"please keep me updated about oximeters "
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Since I am feeling crochety today.
1] Would you please explain to me WHY it is DANGEROUS for an apnea patient to adjust their xPAP pressure 2-3 cms one way or the other but NOT DANGEROUS for a sleep doctor or a local DME's RRT to set an apnea patient's APAP with a wide open range of 4-20 cms?
and while I am at it
2] WHY a patient should NOT have access to their xPAP data any dibblety-d*mn time they please instead of just whenever they can get their local DME supplier, or sleep lab or sleep doctor to do a data download FOR them?
1] Would you please explain to me WHY it is DANGEROUS for an apnea patient to adjust their xPAP pressure 2-3 cms one way or the other but NOT DANGEROUS for a sleep doctor or a local DME's RRT to set an apnea patient's APAP with a wide open range of 4-20 cms?
and while I am at it
2] WHY a patient should NOT have access to their xPAP data any dibblety-d*mn time they please instead of just whenever they can get their local DME supplier, or sleep lab or sleep doctor to do a data download FOR them?
Views: 159
Replies to This Discussion
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Permalink Reply by Judy on
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Nope, jnk. The RT didn't question it at all, just set it 4-20 as scripted.
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Permalink Reply by susan mccord on
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Duane McCord???? Is he related to me???????
Susan McCord :-)
Judy said:Ah, but Duane McCord!!! You did NOT answer MY questions. Please, do. And Rock Hinkle, I see you posting in another thread. Where are you w/this one?
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Permalink Reply by RockRpsgt on
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As medical professionals we have to assume that the doc knows best. We are after all extensions of him/her empowered to do only what they give us permission to do. Questioning a doctor's decision in front of a patient is bad form. Any questions your RT had should have been asked prior to delivering you your machine. I believe it to be naive to believe that we are smarter than our physicians. Yes I have met my share of docs with no common sense, or street smarts. very few, if any, have been intellectually slower than me.
Judy said:Nope, jnk. The RT didn't question it at all, just set it 4-20 as scripted.
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Judy, you are my evil twin!!!!!!!!!!! Kickin' it up a notch all the time, eh???? lol
McCord (that would be SUSAN McCord, not Duane McCord !!!!!!!!)
Judy said:Ah, you are so perceptive, Cindy!!! LOL
But they are questions gleaned from my own experiences or from the experiences of others that I've read in the various apnea support forums that seem to be valid and not a misunderstanding by the person posting the experience.
Believe it or not I really AM interested in hearing the "other side of the story". It never hurts to see and hear things from another perspective than our own. Son of a gun! SOMETIMES I even find that my idea of some situation is actually w... wr... wro... not quite right. *wicked grin*
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This makes sense to me, Jeff. I'm hoping to get some clarity when I finally get seen on 9/1, and this gives me a place to start from so I don't sound totally stupid which, by now, I'm not, at least not totally!
Susan McCord
j n k said:If a person has been diagnosed strictly and purely obstructive, self-titrating is easier than learning how to make a pot of coffee. If it is too strong, use one less scoop next time. If it is too weak, use one more scoop next time. (Are you still with me, Duane? If not, quit playing with your fingers and pay attention!)
A self-titrator starts at the pressure prescribed according to a doctor's interpretation of the titration from one night in a strange bed hooked up to the mother ship. After a few weeks at home at that pressure getting used to the therapy, a selfer may try 1 cm higher for a week or two to see if the number of events goes down or goes up. If the number goes up because of an occasional harmless central or two, naturally the selfer takes the pressure back to where it was for a week or two, since it didn't improve anything in the numbers or how the selfer felt. Then a selfer may try the pressure 1 cm lower for a week or two to see if the number of events goes up or down. If the number goes up because of some obstruction returning, or some snores, naturally the selfer takes the pressure back to where it was.
