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Dr too slow? Go to the hospital?
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dd777 Offline

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Post: #1
Dr too slow? Go to the hospital?
My husband has been seeing a dr - we have been making some new discoveries about why he doesnt feel well. however the dr seems to be moving very slow and I'm worried something is going to happen before the dr gets things sorted.

Just recently we got my husband's Oximetry results and they seem alarming to us. The guy how we got the Oximetry device said he is very concerned and thinks my husband should be put on oxygen immediately.

I guess my question is this -- has anyone seen results like this? And does anyone think it could warrant bypassing his dr and going straight to the hospital for observation? we don't want to overreact, but i also want to make sure my husband gets the care he needs before it is too late.

I have searched the internet to find something to put my mind at ease but everything i've seen so far says to be alarmed when numbers are much better than what are shown on his chart. I have also read that it is most important to treat the patient - not the numbers - well, my husband is very ill and I can see with my own eyes that he needs some sort of treatment.

His dr has already mentioned that he believes he's suffering from hypoxia and bradycardia .... but still nothing seems to be happening. She we insist on a referral to a cardiologist? ask for oxygen? go to the hospital? try to find a new dr? I'm not sure where to go from here.

I've attached his chart -- We are new to all of this stuff and having a hard time knowing how to tell if our dr is moving fast enough. I'd love to have some other people's eyes on this to just get some feedback for how urgent other people would feel about it.

Thank you for your time.


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03-17-2016 10:37 AM
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dd777 Offline

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Post: #2
RE: Dr too slow? Go to the hospital?
The overview / front page of the report says:


-- Highest Pulse: 197
-- Lowest Pulse: 40
-- Mean Pulse: 96

-- Highest SpO2: 100%
-- Lowest Sp02: 43%
-- Mean SpO2: 76.7%

-- The longest continuous time with saturation <= 88 was 00:59:56

-- The total time with a decrease in saturation more than 5 below the mean was 5:21:56

-- A desaturation event was defined as a decrease of saturation by 3 or more. 2 events were excluded due to artifact.

-- There were 12 desaturation events over 3 minutes duration

-- There were 375 desaturation events of less than 3 minutes duration during which:
- the mean high was 60.5% the mean low was 52.3%
- the mean length of events that were >=10 sec & <=3 min was: 30.7 sec.
- desaturation event index (number of events per hour): 31.2
03-17-2016 11:00 AM
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justMongo Offline

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Post: #3
RE: Dr too slow? Go to the hospital?
Keeping in mind this is not medical advice----
If the oximetery is a true representation, then he goes from bradycardia to tachycardia just before 22:30 hours; and the oxygen saturation drops to the 50 - 60% range. Would I be correct that he went to sleep at that time?

I'd be beating down the door of a cardiologist. My amateur guess is that either: 1) low Oxygen runs up the heart rate. Or 2) The heart is going into some irregular rhythm that does not permit oxygen saturation.

If the data is true (and not some artifact *) then in my amateur opinion it requires immediate attention.

*Some inexpensive oximeters provide poor data quality.

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.
(This post was last modified: 03-17-2016 12:09 PM by justMongo.)
03-17-2016 12:08 PM
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dd777 Offline

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Post: #4
RE: Dr too slow? Go to the hospital?
Thank you for your thoughts @justMongo -- I believe you are right. he usually goes to bed at 9pm on the dot and takes him a bit to fall asleep. i would say he generally is asleep by 10 or so which would line up with that analysis of the chart.

we haver several nights of data that show this is a consistent pattern and the tech who dropped off / picked up the device assured us the data must be accurate. Sad

My husband saw his doctor today (just got home) and made him take another look at the most alarming numbers - and the dr became a little more concerned, seemed he did not look at them very closely until then - and said the same thing "are these numbers right?". He gave us a referral to a Pulmonologist to see about prescribing oxygen treatment.

His dr did a 4 hour glucose test on him yesterday and today he told him the test shows both Hyperglycemia (blood sugar starts out too high) AND hypoglycemia (after eating it falls toooo low). He is not on any medication for diabetes and has not yet been officially diagnosed with diabetes for some reason - he has seen several doctors about it and they all seem confused by his data. They start out saying yes you MUST be diabetic given your symptoms even though you don't seem like a candidate (he is very LOW weight 130 pounds!!!, eats healthy, etc) -- but then they do more testing and get confused and it seems to pitter to a halt. Anyway .... maybe this new doctor will keep investigating even after he gets stumped. Its probably all related.

Today his dr also did an Electrocardiogram (FINALLY!) and it showed there is something wrong with his heart. Prolonged QTC. He ordered an Echocardiogram to investigate further.

It looks like it will at least be another few days before anything new happens. I'm trying to stay calm and not have too much anxiety that he's going to die in his sleep, have a heart attack or stoke or something. I'm worried about how much damage this lack of oxygen is doing to his organs.
03-17-2016 12:25 PM
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justMongo Offline

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Post: #5
RE: Dr too slow? Go to the hospital?
(03-17-2016 12:25 PM)dd777 Wrote:  His dr did a 4 hour glucose test on him yesterday and today he told him the test shows both Hyperglycemia (blood sugar starts out too high) AND hypoglycemia (after eating it falls toooo low). He is not on any medication for diabetes and has not yet been officially diagnosed with diabetes for some reason - he has seen several doctors about it and they all seem confused by his data. They start out saying yes you MUST be diabetic given your symptoms even though you don't seem like a candidate (he is very LOW weight 130 pounds!!!, eats healthy, etc) -- but then they do more testing and get confused and it seems to pitter to a halt. Anyway .... maybe this new doctor will keep investigating even after he gets stumped. Its probably all related.

