Dr. Krakow, salesman extraordinaire? UPDATED

NightMonkey wrote: Well you know the doctors you have met and I don't, but even if you claim this as a general premise, I disagree with it.

No, I can't claim this as a scientifically provable general premise.

NightMoney, a quote in your post leads me to believe you're a doctor.

If this is true, I assume you've met many other doctors on a social basis.

But how many have you met as a patient, and as a patient suffering from a serious disease?

When you're an early stage cancer or cardiovascular disease patient, a compete practice (with a roster of surgeons, full diagnostic equipment etc) stands to make an easy 5 or 6 figures of income from you until you reach your "actuarial endpoint", aka death.

In a wildly competitive field like cardiology in NYC, a couple hundred grand per patient tends to focus doctors mind on the bottom line sharply.

_______________________________________________________________________________________

WEDNESDAY

Just a month ago, I had a pain in my calf when I walked.

Visiting my regular cardiology practice (it's a very large one, with 2 floors of specialists, diagnostic equipment, etc), I had an ultrasound.

The ultrasound revealed a 90% stenosis (blockage) of my inner femoral artery.

This ultrasound was on a Wednesday afternoon. An hour later, my regular cardiologist (who I love dearly and believe was acting in good faith), had me booked into NYU on Monday for an angioplasty/arthrodectomy and possibly a stent.

I was scheduled to meet the practise's interventional cardiologist (the man who would do the procedure) two days after the ultrasound, on that Friday.

I frantically studied the literature, learning as much as I could. Then I placed calls to four other interventional cardiologists, doctors who had headed decency large studies in peripheral artery disease.

Late Thursday night, I received a call; it was from a principal investigator (on at least 4 studies) and he told me: "There is no evidence showing that you have to rush into this. I'd give conservative treatment a try first"



FRIDAY (Law and Order's "Doink! Doink! sound)

Friday morning, I met with my practice's interventional cardiologist. He was charming, pleasant, and we had a detailed discussion about the procedure he was to perform.

At one point he said: "The worst that could happen is . . ." and started to list some post surgical complications.

I smiled broadly, laughed, and interrupted him: "Sorry to interrupt, doctor, but the worst that could happen is I end up dead."

He laughed with me, and said: "Oh that. (long pause) Yes, it's true, but let's not think about that for now. Besides, uh, that, the worst that can likely happen is . . ."

We ended the appointment cordially. As we walked out of his office, heading toward the main nurses/staff counter, I casually asked if there was any rush to do the procedure.

He said: No there wasn't.


AN ENCOUNTER AT THE COUNTER

By the time we reached the nurses counter, I was surrounded by sympathetic nurses, other doctors, and even my utrasound tech.

They handed me a bunch of pre-surgical forms, and began explaining what I should expect on Monday.

I protested: "There's no rush to this, so I don't want surgery right now"

..............

Sudden silence.

You could actually feel the air in the room change.

My cardiologist pulled over my interventionist and softly hissed: "We need to talk about this."

Knowing that I'd need a CD copy of my ultrasound for the other doctors I was going to meet, I asked for a copy from a tech.

With barely concealed anger, she replied: "It'll take 48 hours or more. And that's from Monday."

This would mean that for two of the doctor I had booked on Monday, the critical diagnostic ultrasound CD wouldn't be ready.

So, I lied: "But it's for Dr X. (Their interventional cardiologist) He said he needed a copy."

The tech's face brightened up: "Oh, if your keeping this in-house, I'll have a copy ready in 10 minutes"



A HAPPY ENDING, FOR NOW

End of story: all the other doctors I had booked agreed that there was no rush. Conservative therapy (no surgery, exercise, weight loss, change of diet, statins)), was the right choice for now.

When I related my tale of being surrounded by the doctors, nurses and staff at my original practice, and their palpable group "push" to have me in surgery on Monday, the principle investigator (who had called me late Thursday night, and had literally saved me from unnecessary surgery}, laughed and said.:

"Most cardiology practices in the city are like aggressive car dealerships. Once your in the showroom, you're not leaving with out buying a car."

