Dr. David M. Rapoport at Manhattan A.W.A.K.E. on May 5, 2010

jnk wrote: but he was speaking to an audience mostly made up on non-computer-users, judging from the people I spoke to afterward.

Now I have to pick on NYC again. As a rural southern native I find it amusing that a meeting in Manhattan is loaded up with computer illiterates. (Regis included I am sure)

Redeye wrote:jnk: Thank you so very much for reporting on this. You are indeed a fantastic correspondent.

Redeye

You are very welcome. And thanks!

I know the whole thing was taped by a guy using a fancy-looking video recorder, so I hope it gets posted somewhere.

roster wrote:

jnk wrote: but he was speaking to an audience mostly made up on non-computer-users, judging from the people I spoke to afterward.

Now I have to pick on NYC again. As a rural southern native I find it amusing that a meeting in Manhattan is loaded up with computer illiterates. (Regis included I am sure)

Most at the meetings are older than me and may have been referred to the meetings by one of the doctors who attends. It may be that the people having trouble who aren't getting info online are the ones most likely to make it to the meetings.

I think that the average Manhattanite over 60 (much of the audience at that meeting) has had little need for computer use if his work does not, or did not, require it. Hardcore urban living puts people where everything they might buy is within a block or two. Libraries and museums are all around, and information is constantly pushed in your face with the newsstands and corner magazine stores. There may be enough face-to-face social contact to make for little need for online social networking.

My travelling to the meetings from Brooklyn means that as far as most Manhattanites are concerned, I'm basically commuting in from the rurals. (Or at least the suburbs.)

It still cracks me up when I hear someone in Brooklyn say they are going over into "the city."

Hey, did i hear my name somewhere a few posts back?? I'm READY, who we gonna go hassle NEXT?!

Interesting, from the few comments you made, it seemed more like he was focusing on very specific functionality-tweaks... sort of like what happens when a product's feature set has been fully saturated and they're looking for the (small) "one thing" that differentiates it from the competitors and also a reason to jack up the price because of its advanced features (that most people don't need, while spoiling features that most people DO find useful)... i've seen that in the company i was working for (also active in medical equipment). But maybe that view is too simplistic and I'm biased, and when taken in context perhaps the whole presentation was interesting & useful. It will be nice if they post the video online.

Thanks for the summary jnk!!!

echo wrote: . . . from the few comments you made, it seemed more like he was focusing on very specific functionality-tweaks... sort of like what happens when a product's feature set has been fully saturated and they're looking for the (small) "one thing" that differentiates it from the competitors and also a reason to jack up the price because of its advanced features (that most people don't need, while spoiling features that most people DO find useful)...

"All the so-called cool developments that have come before from the other companies aren't really that cool so you don't need them; but the stuff I'm working on right now may change everything!"

I think you nailed it.

Thanks Jeff for that informative report. I felt I was there with you. I could hear CB reciting his beautiful poetry accompanied by you on guitar! Poor Dr Rapoport didn't stand a chance. And who are you calling a conceited jerk? Seriously, the sleep dr we consulted 2x was very knowledgeable about the dx and treatment of OSA, knew all about the advances made in equipment and how they all should work, but a doctor or researcher just can't understand the therapy issues we face unless he were in the "trenches" with us or is listening very carefully to patients and taking their struggles seriously. And that's besides giving us instructions that were off base like wide open pressure settings, making the straps real tight if there's leaking,and software isn't necessary because it's not very accurate, etc, etc.! A few years ago when driving was not such an issue, we could have zipped up the NJ Turnpike and through the Lincoln Tunnel and attended the meetings with you. We went to NYC quite often. Oh well, such is life!

jnk wrote: My travelling to the meetings from Brooklyn means that as far as most Manhattanites are concerned, I'm basically commuting in from the rurals. (Or at least the suburbs.)

It still cracks me up when I hear someone in Brooklyn say they are going over into "the city."

Could I say that the average IQ in Manhattan increases when you attend the meeting and decreases when you depart?

roster wrote:. . . People often do not fit our stereotypes. . . .

I'm sure I have my preconceived notions and stereotypical categories in my head, like everyone does, I guess. (We have to organize the world and our experience in it somehow, right?) But I've lived in hill country (Pike County, Kentucky), in a subdivision (Louisville), in horse-farm country (Lexington), and in Brooklyn Heights, and I have found that most everyone I meet is an expert at something if I have the time to listen to him or her talk about personal interests. And I find that people are mostly just people all over the world.