The point is to keep pressure as low as possible but as effective as possible, for maximum comfort and sleep effectiveness, night-to-night, every night, while sleeping in one's own bed, not worrying about the pressure-police coming to me in my bed to arrest me--oh no!
I believe the majority of sleep docs have no problem with that approach for most patients. So it is nice to keep the sleep doc on board. That keeps you safe and keeps the doc educated about what his patients find works for them.
Rocket science it ain't.
And the point, as Judy so eloquently put it, is that any patient a sleep doc is willing to allow to use an auto set up wide open 4 to 20 has been approved by said sleep doc to ignore occasional pressure centrals, and Duane's fingers.
jeff
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Be strong, Duane! It'll be over soon!!!!!!!!!!!!!
McCord lol
susan mccord said:This makes sense to me, Jeff. I'm hoping to get some clarity when I finally get seen on 9/1, and this gives me a place to start from so I don't sound totally stupid which, by now, I'm not, at least not totally!
Susan McCord
j n k said:If a person has been diagnosed strictly and purely obstructive, self-titrating is easier than learning how to make a pot of coffee. If it is too strong, use one less scoop next time. If it is too weak, use one more scoop next time. (Are you still with me, Duane? If not, quit playing with your fingers and pay attention!)
A self-titrator starts at the pressure prescribed according to a doctor's interpretation of the titration from one night in a strange bed hooked up to the mother ship. After a few weeks at home at that pressure getting used to the therapy, a selfer may try 1 cm higher for a week or two to see if the number of events goes down or goes up. If the number goes up because of an occasional harmless central or two, naturally the selfer takes the pressure back to where it was for a week or two, since it didn't improve anything in the numbers or how the selfer felt. Then a selfer may try the pressure 1 cm lower for a week or two to see if the number of events goes up or down. If the number goes up because of some obstruction returning, or some snores, naturally the selfer takes the pressure back to where it was.
The point is to keep pressure as low as possible but as effective as possible, for maximum comfort and sleep effectiveness, night-to-night, every night, while sleeping in one's own bed, not worrying about the pressure-police coming to me in my bed to arrest me--oh no!
I believe the majority of sleep docs have no problem with that approach for most patients. So it is nice to keep the sleep doc on board. That keeps you safe and keeps the doc educated about what his patients find works for them.
Rocket science it ain't.
And the point, as Judy so eloquently put it, is that any patient a sleep doc is willing to allow to use an auto set up wide open 4 to 20 has been approved by said sleep doc to ignore occasional pressure centrals, and Duane's fingers.
jeff
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I truly believe that I would have to question the mind set of anyone who wanted to change any type of their medical treatment without wanting their doctor to know. This argument is not about who is smart enough and who is not. It is about what is best for the individual pt. We compare CPAP to diabetes all of the time, yet we do not talk about all of the patients that make mistakes with there insulin treatments everyday. Why is it so important that you be allowed to change your pressures? I do not understand. i have seen people get obssesed with their pap therapy. Striving to get their AHI to 0. Is raising the pressure for this truly helping their sleep. Maybe maybe not. Pap therapy, to me anyway, is about getting back to good sleep. Seems to me like stressing over things like self titration would be counter-productive to that goal
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Permalink Reply by Dan Lyons on
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Mr. Hinkle,
I take a total exception to your statement here.
If the doctor says it will get better if you walk off the cliff, you’re not going to question his order?
You, and every other person in the medical profession had better be questioning everything, unequivocally. If you don't question everything, and the doctor has erred, because you followed his directive knowing it to be flawed, in addition to getting sued, you’re criminally negligent - period. (I know you don’t like the idea, but I suggest you educate yourself to the criminal laws to which you can be subjected to in relation to your job duties and responsibilities.)
To question him openly, whether in front of a patient or not, may save a persons life and it is your duty, whether you like it or not, to protect the patient's well being contrary to your fear of hurting the poor physician's feelings.
