Unsatisfactory followup appointment

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Spiritus
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Unsatisfactory followup appointment

Post by Spiritus » Mon Dec 13, 2004 11:01 am

Hi,

I just got back from my followup appointment with my sleep doc, and I'm feeling a tad disgruntled.

As I mentioned earlier, I only slept 4 hours on my titration sleep study, and now that i've experienced around 4 nights with the new pressure, I'm still very sleepy in the daytime. I wake up after about 4 hours, and take the mask off. Since I'm not compus mentus in that situation, I get up, go to the bathroom, and then promptly fall back to sleep - sans mask.

My appointment with the doctor lasted a total of 5 minutes. During that time he told me that my breathing is now fine, and that they will call me in a year for a followup appointment. He also said that if I keep waking up in the night, he will prescribe a hypnotic (I don't recall the name) that has a 3 hour half-life.

I felt stressed at the way I was being rushed, and didn't even have the presence of mind to ask for a script for an autopap - my main immediate concern.

Now I need to figure out a way to get an autopap script. Perhaps my GP will write one, but then again I don't know if GPs can write cpap scripts.

Rob

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Nenetx2004
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Post by Nenetx2004 » Mon Dec 13, 2004 11:50 am

Yikes! I would definitely call back and get another appointment to resolve some of your unanswered questions. My first visit to an ENT was very rushed. The doctor interrupted me on several occasions and even answered a cell phone call in the middle of the consult! The next time I saw him was better. He seemed less rushed but still didn't address some of my questions. My best results and the appointment where I got the most questions answered was with my respiratory therapist associated with the DME. She's been wonderful.

Good luck!
Jeanne

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deadtom

Post by deadtom » Mon Dec 13, 2004 1:17 pm

I have been using my autopap with full face mask for a few days and also wake up about four hours into my sleep.

Is this normal to start out? How long until I sleep all night with it?

chrisp
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Post by chrisp » Mon Dec 13, 2004 4:13 pm

Well My theory is that you've been getting along with minimal and poor quality sleep for so long that a few hours of quality sleep and your good to go .. That was my problem. I had to take ambien and then slowly decreased the dose. I still take 1/2 a ambien now and then. Have you looked into one of those new foam mattresses. They sure are nice. No more tossing and turning. tempurpedic is the costly name.. There are other knock offs that are very reasonable...Good Luck.........

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rested gal
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Post by rested gal » Mon Dec 13, 2004 5:30 pm

Hi Rob,

Yes, a general practitioner M.D. can write a prescription for autopap. That's how I got mine...script from a good old family doc. Doesn't have to be a specialist of any kind.

For what these doctors make, a quick 5 minute followup (probably after you wait an hour or more in the waiting room!) on something as important as what he expects you to use for a YEAR before your next appointment .... ridiculous. That's why it's probably a good idea to go into it with a written list of questions. The more hurried the doctor acts, the slower you can tick off the questions as you work your way down your list.

Rob, you're a very smart man and have already been doing a lot of research into this kind of therapy. I feel soooo sorry for the elderly or the not very medically inclined. Just think what they must go through while they earnestly try to do what the doctor-god tells them. Especially when they are given what most people are handed in the way of machines/masks/no heated humidification. Tossed out to sink or swim. Sad.

As for difficulty sleeping... it definitely can take awhile, no matter how comfortable the machine/mask are. It's a whole different (and strange) way of sleeping at first - all this gear. I think a lot of us traded the disruption from apneas and hypopneas for disruptions due to mask discomfort, leaks, noise, etc. Sleep disruptions are sleep disruptions, whatever the cause. All we can do is keep working on making it as comfortable as possible and gradually get used to it. I did find that I felt better after even 4 or 5 hours of "wake-up-now-and-then" sleep on cpap than I ever did after 8+ hours of "struggling-to-breathe" sleep - a struggle I wasn't even aware of for so many years.

AirHog
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Post by AirHog » Mon Dec 13, 2004 7:10 pm

Good point rested gal, a couple of hours smokin the cpap is still better than eight hours of gagging and near suffocation. I sometimes have bad nights where I'll pull the mask off after a few hours and I don't remember it. Overall I still feel better, it's startin to come around and you just have to keep the big picture in mind............gotta walk before you run.

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WillSucceed
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Poor follow-up appointment

Post by WillSucceed » Mon Dec 13, 2004 8:20 pm

Rob:
I think that you have lots of reason to be disgruntled and I'd encourage you to advocate for yourself as much as possible. You really do deserve better than what your Dr. gave you.

My sleep Dr. also gave me less than his undivided attention during the one and only appointment that I got with him. Since that appointment, more than a month ago, I have called several times asking to speak to him as I was having significant chest pain from the pressure but I have not been able to have audience with him. I ended up faxing my questions/concerns to him -I wanted him to get the hint that I was serious and now I get responses from his secretary.

Over two weeks ago I called and found out that he had received the results of the two home studies that I had completed (using 2 different autopap machines) and I requested that he re-evaluate my pressure needs beased on the autopap studies. This was necessary as the poor 2nd sleep study that I had undergone in his office gave useless data and he "guessed" (he told me this during my one and only appointment with him) at the pressure that I should be on. Anyway, I called today and found that not only had he not bothered to review the autopap study reports that he has had for over 2 weeks, he has buggered-off on 3 weeks of holiday. So, I'm to either continue trying to endure a high pressure on CPAP that gives me pain or, just turn the pressure down to whatever I can tolerate and "hope" that I get some benefit from it. I had asked for a letter from him that I could use to petition the insurance company to pay for an autopap machine, but apparently he is too busy to write one for me.

