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Muffy does not participate in "dial wingin'" for a host of reasons, including, but not limited to, if she is, in fact, a "trained professional" (something that I don't see her ever having admitted to being), then she cannot do "E&M"; and frequently, if not the majority of the time, important information that would have a significant effect on treatment management is missing.BrianinTN wrote:Muffy: I'm going to ask a probably-stupid question because even after reading everything written here, I'm still pretty confused on one point. What is it that you would advise Paper_Nanny to be doing with her pressure and backup rate settings, both "now" to provide a consistent and not-dial-winged data set for her doctor...
Putting myself in her shoes and looking at her data, I don't know what those defaults would or should be...
However, in response to your question, she should be on what the physician wants her on. At The Peak of the Madness, should she have given that DL to the physician, he would have had no choice but to say "See, ITYS, now do what I say for another month and then we'll see what happens."MSD and my neurologist both concluded that drug effect was not an issue.
Actually, other than the awakenings, her diagnostic PSG looks quite good, with the exception of Sleep Efficiency (although Split_City would call it normal, but his lab is in his garage).BrianinTN wrote:she seems to have had both qualitatively and quantitatively poor sleep (even relative to her diagnostic PSG) with the latest assortment of constant pressure and constant bilevel pressure winging.
Actually, I'd love to hear what you have to say.BrianinTN wrote:I wrote a paragraph summarizing her data, with a little thesis too, but I'm axing that for now.
Paper_Nanny wrote:I am nowhere near that portable with my searching! And now, I find I made much of this evening "idle time" by searching for posts by or about NotMuffy/ StillAnotherGuest.rested gal wrote:Also try those things in your idle time (like in a doctor's waiting room) putting in the names:
NotMuffy
StillAnotherGuest
I hope you understood that I was redefining "idle time" as "time spent searching for NotMuffy and StillanotherGuest on Google and cpaptalk". I wasn't implying that time spent on those searches was "time spent doing nothing useful." Quite the contrary. I find the information in those posts to be informative, useful, and helpful, to the extent that I can understand the information being discussed.NotMuffy wrote:OK, off to the beach!
Don't want to turn this day into "idle time"!
S/he is a professional "baked goods". I don't know if that was by training or by inheritance, though. Could be the latter, considering the cousin in Great Britain.Guest wrote:What kind of trained professional is Muffy?
I am new to this forum but I have been following thi thread.
Adding "I told you so" to the growing list of acronyms I hadn't seen before. At least that one was easier to figure out than, "SB'sC." (which I really LIKE... once it was explained! )NotMuffy wrote:"See, ITYS, now do what I say for another month and then we'll see what happens."
Flipping back through the pages...like going on a scavenger hunt to find all three. In my idle time, of course. There's a SB'sC I'll find all three.NotMuffy wrote:That said, 3 treatment approaches have been suggested.
Flipping back through the pages...like going on a scavenger hunt to find all three. In my idle time, of course. There's a SB'sC I'll find all three. [/quote]NotMuffy wrote:That said, 3 treatment approaches have been suggested.
Artifact.Paper_Nanny wrote:What's with that break in the breath there?
rrrrrrrrrrrrtifacts.Paper_Nanny wrote:What are those things that look like the letter "r" being written in cursive?
viewtopic.php?p=614108#p614108NotMuffy wrote:For instance, sitting down with a sharp pharmacist and looking at drug hygiene may be helpful (if that hasn't already been done). Stuff like looking at nighttime duloxetine dose and seeing if that's the best way to meet goal (does the lowering of arousal threshold create more issues than amelioration of other symptoms). Or if anything can be done with the methylphenidate - modafinil thing.
NotMuffy wrote:Anyway, in relation to the SDB issues, with clonazepam, baclofen, carisoprodol, cyclobenzaprine, trazodone and tramadol all having sedative properties, the first thing I would look for is if you've moved out of "sedation" into "chronic respiratory depression". The elevated CO2 (while it could have been metabolic) now appears to be respiratory, and an ABG may be in order (what you really needed to do was monitor ETCO2 during the NPSG, but that ship has sailed). If your PFT is normal, then the respiratory depression (if present) is central.
Got headaches?
OTOH, you got methylphenidate and modafinil that may counteract some of the sedative properties. OK that's cool, except they may also create sleep disruption, and your DLs are not reflecting respiratory events but rather sleep disruption. The timeline I was referring to was in relation to the sleep studies (were you taking all that stuff during NPSG, or were one or more added since then). The NPSGs don't appear to have a lot of sleep fragmentation, however (aside from maybe a few too many awakenings).
BTW, I'd also check with the pharmacist about the modafinil-tizanidine and trazodone-methylphenidate combos. There may be some metabolism things you might not want there.
However, the liklihood that you are dead is 99.99999999....gvz wrote:..if there is infinite time before and forever, the probability that you would be aware of your existence (overall) is 100%.NotMuffy wrote:If time is infinite before us, and time is infinite after us, the liklihood of being alive at a point along the continuum such that you would be aware of your existence is absolutely impossible.
Flow limitations.Paper_Nanny wrote:What are those things that look like the letter "r" being written in cursive?
That would be more like "treatment optimization", and it may be that nothing will be able to be done there.rested gal wrote:I think this might count as a second "suggestion"...
Oh right, Thomas.Paper_Nanny wrote:S/he is a professional "baked goods". I don't know if that was by training or by inheritance, though. Could be the latter, considering the cousin in Great Britain.Guest wrote:What kind of trained professional is Muffy?
I dozed off while I was taking it.