Message for Avi

Janknitz · Post by **Janknitz** » Wed Apr 27, 2011 4:01 pm

You ask me a question in a PM, but you have message receipt disabled so that I cannot respond to your PM. If you want a response, you'll have to ask the question publicly or enable your message receipt function.

scrapper · Post by **scrapper** » Wed Apr 27, 2011 5:10 pm

He's probably added you to his "Foe" list with the rest of us.........

avi123 · Post by **avi123** » Wed Apr 27, 2011 6:09 pm

Jan, sorry about it. I 'll try to fix it. Here is my message:

Upgrade my CPAP to APAP under Medicare rental arrangement

Sent at: Wed Apr 27, 2011 4:30 pm
From: avi123
To: Janknitz

Hi Jan, by any chance do you know if under Medicare rental I can change my CPAP to APAP?

I am in the 6 month of rental under Medicare. My DME on its own changed the S8 Escape II with S9 Elite in the third month of rental. But my AHIs are still high and I need higher pressures to counteract the Obstructive and not burden the Centrals. My sleep doctor MD gave me an RX for an S9 Autoset. But the DME (who is Medicare provider) emailed this to me:
*********************************************

Mr. Avi, YYYY contacted me regarding your request for a new auto cpap unit. We have already evenly exchanged your cpap unit once, which is not our policy, because you are a valued customer that we want to help. Your insurance did not cover this exchange, as insurance companies do not allow that practice and do not cover any expenses incurred. {this sort of correct. The DME was denied payments more than 20 times as "Duplicate service-previously processed}

If you would like to cash purchase an auto cpap, we have very competitive pricing—around $1000 for both the flow generator and humidifier. We are happy to help you in this manner, but are unable to do another exchange of a used unit for a brand new one. Insurance companies will not recognize a physician’s order as a reason to cover another unit for you.

Thank you for your email and please let us know how we can help from this point forward.

Clinical Manager

*******************************************************

Jan, any idea how to go about it? Reminding you that I am using a CPAP being amortized at Medicare for the 7 more months.

I read your reports but I don't think that a similar case is covered there.

I am fully covered by Medicare and Medigap.

Thanks.

Avi

avi123 · Post by **avi123** » Wed Apr 27, 2011 7:25 pm

scrapper wrote:He's probably added you to his "Foe" list with the rest of us.........

Scrapperrer, a few time I asked you if your Ostrich is Kosher to eat but you never replied. So what am I to do?

Janknitz · Post by **Janknitz** » Wed Apr 27, 2011 8:01 pm

The DME is under NO obligation to switch out your CPAP for an APAP after six months of use. And there's no incentive to do so. Why should they be stuck with a used CPAP machine with hundreds of hours of use and give you your THIRD brand new machine--a more expensive one, no less? And with half of the capped rental fees used up, no other DME is going to want to give you an expensive APAP machine--no profit for them--so playing the car sales game ("I'll walk if you don't meet my price") isn't going to work this time. If you turn in that machine because you want the APAP now, you're going to find yourself SOL.

You were extremely lucky to get your Escape swapped out after 3 months of use, and it's too bad that you didn't push for the APAP then. IMHO, it also takes a certain kind of chutzpah to demand ANOTHER new machine at this point. I'm sure they are thinking "what will he ask for next????" You even have ME feeling sorry for the DME in this one, and that's not a familliar feeling for a DME that routinely foists data-less machines on unsuspecting newbies.

Your best bet is to buy your own ResMed S9 Autoset flow generator that can be used with your existing humidifier. I wouldn't recommend paying the outrageous price of $1000--you can find much better prices online, through Craigslist, secondwind.com, etc. Or you could consider a less expensive APAP system like the Intellipap that many people here are quite happy with. But give the poor DME a break!

scrapper · Post by **scrapper** » Wed Apr 27, 2011 8:42 pm

viewtopic.php?f=1&t=60788&st=0&sk=t&sd=a&start=15

I think that you're mistaken. S9 Elite will give you any pressure up to 20 cm H2O on inspiration. On expiration the EPR could drop the pressure by 3 cm H2O within one cm steps. One thing it does not do is to change pressures on its own upon detection of Apneas. Doing so (using a S9 Auto Set) you need to trust the machine to be your doctor. I would not trust it especially b/c it uses a still unproved technology. But many in this forum do. IMO, most posters who do it are sort of Sleep Doctors' impostors. Of course they can do it safely b/c they are hidden from their real names and thus are NOT legally responsible. So they are free to take stupid guesses on your life well being. Why not turn you into their Guinea Pigs?

So I'm guessing, avi123, that you've finally changed your mind about the S9 AutoSet?

As for the ostrich............I haven't answered your question, because I don't know the answer. When this is the case, I don't post. I find this to be a good rule to follow on forums.

DoriC · Post by **DoriC** » Wed Apr 27, 2011 9:03 pm

Avi, if the object is to try to find the optimal pressure to reduce your apneas, you can do that with the Elite you have by raising the pressure 1cm at a time for a few days at each pressure and watch the data. Many people find their "sweet spot" that way if they have software. Am I missing something?

avi123 · Post by **avi123** » Thu Apr 28, 2011 8:22 am

Thanks Jane. If I buy a new S9 Autoset Flow Generator only on my own for around $800 and connect it to my present rented S9 Elite humidifier (it was used when given to me) what about the 6 months rental left for the DME to charge Medicare? Will they continue to charge Medicare for it?

avi123 · Post by **avi123** » Thu Apr 28, 2011 8:33 am

not relevant

Slartybartfast · Post by **Slartybartfast** » Thu Apr 28, 2011 8:42 am

avi123 wrote:
scrapper wrote:He's probably added you to his "Foe" list with the rest of us.........