That's called a Glucose Tolerance Test.
https://en.wikipedia.org/wiki/Glucose_tolerance_test
Slender people can have diabetes too.

(03-17-2016 12:25 PM)dd777 Wrote:  Today his dr also did an Electrocardiogram (FINALLY!) and it showed there is something wrong with his heart. Prolonged QTC. He ordered an Echocardiogram to investigate further.

Prolonged QTC is a electrical anomaly. It should be investigated; but may be caused by medications. The Echocardiogram will give a look at the structure of the heart. It's a real-time image that shows the motion of the heart wall and valve action. Plus, it uses the Doppler principle to view flow velocities and regurgitation (valve leakage.)

Suggestion: I would request he wear a 24 hour Holter monitor to see his EKG during sleep. Might give a clue as to why his rate goes up during sleep. An EKG in the office is just a moment's observation.

Would I be out of line to ask his age?

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.
(This post was last modified: 03-17-2016 01:17 PM by justMongo.)
03-17-2016 01:14 PM
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JudgeMental Offline

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Post: #6
RE: Dr too slow? Go to the hospital?
I certainly can see how/why your anxiety levels and concerns are high in reference to your husbands unhealthy (in my opinion) situation.
Sometimes bluntness rather then walking on egg shells is prudent on an open forum.
Unanswered questions seem to be in order.. Why it's taken so long to do anything. Has he refused medical treatment. Has your insurance or non-insurance required you to see this particular lackadaisical Physician.?
Hopefully, the new Physician (pulmonary) will indeed see the severity of your husbands unhealthy condition and forge ahead on the matters more quickly. Hopefully, for the best..

Yesterday is history; Tomorrow is a mystery; Today is a gift; Thats why its called "The Present".
03-17-2016 01:18 PM
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49er Offline

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Post: #7
RE: Dr too slow? Go to the hospital?
dd777,

Your husband might want to purchase a glucometer and start measuring his blood sugar in response to the foods he eats. That is how I knew I had a problem in spite of doctors not being concerned even though I recently joined the pre diabetic club.

By doing this, he'll learn what foods cause big time spikes vs. the ones that don't. For example, oatmeal, which is thought of as a diabetic friendly food by some in the medical profession caused me to have a 78 point spike which is not good. Fats and a moderate amount of protein do not.

I would also google the diabetes daily forum as I have found those folks very friendly and helpful.

Best of luck.

49er
03-17-2016 01:41 PM
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dd777 Offline

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Post: #8
RE: Dr too slow? Go to the hospital?
(03-17-2016 01:14 PM)justMongo Wrote:  Would I be out of line to ask his age?

Not at all! He is 45.

He has been ill since before I have known him (15+ years). He has been on a pain management / opiates care with doctors due to chronic pain - and yet i just learned today that it is a requirement that these drs do regular EKGs if their patient is on these types of medications, and today was his first one! he has been on the pain management plan for about 3 years at a low-ish(?) dose (10mg of ocycodone 3 times a day if I remember right) and is currently on a reduced dose to taper off in order to try to get accurate tests and see what affect they may be having. i think its possible the medication is part of the problem, at the same time his broader range of symptoms have been going on long before he started pain management. He decided to start pain management when our son was born so he could be more active / involved father.

This is the main reason why he feels "stuck" with this dr. He's worried about insulting him or looking like he is trying to go around him. So my husband is doing everything requested of him. He sees his doctor once every two weeks, a nutritionist once a week, an a physical therapist twice a week. This dr he is seeing now (for the last few months) seems to be making good ground in terms of finding problems that the other drs weren't seeing or considering (i.e.: testing for sleep apnea, etc) -- BUT now that we are seeing some scary results it feels like even though we are seeing the dr so often, it is moving so slowly to do anything about them.


(03-17-2016 01:14 PM)justMongo Wrote:  24 hour Holter monitor to see his EKG during sleep

this sounds like an EXCELLENT idea. I will tell him to ask about that!!!
(This post was last modified: 03-17-2016 02:02 PM by dd777.)
03-17-2016 02:01 PM
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justMongo Offline

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Post: #9
RE: Dr too slow? Go to the hospital?
The opiate pain meds are significant. They lower central respiratory drive.
That can cause central sleep apnea.

Doctor's, like all people, have different egos. Mine might feel I didn't have faith in him if I went to another GP. But, he doesn't mind if I self refer myself to seeing a specialist. I make sure that all reports generated by specialists get to my GP so he knows what's going on. I am also very conscientious about letting everyone who treats me know what medications I am on. Even my dentist!

Has he had an in-lab sleep apnea test? If so, what were the results? If not, is one scheduled?

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.
03-17-2016 02:16 PM
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dd777 Offline

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Post: #10
RE: Dr too slow? Go to the hospital?
Agreed about the pain medication risks. It has been a matter of pros vs cons and once the cons started outweighing the pros recently we decided to taper off. He seems to be handling that quite well. Considering.

(03-17-2016 02:16 PM)justMongo Wrote:  Has he had an in-lab sleep apnea test? If so, what were the results? If not, is one scheduled?

NO. His dr mentioned this as a next step but still not actually scheduled.

Its worth noting after doing more research that my husband had Rheumatic Fever when he was a child. We always have to tell the dentist that. I read more about it today and can see that he did NOT have the proper long term treatment (in some cases I have read that he should have received yearly antibiotic shots for 21 years or something crazy like that). I still don't understand much about Rheumatic Fever but given what I've read today I wonder if that caused heart damage, leading to some, many or all of these issues.
03-17-2016 02:34 PM
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