CPAPtalk.com

Calist wrote:Reconcile that with AASM's whining about RDI.

Reconcile this.

NotMuffy wrote: Reconcile this.

On that note. I'll be back next week guys.

Robysue- Go get tested at an accredited lab and stop talking to those jerks that diagnosed you. Make sure the lab you go to AASM accredited. Settle for nothing less.

Guest- Official welcome and please stick around! We need you here.

kteague- hold down the fort!

sleepyb- No one listen to this guy! It's a dog in real life. Looks like a Labrador from the portrait! Not sure how he is using the keyboard he has no thumbs!!!

Notmuffy- Don't be muffy!

NotMuffy wrote:

Calist wrote:RDI is crap and you know it!

The only thing I "know" is you have NFI what you're talking about.

You go, NotMuffy!!!

I've been reading and following the threads with calist's rants and raves with interest. At first glance, it almost appeared that calist has some knowledge about which he spews, but a few of his comments have proven that NotMuffy's above comment is right on.

Calist, if you are on the up and up (which I seriously question as do most others here), your method of sharing information is flawed and counterproductive. Even me, just a stupid patient, has seen you trip up with declarations of fact that are indeed, fiction. I can think of two comments off the top of my head that have proven for me, beyond any reasonable doubt, that you are full of dog doo.

Calist, much of what you have said in this thread (among others) is 100% incorrect. Because of that, everything you say is now suspect. In truth, I could give a rat's butt about your rants and raves, but fear some newbie will come here and see some of your nonsense, take it as truth, act on it, and really screw themselves up.

calist wrote:

Your referring doctor (for reasons unknown) sent you to this unaccredited lab. I know they are unaccredited because they are using RDI. Accredited labs are not permitted to use RDI.

The lab where my sleep studies were done is fully accredited by the AASM, the only organization I'm aware of that accredits sleep labs here in the US. You do not know what you are talking about here.

So I don't care what AASM says about RDI. No one does. If they want to move their entire scoring criteria over to an RDI model, they'll only be hurting themselves in the long run.

The International Classification Of Sleep Disorders (ASDA pocket edition) clearly states...

Diagnostic Criteria: Obstructive Sleep apnea syndrome (780.53-0)

D: Polysomnographic monitoring demonstrates:
1: More than five obstructive apneas, greater than 10 seconds in duration, per hour of sleep and
2: arterial oxygen desaturation in association with apneic episodes

Reconcile that with AASM's whining about RDI.

So the good news is that according to calist, my baseline study shows I do NOT have apnea since my AHI (without the respiratory event related arousals) is only 3.9, which is WELL below 5.0. Ain't that great?

The bad news is that calist is way, way off base, so I guess I'll continue to be a compliant patient (the kind calist says he wants to deal with) and continue using my CPAP after all.

And it's kind of amusing that in another thread, calist uses AASM standards to attack "unreliable" data coming from APAP/CPAP machines, but here he attacks the AASM standards themselves.

Here's my take:


Calist is full of contradiction
Calist is clearly full of himself
=========================
Calist is therefore contradiction

Dang. I just now scrolled through this thread, meaning I stayed on the down arrow until I came to a post here and there that was short enough to read. People, we (including me) need to quit tanglin with Calist. I've already forgotten who, but some people have pointed out he has issues. Just this thread alone makes that obvious.

Calist, buddy, you need some help. I don't know the source of your problems, but something is wrong with you. Maybe you need another sleep test by a competent sleep lab, or maybe you need to see a psychiatrist, or maybe you need a complete physical with a good internist who can put all of the pieces of the puzzle together. Make sure you tell your doctor that you suspect you have an anger issue or maybe a personality disorder or something. The roots may be bioligical or psychological, but whatever it is, you really need help.

Print this entire thread out and take it with you. It may be helpful to the doctor to scan through it to see what you are actually doing.

I know I shouldn't feed the troll, but I just can't resist this.

calist writes:

Granted. I will agree with that [the need for patient education] at least in theory but do you see where I am coming from? I have seen way too many physicians that would rather take the extreme opposite stance by rubber necking a patient, agreeing to anything they say and breaking down a layman's terms explanation so far for a patient that it borders on complete fantasy.

Educating people is hard work. One thing that teachers at all levels can tell you though: If you expect your students (i.e. patients) to be incapable of learning anything, they will sink to your low expectations of them. If you think that your students (i.e. patients) can and want to learn something, then some (most) of them will learn a thing or too. Maybe the docs who behave like this need to learn how to educate their patients?

