Dr. Krakow, salesman extraordinaire? UPDATED

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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rocklin
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Re: Dr. Krakow, salesman extraordinaire?

Post by rocklin » Sat Dec 03, 2011 12:59 pm

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(one:)
rocklin wrote: Pick up the phone and call the dude.
Barry called me on his cell five minutes ago.

While very busy, he seems eager to talk to any sleep med guy / gal who calls him.

Dave, when I visited your lab (not that long ago), you had a grand total of four beds, all empty.

So, if you don't mind my asking, why don't you just:

(two:)
rocklin wrote: Pick up the phone and call the dude.
That is, if you're serious about sm.

If not, if this whole guru act of yours is just internet posturing, that's cool, too, I'm too busy getting slammed by real life to give a sh*t.

Go Knicks.

roc
NYC

Oh, did i mention:

(three)
rocklin wrote: Pick up the phone and call the dude.
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Last edited by rocklin on Thu Jan 19, 2012 3:09 am, edited 1 time in total.
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It is easy to be brave from a safe distance - Aesop
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jnk
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Re: Dr. Krakow, salesman extraordinaire?

Post by jnk » Sat Dec 03, 2011 3:49 pm

I personally respect that there are docs like Dr. K who are available for those for whom normal mainstream titration protocols have failed to provide sufficiently-improved sleep. There comes a time for any suffering patient in that position when moving into the cutting-edge experimental realm of treatment is the right thing to do, and I think it is smart to do so in the hands of a respected doc who has a staff looking for nuances that aren't yet accepted as significant by your average neighborhood sleep doc.

That said, I VERY much respect those like DDave who have every right to insist on some scientific basis for any approach before showing ANY respect for it. Applied art is applied art. Science is science. So the answer "we don't know why it helps patients--it just does" is a perfectly valid answer from the perspective of any patient being helped by something, but it would be considered nonresponsive, at best, by any pros in related fields attempting to understand why a doc is doing what he he is doing.

I have a feeling that any hard data on the approach of using ASV for purposes beyond what it is designed for are more likely to be released in a location other than cpaptalk.com, though, don't you?

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ignorant1
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Re: Dr. Krakow, salesman extraordinaire?

Post by ignorant1 » Sat Dec 03, 2011 5:06 pm

.

Ah - yes indeed JNK! Another voice of reason & clarity rises amongst the din….
ignorant1 wrote: Current settings: I’ll PM you.

Deltadave wrote: I knew it!

THAT'S the Big Secret!
Yes! THAT IS the BIG SECRET! Dr. K discovered one, and only ONE pressure setting that works for EVERYONE - and for EVERYTHING! Not only does it cure ALL SDB problems, it cures warts, arthritis, baldness, hemorrhoids, dyspepsia, bad breath & gout. If it’s initiated within two hours of death, it will cause the dead to rise once again! It’s a MIRACLE!

Tilting at windmills…

DD, I’ll reiterate once again that there is no big secret. Continuing to propagate the myth of a “big secret” serves only to perpetuate a false premise for you to refute. Come on now - we know someone of your caliber can do better than that! My personal identity however IS a secret; who knows, maybe I’m actually one of Rocklin’s alter egos run amok? (Cheap entertainment: watching a schizo arguing online with one of his alternate personalities?)

Rocklin – Regarding the Pearly Gates: I don’t think any xPAP device is rated to work at that altitude. (And aren’t you making an assumption of where I’ll be going?) And what’s up with the helium? I mean, REALLY now - helium? Are you guys still a little gun-shy about the whole hydrogen thing? Just one massive fireball way back in 1937 and you guys run for the hills? Why did you ever think of yourselves as the “master race”, let alone have any chance of ruling the world? Dumme kinder!

On the other hand, I do have to agree with the epiphany you had during that brief moment of clarity:
Pick up the phone and call the dude.
I’m starting to realize that any attempt to alter anyone’s strongly held beliefs here is tantamount to trying to convince someone that their political or religious beliefs are just <possibly> erroneous. To wit, this is an exercise in futility.

So now the mantra is JUST CALL THE MAN! Get it straight from the source. There is no big secret. If you really want some evidence, I’m sure that Dr. K would be willing to talk with you. Maybe he’ll share what he’s learned with you and send you some specific PSG data. Wouldn’t that be better than pouring through the data from just one (relatively random) patient’s PSG? Or are you afraid that he’d “stack the deck” in his favor? Then again with your expertise, wouldn’t your “BS meter” go off and you’d be able to detect that?