Scrapperrer, a few time I asked you if your Ostrich is Kosher to eat but you never replied. So what am I to do?

I'm not Scrapper, and I don't play one on TV, however, but I've been called an "oy-ster"** a few times.

Leviticus 11 states

"And these you shall regard as an abomination among the birds; they shall not be eaten, they are an abomination: the eagle, the vulture, the buzzard, the kite, and the falcon after its kind; every raven after its kind, the ostrich, the short-eared owl, the sea gull, and the hawk after its kind; the little owl, the fisher owl, and the screech owl; the white owl, the jackdaw, and the carrion vulture; the stork, the heron after its kind, the hoopoe, and the bat."

So, no, the ostrich isn't Kosher. But it tastes like chicken, so they say.

**http://www.diclib.com/cgi-bin/d1.cgi?l= ... id&id=7075

avi123 · Post by **avi123** » Thu Apr 28, 2011 8:55 am

Slartybartfast wrote:
avi123 wrote:
scrapper wrote:He's probably added you to his "Foe" list with the rest of us.........

Scrapperrer, a few time I asked you if your Ostrich is Kosher to eat but you never replied. So what am I to do?

I'm not Scrapper, and I don't play one on TV, however, but I've been called an "oy-ster"** a few times.

Leviticus 11 states

"And these you shall regard as an abomination among the birds; they shall not be eaten, they are an abomination: the eagle, the vulture, the buzzard, the kite, and the falcon after its kind; every raven after its kind, the ostrich, the short-eared owl, the sea gull, and the hawk after its kind; the little owl, the fisher owl, and the screech owl; the white owl, the jackdaw, and the carrion vulture; the stork, the heron after its kind, the hoopoe, and the bat."

So, no, the ostrich isn't Kosher. But it tastes like chicken, so they say.

**http://www.diclib.com/cgi-bin/d1.cgi?l= ... id&id=7075

***************************************

Yes, I see the same here but let me come back:

http://www.milechai.com/judaism/kosher-animals.html

One error here is that Locust which is not mentioned is an insect but Kosher, as I understand it. Some sceintists say that the Manna which the Isrealites ate in the desert after leaving Egypt was the Locust.

p.s. what about this:

http://israelity.com/2009/03/06/ostrich ... ercoaster/

M.D.Hosehead · Post by **M.D.Hosehead** » Thu Apr 28, 2011 10:02 am

avi123 wrote:

As to self titrating on the S9 Elite, you can see here my self titration log done over the recent three months. Apparently there is not a trend showing up. But, as I mentioned above the S 9 Autoset will allow to go above the 9.6 cm pressure to open Obstructive apneas BUT drop the pressure when encountering Central Apnea events.

There is a typo in the Central Apnea column at the 4th raw. It should 6 instead of 11.

JMO, but I think you're making progress. Do you have an oximeter? The reason I ask, is that it's possible some of the "centrals" are not "real," especially the ones near sleep onset and awakening. If the centrals aren't accompanied by desats, you may not need to worry about them.

Many of us need more than 9.6 cm. If, in fact, you can disregard some of the "centrals," it may be no problem to go higher.

ozij · Post by **ozij** » Thu Apr 28, 2011 10:14 am

No cpap - fixed or auto - will "open" an apnea. Continuous Positive Air Pressure is there to stend your airway and keep it from collapsing, but if it collapses, it collapses. With proper pressure, in garden variety OSA, most obstructive apneas will be prevented - or perhaps be shorter, but none are "opened".

You are also mistaken in assuming the Autosed will "drop the pressure" if it encounters a central apnea. It will do no such thing. After an apnea it condsider obstructive, an Autoset will raise the pressure. After a central apnea it will simply not make any changes.

You have got many flow limitations - these are going to drive the Autoset's pressure up -- in an attempt to get rid of them. The Autoset is very responsive to flow limitations.

What do your snores look like on the ResScan charts?

70sSanO · Post by **70sSanO** » Thu Apr 28, 2011 10:38 am

I am far from an expert, but if you are self titrating you have no idea if 9 or 19 is the correct pressure. I had a sleep study done a long time ago and I was at 10 when I started lookiing at data. In less than a month I am at 13 and my numbers are better, but there are always days when they are not as good.

Because I knew I needed to start at 10, I didn't waste time at 6, 7, 8, etc. trying to decipher my numbers that were really too low to make a real impact. I followed advice I got reading other posts on this forum that suggested getting the OBS number down first and then go from there. Raw numbers for centrals can be worthless. I woke up at 4:30am the other day and snoozed for about 15 minutes and picked up 15 centrals.

John

SleepingUgly · Post by **SleepingUgly** » Thu Apr 28, 2011 11:34 am

No, ostriches are not kosher, unless they are cooked in Matzo Ball Soup, in which case they are considered by some to be kosher by proximity.

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