There are two sides to this argument, one is that physicians should tell patients nothing and expect complete obedience regardless of their feelings and questions in favor of the medical science objective.

On the other side, the extreme opposite, we have the idea that physicians should pander for a patient's personal approval by talking to them, sympathizing with them, patronizing them, making them feel like they are a part of the process and all of this at the EXPENSE of medicine.

You're setting up a false dichotomy here: It's not a choice between expecting complete obedience from patients who are intentionally kept ignorant of their own condition and pandering to patients at the expense of the medicine.

Should a doctor treating a patient for diabetes not educate the patient about what symptoms to look for that indicate the blood sugar is out of whack, either above or below the target range? And what to do if those symptoms occur?

Should a doctor treating a patient for high blood pressure not educate the patient about the required regime of taking the medication, the common side effects of his medication, and the consequences of not properly managing his blood pressure problem?

A quality doctor will take the time to properly educate his patients about their conditions.

May I remind all that we have a wonderful function available to us called "Friends and Foes"

To use it, go to User Control Panel (upper left corner of web page, under the search bar) and find the tab marked Friends and Foes.
Click on it, then click on the option "Manage Foes"
Add calist in the box "Add new Foes"

Then sit back and enjoy the peace and quiet!

snnnark wrote:May I remind all that we have a wonderful function available to us called "Friends and Foes"

To use it, go to User Control Panel (upper left corner of web page, under the search bar) and find the tab marked Friends and Foes.
Click on it, then click on the option "Manage Foes"
Add calist in the box "Add new Foes"

Then sit back and enjoy the peace and quiet!

Are you kidding me? This is the best entertainment I've had all week. I know, I know, I have a dull life.

Yeah I sometimes enjoy a good bunfight. But when the idiot says sometime like...

Calist wrote:

...
Efficacy of Adaptive Servoventilation in Treatment of Complex and Central Sleep Apnea Syndromes
http://chestjournal.chestpubs.org/conte ... l.pdf+html
...

Auto Servo Ventilators are crap and cure nothing. They were designed to correct 'Complex Sleep Apnea' which is french for 'Donno howto fix patient'. They are basically auto-titrator bipaps with three pressures instead of two. There is no way they are going to fix a true central that wasn't caused by a doctor overtitrating his patient.

then I have a problem. What if a newbie reads this and believes it cos it supposedly comes from a RPSGT. (which in his case stands for Ridiculously Pompous Self-centered Gutless Twerp)

I agree that he is an absolute idiot, but watching him make a fool of himself has been interesting.

He is so far off base about so many things. I think that even newbies could see through his crap. I wouldn't be surprised if he worked at the sleep lab that I went to.

OutaSync wrote:I wouldn't be surprised if he worked at the sleep lab that I went to.

Now THAT'S funny, I don't care who you are!

Ok, I know I'm feeding the troll again. But calist wrote this about one of my post's last night and it got by me at the time: I didn't read this post close enough to note that calist was not only insulting my intelligence, but also both the intelligence and competence of my PCP and misreading what went on between me and the ENT who diagnosed me with necrotizing sialometaplasia approximately three summers back. As an FYI, necrotizing sialometaplasias are not routine, run-of-the-mill conditions that PCPs see every day. (Want to take a look? Here's a link: http://emedicine.medscape.com/article/1077574-overview )

calist writes:

robysue wrote:

, and it turns out that certain kinds of oral cancer display many of the same symptoms. At the start of this problem, the pain was excruciating and after taking one look at my mouth, he could tell he really didn't know what was going on, but that it looked bad: His office made an emergency referral to an ENT who could see me that afternoon.

He was the doctor that holds patients hands when they cry and he referred you to the guy he knew was going to fix you. Classic.

What do you expect a PCP to do when they're faced with something that looks serious, might be oral cancer, but is in a patient who has (1) never used any tobacco products, (2) has no serious on-going medical problems, and (3) has developed a mouth-ulcer-from-hell very, very quickly? You tell them you think it might be cancer and give them a referral to an oncologist/ENT for follow-up? Or you admit you don't know what's going on, but that it needs to be seen immediately be a specialist and arrange for that appointment before the patient leaves the office? Personally, I think the second approach is the more reasonable approach.

robysue wrote:

So obviously I was emotionally upset and pretty worried by the time I got to the ENT's office. At that first appointment, the ENT recommended watchful waiting since I was such an unlikely candidate for oral cancer and a small biopsy.

He suspected what it was but was afraid to say it since it was so rare. He wanted to wait for symptoms either way. Smart guy.