Gotta run again - going to see another guy about this rapture thing. Turns out the first guy was a con artist. I'm so damn gullible!
“Ignorance” is not pejorative; it is simply a lack of information. “Stupidity” is an inability to utilize available information.

just askin

Re: Dr. Krakow, salesman extraordinaire?

Post by just askin » Sat Dec 03, 2011 6:32 pm

is it a requirement to have more than 1 username when posting in this forum or is it just in this thread
just askin

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deltadave
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Re: Dr. Krakow, salesman extraordinaire?

Post by deltadave » Sat Dec 03, 2011 8:34 pm

ignorant1 wrote:DD, I’ll reiterate once again that there is no big secret.
Actually, I completely agree.

Back on 11.22.2010
ignorant1 wrote:And I also know precisely how much of a difference just 0.5cm pressure difference can make! As I said before, my effective treatment pressure seems to be right AT the threshold after which aerophagia rears it’s ugly head.
The pressures at the time were reported to be in the 11.0 - 12.0 cmH2O range. As has been offered in this thread, a reduction in mean pressure would appear to have a favorable effect on aerophagia. Once ASV was started, the resultant lower EEP level would significantly lower mean airway pressure, which in turn could easily explain improvement in aerophagia and sleep quality.

Have a Happy Rapture.
...other than food...

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deltadave
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Re: Dr. Krakow, salesman extraordinaire?

Post by deltadave » Sat Dec 03, 2011 9:05 pm

SleepingUgly wrote:Which ASV would achieve Lowest Effective OA Treatment Pressure?
AutoSV Advanced, of course! The only one that floats the EPAP. BTW, there's an interesting article in the Journal this month that showed AutoSV Advanced generated a lower MAP than the earlier version:

http://www.journalsleep.org/ViewAbstrac ... 8356&tab=2
SU wrote:Do you think it has a better shot of reducing overall MAP and therefore aerophagia than my S9 VPAP?
I see no evidence that that would be the case.
...other than food...

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SleepingUgly
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Re: Dr. Krakow, salesman extraordinaire?

Post by SleepingUgly » Sat Dec 03, 2011 10:04 pm

deltadave wrote:
SleepingUgly wrote:Which ASV would achieve Lowest Effective OA Treatment Pressure?
AutoSV Advanced, of course! The only one that floats the EPAP.
By floats do you mean that there isn't a set PS that doesn't change? Interestingly, when I tried a PS of 5, I started getting centrals.
SU wrote:Do you think it has a better shot of reducing overall MAP and therefore aerophagia than my S9 VPAP?
I see no evidence that that would be the case.


Then what are my options? I'm pretty sure this aerophagia isn't going anywhere. There is some variability, but clearly the higher the pressure, the greater the risk of aerophagia. At some pressures even below what I need, it's guaranteed. For example, if I set it to 12/8, which is probably much lower than I need, I will definitely get aerophagia. If I set it at 10/6, I will sometimes get aerophagia, sometimes not (and of course everything in between is an option too).
Never put your fate entirely in the hands of someone who cares less about it than you do. --Sleeping Ugly

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rocklin
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Re: Dr. Krakow, salesman extraordinaire?

Post by rocklin » Sat Dec 03, 2011 10:45 pm

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jnk wrote:That said, I VERY much respect those like DDave
So do I.

And it is entirely possible that further research will validate Dave's skeptical POV.

If Dave didn't exist, we would have to invent him, if nothing else than for our own sanity.


_________________________________________________________________________________________________________________________________________


jnk wrote:Applied art is applied art. Science is science.
The conventional wisdom. And, imho, utterly beside the point.


_________________________________________________________________________________________________________________________________________


ignorant1 wrote:who knows, maybe I’m actually one of Rocklin’s alter egos run amok?

(Cheap entertainment: watching a schizo arguing online with one of his alternate personalities?)
No worries, dear sir, if you were actually one of my alter egos, I would've imbued you with the gift of genuine wit.

_______________________________________________________________________________________________________________________________________

ignorant1 wrote:Why did you ever think of yourselves as the “master race”, let alone have any chance of ruling the world?
I fear there you go again, kind sir.

