Help me to design a new machinery for u!

[xj220c]

None of the cutesy things you quoted require submissions to government authorities (FDA approval),

Maximum methylene chloride content in coffee - regulated by the FDA under 21 CFR 173.255(c)

Cookware that leaches dangerous contaminates like lead and cadmium - prohibited under 21 USC sections 402 and 409, see also FDA Compliance Policy Guide Sec. 545.450 (setting forth acceptable lead leach levels in ceramic food containers) and FDA Laboratory Information Bulletin 4126 (setting forth appropriate testing procedures for determining lead leach levels by atomic absorption spectroscopy)

Pasteurization standards for milk products - heavily regulated under a wide variety of federal, state, and local laws generally following the FDA Pasteurized Milk Ordinance (which has been upheld by the courts since the early 1900's)

Honestly Rooster, you're just not in touch with reality on this subject.

Sad and frustrated,
XJ.

[roster]

Like I said, none of them require submissions to government authorities - they only have to meet the standards, they don't have to submit the products or the design of the products or studies on their effectiveness and safety. CPAP manufacturers have to submit all of that for FDA approval in advance of selling. That is quite a significant difference.

Your repeated smokescreens have not hidden that the original question still stands unanswered: What are the FDA regulations, retail licensing requirements and prescriptions protecting the consumer from?

The answer is, "Nothing, they are only driving the prices up and inhibiting competition and innovation."

[xerort]

To answer all your questions about why cpap technology is moving "so slowly" and why it is so far behind, and how come there are no obvious things like oxymetry adaptors, easier interface for you to check your useage, etc. etc. etc.....

Because, frankly, you don't need to know that stuff. You honestly don't. It benefits you in absolutly 0 ways.

Useage: did you use your machine last night? Good for you. Does it matter what your AHI is? Not a lick. What was your sat last night? Doesn't matter.

See, when the average individual is given this information, they start to get more and more obsessed with it. It's actually a documented thing. Well documented. Easiest example I can think of is with vent patients. Sometimes a vent patient will become overtly worried about what setting their vent is on. If you switch them to a setting that is designed for weaning, they get nervous, and end up working themselves into a spasm. I once had a vent patient who every time I switch them to cpap (yes, just about the exact same thing you put on your face) they would just about have a stroke, swearing that they couldn't breath. So, onetime while they were sleeping, I walked in, and switched them over to cpap. They were fine. four hours later, I came in and switch them back to their normal mode. They mouthed "Did you just switch me onto cpap?!??!" I said "Yep!" and they started flipping out. 15 minutes later, I came and said "Ok, ok, I'll switch you back! calm down, it will be ok!"....... and proceded to switch them back to cpap.

This went on for about four days, with all the therapists playing along. Finally, I walked in to take them off the vent. WHen they started to panic, I showed them the vent sheet, where they had currently been on cpap for over 24 hours.

Sometimes we know what is best for you.... because, you know... we are trained to know whats best for you.

I had a patient who swore that she did better on one setting then another, and she wanted her doctor to write a perscription for that setting. It was, oh, about 10 above what she was currently on.

Why? Because she somehow got ahold of the program for downloading her information about her sleep that her machine is putting out, and decided that she was qualified to adjust her own machine.... so she did.

And she paid the price for it.

See, Cpap is an artificial means to provide additional PEEP to the body. But it does more the just splint open the passageways to your lungs. It can open collapsed lung tissues, help with oxygenation, and oh man, what else was it... something else... can't quite remember it......

Oh yeah, decrease the venus return to your heart, putting you into congestive heart failure. The patient, who already had congestive heart failure, made her condition worse, and ended up in the hospital.

Furthermore, I have seen oxygen patients who have bought pulse oxymeters go ahead and increase their oxygen levels. And thus knock out their hypoxic drives, and just about KILL THEMSELVES.

You are NOT QUALIFIED to interpret that information, therefore they do NOT make it easily accessable to you.

