleep apnea and cardiovascular disease" and got lots of information from numerous reliable sources. Here, to my surprise, is an example that dates as far back to 2001.http://www.ncbi.nlm.nih.gov/pubmed/12742277. If Google doesn't convince you, then try your APAP machine for about 3-6 months and give Google another chance.

richard rydza said:

Thanks, One topic I had to study was the sleep pattern. I worked in Occupational health for 20 years dealing with the workplace environment including every physical and environmental impact the workpace has on the body. This included chemical exposure, airborne contaminents, and all the bodies routes of entry. I even had to focus on the topic you discuss, the acute and chronic effects on those employees who perform shift work and who work combined shifts including midnight shifts. These employees definitely never received the appropriate sleep supposedly. I understand the circadian rhythm process completely since it is a one year study including research in several occupational settings. I had procured numerous data for NIOSH reagarding a population in a selected occupational setting. Even timing for certain medical treaments use the circaian rhythm process in order for treatment to be successful, one being certain horomone therapies. Now you are going in the right direction when ones has OSA and their sleep is disrupted, yes, I agree that a good night sleep without interruption is important. You are good and the response I was waiting for! Great thinking. Someone is thinking out there!!!! Usually melatonin markers are used in conjunction with core temperature rectal preferably when determining rhythms. Remember this disorder , the circadium rhythm disorders are caused by, Shift work, what i talked about in the reasearch I did for NIOSH, Jet lag when one travles in time zones, medication especially, like opiads, how about sleep disorders like waking from normal sleep rhythms or patterns. . I agree that sleep pattern is important and if their is a disruption from the pattern, a disorder is likely to occur. These events are recoverable sometimes though. We also found that those who work night shift from the population in the NIOSH study, those who were born with a circadium rhythm, eastern time zone, normal sleep time, found that over 50% morbidity rate before the age of 60 years old and numerous health conditions including heart disease and obesity. Great job on your thought process. Are you familiar with Chronotherapy??? Chronotherapy is a behavioral technique in which the bedtime is gradually and systematically adjusted until a desired bedtime is achieved. Bright light therapy is designed to reset a persons circadian rhythm to a desired pattern. When combined, these therapies may produce significant results in people with circadian rhythm disorders.
These are the type of out of the box therapies I look at and it appears you do the same. Koodos to you! As you know providing medical advise on site like this is compromising to current positions one might retain with contract either with a hospital or private practice so that is a big reason why personal disclosure is not a good idea for me at this time. Any physician or even medical provider must be extremely careful when posting imput on any medical site. In fact my employer requires knowledge a release signed and usually it is forbidden. I again just hopes the comments we make assist others in making better decisions about their health. I like to raise questions and even be professionally combative not just to prove a point but to make people think about thier care. Is it the best care, Is the current diagnosis correct or is their something else they missed, and believe me it happens alot especially in smaller area hospitals where the pick of the medical providers is limited. Everyone makes mistakes. I make mistakes, you make mistakes but i am sure as you know when decisions we make, can make the difference in someones life, I am ANAL and need to be right. I strive to be right, I need to be right and mostly I want to be right so I can do the best I can for patients. A recent poll conducted by a local HMO suggested patient, provider relationships are compromised. The answers most stated were: the doctor mis-diagnosed me, doctor refused to listen to me, when I told the doctor I read something about my conditon he refused to listen. Thanks again! You are good!!!
Rock Hinkle said:

Rchard do not get me wrong. I applaud and respect what you do. Had I started my healthcare career earlier diagnostic medicine would have been my route. Your out of the box ideas are truly thought provoking. please embrace PAP therapy and sleep education for your pts sake. Treating any underlying cause is the answer to most medical disorders. Sometimes that underlying cause is bad sleep. No matter what is going on with you bad sleep will limit the healing process.

I would suggest that you read the sleep bible that Dr. Mack suggested. the promise of sleep is another great book for sleep basics. Learn about the circadian rythm, biological clock and how they pertain to hormone production and distribution. In my opinion most underlying conditions begin with a hormonal imbalance of same nature. Our circadain rythm controls hormone production. Sleep is one of the biggest factors in circadian rythm function. i would love to be able to talk to you about how our 2 fields could help one another. it is my opinion that no matter waht medical practice you are in you should always start your pt conversation with three questions:

What brings you to see me today?

How do you feel right now?

How are you sleeping?

• ▶ Reply

Permalink Reply by Charles Austin Beck on February 16, 2010 at 9:54am

For me if I am sitting up in a chair I do not have a breathing problem, at least I am not aware of it. My problem hits if I am laying down.

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