Rock Hinkle said:As medical professionals we have to assume that the doc knows best. We are after all extensions of him/her empowered to do only what they give us permission to do. Questioning a doctor's decision in front of a patient is bad form. Any questions your RT had should have been asked prior to delivering you your machine. I believe it to be naive to believe that we are smarter than our physicians. Yes I have met my share of docs with no common sense, or street smarts. very few, if any, have been intellectually slower than me.
Judy said:Nope, jnk. The RT didn't question it at all, just set it 4-20 as scripted.
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Permalink Reply by cdhakl on
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Dan Lyons said:
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Mr. Hinkle,
I take a total exception to your statement here.
If the doctor says it will get better if you walk off the cliff, you’re not going to question his order?
You, and every other person in the medical profession had better be questioning everything, unequivocally. If you don't question everything, and the doctor has erred, because you followed his directive knowing it to be flawed, in addition to getting sued, you’re criminally negligent - period. (I know you don’t like the idea, but I suggest you educate yourself to the criminal laws to which you can be subjected to in relation to your job duties and responsibilities.)
To question him openly, whether in front of a patient or not, may save a persons life and it is your duty, whether you like it or not, to protect the patient's well being contrary to your fear of hurting the poor physician's feelings.
Rock Hinkle said:As medical professionals we have to assume that the doc knows best. We are after all extensions of him/her empowered to do only what they give us permission to do. Questioning a doctor's decision in front of a patient is bad form. Any questions your RT had should have been asked prior to delivering you your machine. I believe it to be naive to believe that we are smarter than our physicians. Yes I have met my share of docs with no common sense, or street smarts. very few, if any, have been intellectually slower than me.
Judy said:Nope, jnk. The RT didn't question it at all, just set it 4-20 as scripted.
Rock Hinkle said: As medical professionals we have to assume that the doc knows best. We are after all extensions of him/her empowered to do only what they give us permission to do. Questioning a doctor's decision in front of a patient is bad form. I believe it to be naive to believe that we are smarter than our physicians. Yes I have met my share of docs with no common sense, or street smarts. very few, if any, have been intellectually slower than me. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
If Michael Jackson (or a member of his family) could actually think coherently through his / her "self Rx" drug induced haze, would 'anyone' question a doctors decision to administer DipriVan in a "patients" private bedroom without immediate access to a resuscitation cart? "Bad form" would probably have been the last thing on any ones mind during the hour the Doctor took to weigh up his options & decide how much trouble his quest for the Kings $ had gotten him into! Michael was "smarter" than his physician (health care professional), or so he believed, because Michael was the King of Pop. But now it appears he may have been sadly lacking in actual medical knowledge. He could produce "killer" music / MTV videos, but no one in their right mind would think him capable of managing his own "sleep disorder(s)" or mental aberrations. As the media fueled criminal court cases & lawyer litigation "professionals" gear up to begin reaping the millions of dollars that will be made off of this "King of Pops" pathetic demise, the AMA will meet in closed door sessions & then quickly & surgically "cut loose" the attending doctor(s) & health care professionals that will ultimately be found to have attached themselves like leeches to the "Kings" gold mine. All will be "to blame", including Michael Jackson, as well as his entire entourage of "hangers on". Like police, lawyers, judges, politicians, who "police their own professions, etc, etc, ad nauseum; eventually time will pass & once more, just like Elvis, Marilyn, Janis, Jimmie, Michael Hutchence (sp?), Jim Morrison 'et al', the medical profession will go back to doing what it has always done & ordinary folks will go back to managing their own "health / wealth / business" affairs & the cycle will begin again. Not every one is smart, capable, knowledgeable or interested enough to effectively be involved in the management of their own personal "affairs", nor are all paid professionals of any ilk or persuasion capable of managing a "laypersons" affairs. Most are honest & ethical, some are not. There is no universal correct answer