If you take medication, once you have paid the pharmacy for it, it is yours. Does that mean you can go and adjust your dosage all willy nilly? Well, you can... enjoy your coma.

Unless you have MD or RT after your name, you should not be adjusting your own pressures. As, well, you know. It's kind of against the law. You can believe me if you want, I don't really feel like looking up the codes and regulations.

And that information is just about useless unless viewed in the proper light, with all facts and figures open and acounted for.

That's why you will most likely never see any of those easy to use adaptors on your cpaps, and why most doctors and home care companies will not sell those machines that do.


However:

F&P is coming out with a machine that has an alarm clock. You can also put 5 mp3's on it so you can wake up to your favorite songs. Can't wait to teach my average patient that!


-xero, who yes, is an RT.

[rosacer]

xerort
To answer all your questions about why cpap technology is moving "so slowly" and why it is so far behind, and how come there are no obvious things like oxymetry adaptors, easier interface for you to check your useage, etc. etc. etc.....

Because, frankly, you don't need to know that stuff.You honestly don't. It benefits you in absolutly 0 ways.

I completely disagree with you. You seems to be generalization a lot speaking about two patients who made weird things with their equipments.

If I have waited after my careless Dr I had at the beginning to really prescribe the TRUE pressure I needed I would still be, today after almost one year, struggling. My dear Dr invented a pressure, yes I never was titrated; he ordered the RT to set a CPAP with an pressure he get from his pocket. I was feeling tired still and the Dr and the RT where reading the data and telling all was good, I was imagining I was tired.

You speak as if we are a gang of low IQ unable to put information together in most of the cases in more intelligent way than a lot of Dr and RTs (yes RTs too) out there.

I can tell you about the stupid statements I have hear from friends of mine who went to see the RT from their DME whom only preoccupation is to sell them the first mask and machine the try.

I'm more than happy that we can read our data as frequent as we want and not need to depend on a salesman. I'm more than happy that I started reading my data, other way I would never have known what was going on.

Yes there are good Dr.s as well as good RT's but that's not always the case.

My health is my responsibility and I don't think there would be somebody else more interested in my well being than me.

Hasta la vista...

Rosie

[xerort]

Oh yeah, well I completly disagree with you!

So

Your situation shouldn't have happend. Your doc should not have given you a pressure without a titration, and when your RT heard that you were still tired and such, you should have been given an auto-titration.

This is more of an issue with having a bad doc/rt team then needing your download information.

I have no doubt that some of my patients are more intellegent then me. In fact, I once had a math professor figure out, during the course of his stay, how many cmh2o were in a psi. Took him like 3 hours or something. (It's 72, btw). He was definitly smarter then me.

Except when it comes to things respiratory. He could beat me in math, no doubt. Drop him in the average situation that an RT faces everyday, and he'd be lost.

There is a reason that being an RT requires a degree, as well as some pretty grueling testing, in order to be officially liscensed.

And to be honest with you? I get a patient into my office, and I ask them what is going on. From there, I make a decision about which mask I think is best, which machine I think is best. That is part of my job. I pick what I think is best for my patients, because that is what I am trained and experienced to do.

95% of my patients walk away with the same mask. Same with machines and nasal systems. Why?

Because there are many, many different types of masks. If I showed each patient each different type of mask, it would take a long, long time. Why waste time? Why not just show them what is the best of the best, in my honest professional opinon?

Each patient has a different situation, however most situations are solved by the same mask. "It's too uncomfortable. It leaks too much. It's too tight. The gel broke and it's sticky. It's too hard to clean. I dont like the way the foam feels on my face. it leaves marks on my face. It casuses abrasions where my face meets the mask. It falls apart too quick. There are cockroaches in my machine."

Wait: that last one wasn't about a mask. It was about a machine. and yes, it did happen.

The thing is, I could say "Ok, well, lets see what we have that could fix your problem!" and show them 8 different masks.

Or I could say "Ok, well, let me show you my favorite mask, the mask I have the most luck with, the mask that 95% of my patients end up with, the mask I get the least complaints about, the mask that has the highest customer satisfaction, etc. etc. etc."

