My horrible doctor experience!!!

[TuckNRoll]

I just recently got insurance coverage through my job and haven't been to a doctor in many years. I decided that I would find myself a doc and get the full battery of tests (including a sleep study since everyone I know tells me how horribly I snore). The doctor set me up with an appointment at the sleep lab on December 12th and everything was great. The following week, I got a call from the sleep lab stating that I have been diagnosed with severe obstructive sleep apnea and said that they sent the results to my doc. Between having a new baby boy and the holidays, I finally got to get back to the doctor to discuss the sleep study on January 7th. At my appointment, the doctor says that before he sets me up on CPAP, he wants me to try using Oxygen at 1LPM nocturnally and to raise the head of my bed up a couple of inches. He ordered me to go to get a CT scan of my nasal passage and soft tissue of my neck to see if "maybe an ear nose and throat specialist could take care of the problem before he prescribed CPAP therapy". Let me mind you that during my sleep study I had experienced 82 obstructive apneas and 117 hypopneas, giving me an apnea/hypopnea index of 121 per hour.
I have been employed in the DME industry for over 20 years now and know more than the average Joe about this stuff, so it really sounded fishy to me that a pulmonologist who read the sleep study recommended that I start CPAP therapy and my doc is telling me to go on Oxygen and raise the head of my bed.
Luckily, the pulmonologist that read my study, sends the DME company that I work for a fair amount of referrals and our marketing rep has a good relationship with some of the girls in his office. I scheduled an appointment to discuss what my doctor had prescribed and as soon as he looked at the orders, he told me that what my doc had done was "borderline malpractice" and that prescribing O2 to a person with severe sleep apnea could have deadly conscequences. As many of you know, when a person with sleep apnea stops breathing during the night, your O2 sats. decrease. Your bodys' natural reaction is to wake up so that your O2 sats. goes back up. If you were using O2, and you stopped breathing, your body does not react normally, because your O2 sats. aren't dropping to the lowered levels that it normally would without the O2. therefore, it does not react normally to wake you up.
Needless to say, I will no longer be going to this other doctor ever again and the pulmonologist wrote me a script for CPAP and got me back on track.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, DME

[jsmythe]

Hello there, first of all, let me thank you for the information on the O2. I was on oxygen for about 3 years before diagnosed with SA 3 months ago. The doctor wouldn't put me back on it, he said he didn't think that I would need it with the cpap. At my study, I was having a minimum of 80 apneas an hour. My oxygen level dropped drastically. They had a cylinder close by in case I needed it.
But point is, I couldn't figure out why he wouldn't put me back on the O2, now I know. Thanks again.

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

[Wulfman]

Tuck,

Now you know why some of us have the feelings that we do toward our doctors and others in the medical profession.

Sorry to hear about your experience.

Den

[RosemaryB]

I'm glad you got the help you needed and quickly. But it's scary to have doctors make mistakes like this.

BTW, the explanation of the O2 was helpful to me since I know someone who was put on O2 while she waited for her titration study and cpap machine. At the time it seemed reasonable, but now I see how it could be irresponsible. HOwever she had moderate OSA, so perhaps that would not be as big a problem.

[rested gal]

Wow, Tuck.

Good thing you and the pulmonologist know a LOT more about this kind of thing than your GP does.

Sad to think what happens to others in that particular GP's practice even without prescribing nocturnal O2 -- suggesting that they be evaluated for surgery instead of going onto cpap. Stupid.

[j.a.taylor]

Tuck,

Glad to hear that you knew your stuff, but I feel bad for that doc's other patients.

It just confirms what we all know--unless the patients take responsibility for their own treatment, and advocate for themselves, they're only getting half their treatment or less.

[Country4ever]

I'm glad things are working out for you.
About the O2.......if you're having apnea, you wouldn't be getting the O2, right? I don't think it would have been life-threatening, like it is with people with COPD. When you have apnea, nothing gets in and we're awakened by the increased Co2. When you have hypopnea, some is getting in, so receiving O2 might not be bad. In fact, it might keep you ventilating better until you closed off completely, at which time your CO2 would raise and wake you up.
Just trying to think it through.....

[Slinky]

I agree with Country4Ever. That makes much more sense to me than that pulmonologist''s explanation. AND, if the desats were THAT low and or that long, I'd be wanting an overnight oximetry whilst on CPAP just to be sure if I were still encountering a lot of hypopneas despite few or no apenas!

[Snoredog]

What was your SAO2 level dropping to during the sleep study?

I would agree with others, I would think a Pulmo would have more experience with supplemental oxygen than a GP, but the pressure bleed of oxygen is not going to be enough to splint your airway open.

The smarter thing to do would be to trial cpap and see what it does to your oxygen levels, if it brings it back to normal then you don't need any supplemental oxygen.

But if the GP looked in your nose, they may have seen some nasal obstructions which need to be addressed by a ENT, CPAP can only be successful if you can freely breathe through your nose.

[Moby]

Isn't it the raised CO2 level that triggers respiration, not the decreased 02?

It's the struggle to breathe that wakes us up.

I remember from my time in medical wards that oxygen is given at a lower rate to someone with COPD (chronic obstructive airway disease), as you say, Country 4ever. The rational was that they had grown used to a higher threshold of CO2 before inspiration was triggered. So continuous oxygen does not allow the CO2 level to build, and so their threshold for triggering inspiriation was not reached, so they stopped breathing.

I guess the question is "Is OSA a form of COPD?" I'd guess no, because during our "non REM" sleep we are breathing normally and our CO2 thresholds are behaving normally.

So maybe the pulmonologist had another reason to object to the O2 therapy?
Or maybe he thinks it borders on malpractice because CPAP would address a serious problem effectively and instantly and the other Dr was dilly dallying.

Just trying to think it through.

Di


Edited out ref to SWS - thanks to forum member who tactfully pointed out my mistake!

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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP

[lvwildcat]

I agree with the pulmonolgist in this case. Severe sleep apnea? 1L of oxygen...thats not going to help ANYTHING...neither will your head being elevated. Thank goodness the pulmonolgist felt so strongly and is acting on the results of your study

[Pilot_Ron]

I'm glad my (gp) doctor doesn't know anything, and I think he realizes that. No matter what your problem is, he will not diagnose anything more complicated than the common cold. He sends you out the door to a specialist.

Last time I saw him, he sent me out with a shopping list of people to see, one of which was a sleep specialist.

And he wonders why I only see him when there's a problem.

Glad to hear you didn't take his reccomendations at face value though. Best of luck with your therapy.