I try my best not to judge or attribute bad motives, regardless of how much I've sliced and diced the good doctor in this thread. (He is enough of a celebrity to enjoy the attention, either way, I'm sure. Much like Regis. )

What saddens me is how much the people at those meetings want help to make their PAP therapy work and how little help they are getting, even though they have doctors who care, DMEs with decent equipment to provide them, and fellow patients sitting all around them. My habit after each meeting is to look for who has the most confused or lost look on his or her face, to walk up to them, and then to say "So, were all your questions answered here tonight?" Then they generally laugh, say "no," and tell me their story. I learn more from hearing their problems than they learn from me, I'm sure. But hopefully I'm able to point them in a direction for further help. I've learned the "blank stare" reaction to my mentioning "forums" and the Internet, though. And I have gotten that look from obviously highly educated, brilliant people.

PAP therapy is a great equalizer. We all have to breathe. We all have to sleep. Both are mostly a mystery to every human. And how the medical system works (or, more accurately, doesn't work) is not intuitive for anyone, no matter how much literary acumen is in the person's head or how much cash is in the person's pocket. Helping someone learn about PAP therapy is like helping crash survivors learn how to find shelter, water, and food, it seems to me. It is basic to life for the OSA sufferer but not a skill set many people have developed, no matter their age, background, or location.

[Suddenly flails arms and awkwardly falls off soap box.]

jnk wrote: Helping someone learn about PAP therapy is like helping crash survivors learn how to find shelter, water, and food, it seems to me.

I will try to remember that good one.

redeye wrote:jnk: Thank you so very much for reporting on this. You are indeed a fantastic correspondent.

Redeye

Absolutely! That was a great read, Jeff!!

About Dr. big-R, aka F&P... ...

jnk wrote:For example, he seems to feel that bilevel and APAP and exhale relief are mostly failed ideas, since it hasn't been proved that people are more compliant with them. I agree with him that straight CPAP is a wonderful thing and as efficacious as a therapy can be. But if comfort of the patient is a consideration, I don't see how those developments can be considered somehow less than ideal. I wonder if he would feel the same way about those developments if he was more directly connected to the big "R" companies? Hmm.

Heheh...exactly. Also, I wonder if he'd feel the same way if he were a CPAP user himself. Bet he'd have himself bilevel machines in every room of his house!

jnk wrote:He kept saying that he wasn't there to try to sell anything, but he sure talked a lot about some sense-awake or sense-asleep nonsense--the ability of a machine to sense when a patient was awake or asleep.

Yeahhhh....righhhht. From the time I first read about it, I've thought Fisher & Paykel's SensAwake™ thingie was at the least, nonsense; and at the worst, a bad "feature" to introduce into CPAP therapy. But whadda I know. I'm not a doctor. My nickname starts with a small "r" anyway, not a big one!

jnk wrote:He kept talking like it would be ideal for APAPs to drop to 4 cm the moment someone wakes up. He even said he wished it could go lower! And he kept referring to the PAP "turning off" when someone woke up. Apparently he has never used a CPAP to experience how hard it is for many people to breathe at low pressures with a mask on.

Apparently, for sure.

Jeff, what a great report on the meeting!! Wish I'd been there to join in the eye-roll looks you and Mike were exchanging. We'd have been cross-eyed by the time Rapoport was done.

As for noncompliance... I've always thought the #1 problem most people have in being able to do any kind of CPAP at any kind of pressure is:

the MASK

There are many machines with enough comfort features to make using the machines themselves do-able. Sense-awake would not be my idea of a good feature at all, imho. But that's just me.

However, finding a mask a person can actually sleep in... well, I think MASK issues cause the biggest problems that lead to so many CPAP drop-outs. "SensaFace" might be a better thing for Dr. R to spend his time on.

Interesting speaker though he may be... enthusiastic about CPAP though he may be... ever since I read Dr. R's thoughts in a link -SWS posted a long, long time ago, I've not had much confidence in some of the notions the good doc has:

http://www.pulmonaryreviews.com/sep02/p ... Index.html

I agreed with Dr. Colin Sullivan. Of those two doctors -- Sullivan and Rapoport -- I'd sure want to be under Sullivan's care. Not Rapoport's.

But again, that's just me. I was a drowsy driver with a PSG diagnostic overall AHI of only 7.8 (nowhere close to the AHI of 15 Rapoport considered to be the threshold where CPAP would be useful. ) who experienced a dramatic improvement in driving alertness immediately after I started CPAP six years ago.

With me on the CPAP therapy Dr. R wouldn't have thought I needed ... ... the highways I'm on are most definitely safer.

jnk wrote:Actually, all in all, this may have been the most educational of all the A.W.A.K.E. meetings I've ever attended in that it brought me face to face with the lack of basic understanding of some of the luminaries in the industry on the research and hardware development front.

You do have a way with words, Jeff. Loved that!

well said jnk, roster, rg. Jnk don't you ever get off that soapbox!

BTW RG glad you're no longer a danger on the road Everytime I see an accident I wonder what are the odds that they fell asleep at the wheel?

And I agree with you on the MASK!

The talk is now posted in its entirety at viewtopic/p481272/viewtopic.php?f=1&t=5 ... 82#p480978