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[CPAP] Beyond ASV with Overlap Syndrome!
RE: Beyond ASV with Overlap Syndrome!
Okey Dokey, I did my PFT today finally! The 2 sticks for ABG can be painful. Why 2? My arteries are stubborn and stick 1 didn't yield enough arterial blood. Did the rest of the huff n puff test but without the usual nebulizer treatment in the middle of the PFT due to COVID-19. Seeing Doc and staff next week, 6/19/2020, to sell them on the Astral 150. And no offense to Philips products, but I'm not taking their Trilogy home.

Coffee

Other news, the heart has a mild to moderate "issue" that cardiac doc will discuss in office next week. Issue revealed after recent-ish 30 day Holter Monitor session and the 2 part echocardiogram and nuclear/chemical stress test. Dave does not/cannot run the hamster wheel treadmill.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Beyond ASV with Overlap Syndrome!
Cardiac doc visit today to review echo and stress test results:

Cardiac Dr. says I have Premature ventricular contractions (PVCs), a condition where the ventricles (lower chambers) may add their own beat that's off timed from the norm. It can contribute to lessening the heart efficiency rating and/or may cause either an added or skipped beat. My ventricular efficiency is at about 60%, and 50% is a red flag according to him. He mentioned a leaky valve as well. FWIW I'm now scripted to take double the prior 20 mg cholesterol pills which is now changed to Rosuvastatin calcium 40 mg along with the continuing of low dose aspirin 81 mg, and Diltiazem HCL 30 mg. He also stated that an NIV would be OK, and not having it for Respiratory Overlap treatment is not OK.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Beyond ASV with Overlap Syndrome!
Well gee Dave, for a young guy you're a car wreck. Keep up the good work staying on your feet as long as possible.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Beyond ASV with Overlap Syndrome!
What Sleeprider said! I sure hope you are still under warranty. Big Grin
Crimson Nape
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Beyond ASV with Overlap Syndrome!
Thanks guys. I'm doing about as good as it sounds. I really am OK most times; debatable but we should let "OK" pass. I can't be in a rush to do things or the valves, lifters, or gaskets leaks a bit I suppose. Not due for an overhaul anytime soon, which I'd rather avoid if I can. I'm hoping to be done with surgeries for a long while. This does put a bit of emphasis on getting apnea under control again ASAP. FWIW so far Medicare has covered as it should.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Beyond ASV with Overlap Syndrome!
Update on pulmonary: PFT showed improved breathing with less restriction. Doc has suggested that since he can't prove chronic problems with this result, he's suggesting trying the ASV again with modified settings. Setting changes are as follows: EPAP 8-15 PS 4-12. PS Min up 2 clicks and EPAP Max up 2 clicks. I'm only doing so, so as to prove or disprove the ASV therapy provided is or is not working for me.

Interesting news is that the RT at Apria told me that she would report the ASV is broke to move me to a new device if it becomes needed. She still wants me on the Respironics Trilogy, and stated the one she's familiar with has a variant of AVAPS called eVAPS. I'll have to do research on it. I may have to take her professional opinion/advice to move to an appropriate machine, if this trial of the new ASV setting adjustment fails. I said I'd try it and I'll do just that. Ironic that getting better regarding COPD affects getting the proper machine, but it's what it is.

PS I'm wondering if the RT meant AVAPS-AE which is an auto adjusting EPAP...
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Beyond ASV with Overlap Syndrome!
News about my status: I had a new visit yesterday 7/29/20 with pulmonary doc to discuss the ASV not playing well. He suggests changing down all pressure settings AND change backup rate. The BR setting is not on this device, which I've told him before.

I have referred myself to WellSpan Pulmonary and go today to sign the release of medical info to be pulled from the other doc. He's just overwhelmed and has no clue on how to handle my complex case. So see ya bye doc. This sets me for a new patient appointment end of August. It's a month wait, but I wasn't due to see soon to see prior doc for another 2 months while trying the new guaranteed to fail settings. The reason I don't get PCP to take charge of this is he'd rather specialists to take care of specialty aspects like my Overlap of COPD and Complex Apnea. I can accept that as this doc really does great at general aspects.

NO not doing the setting change as I do know they'd fail to treat.
For the record he has scripted:
EPAP 5-12
PS 2-4
IPAP Max 20
BR 8

He really does not know what settings are available. My ASV set to that would have IPAP of 7-14.

Dont-know here have some buttered Eat-popcorn
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Beyond ASV with Overlap Syndrome!
an update:

I have self-referred to a WellSpan Pulmonary team in Chambersburg. I had an initial consult today. We are changing my inhaler meds if the insurance formulary permits. And I will take a new sleep study and possibly a new PFT. The PA-C is actively working on scripting a nebulizer and getting a DME chosen by me to provide it possibly by next week.

The PA-C I talked with today said the ASV isn't correct for me in that it should have an option to manually set backup rate and it probably needs timing control pending sleep study results and doctor input. She stated it will mean that I must go above ASV given my COPD/apnea status.

I discussed about me being on "an apnea forum" and my reading OSCAR data and the fact I have self-titrated and have thus far done all my own adjustments as the DME and docs I've dealt with do not know how to set my ASV. She said nothing negative, but did say I'm far more informed than any patient she's dealt with. FWIW I like the new pulmonary team after just one visit. There's a sense of knowing a lot more about how to treat my issue properly. The other pulmonary didn't know how to treat my case properly, as it all eventually came down to if it's not working, it must be something I'm doing wrong. So I did what I advocate, I left them for good onto a better medical team.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Beyond ASV with Overlap Syndrome!
Hmm apparently COPD patients should have a home nebulizer to use first, then administer your inhalers. As noted from yesterday, I self referred to a new pulmonary medical team based in the Chambersburg, PA's WellSpan system. I had talked with the nurse at yesterday's consultation. She scripted a home nebulizer which was already delivered today by Lincare's RT. I've already had Lincare as the DME for my hospital bed, and they have worked overtime to get that approved, so I will move my upcoming ventilator need to them as well. The RT was here at the house for that new nebulizer and I had told her that her manager knew I'd be getting a ventilator soon. He mentioned this same RT will bring the vent after the order is competed. So one parting comment she made is that I'm very well informed about my care, and that she will program the vent with me in attendance so I can see what and how to adjust it myself if needed.

Coffee
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Beyond ASV with Overlap Syndrome!
They're catching on to you.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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