Why did you ever think I was German?

I employ Dr. Strangelove as my avatar because he travels the world as I do: in a wheelchair.

And, as a member of the tribe who lost relatives in the ovens, and thus, is just a mite bit touchy about the whole subject, I find your post to possibly—just possibly—be in somewhat questionable taste.


_______________________________________________________________________________________________________________________________________


(my 2nd personality, Clarence Darrow, jumping up and bellowing to the judge:)

I object!

(me again:)

Noted.

Asked and answered.

(My 3rd personality, the-sharp-as-a-barbers-straight-edge-razor Dennie Terrio, shouting joyously to the whole court:)

Dance! Dance Dance!



Image

(sorry ems, but I couldn't resist, save me, save me)

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Last edited by rocklin on Sun Dec 04, 2011 7:46 am, edited 1 time in total.
.
It is easy to be brave from a safe distance - Aesop
.

jnk
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Re: Dr. Krakow, salesman extraordinaire?

Post by jnk » Sat Dec 03, 2011 11:31 pm

rocklin wrote:
jnk wrote:Applied art is applied art. Science is science.
The conventional wisdom. And, imho, utterly beside the point.
On its face, yes, utterly beside the point. But if one considers docs who treat to be mostly artists and docs who research to be mostly scientists, then it is possible to read posts by the people who genuinely admire the art of K and posts by people trying to find the science of K and failing, and can sincerely agree with both of them in a wishy-washy sort of way, like me, and still maintain some semblance of self-respect. Or at least that's my goal. One day. Long-term.

Then again, I didn't choose a humorous Nazi character as my avatar then consider bad German jokes by others to be verboten. That kinda stuff just goes over my head. So what does I know. I ain't got no wit.

jnk
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Re: Dr. Krakow, salesman extraordinaire?

Post by jnk » Sat Dec 03, 2011 11:42 pm

NotMuffy wrote:
just askin wrote:is it a requirement to have more than 1 username when posting in this forum or is it just in this thread
Not a requirement, but doesn't hurt.
1001? I'm shocked!

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deltadave
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Re: Dr. Krakow, salesman extraordinaire?

Post by deltadave » Sun Dec 04, 2011 4:31 am

SleepingUgly wrote:
deltadave wrote:
SleepingUgly wrote:Which ASV would achieve Lowest Effective OA Treatment Pressure?
AutoSV Advanced, of course! The only one that floats the EPAP.
By floats do you mean that there isn't a set PS that doesn't change?
No, that EPAP is part of the algorithm and will automatically adjust to (hopefully) find the Lowest Effective Therapeutic End-Expiratory Pressure, which in turn will have the greatest effect on reducing MAP.
SU wrote:Then what are my options?
Go to Maimonides?
SU wrote:I'm pretty sure this aerophagia isn't going anywhere. There is some variability, but clearly the higher the pressure, the greater the risk of aerophagia. At some pressures even below what I need, it's guaranteed. For example, if I set it to 12/8, which is probably much lower than I need, I will definitely get aerophagia. If I set it at 10/6, I will sometimes get aerophagia, sometimes not...
The defense rests.
jnk wrote:...posts by people trying to find the science of K and failing...
I haven't found any unicorns either, and there's an excellent explanation for that.

BTW, Barry's a good insomnia guy. "IMHO", after dropping MAP via bilevel to reduce aerophagia, Ig1 improved Sleep Efficiency through hygiene and CBT.
deltadave wrote:
ignorant1 wrote:DD, I’ll reiterate once again that there is no big secret.
NFS.
jnk wrote:
NotMuffy wrote:
just askin wrote:is it a requirement to have more than 1 username when posting in this forum or is it just in this thread
Not a requirement, but doesn't hurt.
1001? I'm shocked!
Hey, if somebody's gonna throw one down the center of the plate, I'm more than happy to knock it out of the park.
gvz wrote:Unfortunately, there will be no rapture in 2012. They figured it out. Sorry Muffy.
Since by definition, no one knows the hour, etc., then that isn't/won't be the Rapture.
...other than food...

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SleepingUgly
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Re: Dr. Krakow, salesman extraordinaire?

