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There, there, dear...Managing the sleep specialist at the first follow up
#11
RE: There, there, dear...Managing the sleep specialist at the first follow up
I'm so glad that you have advised bullet points. That is a huge advantage.

Watch out for the grrr. I was in that mode with new doctor and it complicated things too much. We didn't get into constructive conversation until the last part of the office visit. Don't make the same mistake I did!

Yeah, I figured the tiredness was extreme based on your other thread. I would still gloss over the tiredness during the opening 5-10 minute overview, but emphasize it once you are into the charts - as a symptom of what is being shown in the chart.

Definitely watch out for the grrrr though. I had the doctor's back up from the moment he walked into the room, and it didn't help my case (although we overcame it later, but what a freaking waste of time).

eta: and by glossing over the tiredness, I do not mean to ignore it or minimize it - just do not allow her to go into a 20 minute lecture or argument about how your tiredness is normal for new cpap users. Agree with her. But argue your case once you're into the details of the chart. I hope that makes sense. I'm so tired I can't think. Sad
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#12
RE: There, there, dear...Managing the sleep specialist at the first follow up
(10-18-2017, 07:59 PM)kiwii Wrote: I'm so glad that you have advised bullet points. That is a huge advantage.

Watch out for the grrr. I was in that mode with new doctor and it complicated things too much. We didn't get into constructive conversation until the last part of the office visit. Don't make the same mistake I did!

Yeah, I figured the tiredness was extreme based on your other thread. I would still gloss over the tiredness during the opening 5-10 minute overview, but emphasize it once you are into the charts - as a symptom of what is being shown in the chart.

Definitely watch out for the grrrr though. I had the doctor's back up from the moment he walked into the room, and it didn't help my case (although we overcame it later, but what a freaking waste of time).

eta: and by glossing over the tiredness, I do not mean to ignore it or minimize it - just do not allow her to go into a 20 minute lecture or argument about how your tiredness is normal for new cpap users. Agree with her. But argue your case once you're into the details of the chart. I hope that makes sense. I'm so tired I can't think. Sad

Great advice!  Thanks  In reality, I'm most concerned that she'll try to steamroll me and I'll leave there angry and feeling like nothing got accomplished. It already sounds like she's wrapped up in compliant behaviors and normalizing my tiredness in an email she sent me. I realize that's what she normally has to work with, but  Oh-jeez.
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#13
RE: There, there, dear...Managing the sleep specialist at the first follow up
I was in similar situation earlier this year on that BiPAP. A part of me wanted to smack doc with a big mallet. His answers seemed opposing just to be contrary. Like 2 years ago when I weighed 300, comments in my file "patient seems to be doing well on CPAP pressure 18. Weight is OK." Patient was not breathing out against 18, and was not OK at 300#. Early this year at 205..."Patient seems to be doing well on BiPAP, could stand to lose some weight." Uh yeah. BiPAP was CAUSING centrals! I'm (was) extremely tired doc. When I use BiPAP I'm more tired than I was 6 hours prior. Whiz the complaint over his head.

Hey he retired possibly because of me, so victory to me in the end. Another in his office pointed out I'd had an appointment with them to see I needed ASV then his tune became let's get you on ASV because BiPAP is causing central apnea and will make you more tired. Thanks doc.

In all seriousness, be polite and professional. AND state YOUR case in a clear, concise, factual fashion. Then if that doesn't work...mallet time!  Smile 

sarcasm with mallets may be hard to accept and only you can prevent mallet bumps! the author of this post is covered by the law firm Dewey Cheatum and Howe...

[Image: T5VXqiP.jpg]
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

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#14
RE: There, there, dear...Managing the sleep specialist at the first follow up
Dress up in all black like a Vampiress! That will rock them back on their heels.   Crazy
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#15
RE: There, there, dear...Managing the sleep specialist at the first follow up
(10-18-2017, 09:39 PM)Walla Walla Wrote: Dress up in all black like a Vampiress! That will rock them back on their heels.   Crazy

Guys need not follow above advice...
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

Wiki Info for Beginners
Organize Charts
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#16
RE: There, there, dear...Managing the sleep specialist at the first follow up
You are doing your part by being compliant. In addition you are an informed patient and realize the you are not doing well enough to realize the benefits of CPAP therapy in spite of that effort. You have studied your problem and worked to find optimized settings to minimize AHI and fatigue; however your events still remain high. This is not a titration issue or patient compliance issue, it is a therapy issue.

You need a different form of therapy to resolve the sleep disordered breathing that is disrupting your life. Your events are mostly central apnea and hypopnea and CPAP does not treat central events. Your breathing has persistent flow limitation that does not resolve at any CPAP pressure. Since you do not tolerate or benefit from CPAP, you want to be evaluated for bilevel and/or ASV.

That's your story...stick to it.
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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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#17
RE: There, there, dear...Managing the sleep specialist at the first follow up
(10-18-2017, 09:42 PM)Sleeprider Wrote: You are doing your part by being compliant. In addition you are an informed patient and realize the you are not doing well enough to realize the benefits of CPAP therapy in spite of that effort.  You have studied your problem and worked to find optimized settings to minimize AHI and fatigue; however your events still remain high.  This is not a titration issue or patient compliance issue, it is a therapy issue.  

You need a different form of therapy to resolve the sleep disordered breathing that is disrupting your life.  Your events are mostly central apnea and hypopnea and CPAP does not treat central events.  Your breathing has persistent flow limitation that does not resolve at any CPAP pressure.  Since you do not tolerate or benefit from CPAP, you want to be evaluated for bilevel and/or ASV.  

That's your story...stick to it.

Thanks  Awesome! A script!
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#18
RE: There, there, dear...Managing the sleep specialist at the first follow up
Lolabove
He said it.
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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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#19
RE: There, there, dear...Managing the sleep specialist at the first follow up
All the best for a productive appointment, and a reasonable response. By morning (our time), I hope to hear good news Big Grin
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#20
RE: There, there, dear...Managing the sleep specialist at the first follow up
(10-19-2017, 12:19 AM):thanks:Doza Wrote: All the best for a productive appointment, and  a reasonable response.   By morning (our time), I hope to hear good news Big Grin

Thanks  Hate to disappoint you in advance, but the appointment is next week.
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