Which would you prefer? Having a professional, who wants you to use your cpap, who wants you to be happy, who wants to do the best that he can by you, who cares that you have the best experience you can, or the RT that wants you to make your own decision, which might be a bad one?

I don't make money for my company, I am not a salesman. The rentals we receive off the equipment I set up and the masks I put out makes my company money. However, each mask and machine is charged at the exact same rate! If I didn't care, I could just throw any mask at a person, any machine, and make the same amount of money for my company that I would if I spent the time explaining exactly WHY I like a certain mask for there situation.

I am a respiratory therapist, and I am DAMN proud of it. I love being an RT, I love my job, I love my patients. And honestly? My patients love me, because I honestly and truly care about them. I want them to wear their cpaps, and I want them to have the best experience that they can.

I'm sorry your DME doesn't employ me. There should be more "me" out there, I guess. I'm pretty handsome to boot.

But I still say that for the average individual, getting the information from their download does little to help them. However, I will add the following statements:
You do not need to see your download information:
1) If you have a good doc/rt/dme.
2) If things are going well with the cpap, or if things are going poorly then refer to 1)
and lastly, and probably most importantly
3) If you don't argue with me for more then five minutes.

[Slartybartfast]

[Excision of large verbiage mass]

You do not need to see your download information:
1) If you have a good doc/rt/dme.
2) If things are going well with the cpap, or if things are going poorly then refer to 1)
and lastly, and probably most importantly
3) If you don't argue with me for more then five minutes.

But that's just the point. Lots of us would rather sit next to the pilot when we fly so we can see what's going on. Without access to data, we're blindly trusting a medical team that is most often largely unknown to us.

Old Russian Proverb: "Trust but Verify"

[So Well]

There is a reason that being an RT requires a degree, as well as some pretty grueling testing, in order to be officially liscensed.

From there, I make a decision about which mask I think is best, which machine I think is best. That is part of my job. I pick what I think is best for my patients, because that is what I am trained and experienced to do.

95% of my patients walk away with the same mask. Same with machines and nasal systems. Why?

Because there are many, many different types of masks. If I showed each patient each different type of mask, it would take a long, long time. Why waste time? Why not just show them what is the best of the best, in my honest professional opinon?

I am a respiratory therapist, and I am DAMN proud of it. I love being an RT, I love my job, I love my patients. And honestly? My patients love me, because I honestly and truly care about them.

I'm pretty handsome to boot.

Handsome to boot? Your personality is about as handsome as a boot that has been walking in the pig lot.

Enjoying massaging your ego here?

Tell me, it seems you come from a long line of mushroom farmers don't you??? It's bred in to you to treat your patients like mushroom farmers treat the mushrooms.

Cover 'em in manure and keep 'em in the dark.

Your posts are not inspiring any patients to have confidence in sleep professionals.

You are one of the little reasons that this forum has been so popular - patients can come here and deal with other patients and avoid the arrogant know-it-all professionals like you that have been doing them a disservice while pumping up their own egos.

Your posting is a disgrace to your profession.

[SleepingUgly]

I once had a vent patient who every time I switch them to cpap (yes, just about the exact same thing you put on your face) they would just about have a stroke, swearing that they couldn't breath. So, onetime while they were sleeping, I walked in, and switched them over to cpap. They were fine. four hours later, I came in and switch them back to their normal mode. They mouthed "Did you just switch me onto cpap?!??!" I said "Yep!" and they started flipping out. 15 minutes later, I came and said "Ok, ok, I'll switch you back! calm down, it will be ok!"....... and proceded to switch them back to cpap.

This went on for about four days, with all the therapists playing along. Finally, I walked in to take them off the vent. WHen they started to panic, I showed them the vent sheet, where they had currently been on cpap for over 24 hours.

My patients love me...

Well, maybe not ALL your patients love you.

[chunkyfrog]

If he had pulled that crap on ME, I guarantee he'd be in line the next day at the unemployment office!