NightMonkey wrote:This is the consumer expecting the very best products/services and expecting to get them for "chicken feed".

My co-pay is only $15 but my annual premiums (negotiated through a huge union) run many thousands. And the doctors receive much more than my co-pay.

NightMonkey wrote:It took me two years to learn to winnow those customers out of my active customer list.

Ever wonder what happened to those patients? (holding out my two hands to you): "Well, Neo. The Blue Pill or the Red Pill?"

Businessman first . . . or doctor first?

NightMonkey wrote:But I do wish you the very best in working your way through the system and getting top notch help at a reasonable price.

I've been successful at it for thirty years. Believe it or not, a number of the very best clinicians in the world . . . choose doctor first.

I would like to know your opinion of Dr. Park. I have been thinking of making an appointment to consult with him. It will be a big expense for me but if he is very good it will be worth it.

Thank you in advance

Dr. Krakow's website says that most people coming from out of state will not be able to go through insurance to get a sleep study done (or something like that).

If it is the case, it is a shame that Dr. Krakow's techniques have not been subject to empirical tests, and that he hasn't published his findings in peer reviewed journals. He's obviously more of a clinician than a researcher, which is pretty typical of the vast majority of doctors. It doesn't mean his techniques don't work, only that we don't know if they work or not. If a top notch researcher in the field were to endorse Dr. Krakow's views and methods, that would go a long way toward convincing me of their worth (journal publications or not). But I'm not sure how anyone like that would know exactly what Dr. Krakow is doing unless he communicated his anecdotal findings in some form or fashion.

My point about Dr. Krakow's posts was simple: 3.5 years ago, he did not come here to present his work with an ASV, at that time he was working with a machine that he found highly adjustable - Puritan Bennett's bi-level machine. That one is no longer available.

Dr. Krakow did not do much discussion of his ASV therapy on this forum.

Carbonman - member of this forum gained a lot from the book Dr. K. came here to sell 3.5 years ago

JeffH - member of this forum travelled to NM a few months ago after years of struggling with unsatisfactory therapy. He ended on an ASV (tried a bi-level first) and is feeling better. Here's what Jeff (a long time member) said to Bright Choice (a very new member) when she was wondering if a visit to NM was worth it:

JeffH wrote:I'd say go for it. He's a nice, caring doctor with a good staff. Also, he doesn't prescript straight cpap to anyone. It's Bipap or greater to all his patients.

This was before he even started the ASV. He started on VPAP - his choice - it was unsatisfactory, eventually the clinic gave him an ASV to try at home (in Oklahoma).

He also said:

JeffH wrote:

Bright Choice wrote:Jeff, I'd like to hear more of your experience at Dr. Krakow's sleep center. Do you live in Albequerque? I am contemplating getting a second opinion there for fine tuning UARS treatment but I would be coming there from Colorado.

No, I live in Oklahoma. I just called them up and asked if they took Medicare and they did. Got in in about 10 days from the first call. Sleep tech I had was great...a guy named Gabe. He worked with me thru the nite to help me finally get some good sleep. I was surprised that I needed as much pressure as I ended up with, but going from nasal pillows to a full face mask makes the extra pressure more tolerable.

Bright Choice came back with an ASV - and is doing better that she did before.

Mike6977 wrote:NightMonkey wrote:
It took me two years to learn to winnow those customers out of my active customer list.

Ever wonder what happened to those patients? (holding out my two hands to you): "Well, Neo. The Blue Pill or the Red Pill?"

I'm pretty sure NightMonkey is not a doctor. He is simply a believer in the capitalist system.

Those of you who are so inclined may now go back to your usual program of bickering about the politics of capitalism and it's role in the quality of medical care in the US.
Drop a note to Roster, he loves those discussions - has an approach (and style....) very similar to NightMonkey's.