to any of these problems in life. If you can manage & input into your own health care, you should do so & be allowed to. If your Dr., RT, Therapist, Pharmacist, RN, Sleep Doctor, hypnotist, witch doctor, holistic shaman, clairvoyant, tarot card reader, astrologer, medicine man or any one of the dozens of newly invented health care professionals is honest, ethical, trustworthy & capable ( in your opinion), then let them wholly manage your issues / care. If they are not (the $64.00 question is: how do you tell?), cut them loose & find another that will cash the insurance / Federal Health Care checks. There are many out there that will help you. If you can't find any, members of THIS LIST will be able to point you in the right direction. I bought my own ResMed AutoSet Spirit II APAP & my wife has now started her own 4 week home trial of this same ResMed machine. I had an "in hospital overnight sleep study" done at our general hospital here. The data collected was "useless" as I was in a tiny bed, wired for sound as well as all the other bells & whistles any modern govt. funded sleep clinic can provide. The RN / RT doing the over night monitoring said I never entered anything close to REM sleep & had to keep checking the leads / wires periodically to make sure they were all patent / working, as almost no useable data was being recorded. I had been on the "sleep study" waiting list for over 7 months & only scored the sleep clinic over nighter because someone on the list "failed to show" & I was willing to come in and take their spot. I had paid for my own "at home / over night - own bed" sleep study made available through one of our local chemists (drug stores in USA). This costs A$100.00 and the computer chip collected data is then downloaded onto the InterNet where it is read / analyzed by a certified Sleep Doctor in Melbourne, Victoria. He sends back a full report / readouts etc. along with his diagnosis / Rx & recommendations for use by my GP, Sleep Clinic, chemist or whoever might be interested or in the financial chain of this newly promoted "sleep care industry". I kept the follow up appointment with the 'official sleep clinic' & the Doctor there was "old school" & gratefully accepted my privately purchased sleep study data. He said the Dr. in Melbourne was one of the best in Australia ( would any Dr. say anything other than that about another Dr.? ) & was grateful the in home study data was available, as the Clinic generated data was "useless". (no body's fault, the way it is in the real world, sometimes). I had by then already finished my 4 week home trial of the ResMed brand machine / mask(s) & had purchased my own gear. I also bought the ResMed Clinical software & downloading USB 'port' attachment for my rig. I check my own "numbers / data" via the LCD screen every morning after leaping out of bed fully refreshed & well rested. I download the full data onto my own PC when I feel like it. I have adjusted / tweaked my settings to suit my own perceived "issues" & now just check the numbers via the screen as I don't think I can improve the settings or my results. The sleep clinic doctor wished every patient took as much interest in their own management & said to only darken his door if I had any un foreseen problems or questions. They are so overloaded with public patients they will never clear their backlog ( the govt. tax dollars only go so far, that is the 'real world'). My GP is more than happy to let me manage my own sleep therapy. He admits I now know more than he does about the actual use / care - feeding of ResMed gear). My wife is a retired RN & as it is her own body / health, she is now managing her own machine / settings & therapy. We will download her data / numbers & provide to our GP for his oversight. He advises us to manage our own therapy as we know more than he does now & he has enough on his plate with out specializing in "sleep disorders". He refers his patients to either the sleep clinic or the chemist. The chemist that provides the initial in home sleep study, 4 week machine / mask(s) trials also just happens to have the franchise for ResMed for our region. They also provide full back up / support AFTER you buy the ResMed machine from THEM. They make money, ResMed makes money, the GP makes money, the sleep clinic continues to be funded by the Government (tax payer) and my wife & I now have had our lives changed by these machines / technology. Not for everyone, but if you are lucky / blessed enough to be able to AFFORD your own personal machine(s) and have the interest & "smarts" to be able to manage your own care, why shouldn't you be able to do so? A little bit of knowledge is a dangerous thing but knowledge is also "power" & can be used to change your / spouse's lives...................... Just ask Michael Jackson or his attending physician "health care professional", but of course the King is Dead, so you can't ask him!
