In my defense.

[xerort]

As opposed to trying to post on all the topics/statements, etc. etc. etc. that have been popping up about me, allow me to state a few things.

For those who don't know and don't care, feel free to ignore.

1) I, am not, and never will be, an alt to anyone. I have no idea who calist or whatever is. I have too much to do in my life to go around and purposly rile up a random internet board. I came on this board to (try) help. I have (tried) to help in other posts.

2) Yes, I still feel that for the average patient, viewing useage information through download or otherwise, is a reletivly useless thing. As long as you have a good rt/doc working with you, they should 1) be reviewing that information WITH the patient, to ensure the patient understands, and 2) LISTENING to you. A patient who educates themselves and, as is so common said on this forum "takes charge of their care", AS LONG AS THEY ARE EDUCATED, is a good thing.

3) I have NEVER, NOT ONCE, NOT EVEN FOR A MOMENT, purposly insulted anyone. If anyone felt insulted by things I said, I appologize, right here, right now. I did not mean to come off as arrogant and appologize if I did.

4) I voiced an un-popular opinon, which I feel is fact. For that, I am insulted, called a bad RT, told "I keep my patients like a mushroom farmer", told I had a large ego (which honestly, if you got to know me, you would know I really, truly am not. qutie the opposite.... and that was because I made a joke about me being handsome, intellegent, blah blah blah.... which honestly was a joke)

Very nice reception.

5) I will never, ever support a patient changing their own pressures. It is dangerous and illegal. end of story.

6) I never said that anyone was less intellegent then me. In fact, I even stated that I have many patients that are more intellegent then me. Kind of funny how i then got called a "lowly tech", by someone bragging on their ivy league education. What I DID say is that viewed in the wrong light, or by patients who don't understand what they are looking at or who don't know what to look for (I can't remember exactly, see number 7) it is a bad thing.

However, to the person who did bag on me because they are "more educated" then me, I'll pose a challenge. I never said I could do your job, however, you put my job down and implied that anyone who read journals could do my job, then refered to me as a "lowly tech". Next time you take your car to the shop, need your fridge worked on, have a loved one on a ventilator, make sure you refer to the person doing the job as a "lowly tech" then throw your education in their face.

Come on, I dare you.

7) I see my original posts were deleted. Awesome. Very nice of you to allow others to express opinons contrary to your own.

Not all of my patients love me. You are correct. I'm not the messiah of cpap, and I make mistakes. However, when I make a mistake, I admit it, appologize, and rectify the mistake as quickly as possible. Which is one of the reasons many of my patients do love me, because I am honest and straight forward with them, especially when I make mistakes. Because I listen to them, I take how they feel and what they say into account, and provide them the best service that I can.

9) And for the record, as far as my 95% of my patients walk out with the same mask statement:
The reason 95% of my patients walk out with the same system, is because 1) the system is versitile. 2) the system seals extremly well very easily 3) they system is highly adjustable 4) the system is extremly comfortable. If a patient does not like the mask I reccommend, for any reason, I listen to the issues they have, then switch them out, with (gasp) another mask that I reccommend. If they don't like that one, then I do it again.

However, I'm willing to try the "push the patient into the mask room and say "have fun!" approach you all reccommend so much.

The thing is, I know about every mask that we carry, I know what they are used for, and what alternative uses are. I've worked with each mask, held each mask in my hands, played with them. Taken them apart, put them together. Tried most for a few minutes, many for longer, some overnight. I've sampled something like 45 different masks at home, overnight. If a patient comes in and says "I want a nasal mask that I can wear my glasses with" my prefered mask is right out the window. If they say "I want a nasal system, but my nose hurts when I wear most" same thing. If they say I can't get a seal on my full face because of my beard, same thing. This mask is uncomfortable, too heavy, to light. falls apart. Breaks. gets sticky. SMELLS FUNNY. You NAME it I have probably heard it. And everytime a patient comes in, and starts talking to me about what type of mask they want, what type of things they hate or like, what experiences they have had, I start formulating in my mind which mask would be a good fit for them. As they give me more info, masks get added on or taken away. When I have one or two masks in mind, I say Ok, lets see what we have that can fit your needs. And I bring them those one or two masks. Typically, it will be one or two masks in the same category: either pillows, nasal, or full. Sometimes, my choices are wrong. The patient doesn't like the way they feel. The patient doesn't like how heavy they are, or whatever. Then guess what? I go get them OTHER masks I had in mind. And always, ALWAYS, I end the fitting with "Does this mask feel good to you? Comfortable, lightweight? DO you think you can sleep with this mask?" Sometimes, they say "Well, I mean, your the expert, and if this is what you reccommend..." and when I hear that, I say "Yeah, that's what I reccommend: but what is important is how YOU feel about it, do you have concerns about the mask?"

