What now? Morbius, your input, please?

Brief rundown: Dad's nearly 86, has dementia, and is recovering from surgery last September. I'm here in FL helping out, as he's pretty weak these days. LSS, I got him tested for apnea a couple of months ago (I've suspected it for years), he was diagnosed as severe, and he got an APAP at the end of March. He's a trooper about using it and his F10 mask. His data's looking pretty decent these days, except for the amount of PB being recorded. Some nights, it's even worse than the two nights' data shown below, and I wonder if Dad needs an ASV like the one I use. Any input appreciated.

My neighbor did finally send my recording oximeter from home a few weeks ago, and Dad wore it one night, but I was having computer issues, and the pc wouldn't upload the oximeter's data; I subsequently had the DME provide an overnight oximeter for two nights, and the results (and the data from his APAP for those two nights) are below. The DME tells me that the one oximeter graph covers both nights. I think his O2 looks pretty good; anything to be concerned about?

After looking at his pulse, is he possibly on a Beta blocker? Either way, you need to notify the doctor this condition.

Good Luck!

BleepingBeauty wrote: I wonder if Dad needs an ASV

So the first thing you need to do is make sure his EF isn't in the exclusion category (<45%). And upon further review, we find

BleepingBeauty wrote:LV ejection fraction of 55-60%

The graphs are so compressed as to be nearly worthless (for our purposes), data sampling every 4 seconds...

I can't work under these conditions!

So you have a couple of 70% sats, which of course would be panic time, but those look like artifact. Overall, most of the time he's in the 90's, so that's better than good, that's great.

But of note is that heart rate variability. There's nearly a 20 beat swing there. That could be from the periodic breathing. Does he have a fib?

Thanks for looking at this.

Morbius wrote:

So you have a couple of 70% sats, which of course would be panic time, but those look like artifact. Overall, most of the time he's in the 90's, so that's better than good, that's great.

I thought so, too.

But of note is that heart rate variability. There's nearly a 20 beat swing there. That could be from the periodic breathing. Does he have a fib?

To my knowledge, Dad's never been diagnosed with A-Fib. His PCP put him on Multaq several months ago because his heart rate was dropping to the point where he got dizzy/lightheaded and he was having episodes that we described as him "zoning out" for about 3-4 minutes. His eyes would be open but glazed, with a very far away look, and he wouldn't respond to either touch or speech while he was in the throes of one of these episodes. For all intents and purposes, it was like he was in a coma for a few minutes.

Thankfully, these episodes occurred while he was sitting, so we just had to keep him propped up so he wouldn't slump to the floor. The episodes were scary, and I've not heard any real explanation for them (other than his heart rate dropping); but he was on the Multaq when they occurred, so I don't know what that means... He hasn't had an episode in several weeks now, so I hope that's no longer an issue for him.

If it appears that he *does* need an ASV, I wrestle with whether or not to pursue getting him one. On one hand, I want his quality of life to be as high as possible; but on the other, I wonder if I should be content with the fact that he's getting pretty good therapy with the APAP (his data, aside from the amount of PB, looks pretty damned good). It's hard to accept that he's almost 86, he's not well (physically and now mentally), he'll never again be the guy he was, etc. It's really difficult for me to come to grips with the fact that, much as I want to, I can't "fix" him. Maybe I should just be grateful that I've gotten him this far, hope for the best, and not push any further. I need a really good cry...

All you can do is what you think is best, moment to moment. Enjoy what you can. I am sorry, but I have been through something similar. When it is done, you will know that you did the best you could. That brought me comfort.

yippeekia wrote:All you can do is what you think is best, moment to moment. Enjoy what you can. I am sorry, but I have been through something similar. When it is done, you will know that you did the best you could. That brought me comfort.

Thanks for saying that. I *am* grateful that I can be here and spend so much time with Dad now; we've been separated by many miles for several years. It's just painful to see him so frail and weak, and it's tough to realize that I can only make the day-to-day stuff a little easier, try to make him laugh and enjoy life a little more than he would otherwise, and just be sure that he knows how much I love him. I've done what I can to make him physically better by helping him to exercise when he feels up to it, making sure he's eating well and is taking his meds, and by getting him tested for apnea and now successfully using the APAP; but he's pretty much sworn off doctors from now on, so I'm not going to push for an ASV. He's getting good therapy now, so I'll have to be content with that, try hard to ignore all the PB I see on his data, and leave the subject alone.

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Morbius, thanks for your input. As always, it's appreciated.

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I've disconnected the humidifier from his machine for the past couple of nights. I told him I was doing it and to let me know if the air felt too dry as a result. So far, he says he hasn't even noticed. (Being that he's in south FL and the air is humid as hell, I figured if he can use the machine without the humidifier, it'll be one less thing for my mother to have to deal with if/when the time comes that I go back to AZ.) The machine's on auto start/stop; with no humidifier to fill, my mother won't have to do anything at all re: the machine. I'll consider it a victory if she'll just agree to put in new filters when needed and to wash his mask/headgear every now and then. I can take care of getting him resupplies by phone from AZ. (Not that my ability to go home is even on the horizon right now; just thinking ahead and trying to cover the bases.)