How Do I Handle My Doctor?

[millich]

Background: Saturday will mark 1 month of CPAP therapy and, thanks to everyone here, I'm making great progress! My prescription was for 4-20 but I had the DME set it at 6-20. Since that time, I've bumped it to 7.5 and dropped peak pressure to 18. With these changes, my numbers (espec. VBS) are better and I don't wake up from the wild changes in pressure. I figured I could tell my doc that I felt the need for an increased flow when I changed to nasal pillows while out of town and I'd pretty much be covered. My 1 month follow-up appt was scheduled for this week and I was leaving things as they are until then.

Now, however, my appt has been pushed back 4 weeks and I want to fiddle just a little more with my lowest pressure. During my sleep study, the initial pressure used was 11 and that was upped to 13. On the 13, I still had an AHI of 13.5 with no centrals. So, I truly don't think that tweaking my minimum pressure up is out-of-line at all given the data.

QUESTION: What do I tell my doctor? Do I call now and say that I I want to change my pressure? If so, what do I say? Or do I wait until the appointment and hope he doesn't notice? If he does notice, how do I explain myself? There is a good chance this guy will just take a quick look at compliance data, be happy that I'm saying I'm doing well, and tell me to be on my way. BUT, I don't want to p*ss him off. I may need him in the future.

Thanks as always for your help!!!

[Wulfman]

A couple of questions.......

Is this YOUR therapy? (I presume you're the one who has to sleep with this stuff attached to your face every night?)

Does the doctor work for YOU? (Are you paying him or is he paying you?)

If both answers are the same, then you should have nothing to fear if you get those points across to your doctor.

And, if he doesn't "get it".......whip out the 2X4 and thump on him till he DOES.

Den

[Julie]

Honestly? I wouldn't even mention it. We all change our pressures fairly often, and no one seems to care until we put them in a position of having to react, such as when going to a DME and asking them to show us how to do it, and they tell us it's illegal . Your doctor doesn't want to know, then he won't have to say or do anything. Alright, if you had e.g. gotten a very serious diagnosis, and maybe a Bipap with specific settings (all you got was an auto machine and default settings, which are not prescription ones anyhow!) and you just arbitrarily changed everything radically in the first week, saying your friend thought you should, well the doctor would be right in getting upset, but what you're doing almost doesn't qualify as changing anything, tweaking is almost an exaggeration! You should in fact, have gotten a proper scripted setting of e.g. 10 or whatever, but didn't, and your therapy was left to the machine to decide, so I wouldn't bother the doctor with trivia that he'd have to then figure out how to deal with!

[stanps]

QUESTION: What do I tell my doctor?

I'm in the same boat. The lag times and miscommunications between my doctor, my DME and myself would be a comedy of errors if it were not such a serious issue. I had the audacity to bump up my CPAP pressure 1 CM H2O, which solved my problems. The way I see it, I'm the one who has to deal with being sleep deprived everyday. I'm pretty well forced to take matters into my own hands.

[jdm2857]

If you adjust your therapy and can demonstrate good results and your doctor stands on ceremony -- get a new doctor!!

[SleepyT]

QUESTION: What do I tell my doctor? Do I call now and say that I I want to change my pressure? If so, what do I say? Or do I wait until the appointment and hope he doesn't notice? If he does notice, how do I explain myself? .... I don't want to p*ss him off. I may need him in the future.

Wulfman is right...it is your therapy, not your doctor's....but I understand your need to soft pedal it as well. Just tell your doctor you have taken a proactive stance...and are educating yourself...and since you can't see your doctor or call your doctor every time you have to make a tiny adjustment.........you've decided to take care of your own health in between doctor visits.

Some doctors will be cool with this...some won't! C'est la vie!

[BlackSpinner]

I just came back from a visit to my sleep doctor - post titration visit - He told me that I needed to up my pressure but if I wasn't comfortable at that pressure to take it back down and get an oximeter and come every 6 month for a check up. When I asked for a new cpap prescription (I lost it when i was at the dme) because I wanted to get my stuff online, he ripped up the instructions to the dme and rewrote my prescription.
My pressure, my treatment, my choices - he was totally ok with that.

Go prepared, go with documentation, expect the best. You wouldn't put up with crap from your plumber or electrical contractor, why should you put up with it from your medical contractor?

[millich]

Thanks everyone. I feel empowered!