struck out with regular doc and apap

[chdurie2]

for those of you who know about my mini-saga re: getting apap machine, just wanted to let you know that regular doc said i would have to go to sleep doc for apap prescription because sleep study is five years old. ii got my cpap then, used it for about a month, then gave up, and re-started about four months ago, and it's been up and down, but i've been compliant.

nitially, he looked willing to prescribe, but when he saw sleep study was five years old, he said he wouldn't do it. don't know if that was all there was to it. i go to this guy once a year or so, usually go get my thyroid checked and/or for a physical, meaning there's no great rapport. also, i was a real mess when i saw him the other day; i'm going through a lot right now and told him i needed some xanax badly (anti-anxiety) meds. he gave me the xanax temporarily, told me to see a psychiatrist for the anxiety and to see the sleep doc for the apap. at least he gave me nose spray when i told him i couldn't breathe through my nose with the cpap.

i guess he figured this might be a complex case and he wasn't going to deal with it.

we'll see what happens with the sleep doc. i guess theoretically there could be some issues. i have an appointment with sleep doc on saturday, so i'll let you know what happens. my guess is he'll want to start from ground zero.

well, i have an appointment anyway on saturday with the sleep doc. maybe this is for the best. i've got a big deviated septum issue-don't know how much that matters in the end.

thanks for everyone's help. i'm not going in there saturday empty-handed. i've got y'all's advice.

caroline

[snoregirl]

I take it you don't have the prescription from 5 years ago? I think it is still fine for Cpap.com

[chdurie2]

no, i don't. and it's the sleep doc's prescription, so i don't think he'll give me a copy. if he'll go for it, he'll just write me a new one on saturday. i'd like to do this one through insurance, since i pay a lot for insurance, and i've already bought a few masks this year out of pocket.

i could buy one on ebay/yahoo, too.

as someone wrote on a thread i posted last week, maybe there are issues that are better addressed than not. so i'm trying to be positive. i just hope if the sleep doc makes me go through another sleep test, he can get me in and out of there fast. and i've felt for a while that i might be better off with the deviated septum operation, although once again, i don't really have the time for it.

so we'll see.

thanks.

caroline

[nodding off]

Hi Caroline,
Get a copy of your 5 year old sleep study. You have a right to it. Then find a doctor willing to review it with you and talk reasonably about it. If this individual can convince you there is merit in another sleep study, fine. Most likely, unless something has changed physically for you, besides the passage of time, they will write you a prescription. I personally have had 3 sleep studies in the last 12 years, the last one 2 years ago and guess what...I still have severe OSA. My family doctor (I fired my sleep doc 2 years ago after the last sleep study) is very helpful, and has even written me a scrip for APAP. Best of luck to you.

[Guest]

I'd get a new doctor, seems like the one you have only wants to refer you on to other specialists and get paid for being a traffic cop, either that or he thinks your a lawyer

Get a OD or a doctor that is not afraid to practice his craft. When they want to refer you all the time it means they don't know about the therapy they are prescribing.

YOU need to go in when seeing your doctor demonstrating knowledge about OSA subject and the therapy your asking for. When you can demonstrate you know more about the disorder than your doctor, then they won't have a problem supporting you.

[Guest]

Prescriptions are only good for 2 years.

[Guest]

also, i was a real mess when i saw him the other day; i'm going through a lot right now and told him i needed some xanax badly (anti-anxiety) meds. he gave me the xanax temporarily, told me to see a psychiatrist for the anxiety and to see the sleep doc for the apap. at least he gave me nose spray when i told him i couldn't breathe through my nose with the cpap.

i guess he figured this might be a complex case and he wasn't going to deal with it.

Does anyone else find it incredibly ironic that this doctor had no problem writing a prescription for Xanax, but balked at writing a prescription for APAP? I think that says a lot about the mindset of today's physicians. I don't understand it, I really don't.

Caroline, I'm not implying you shouldn't have the Xanax, so don't take that the wrong way. I just find it stunning that he didn't hesitate to give you that, but had misgivings about CPAP. I'd think it would be the other way around.

[Snooter]

Does anyone else find it incredibly ironic that this doctor had no problem writing a prescription for Xanax, but balked at writing a prescription for APAP? I think that says a lot about the mindset of today's physicians. I don't understand it, I really don't.

OK, I’ll stick up for the doctor here. He/She is probably familiar with the side effects of Xanax and your medical history. No problem there. But let’s say they reissue your 5 year old CPAP prescript which has an 8cmH20, but after 5 years you really need 11cmH20. You get a stroke and then the doctor gets sued because they didn’t retest you like they should have.

What would you do if you were the doctor, ?


Snooter

[Guest]

What would you do if you were the doctor, ?

Go look at a new Mercedes...

[Guest]

But let’s say they reissue your 5 year old CPAP prescript which has an 8cmH20, but after 5 years you really need 11cmH20. You get a stroke and then the doctor gets sued because they didn’t retest you like they should have.

What would you do if you were the doctor, ?