I'm off.

I'll actually post to this thread as an actual patient of Dr. Krakow.

Over all I had a good experience with him. I'm now on ASV and sleeping better than I have in a long time. Last nites AHI was 0.4 with one wake up in the night.

After my last sleep study with him the in person appointment the next morning was one hour and 20 minutes long. When is the last time a doctor spent that much time with you? Yes, me neither...LOL.

Walking out the door he had some interesting things to say about the future of medicine in general. IMHO all cpap machines will move toward what an ASV is now. It is just better therapy, and I think Dr. Krakow is ahead of the times.

JeffH

SleepingUgly wrote:it is a shame that Dr. Krakow's techniques have not been subject to empirical tests, and that he hasn't published his findings in peer reviewed journals.

It doesn't mean his techniques don't work, only that we don't know if they work or not.

Exactly.

Well said, SleepingUgly.

Unless Dr. Krakow has just completed a well-designed study on ASV, there's no way he'll be published in a good journal.

Typically, good journals prefer you design a prospective study, one with with at least a randomized control arm.

That means he'd have to randomly assign similar patients to say, an established ASV protocol, and assign an equal number of patients to his special brand of ASV titration.

The journal might also want the PSG readings to be "blinded", so that the interpreter of the results wouldn't know if he was looking at the treatment or the control arm.

There are other journal publishing parameters to consider, and all of this takes time and planning.


..................................


In his interview with Dr. Park, I believe Dr Krakow said that he's been focusing most of his patients on ASV for the past 24 months.

That's plenty of time to have enough data to write a general, retrospective paper giving some specifics about his treatment and his results.

He could make such paper available to patients and other practitioners.

EDIT: Just saw your post, JeffH. Thank you for relating your experience with Dr. Krakow and company. I'm pleased it worked out so well for you.

I hope other patients of Dr. Krakow will do the same.

____________________________________________________________________

Guest wrote:I would like to know your opinion of Dr. Park.

Unfortunately, I met Dr. Park very early in my journey into Sleep Disordered Breathing Land, even before I had a sleep study in hand, and I had zero knowledge of the field.

So, I didn't know enough about SDB to hold an intelligent discussion with him.

Keep in mind that he is an ear, nose and throat doctor, with an avid interest in sleep medicine. He is not a sleep doctor. He does not run a sleep lab.

When I met Dr. Park, he wanted my sleep clinic to follow one of Dr. Krakow's protocols, and I believe he tried to set up a 3 way conference call, but nothing ever came of it.

In retrospect, I wish he had just steered to me away from getting a study at the rather mediocre sleep clinic I had picked at random, and that he had suggested a decent DME.

At that point in time, that was the advise I could actually use from him.

Thus, I can't recommend him to newbie patients.


........................................................


Before paying for a consult with Dr. Park, I'd say you should have some experience with CPAP or VPAP, at least a couple of months, and suffer some problem your current sleep doctor is unable to resolve.

I'd also recommend you gain some knowledge of the field, easy to acquire here at CPAPtalk if you spend the time.

It's cheaper and easier to post your problems here, (don't be an anonymous hit n' run guest!) and try the very knowledgeable suggestions before you shell out dollars for another doctor.

You don't want to pay Dr. Park $400 to tell you that you have a mask leak problem.

Ok, I guess I will jump in here, although rather reluctantly. I don't like the debating of the "pros" and "cons" of Dr. Krakow in this thread, but now I feel I would be remiss if I did not share my experience.

I have had two sleep docs, both Board Certified Sleep Specialists. I have had sleep studies done at two labs. Do you know the difference between "Night" and "Day" ? Well, that really says it all...

First sleep lab - "Well, I'm sure you don't have sleep apnea because you don't have a thick neck..."
First sleep doc - "Why don't you try cpap - it will either work or not, I'll see you in 6 months..."