Post by SleepingUgly » Sun Dec 04, 2011 8:01 am

deltadave wrote: "IMHO", after dropping MAP via bilevel to reduce aerophagia, Ig1 improved Sleep Efficiency through hygiene and CBT.
I thought he was on bilevel before ASV and it didn't help his aerophagia. ignorant1, is that right?
Never put your fate entirely in the hands of someone who cares less about it than you do. --Sleeping Ugly

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ignorant1
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Re: Dr. Krakow, salesman extraordinaire?

Post by ignorant1 » Sun Dec 04, 2011 12:48 pm

Rocklin wrote:
No worries, dear sir, if you were actually one of my alter egos, I would've imbued you with the gift of genuine wit.
Your currently dominant (“Rocklin”) personality has obviously taken majority dibs on the “wit” lobes of your brain, leaving us alter egos struggling to achieve half-wit status. You should try to learn to share better amongst yourselves. Ourselves? I’m so confused.
jnk wrote:
That said, I VERY much respect those like DDave
Rocklin wrote:So do I.
And it is entirely possible that further research will validate Dave's skeptical POV.
Agreed. And it is also entirely possible that further research will invalidate Dave's skeptical POV. Time will tell. It’s all just speculation and hypotheses until proven or disproven. And yes, I still highly respect and value DeltaD’s contributions here. It’s nice having him around – he’s kind of like the living antithesis of the old bumper sticker from the 60’s that reads “question authority”.
Deltadave wrote:
IMHO", after dropping MAP via bilevel to reduce aerophagia, Ig1 improved Sleep Efficiency through hygiene and CBT.
Nope. My bilevel experience was very short term and didn’t help my aerophagia problem at all. I can’t explain why, but maybe it had something to do with an allergic reaction to my unicorn? And no again on both the CBT and sleep hygiene too – nothing’s changed there.
Deltadave wrote:
…As has been offered in this thread, a reduction in mean pressure would appear to have a favorable effect on aerophagia. Once ASV was started, the resultant lower EEP level would significantly lower mean airway pressure, which in turn could easily explain improvement in aerophagia and sleep quality.
O.K.- Now we’re finally getting somewhere! Straight from the Oracle of DavePhi! (Get it? Delphi, Davephi. Horrible no? Any (witless) joke that needs explanation shouldn’t be uttered in the first place – right Rocklin?) So now we have an expert in the field offering a solid scientific explanation as to why some people are finding that ASV mitigates aerophagia. AGAIN, not everyone, but SOME people benefit from this aspect of ASV therapy. AGAIN, nothing is a panacea.

Now that Deltadave has joined us formerly irrational “believers” here on the dark side, is the case now closed on that particular matter? Kindly note the sequence of events: there was first an unexplained effect that prompted looking for a cause, and then an analysis that ultimately led to a logical scientific explanation of cause & effect. Observation of the phenomena preceded explanation, just like innumerable scientific discoveries. I’m feeling particularly rapturous now! OMG Look! A 600lb gorilla!
Rocklin wrote:
If Dave didn't exist, we would have to invent him, if nothing else than for our own sanity.
I did pose the idea earlier that perhaps he is actually an Artificial Intelligence program. I even proffered a Nobel prize election for the program’s creators. Perhaps until we have absolute scientific PROOF that Dave is indeed actually human, we should just go with that A.I. assertion? So what DOES Deltadave eat for breakfast? Oatmeal or electrons?
Rocklin wrote:
And, as a member of the tribe who lost relatives in the ovens, and thus, is just a mite bit touchy about the whole subject, I find your post to possibly—just possibly—be in somewhat questionable taste.
Jnk wrote:
Then again, I didn't choose a humorous Nazi character as my avatar then consider bad German jokes by others to be verboten.
Yes jnk – the irony is lost on my witless & addled brain too. And Rocklin - I can speak with a clear conscious. Half of my family tree looks like it got hit by that damn flaming zeppelin of yours. Maybe you should stick with helium instead of hydrogen. And speaking of light elements, don’t forget your lithium! (And now should I try to offend the creationists by making a joke about how the monkeys simply broke some limbs off the family tree WAY back in time?)
Rocklin wrote:
Why did you ever think I was German?
It was your accent that slipped out a while back, and that gave up your secret. But the real proof is in this editorial I dug up – the one that you wrote several years ago:

Euro-English, an unsolicited editorial by Rocklin
The European Language Commission has just announced an agreement whereby English will be the official language of the European Union rather than German, which was the other possibility. As part of the negotiations, Her Majesty’s Government conceded that English spelling had some room for improvement and has accepted a 5-year phase-in plan that would be known as “Euro-English”.

