help me address these comments

[Guest]

Received an interesting comment on a video that shows people how to get into all the menus on the m series machine. What is the best way to address this comment?

rangermedicman Why? I don't understand this video???? I am a RPSGT, CCEMT-P I have worked in the sleep field for seven years and in Paramedic medicine for over 24+ years. I am in the opinion that if you post information on a web site YOU SHOULD BE RESPONSIBLE for ANY adverse consequent of a person following your directions. Like spontaneous pneumo thorax (too much air in lung that it POPS!) or any cardiac ectopy that is caused by increased CPAP/thoracic pressure!

[echo]

well in addition to the standard 'stick your comments where the sun don't shine' ....

you can also mention to him that diabetics are allowed to control their own insulin shots yet they can also kill themselves by giving themselves too much/too little insulin. why aren't OSA patients "allowed" to have control over their own therapy? knowledge = power, and with the low compliance levels of OSA giving patients MORE information and MORE control over their own therapy can actually INCREASE compliance. Just because we know how to change our settings doesn't mean that we're ignorant back-hills folks that won't work with our doctors and medical professionals to find what works for us.

Sheesh

This has been discussed here many times. maybe you should just point a link to this forum. ohhh yeah maybe we should do a poll as to how many people have gotten pneumothorax because they adjusted their own pressure (usually with the knowledge of their doctors) versus the number of people who stopped CPAP (and eventually died, developed heart disease, stroke, heart attack, falling asleep at the wheel, etc) because their doctors and medical professionals wouldn't work with them to get the treatment right... jnk, aren't polls your speciality area?

EDIT Found some more info :
Article: http://www.cpap-supply.com/Articles.asp?ID=143
And a quick search of Google scholar (http://scholar.google.com/scholar?start ... s_sdt=2000) reveals that pneumothorax with CPAP mostly occurs in newborns or those with severe lung diseases (people which are ALREADY being treated by a doctor anyway).

So I'd ask for an article describing the mechanism and/or cases studies of otherwise relative healthy people who have developed pneumothorax as a result of too-high CPAP pressure.

[Guest]

Thanks Echo! I already have a link on the video that points to this site. I'm going to add a link to this discussion thread. I think that's the easiest way to deal with it since the comment system on YouTube is really screwed up.

This is the the video: watch?v=XKQcRsmOn1U

I'd post a link, but it doesn't let me.

[echo]

Guest, I'm really glad this was a serious post sometimes the flamers, you know, drop a comment and run

Post this too:
wiki/index.php/Reasons_to_Use_APAP

And especially this part of that article with some nice scholarly links:

American Journal of Respiratory and Critical Care Medicine, Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure? http://ajrccm.atsjournals.org/cgi/conte ... /167/5/716 Quote: Home self-titration of CPAP is as effective as in-laboratory manual titration in the management of patients with OSA.

Nonattended home automated continuous positive airway pressure titration: Comparison with polysomnography http://www.sleepsolutions.com/clinical_ ... o-CPAP.pdf Quote: Nasal APAP titration in this study correctly identified residual apnea equivalent to the use of PSG. This correct identification allows the physician to accurately access the efficacy of treatment.

Even if this won't help convince the poster that he's just plain silly, at least the other visitors to the video will have some less biased info!

[park_ridge_dave]

Thanks Echo! I already have a link on the video that points to this site. I'm going to add a link to this discussion thread. I think that's the easiest way to deal with it since the comment system on YouTube is really screwed up.

This is the the video: watch?v=XKQcRsmOn1U

I'd post a link, but it doesn't let me.

Not to point out the obvious, but if you joined this forum and registered I believe that you could post the link (correct me if I'm wrong people ) ? At any rate why not join and help us out more

I have just come back from reviewing the video and I think you should tell RangerMedicMan to get over himself and stick his comment "where the sun don't shine"(apologies to echo ). Your video was informative for those users that don't have a manual (or who are Americans and, thus, never RTFM ) or need a little "refresher".

That person "RangerMedicMan" seems to be a "fearmonger" and wants to inflate his/her importance.

I would ignore it!

Cheers,

Dave

[cobra4x4]

Getting into the menu isn't really the issue here at all, Its what do you do once in those menus.

I myself needed to get into the menu on my machine since I bought it used with only 0.2 hrs of use. I am unfortunately in a position where I could not afford a newer machine since I would have to pay out of pocket and this was my only option for getting on cpap therapy in the quickest way possible.

When I got the machine the pressure was set for 13 and I needed a pressure setting of only 7, so I found the manual online and read the whole thing and changed the pressure to my prescribed setting.

Experimenting with ones therapy is just plain stupid, however a well informed individual can and should be able to adjust features to their comfort levels without being charged through the nose. Unfortunately in todays society money seems to dictate what goes on and how the DMEs provide service or lack there of. In alot of cases a well informed individual is better able to keep tabs on their own health rather than someone who they see once in a while, That being said individuals shouldn't try to play doctor either thats why these people have gone to school for many years. Get the information from your specialist that you need to make good sound decisions.