[rosacer]

so well

Handsome to boot? Your personality is about as handsome as a boot that has been walking in the pig lot.

Enjoying massaging your ego here?

Tell me, it seems you come from a long line of mushroom farmers don't you??? It's bred in to you to treat your patients like mushroom farmers treat the mushrooms.

Cover 'em in manure and keep 'em in the dark.

Your posts are not inspiring any patients to have confidence in sleep professionals.

You are one of the little reasons that this forum has been so popular - patients can come here and deal with other patients and avoid the arrogant know-it-all professionals like you that have been doing them a disservice while pumping up their own egos.

Your posting is a disgrace to your profession.

Oh boy So Well, I was really not expecting to laugh that much.



Xerort : I would be curious to know how much, those patients you belittle in your story would still love their handsome damn intelligent out of this world RT, once they know what do you think and say about them. I would expect more respect from somebody who thinks he is so professional and knowledgeable.



OK, this is a completely waste of time because nobody can change the big egos of this world.

Cheers!

[Guso]

I'm replying to the original question.
Just build an ASV machine for less than 400$.

[Jersey Girl]

Dear Xerort,

95% of my patients walk away with the same mask. Same with machines and nasal systems. Why?

Because there are many, many different types of masks. If I showed each patient each different type of mask, it would take a long, long time. Why waste time? Why not just show them what is the best of the best, in my honest professional opinon?

I am very curious to find out which masks 95% of your patients walk away with and which masks you feel, based on your experience, are the "best of the best"?

Jersey Girl

[robysue]

Dear Xerort,

95% of my patients walk away with the same mask. Same with machines and nasal systems. Why?

Because there are many, many different types of masks. If I showed each patient each different type of mask, it would take a long, long time. Why waste time? Why not just show them what is the best of the best, in my honest professional opinon?

I am very curious to find out which masks 95% of your patients walk away with and which masks you feel, based on your experience, are the "best of the best"?

Jersey Girl

What I'd like to ask Xerort is this:

What do you do when that favorite mask you give to (force on?) 95% of your patients is a mask that causes a particuluar patient to tell you the mask feels uncomfortable or the mask does not fit well on his/her face or the mask is too claustrophobic or the mask makes him/her itch (or sneeze) like crazy?

There's a reason that there are "many, many different types of masks": It's because there are many, many different types of faces with many, many structural variations and no mask is going to fit 95% of the sleep apnea patient population sufficiently well to provide all of those patients with the best, most optimal CPAP therapy.

One of the quickest routes to patient noncompliance with CPAP is mask discomfort. In an effort to not waste (his) time, Xerort is likely causing many of his patients to waste substantial amounts of their time in an unsuccessful effort to make CPAP work with an inappropriate mask. And indeed, because Xerort's time is so valuable to him, some of his most unlucky patients likely spend many additional months or years NOT treating their apnea because they find that in their experience the "the CPAP is worse than the apnea."

[xerort]

I came on here to try to help people who were having issues with cpap. I posted in a post about how to design a new machine. I posted FACTS. YOU DO NOT NEED TO SEE YOUR DOWNLOAD. Fact. The number one way to show if cpap is working for you is HOW YOU FEEL.

I got countered by an intellegent, thought out response. I debated the point, and conceded some. I tried to answer questions, with a bit of humor. I tried to have fun. I tried to help.

Sorry. Will not happen again.

[flash2]

gee, shucks, you think a poor dumb, ivy league graduate, with a degree in physiology specializing in nerve and muscle cells can't read the journals and understand the sleep data? Sigh, all that money I paid for my education and all I needed to know I could have learned from a lowly tech. I knew I should have saved my money.

Sorry, been there, done that for breast cancer and back surgery. All my docs have been very supportive and encouraging about patients learning and becoming expert at their personal disease. My oncologist even commented on how much it has helped her stay on top of the newest breakthroughs because we lowly patients have time to research pubmed for the latest and greatest. There's no way a doc can know or do it all.

Glad you provide entertainment.