In the first year, ‘s’ will replace the soft ‘c’. Sertainly, this will make the sivil servants jump with joy. The hard ‘c’ will be dropped in favour of the ‘k’. This should klear up konfusion and keyboards kan have one less letter.
There will be growing publik enthusiasm in the sekond year when the troublesome ‘ph’ will be replased with the ‘f’. This will make words like ‘fotograf’ 20% shorter!

In the 3rd year, publik akseptanse of the new spelling kan be expected to reach the stage where more komplikated changes are possible. Governments will enkorage the removal of double leters which have always been a deterent to akurate speling. Also, al wil agre that the horible mes of the silent ‘e’ in the languag is disgrasful and it should go away.

By the 4th year, peopl wil be reseptiv to steps such as replasing ‘th’ with ‘z’ and ‘w’ wiz ‘v’. During ze fifz year ze unesesary ‘o’ kan be dropd from vords kontaining ‘ou’ and similar changes vud of kurs be aplid to ozer kombinations of leters. After ze fifz yer ve vil hav a rali sensibl ritn styl. Zer vil be no mor trubl or difikultis and evriun vil find it ezi tu undrstand ech ozer.

Zen Z Drem Vil Finali Kum Tru!!
>>>>>>>>>>>>>
Und I mit ad dat dis nu spelung had skrewd up min automatik speler cheker und gramatik und it kriatd much trubl und difikultis!

Enuf sed. Vut iz rily a shem zo iz dat peplz lik SleepingUgly stil hav zer problums, und ve haf not helpd her vid de zolushun yet.
“Ignorance” is not pejorative; it is simply a lack of information. “Stupidity” is an inability to utilize available information.

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Re: Dr. Krakow, salesman extraordinaire?

Post by deltadave » Sun Dec 04, 2011 1:46 pm

ignorant1 wrote:
Deltadave wrote:
IMHO", after dropping MAP via bilevel to reduce aerophagia, Ig1 improved Sleep Efficiency through hygiene and CBT.
Nope. My bilevel experience was very short term and didn’t help my aerophagia problem at all.
I consider ASV a form of bilevel ventilation (those forms being spontaneous, timed, spontaneous/timed, auto and adaptive servo ventilation). I was hoping that using "bilevel" as a descriptive term would aid readers to visualize a pressure waveform that spends most of the time at a lower baseline with only brief peaks at high(er) pressure, and thus, a first-line approach to aerophagia.
ignorant1 wrote:And no again on both the CBT and sleep hygiene too – nothing’s changed there.
There is little doubt in my mind that your Sleep Efficiency has improved. It would have been interesting to see this on NPSG, but what the hey.

Also, while hygiene and CBT may not have been formally identified as such, that's precisely what happened at Maimonides.
...other than food...

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ignorant1
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Re: Dr. Krakow, salesman extraordinaire?

Post by ignorant1 » Sun Dec 04, 2011 2:29 pm

Deltadave wrote:
I consider ASV a form of bilevel ventilation (those forms being spontaneous, timed, spontaneous/timed, auto and adaptive servo ventilation).
My mistake, as ASV is obviously a variant of bilevel. Better to keep the terminology simple per your suggestion.
Deltadave wrote:
Also, while hygiene and CBT may not have been formally identified as such, that's precisely what happened at Maimonides.
While Dr. K does deal with insomnia issues (and his book bristles with CBT type training) I received no formal CBT training while at Maimonides, nor have I put into practice any of the behavior modifications suggested in his book. All other parameters remained the same.
Deltadave wrote:
There is little doubt in my mind that your Sleep Efficiency has improved.
There’s little doubt in my mind too! Sleep efficiency has improved, primarily due to 1.) alleviating arousals due to aerophagia, and 2.) reducing arousals due to UARS. Or I may be mis-using terminology again by saying UARS. Perhaps I should just say that after the breathing waveform was smoothed out while on ASV, the number of EEG arousals decreased dramatically; therefore sleep fragmentation was markedly reduced.

Uh-Oh! Here we go again… (?)
“Ignorance” is not pejorative; it is simply a lack of information. “Stupidity” is an inability to utilize available information.