[DoriC]

Who if not ourselves??? I've certainly "taught" a few of our drs as well as some nursing staff a thing or two about OSA and cpap therapy. I've had some pretty good Professors here! It used to shock me at how uninformed the medical community is about this very common medical condition. It doesn't surprise me now and I try to spread the word wherever I can. One of the young RNs during hubby's recent hospital stay never saw a cpap machine before and barely remembers any classes on the subject. I hope she will now! My son(The Dr) told me they briefly touched on OSA during his pulmonary rotation in the early '90's at a prestigious NYC hospital. Our primary Dr is of the same era and although he was the one who made the diagnosis and referral for the study, he had little knowledge of the therapy used. I knew I shouldn't have started this post!

[LinkC]

Why respond at all? You have your opinion,,,Ranger Rick has his. I'm betting more people will thank you than condemn you (most of them silently),

If it would make you feel more comfotable, add: "Use this information at your own risk."

[Calist]

So I get this patient the other day. He comes in and asks 'Do I really need a sleep test?'.

I looked at him and asked 'How many heart attacks have you had?' He said 'None.' So I told him 'Come back and see me when you've had two.' Just then my other patient turns to me (having evesdropped on us) and said "Hey... I've had two heart attacks!"

"Welcome to the lab!" I declared.

I hate to say this because I know that no one wants to hear it. I hate to say this but... patients are stupid. That is not entirely fair I know, lets say that 90% of patients are stupid. These physicians we have nowadays are all out there practicing preventative medicine. Financially speaking- what they should do is to wait and let patients have at least two massive heart attacks before sending them to the sleep lab for an OSA diagnosis. They would actually make more money that way by waiting until their patients develop serious problems. Treating a patient with serious problems is a lot more lucrative than trying to prevent their patients from getting a serious problem. But sadly, there are a lot of physicians practicing preventative medicine. When a patient develops hypertension or some minor cardio problem, they send the patient to a sleep lab in an attempt to "Fix" this problem before it becomes a serious problem.

It doesn't work though. Preventative medicine is a pipe dream, a fool's paradise. What will happen is that the patient will go to the lab, pick up a diagnosis of OSA, get titrated, be given a machine and quickly decide not to use it. I could list a million reasons why a patient would decide to ignore treatment but whatever they use the justify it to themselves is irrelevant, what it all boils down to is- They have no interest in changing their lifestyle.

So five to ten years later, their chart gets pushed in front of me. Patient, age 55, diagnosed with OSA 10 years ago, noncompliant, 2 heart attacks, 4 surgeries, pacemaker, COPD, back for another sleep study. The person I meet is one I have met a thousand times before. The returning patient is some one in dire need of help. They don't mistrust the procedure or the people giving it to them, they don't question the validity or the age of sleep science. All of the questions that a 'hypertension patient' might ask never seems to manifest on the lips of the returning patient. Every now and again what I get are the words 'Please, please help me.'

And I do. I go all out, I stay late, I pay them extra attention and I give them advise about CPAP use that I really shouldn't be giving them. I tell them how to deal with the DME companies and what to do if their insurance companies give them the runaround. Last but not least I tell them that if they have ANY problems with those scoundrels, they should call me right here at the lab and I'll raise holy hell. I love seeing those patients. It feels so good to get a person that is in dire need of help and intervene in their lives. Just run in and fix everything. No more heart problems, no more EDS (That means Excessive Daytime Somnolence), no more morning headaches.

Just last week I had a patient who had developed bouts of A-fib over the last year and it was really scaring her. When I hooked her up I could see them cranking out across the screen for about an hour as she had event after event after event, choking on her own airway. I titrated her fast and amazingly enough, after going through REM with a clear airway one or two times, her heart rate leveled out. I showed her that morning after I got her up. I was so proud. I felt like I had cured A-fib, hehe. I showed her heart rate at the beginning of the night and at the end of the night. She had had so many surgeries and EKGs that she knew exactly what she was looking at. She burst into tears right there in the middle of the lab.

I was proud of what I had done and happy that she was happy, but it was a little awkward walking a patient out to the waiting room with red puffy eyes. I wish she hadn't been so overly emotional. While I'm at it, let me wish that she had used CPAP ten years ago. Maybe I could even wish that preventative medicine does work. Perhaps I could dream of a world where my patients don't walk into Wal-Greens and throw a fit when the pharmacists tells them they don't know what a CPAC is and they wouldn't 'give them one to try' even if they had one.

I wish my patients would do a little research and not stroll into the lab asking "Is this some kind of new fad thing?" or when they walk into the ER with hypoxia and get all upset when you go to put an 02 canula on them "No! Don't give me oxygen, I don't want to get addicted!"

You see, this is ignorance but not ignorance as most people would define it. A person's understanding of Medicine comes from word of mouth, TV, movies or when a Physician sits down in front of them and attempts to explain things 'In layman's terms'. Instead of pursuing this information and attempting to learn more about it, people have a tendency to debate it and assume themselves to be an expert by means of debate.

"It's all just conjecture anyway, right?"