I have never, once, forced a patient into a mask. And a patient does not leave my office until they are satisfied to the best of my abbility.

And that shows, as I have the highest compliance rating in my company. That is coming from the service rep who does our downloads, who handles every new setup patient we get. More of my patients are compliant in the first three months, the most crucial period of time for a cpap user, then any of the other 12 rt's in my company. Am I bragging? You are DAMN STRAIGHT I am bragging. I am DAMN proud of that. Especially since I have been in the homecare game for the least amount of time.

10) Here is a kicker: I USE CPAP AS WELL. I came on here to help, both as a professional, and as a user. For my professional opinons, I got insulted, made fun of, and basically accused of being a troll. All because I voiced something I feel is a fact (and still do, and always will) opposed what you all beleived. And here is a double whammy....... the mask that I use at home.... IS NOT ONE OF MY PREFERED MASKS FOR PATIENTS! I use an comfortlite 2 mask at home. Consider it quite comfy. most people don't like the "I'm an elephant" design though. My daughter gets a kick out of it when I put it on and make elephant noises. she's two, of course, and does not factor into fitting my patients... ok, it did once, because the patient said "I have a two year old, who is scared when she see's me in my mask...."

Thanks, and I hope you enjoyed the post. I'll post my opinons as I see fit on masks, issues with cpaps, and answer to the best of my knowledge insurance issues, and find answers when I can. If you feel that warrents a banning, go right ahead, feel free. I'll go back to my life as a "lowly tech" and you can all rest assured that another "alt of whoever" (which I'm not) was dashed in his evil plans to "piss you off on the interwebz".

Personally, I've already spent way too much time trying to make random strangers on the interwebz understand that I'm not nearly as big of a douche as they think I am.

xerort

[elena88]

Well lets talk about timing...

yours pretty much sucks, as you arrived just as someone who acts very much like you was banned..


I totally disagree with you about changing pressures, and there is no law on the books saying its illegal, if so, charge me.. charge a lot of us!


Had I not changed my pressure, I would have been suffering for nothing..

I KNOW you appreciate patients trying to be their own health care advocates right?

I KNOW you must want them to be informed..

I KNOW you will change your mind about informed patients being able to follow their therapy by closely montitoring it when they are having a problem.

For you to say otherwise earned you the "lowly tech comment.. as it was very controlling and conceited of you to say that..
"patients should NOT view their data, Fact!"

and THAT is why I wished you away into the cornfield.... that was a blathering idiotic blanket statement you made, truly.. youll find out
why the longer you hang out here..

I do however thank you for joining in and giving some good advice on my thread, and some of the others.. but knock it off with the

"tech knows best stuff, okay? " just some nice little tips and pointers will do nicely.. that will be appreciated..

Shoving stuff down our throats just about nobody agrees with here, is not going to grease the wheels to an optimal experience for anyone one, you
included.. you shouldnt have to defend yourself..

so dont harp on crap that makes you feel you have to..





.

[PST]

5) I will never, ever support a patient changing their own pressures. It is dangerous and illegal. end of story.

That was a long, obviously heartfelt post, which I respect. Therefore I feel bad picking out one little item from all that and challenging it, but that's the give and take of an open forum, I guess. My challenge is this: what makes it illegal? I have searched but never found any law to that effect. Let's say I take a prescription drug like Lipitor, one pill daily. Is is illegal for me to take three pills? If you say not smart, I won't argue, but illegal? I will only believe it if someone cites some law to me.

[cwied]

With all due respect, elena88, I think xerort has acted quite differently than calist. The main similarity I see is their shared opinion that patients have little need to see the data from the machines and should not be adjusting their own pressures.

calist went out of his way to overstate his position in ways that were meant to antagonize the people whose viewpoints he disagreed with. While xerort is pretty blunt, I don't think he's trying to pick fights in the same way. At his worst calist was just out-and-out trolling, which I hope we won't see on this board again for a while.

xerort - you have to understand that people here are sensitive to what they feel is their lack of power when it comes to their own personal care. The system seems to not encourage patients to understand the details of their treatment. I understand that this is because for many patients the level of detail would be inappropriate. However, if we're willing to put in the work to understand more of the details, I think we should be allowed to be more involved in our treatment. Most people posting here have already shown the initiative of finding a venue to discuss OSA and CPAP. I think this alone probably demonstrates above-average effort in making their treatment work. Maybe it isn't appropriate to treat everyone here like an "average patient."