Flame suit on, off my soap box, your mileage may vary...... Curt Hakl - Townsville, Queensland - Australia
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What doctor is going to tell you to walk off a cliff? That is the dumbest thing that I have ever heard. Dan you are a fanatic. Of course I would question my doctor if they gave anyone an auto titrating unit set at 4-20cm. Let alone a COPD pt. that does not mean that I would do it in front of the pt. As well as helping with therapy it is also my job to remove doubt, and instill confidence in my pts. Calling out my doctor's mistake in front of a pt is not going to help any medical situation. the RT in Judy's situation should have had the knowledge to know what to do in this situation. He was an RT for godsake. How could he not be educated in COPD. This to me is individual negligence.
As far as Michael Jackson goes. I do not care. He got what he deserves. How much money do you think he paid for the treatment that killed him?
Dan Lyons said:Mr. Hinkle,
I take a total exception to your statement here.
If the doctor says it will get better if you walk off the cliff, you’re not going to question his order?
You, and every other person in the medical profession had better be questioning everything, unequivocally. If you don't question everything, and the doctor has erred, because you followed his directive knowing it to be flawed, in addition to getting sued, you’re criminally negligent - period. (I know you don’t like the idea, but I suggest you educate yourself to the criminal laws to which you can be subjected to in relation to your job duties and responsibilities.)
To question him openly, whether in front of a patient or not, may save a persons life and it is your duty, whether you like it or not, to protect the patient's well being contrary to your fear of hurting the poor physician's feelings.
Rock Hinkle said:As medical professionals we have to assume that the doc knows best. We are after all extensions of him/her empowered to do only what they give us permission to do. Questioning a doctor's decision in front of a patient is bad form. Any questions your RT had should have been asked prior to delivering you your machine. I believe it to be naive to believe that we are smarter than our physicians. Yes I have met my share of docs with no common sense, or street smarts. very few, if any, have been intellectually slower than me.
Judy said:Nope, jnk. The RT didn't question it at all, just set it 4-20 as scripted.
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Permalink Reply by Duane McDade on
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Now WAIT JUST ONE MINUTE! If any of you are stupid enough to think that an auto PAP sert to 4-20 cm/h20 is going to treat sleep apnea then I've got some land for sale in the deepest darkest regions of Hell. For Gods sake, What the heck are you thinking .,...Have you ever done sleep study with somneone on auto PAP with those settings??? Well we did one in fact five just for giggles and grins, and the results weren't very good. What happens is the apneas turn into hypopneas and the AHI didn't change much it was still in the 35-40 range, but it was 55.. What is the big deal here, I think this whole debate, if thats what you want to call it, is wrong. So the evil medical monster is trying to make you more unhealthy so they can continue to drain you of your hard earned dollars. Are those black helicopters following you again??? I'll say this one more time. The Machine does not know if you are awake or sleeping it uses a small tube to check your breathing. A sleep lab uses brain waves for the sleep, 2 air flow sensors one for pressure (this is the only one the machine has) and one reacts to heat changes. Two resperation belts to to see the effort the patient is making. We have a lot more Data to base our PAP findings , so please don't try telling me this crap, I know better, I want you to do well , and I sure your doctor does too, No one's out to get you, OK?
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Sorry Curt. i am at work and just had time to read what you had said. thank you for the insight. i agree that the information is not dangerous to the majority of the people out there. I had a patient not to long ago with severe anxiety and obsessive compulsive disorder. This pt showed up 3 hours early for her study. i came in early to help her. She made me check her blood pressure every half hour until i put her to bed. During the hook up she diagnosed herself with CHF, COPD, and neurmuscular disease. All of this because she had read about apnea. whichh she ended up having a very mild case of. There is no way that you could convince me that this patient would benefit from knowing how to change her pressures. it is not something that everyone needs to know. That is my opinion anyway.
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