My experience with Dr. Krakow's clinic has been nothing less than extraordinary. This includes 1) the intake process prior to my appointment, 2) my experience in Albuquerque with 3 nights in the sleep lab (a very positive experience in the lab, btw) and 2 appointments with Dr. Krakow during that initial visit and 3) multi-leveled follow-ups following my visit. Every aspect has exceeded my expectations!

I am in Colorado and once I got back home with my RX for asv I had a terrible time with Lincare in terms of getting my machine. Dr. Krakow's clinic stepped in with immediate help. It seems that that had the answer before I had the question. They provided a new dme and I got the machine right away.

I have had the asv for about 6 weeks. Dr. K has requested a full data download twice during that time. (My first doc had no interest in the data). Their Patient Coordinator has been very quick to follow up with me on questions re: masks, aerophagia et al. I feel that I am in very good hands and I am looking forward to another titration and office visit mid-August.

I love the ASV, I love the way I breathe with it, I feel that I finally have an appropriate diagnosis, my AHI is consistently zero and my spo2 desats have totally disappeared. I am feeling great and I am very thankful that I made the decision to go to Albuquerque. I still have some "bugs" to work out, but I have full confidence that I am in the right hands.

I am so glad to have found a clinician who could give me the care and follow-up that I need and expect. There is nothing that I would change about my experience and I really don't care what papers he has or has not published. I don't pretend to have any expertise, but I too wonder, as JeffH alluded in his post, that perhaps asv is the wave of the future in xpap land.

My advice? Definitely do some exploring before you make a decision regarding any medical care. If you don't feel that a particular provider will provide the care that you need/want, you are probably right.

"7/58, three and a half years ago"??- come on guys, grow up!!

That's a great endorsement, Bright Choice! Just so we readers who don't know much about ASV are clear... You have Complex Sleep Apnea, for which ASV is a known treatment, correct? I think some of the questions had to do with ASV as a treatment for ordinary OSA, which is not its standard use, as far as I know.

SleepingUgly wrote:That's a great endorsement, Bright Choice! Just so we readers who don't know much about ASV are clear... You have Complex Sleep Apnea, for which ASV is a known treatment, correct? I think some of the questions had to do with ASV as a treatment for ordinary OSA, which is not its standard use, as far as I know.

My initial diagnosis was UARS or as stated by my first MD: "mild sleep apnea in the form of upper airway resistance", although now I do not believe that my original PSGs were properly done. But, at the time, I did not doubt that diagnosis. The reason I went to ABQ was to learn about these "flow limitations" and to get properly titrated for UARS. I did not go there to for the purpose of getting treated for Complex Sleep Apnea.

The PSG in ABQ was much clearer diagnostically, the diagnosis being Obstructive Sleep Apnea & Complex Sleep Apnea aka CompSA.

I can only speak from my experience - I cannot speak for how they treat "ordinary" OSA - is there such a thing?

Bright Choice wrote:I can only speak from my experience - I cannot speak for how they treat "ordinary" OSA - is there such a thing?

Yes, there is. Plain "ordinary" OSA (which can be effectively and comfortably treated by CPAP or Bilevel machines) is probably the most common form of Sleep Disordered Breathing. Complex Sleep Apnea (CompSAS) has been estimated by the researchers who "discovered" it to affect about 15% of the sleep disordered breathing population.

rested gal wrote:

Bright Choice wrote:I can only speak from my experience - I cannot speak for how they treat "ordinary" OSA - is there such a thing?

Yes, there is. Plain "ordinary" OSA (which can be effectively and comfortably treated by CPAP or Bilevel machines) is probably the most common form of Sleep Disordered Breathing. Complex Sleep Apnea (CompSAS) has been estimated by the researchers who "discovered" it to affect about 15% of the sleep disordered breathing population.

Sure, I understand that.

I was really speaking "tongue in cheek" because when one reads the threads here from people who are struggling with their treatment of OSA, I am sure that not many of these people consider their situation "ordinary".