I would write the prescription for the APAP like Caroline asked. The machine would automatically adjust to the pressure she needed so she wouldn't have to be retested.

Snooter, you might find these links interesting:

Not Every Patient Needs to Go to the Sleep Lab
(A Powerpoint presentation by a well respected board certified sleep doctor/pulmonologist, Dr. Barbara Phillips, at a meeting of the American Lung Association of the Central Coast - November 2004)

and

Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?
Published: American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 716-722, (2003)

[chdurie2]

i'm guessing that mr. liability concern may be right on. i'm not sure this doc knew the difference between apap and cpap. i said this time i wanted an apap and not a cpap, and he nodded, which could have meant anything. then i said i'll show you the sleep study to show you i am a cpap user, and i think the insurance company said to show the regular doc the sleep study--although maybe they didn't. that could have been my mistake. he looked at sleep study, commented on the date, and said i'd have to go back to the folks who did the test.

i didn't explain cpap vs. apap or why it should be low risk for him. but a chicken doctor is a chicken doctor. my insurance company says a regular doctor can prescribe cpap/apap, but my chicken doctor doesn't care about my insurance company. he cares about his butt. and he probably knows little about apnea.

caroline

[birdshell]

You know, I have a lot of doctors and they are great. Once I found my wonderful internist, I was all set because he gives me good referrals. (I respect his values and ethics plus his knowledge.)

It took me a long time to find a good doctor for me. I thought at one point that I would try women. I went to three different women internists. That didn't work, although one of them was a great doctor from a medical point of view. She just did not seem to understand me, nor I her, but I still see a couple of the specialists to whom I was referred by her. (One is her husband, who practices in the same office. )

So my point is that finding the right doctor is sometimes a long process. Fortunately, my insurance has no list of approved physicians so I had the freedom to go to any doctor I choose, as long as he is licensed.

And how did I find this great guy? In desperation, I called a hospital physician referral number and told them I wanted someone who was located so that the office was a free telephone call, would bill my insurance, and was very empathetic. So much for referrals from friends, coworkers, and other physicians.

BTW, an O.D. is a Doctor of Optometry, aka an optometrist. Maybe our guest contributor meant a D.O., which is a Doctor of Osteopathy, often called an osteopath. That was probably a typo!

[sleepylady]

Caroline,

When you do see the sleep specialist this saturday request an APAP. Even if he does want you to have a regular sleep study, at least you can get back into treatment right away.

I do agree with the others. If your doctor isn't willing to be an advocate for you it's time to drop him and find another doctor who won't pass you around. Getting referred to a specialist isn't a bad thing, however, from the sound of his attitude he just isn't very invested in your treatment. I'm lucky that I found a great dr. long ago. She actually set up my sleep study and all my follow-up treatment has been with her. She has other OSA patients so I feel very comfortable with her. She doesn't hesitate in setting up an appointment with a specialist if needed, however, she keeps a great handle on my overall health...including the OSA.

Melinda

[Guest]

I’m not a doctor, but I sleep with one so I get the gist of what they go through. I guess if being threatened of losing your insurance or licence gets you the title “chickenshit” doctor then I like chicken.

APAPs have to have settings defined just like CPAPs. I think a study that is 5 years old is unreliable and any run of the mill lawyer could get a jury to access damages or some board to find your doctor negligent. If you want, I think CPAP.com will sell you a machine without a prescription. You can then be on your own and it would probably work out just fine.

Malinda, your doctor “set you up” with specialists. Unless I get this all wrong I think Caroline ended up seeing a sleep specialist. I would think if Caroline had gone to her doctor soon after the initial sleep study, they probably would not have hesitated making changes based on that current sleep study. She may have then had to deal with the insurance company

BTW, I just recently got my sleep study. The DO who runs the office made the recommendation, my doctor reviewed it and OK’d the results. I too think I would like a APAP but the insurance company kind of gets in the way. I think I will rent a machine for a few months, consult with my doctor. Then give her hell if she does give me satisfaction…..er, I mean I’ll just have her write me a script for an APAP and go fight the insurance company.

Snooter

[Guest]

APAPs have to have settings defined just like CPAPs.

No. That is incorrect. APAPs do not have to have defined settings just like CPAPs. They can run the full range from 4-20cms/ just the way they come from the factory.

I think CPAP.com will sell you a machine without a prescription.

No. That is incorrect. A prescription is required.

Snooter, did you click on the links given to you in the post just after your first one? I doesn't sound like you did, based on the misinformation you have. Here they are again. Click on the links. Read all the way through them. They will explain so much to you about why retesting is unnecessary and why it is not a liability for a doctor to prescribe an APAP.


Not Every Patient Needs to Go to the Sleep Lab
(A Powerpoint presentation by a well respected board certified sleep doctor/pulmonologist, Dr. Barbara Phillips, at a meeting of the American Lung Association of the Central Coast - November 2004)

and

Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?
Published: American Journal of Respiratory and Critical Care Medicine Vol 167. pp. 716-722, (2003)