[SleepTechulous]

Hey man. You don't know me but I've been here and there. For the most part, the board is broken into different sections. There are some people that are just patients and are looking for select answers to a select questions. There are some that have formed an attachment to the 'Community' or 'The Family' as one poster called it. And then there are others that detest all medical professionals. This small group unfortunately has the loudest voice and easilly gets the other groups riled up at people who work in medicine with a form of Xenophobia, mainly by calling them outsiders and 'Intentional trolls'. They will stop at nothing to be rid of anyone that disagrees with their version of medicine.

Wether it is deleting posts (as you have seen), trolling in other threads (as you have seen), wild accusations (as you have seen) there are only two ways that this process will end. Either you will get fed up and walk away (which they are hoping) or they will have you banned (which they can easily do). I won't tell you to give up and walk away, if I did that then I would be a hypocrite as some one told me to do that the second I got here. One thing I will say is something that I am absolutely sure you have not yet heard.

Welcome to the forum.

[Physician]

There is absolutely nothing illegal if a patient elects to change the settings on his/her CPAP unit. It may be unwise in some circumstances, but not illegal.

[Goofproof]

why are people changing their pressures i don't want to interrupt i was just wondering.

Because they are set incorrectly for the best treatment of our Sleep Apnea. You want the pressure that is the lowest that prevents your airway from closing off. Many times the pressure the XPAP GODs set you up to ues are just pulled out of their hat or worse, rather that being detated be results. Keep in mind it's hard to pull the correct number out of the hat, while trying to chew gum, and feel for a wallet at the same time. Jim

Run the DME has called the XPAP Police again.

[jlk]

why are people changing their pressures i don't want to interrupt i was just wondering.

They are checking the jail vacancy in their area. I agree with you, Jim also! I have been changing my pressure to achieve good sleep. I was titrated at 6 several years ago and wasn't getting needed help from the only therapist in my location. I went online and found how to change my pressure. I slowly raised it to 7.2 and slept quite well for a few years. I was in a poor sleep rut and spent time on-line when awake at night. I found this website and read up on several of the threads and thought I can improve my therapy. I got what I felt was a top-of-the-line unit and started looking at my data daily and changed slowly to 8-12 auto and mostly run at 9/ 9.2. I have no apneas or hypopneas on most nights, At a 6 without epr (as my old unit was set) I had over 10 per night. I proved to myself I can sleep well even with apnea. Happy pappin! john

[xerort]

Sleep, that was awesome.


I have never once seen a pressure decided upon or set by a doctor without supporting sleep studies (at least for new setups: older setups are typically set by previous pressures).

In fact, as part of our quality control for my company, before setting up a machine, I have to review the sleep study. Which takes about 2 minutes. From those 9 peices of paper, I can pretty much determine if a pressure is appropriate or not.

And I have yet to see a pressure that is inappropriate. I'm sorry if you have experienced otherwise. I suggest before self adjusting your machine, getting an auto-titration done and requesting the information from that, as that information is most likely more accurate then the infromation from your machine.

As far as not being illegal, I have always been told, by both my employers and my college professors (one of which is nationally respected therapist) that it is illegal, as it is practicing medicine without a liscense. However, I most definitly could be incorrect.

I also just found a post stating it was illegal in NY, which is where I am. That might be causing some of the confusion as well. Not a realiable source, as it's a forum, and I don't know what the rules are for posting links to other cpap forums.

A machine cannot be set by a healthcare professional without a perscription, which is an undeniable fact. However, as far as a patient setting it, I'm sticking with it being illegal.

Will the cpap police come and get you? No. But I know for a fact your DME can drop you for it, to protect themselves.

Again, I say that this is dependant upon a good dme/doc. If your RT is bad, then issues will arrise, obviously. If you notice, the patients who are setting their own machines (I'm assuming here) seem to have two things in common: They have educated themselves, and they are having problems with their dme. My patients when they have issues, the first person they call is me.

Anytime.

Day or night.

That's why I'm awake right now. Had a new setup today. "I can't get my water chamber into my machine...." "You got the mseries auto, right?" "Yeah...." "Turn the chamber around." "I don't think that's going to.... oh... sorry."