Bright Choice wrote:...Every aspect has exceeded my expectations!...

Hearing about your experience is really helpful. If I might clarify one small piece of it...? The line I left in above--what were your expectations? In general, how do your expectations compare with others?

JeffH wrote:I'll actually post to this thread as an actual patient of Dr. Krakow.

Over all I had a good experience with him. I'm now on ASV and sleeping better than I have in a long time. Last nites AHI was 0.4 with one wake up in the night.

After my last sleep study with him the in person appointment the next morning was one hour and 20 minutes long. When is the last time a doctor spent that much time with you? Yes, me neither...LOL.

Walking out the door he had some interesting things to say about the future of medicine in general. IMHO all cpap machines will move toward what an ASV is now. It is just better therapy, and I think Dr. Krakow is ahead of the times.

JeffH

Very interesting observation & comments.

DSM

Bright Choice wrote:Ok, I guess I will jump in here, although rather reluctantly. I don't like the debating of the "pros" and "cons" of Dr. Krakow in this thread, but now I feel I would be remiss if I did not share my experience.

I have had two sleep docs, both Board Certified Sleep Specialists. I have had sleep studies done at two labs. Do you know the difference between "Night" and "Day" ? Well, that really says it all...

First sleep lab - "Well, I'm sure you don't have sleep apnea because you don't have a thick neck..."
First sleep doc - "Why don't you try cpap - it will either work or not, I'll see you in 6 months..."

My experience with Dr. Krakow's clinic has been nothing less than extraordinary. This includes 1) the intake process prior to my appointment, 2) my experience in Albuquerque with 3 nights in the sleep lab (a very positive experience in the lab, btw) and 2 appointments with Dr. Krakow during that initial visit and 3) multi-leveled follow-ups following my visit. Every aspect has exceeded my expectations!

I am in Colorado and once I got back home with my RX for asv I had a terrible time with Lincare in terms of getting my machine. Dr. Krakow's clinic stepped in with immediate help. It seems that that had the answer before I had the question. They provided a new dme and I got the machine right away.

I have had the asv for about 6 weeks. Dr. K has requested a full data download twice during that time. (My first doc had no interest in the data). Their Patient Coordinator has been very quick to follow up with me on questions re: masks, aerophagia et al. I feel that I am in very good hands and I am looking forward to another titration and office visit mid-August.

I love the ASV, I love the way I breathe with it, I feel that I finally have an appropriate diagnosis, my AHI is consistently zero and my spo2 desats have totally disappeared. I am feeling great and I am very thankful that I made the decision to go to Albuquerque. I still have some "bugs" to work out, but I have full confidence that I am in the right hands.

I am so glad to have found a clinician who could give me the care and follow-up that I need and expect. There is nothing that I would change about my experience and I really don't care what papers he has or has not published. I don't pretend to have any expertise, but I too wonder, as JeffH alluded in his post, that perhaps asv is the wave of the future in xpap land.

My advice? Definitely do some exploring before you make a decision regarding any medical care. If you don't feel that a particular provider will provide the care that you need/want, you are probably right.

"7/58, three and a half years ago"??- come on guys, grow up!!

BrightChoice,

Very well put - all of it.

Thanks

DSM

Bright Choice wrote:

rested gal wrote:

Bright Choice wrote:I can only speak from my experience - I cannot speak for how they treat "ordinary" OSA - is there such a thing?

Yes, there is. Plain "ordinary" OSA (which can be effectively and comfortably treated by CPAP or Bilevel machines) is probably the most common form of Sleep Disordered Breathing. Complex Sleep Apnea (CompSAS) has been estimated by the researchers who "discovered" it to affect about 15% of the sleep disordered breathing population.

Sure, I understand that.

I was really speaking "tongue in cheek" because when one reads the threads here from people who are struggling with their treatment of OSA, I am sure that not many of these people consider their situation "ordinary".

So true

D