As you can imagine, I was a bit miffed so, I commented to the very helpful clerk who answered the phone in his office that I am not amused, am feeling that I am not receiving the attention that a patient should get and, was wondering if I should, perhaps, find a new Dr. and consider a complaining to my GP who referred me to this sleep Dr. in the first place.

Low and behold, I got a call about an hour later from the Dr.'s secretary (on vacation in Europe, she told me) apologizing for his not getting back to me and for not having reviewed the reports. She assured me that I could go ahead and purchase an automachine as the Dr.'s letter will make it clear that I need it and, as such, the insurance company will cough up the coin to reimburse me. I'm not convinced that they will so, I'm going to wait until I have his letter and can get the insurance company to pre-approve the purchase.

So, now that you have read this long diatribe... the moral of the story is to recognize that your health is your responsibility, that the Dr. is in business to make bucks and will never be as concerned about your health as you are, and do whatever it takes (rock the boat, nag, complain, threaten to complain to the College of Physicians & Surgeons, WHATEVER IT TAKES) to advocate for yourself until you get the attention and health care that you deserve.

Personally, I'd have chewed the Dr. out if he took a cell phone call during my appointment.

Get tough with him, Rob. You deserve better than what you got.

I'm very curious to know which Dr. you went to; I'd like to avoid his clinic.

Spiritus
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Re: Poor follow-up appointment

Post by Spiritus » Mon Dec 13, 2004 10:24 pm

WillSucceed wrote: Get tough with him, Rob. You deserve better than what you got.

I'm very curious to know which Dr. you went to; I'd like to avoid his clinic.
It was Doctor Hawke, and the clinic is Silent Partners in Toronto.

Rob

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LDuyer
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Post by LDuyer » Mon Dec 13, 2004 10:43 pm

Rob,

Did you say your doctor was a general practioner?

Had you looked into a Pulminary doctor? My GP referred me to a Pulminary doctor who was also associated with a sleep testing center. While my doctor doesn't exactly have the best bedside manner in the world (and I have to fight to get questions asked), he at least seems knowledgable. AND, he has more frequent followup visits scheduled. Perhaps there's something like that where you live, even if it's a little further away. Maybe a lung specialist would be a better doctor to answer your questions. (just a thought)

Linda

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Titrator
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Post by Titrator » Mon Dec 13, 2004 10:50 pm

Hi Rob,

I am sorry you had a bad time at the doctor. I have had experiences like your. You almost have to make a list so you can ask everything you want.

If you have a regular cpap prescription, you can use it to order an Auto.

I would call the doctor back and and say you were not happy with a 5 minute follow up.

Ted

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Spiritus
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Post by Spiritus » Mon Dec 13, 2004 10:59 pm

Titrator wrote:Hi Rob,

I am sorry you had a bad time at the doctor. I have had experiences like your. You almost have to make a list so you can ask everything you want.

If you have a regular cpap prescription, you can use it to order an Auto.

I would call the doctor back and and say you were not happy with a 5 minute follow up.

Ted
So you're saying that if I get my script back from my Healthcare provider (who is in collusion with my doctor - I wan't given a choice of Provider) and fax it to cpap.com, I can buy an auto? If so, I'll get right on it.

Rob

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Titrator
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Post by Titrator » Mon Dec 13, 2004 11:14 pm

Yep!!

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wading thru the muck!
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Post by wading thru the muck! » Tue Dec 14, 2004 5:51 am

The good guys win again!

That gets me in the holiday spirit!
Sincerely,
wading thru the muck of the sleep study/DME/Insurance money pit!

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cktan
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Post by cktan » Tue Dec 14, 2004 9:08 am

Not all doctors know about Sleep Apnea.
Not all doctors who know Sleep Apnea know how to treat.

Sleep Medicine is a "baby" in the field of medicine.
Most doctors graduated 5 years ago did not heard about OSAHS, because it was not written in their textbook at that time! It's true, at least here in our country.

Why the doctor spend only 5 min on you, may be he knew nothing more than that. Even anyone here in this forum might know more than him.

You guys really are very lucky to live in US, Canada, Europe ... and also has this great forum, which provide you a good resource to understand this treatable disease.

My situation is: I usually spent 1 hour explaining to my patient why he/she need a CPAP, and endup with that he/she went to seek for a "second" opinion from a GP, a family doctor, ....
He/she would rather take a sleeping pill as suggested by the "second" opinion and forget about the OSA and CPAP.

Here, we are not just to convince patients to treat their OSA, but also, we need to make a great effort to educate other doctors that there is a treatable disease call OSA, and its significance is no less than a diabetes, hypertension or heart disease.


My advise is: if you have any problems with sleep apnea, find a doctor that is really specialized in it, not any doctor.

Treating OSA requires a team work from a pulmonologist, otolaryngologist(ENT), dentist, neurologist and also a psychiatrist.

I really learn a lot from this forum, and thank God I have this opportunity to join you all.
http://tssm.org.tw/sleepforum
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rested gal
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Post by rested gal » Tue Dec 14, 2004 12:15 pm

Excellent points, cktan. People in your country are lucky you are trying to educate both your patients and other doctors about OSA and cpap treatment. Even if they turn away from your good advice sometimes! That happens here, too, unfortunately.

btw, I love the picture you are using as your "avatar".