And please don't roll your eyes at me. I was not rude or disrespectful to you, please don't be to me.

[Physician]

As far as not being illegal, I have always been told, by both my employers and my college professors (one of which is nationally respected therapist) that it is illegal, as it is practicing medicine without a liscense. However, I most definitly could be incorrect.

I also just found a post stating it was illegal in NY, which is where I am. That might be causing some of the confusion as well. Not a realiable source, as it's a forum, and I don't know what the rules are for posting links to other cpap forums.

A machine cannot be set by a healthcare professional without a perscription, which is an undeniable fact. However, as far as a patient setting it, I'm sticking with it being illegal.

Please provide any State or Federal statute which implies or states that it is illegal for a patient to adjust or change the settings on a legally prescribed CPAP machine which he/she is only using on his/her-self.

The prescription is for the machine. The settings are a "recommendation" or "determination".

SEE HERE: http://www.apneaboard.com/CPAP%20Adjustment.htm

and here's a quote:


...I challenge anyone to show me any local, state or federal law that makes adjusting your own legally-obtained CPAP machine a crime, or even threatens punitive action for doing so. Go ahead - I double-dog dare 'ya. If you can show me such a law, I'll give you a one-year free membership on Apnea Board. Oh, wait... that's already free. Moving right along...

Yes, you must first have a prescription to obtain a CPAP machine - but after you OWN one, you are within your rights to do whatever you darn well please with it, including using it as a leaf blower, running it over with the family car, or... (oh no!) - changing your own pressure settings.

[SleepTechulous]

Please provide any State or Federal statute which implies or states that it is illegal for a patient to adjust or change the settings on a legally prescribed CPAP machine which he/she is only using on his/her-self.

I have to warn you xerort, this is exactly what they are going to do. They will ignore all other statements you make and focus on a single sentence until they have blown it so completely out of proportion that it becomes deluded, out of context and more like an accusation than an actual request for clarity. More importantly however they hope that by focusing on that single statement they will be able to destract others from everything else you have said or plan to say.

[elena88]

oh here we go with the two peas in the pod again...

banned calist, oh I mean, sleeptechulous, what exactly are your intentions?

are you going to report all of us for changing our pressures? Berate us, call us stupid patients again?

are you going to enlist your bobsie twin for support now?

Can you not just enjoy tormenting your own sleep study patients?

[jonquiljo]

I have to warn you xerort, this is exactly what they are going to do. They will ignore all other statements you make and focus on a single sentence until they have blown it so completely out of proportion that it becomes deluded, out of context and more like an accusation than an actual request for clarity. More importantly however they hope that by focusing on that single statement they will be able to destract others from everything else you have said or plan to say.

SleepTechulous: You post like Calist, you delete your posts later like Calist did, you registered 3 days after Calist was banned. 1,2,3. Even if I have you pegged wrong, why do you keep coming here to bother people? You are not winning converts. You haven't been able to start a cult. What - have you been thrown out of too many shopping malls for preaching in front of restaurants? As far as I can tell all you do is provoke people then delete your posts. Find a hobby somewhere else.

Don't you have enough to do at work to keep you busy? Why don't you score a report or look at a printout? Please - why do you take your time to come here and act as a total asshole when no one really wants to listen to you? The last time I remember people doing that was when they were 10 years old!

If you don't have a job - then go get one. If you do have a job - then try to pretend to do something to earn your pay. We don't want to listen to your crap. This is a support board for peers. I don't see any invitations for professional advice. If we wanted professional advice, we all know where we could pay for good advice. So why would we want advice from a freak of unknown origin?

Go away.

[Breathe Jimbo]

Here we go again. Just ignore them after one person has responded.

[jonquiljo]

Here we go again. Just ignore them after one person has responded.

We need a moderator. Bottom line: we didn't ask for "professional" help, we don't want "professional" help, if we wanted "professional" help we would have gone out and found some as there are lots for hire. This is a peer support board. Whether it is Calist, reincarnations of Calist, friends of Calist, or other roaming sleep techs with nothing better to do - we don't want them here, we don't want to hear them babble, we want them to shut up and go away.

Do you really want to spend your time dodging preachers and intrusive posts - or can we just get rid of these people and go back to the place we were before all this hit the fan? Ignoring them has not worked. There are lots of good and interesting people here. Lets give them the peer support environment they deserve. We are attracting to many flies. Time to get an exterminator.