Actually at that first emergency visit, the ENT told me exactly what he thought it was---he even wrote down "necrotizing sialometaplasia" on a sheet of paper,. [Heck, that's the only reason I actually remember the official name for the mouth-ulcer-from-hell three years later.] The ENT explained that what I most likely had was a rare inflammatory condition in one of my salivary glands where the gland was basically destroying itself. He even suggested that I might want to google "necrotizing sialometaplasia" for myself. He told me that the differential diagnosis alternatives included oral cancer and that necrotizing sialometaplasia was a very rare condition, but that in light of the fact that I had no history of tobacco use, it was his opinion that I most likely had a necrotizing sialometaplasia instead of oral cancer and that watchful waiting, the small biopsy, and some pain medication were all he recommended doing at the time since necrotizing sialometaplasias are self-limiting---in other words, they get better all by themselves without any medication or treatment from a doctor. The ENT also told me up front that if my condition did not prove to be self-limiting, then we would have to start looking at oral cancer as a real possibility in spite of the fact that I'd never used tobacco. We then talked about pain management and what could be done to minimize (but not eliminate) my pain during the time needed for the necrotizing sialometaplasia to resolve itself.

And the ENT never claimed he could/would "fix" me up: He stressed, both at the initial meeting and at each subsequent follow-up that there was nothing he could do to make the necrotizing sialometaplasia heal any faster, but that he wanted to see me frequently to make sure the necrotizing sialometaplasia really was resolving itself. We also talked about pain management at all those follow-ups. Each time I went in, the ENT asked me how well I was coping with the pain at each and every follow-up and whether the pain medication was enough to allow me to function.

All in all, I'd say that this whole episode is an excellent example of what I call quality patient education.

So what calist says about my ENT being "afraid to say what it was since it was so rare" is just another example of a whole lotta dog poo.

Finally, calist said

Yeah.... me too. But consider this.... the next time you walk into YOUR doctor's office and show him something he can not diagnose- who is he going to call?

calist, surely you don't expect your PCP to be able to diagnose every possible thing you might ever come down with or develop?

I certainly hope that if I (again) walk into my PCP with a condition he's never seen before that he does exactly what he did three years ago: In other words,
I hope that
1) he's honest and tells me he doesn't know what's going on,
2) suggests that I be seen by an appropriate specialist immediately, and
3) if the condition is significantly alarming, has his staff immediately make the call to the specialist to get me an appointment that day if possible.

Calist wrote:

DoriC wrote:I'm not sure who mentioned Hippocratic Oath here but I'm pretty sure our friend did not take that oath. He mentioned something about the lab so I presume he's a lab tech or implies that he is. Speaking of lab techs, ours was an M.D, educated and practicing in India but was working as a lab tech here for 2years while he studied to meet the requirements to take the U.S. Boards. He was wonderful, dedicated, very knowledgeable, patient and respectful. He took me into the lab and showed me the equipment he would be using, gave me a mini-course on what he would be doing all night and in the morning when I returned, while Mike was still sleeping,he took me back again and let me see him sleeping on the screen and explained the graphs he was looking at. And unlike many others who have said their titrations were not pleasant or accurate, Mike had the best night's sleep in many years and his titration was 13. After 2 years of much experimenting using that pressure as our guide, he now sleeps at 12 which is pretty much on the mark. I hope Bakram has taken the Hippocratic Oath by now, he'll make a wonderful doctor.

Oh my god, I know him. I heard he left GWSDC about six years ago, glad to see he is still running studies.

I must have missed your reply among so many pages, but to be honest I think you should know that in the interest of privacy I thought it best to use a fictitious name when speaking of our sleep tech. Bakram was my son's roommate in medical school many years ago and now practices Urology in another country. I believe it's a fairly common name in India.

snnnark wrote:Yeah I sometimes enjoy a good bunfight. But when the idiot says sometime like...

Calist wrote:

...
Efficacy of Adaptive Servoventilation in Treatment of Complex and Central Sleep Apnea Syndromes
http://chestjournal.chestpubs.org/conte ... l.pdf+html
...

Auto Servo Ventilators are crap and cure nothing. They were designed to correct 'Complex Sleep Apnea' which is french for 'Donno howto fix patient'. They are basically auto-titrator bipaps with three pressures instead of two. There is no way they are going to fix a true central that wasn't caused by a doctor overtitrating his patient.

then I have a problem. What if a newbie reads this and believes it cos it supposedly comes from a RPSGT. (which in his case stands for Ridiculously Pompous Self-centered Gutless Twerp)

OMG -- this is Priceless! I don't know how long it took you to come up with this, but I absolutely love it! I just about fell off my chair with this one!