Actually wrong. Doctor's do not make assumptions. Well, lets say, practicing Doctors do not make assumptions. What they do is they order tests and they PROVE beyond all doubt what a patient has. There is very little guess work involved. Now its true that on Days of our lives we have seen many physicians prattle something off the top of their heads and then order treatment for some obscure disease that only a genius would know about. In real life however that Physician would have a lot of explaining to do after killing so many of his patients.

If you- a patient, want to change the CPAP pressure on your CPAP machine... you should at least have an understanding of OSA (What it is, how it works, what physically causes it, in what stages it occurs, the difference between obstructive and central) PAP treatment (BIPAP, CPAP, AutoSV, AVAPS, what it treats and how).

What this all boils down to is self-titration. If you can come into my lab and titrate one of my patients... only then are you ready to titrate yourself. And if you can do that, then you can surely tell me what a Hypopnea is.

[cflame1]

I hate to say this because I know that no one wants to hear it. I hate to say this but... patients are stupid. That is not entirely fair I know, lets say that 90% of patients are stupid. These physicians we have nowadays are all out there practicing preventative medicine. Financially speaking- what they should do is to wait and let patients have at least two massive heart attacks before sending them to the sleep lab for an OSA diagnosis. They would actually make more money that way by waiting until their patients develop serious problems. Treating a patient with serious problems is a lot more lucrative than trying to prevent their patients from getting a serious problem. But sadly, there are a lot of physicians practicing preventative medicine. When a patient develops hypertension or some minor cardio problem, they send the patient to a sleep lab in an attempt to "Fix" this problem before it becomes a serious problem.

It doesn't work though. Preventative medicine is a pipe dream, a fool's paradise. What will happen is that the patient will go to the lab, pick up a diagnosis of OSA, get titrated, be given a machine and quickly decide not to use it. I could list a million reasons why a patient would decide to ignore treatment but whatever they use the justify it to themselves is irrelevant, what it all boils down to is- They have no interest in changing their lifestyle.

This is soo not the place to tell us as patients that we're stupid... and who are you to presume because somebody hasn't had a heart attack that we haven't watched somebody we love have one? And known why they had it. Or watched them die! Wish that you'd take your attitude to the cleaners.

[carbonman]

well in addition to the standard 'stick your comments where the sun don't shine' ....

visual aid

[roster]

Received an interesting comment on a video that shows people how to get into all the menus on the m series machine. What is the best way to address this comment?

rangermedicman Why? I don't understand this video???? I am a RPSGT, CCEMT-P I have worked in the sleep field for seven years and in Paramedic medicine for over 24+ years. I am in the opinion that if you post information on a web site YOU SHOULD BE RESPONSIBLE for ANY adverse consequent of a person following your directions. Like spontaneous pneumo thorax (too much air in lung that it POPS!) or any cardiac ectopy that is caused by increased CPAP/thoracic pressure!

I would tell him that more than half of his patients are not compliant and their health is being destroyed. I would tell him that he has never encouraged a single patient to get a machine with efficacy data capability and as a result the great majority of his compliant patients have suboptimal therapy and are developing health problems from suboptimal treatment.

I would tell him he has been doing this for the entire seven years he has spent in the sleep field and someday will have thousands of patients suing his sorry ass. I would tell him that on the witness stand for the plaintiffs will be people testifying that his advice was horrible and negligent and that they only got a good therapy after viewing your video and changing their settings.

[roster]

Or give me the link to the video and I will tell him (along with a couple dozen other forum members for sure).

[BlackSpinner]

I hate to say this because I know that no one wants to hear it. I hate to say this but... patients are stupid. That is not entirely fair I know, lets say that 90% of patients are stupid.

Right stupid - Do you drive? do you know exactly what is happening under the hood? Do you tell your mechanics how to fix your car? Can you write the software for your computer? Can you fix it? Do you understand exactly how the stock market works so that you can make informed purchases and never lose money? Do you know where your food comes from? Can you hunt down your own meat and clean it? Can you raise all your own food? Can you make your own clothes from scratch? Can yo make dyes from the materials around you?

If the answer to any of these things is NO the yes, you are STUPID according to your definition!

Lack of information is not stupidity - You were HIRED to provide a service and information you were trained for, just like a car mechanic or an electrician or a house cleaner or a doctor.

So far the stupidest people I have met have been the people running the DME's.

[roster]

Received an interesting comment on a video that shows people how to get into all the menus on the m series machine. What is the best way to address this comment?

rangermedicman Why? I don't understand this video???? I am a RPSGT, CCEMT-P I have worked in the sleep field for seven years and in Paramedic medicine for over 24+ years. I am in the opinion that if you post information on a web site YOU SHOULD BE RESPONSIBLE for ANY adverse consequent of a person following your directions. Like spontaneous pneumo thorax (too much air in lung that it POPS!) or any cardiac ectopy that is caused by increased CPAP/thoracic pressure!

Excellent video! A good public service. Here is the full link https://www.youtube.com/watch?v=XKQcRsmOn1U

You put some good information in the video. I like that warning to not use the "Auto Off" feature.