Dr. Krakow, salesman extraordinaire? UPDATED

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Hey DoriC, your avatar always makes me smile.

DoriC wrote:I'm sure Dr.K didn't need a lawyer to tell him how he wished to proceed.

Here is an excerpt from the email:

"After speaking with our lawyers, we feel that with the direction of
telemedicine legislation, and the legal ethics of providing such a
service, we have come up with an ironclad program"

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DoriC wrote:I'm also not fond of your use of the "salesman" description

1. In today's competitive market, most doctors have to be both clinicians and salesmen. My use of the term is hardly novel. Just google it. Indeed, within their own medical-sales and economics magazines, it' how doctors often refer to themselves.

This is but one of many articles explaining that reality:

http://www.consumerreports.org/health/n ... /index.htm


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DoriC wrote:but the heading sure got a lot of attention which I'm sure was your intent, right?

2. I try to create post headings that will be both accurate and pithy. I do not believe that I have mischaracterized Dr. Krakow. He is, indeed an excellent salesman.

BTW, let me again emphasize that characterization is not a put-down. Great salesman were the sociological and economic engines of change from the beginning of civilization.

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DoriC wrote:Rock, I hope your Drs continue to have patience with you so that you get the help you need.

Thanks. Both Steve and Joesph are incredibly knowledgeable, very direct and honest, yet utterly laid back.

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-SWS wrote: Dr. Krakow's posts here were about using BiLevel to address high upper-airway resistance. His ASV work for that type of SDB is thus off-label. By contrast on-label conditions for ASV include complex SDB, central SDB, and certain types of cardiac SDB.

If you have primarily UARS type problems, then Dr. Krakow's experimental ASV protcol might be a good alternative to consider. But if you are presenting with complex SDB, central SDB, and/or heart issues, then I would think standard ASV titration protocol makes a lot more sense.

Thanks, SWS, your put the issues in bass relief.

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rocklin wrote:.

Hey DoriC, your avatar always makes me smile.

Hmm, I scold you and you sweet talk me! That's how I train all my guys, I like that!

Dead thread revived by SPAM injection.
Antidote administered.
You're welcome.

Somebody beat me to it.
Thank you.

Wow, I just waded through this whole thread. It's such an odd combination of ad hominem, silly humor, and the largest collection of theoretical and experiental reports on ASV vs xPAP for non ComplexSAS. Since this is a topic of enormous interest to all of us with SDB and EDS unrelieved (or partially helped) by xPAP, I'm glad it's bumped.

Personally, I don't believe in the placebo possibility for ASV. I've tried dozens of sleep interventions, and only a few had any noticeable effect, yet I tried each because I thought it could work. If someone who has struggled with SDB for many years finds that ASV titrated by dr. Krakow gives them better sleep, I believe it is treating them.

Seems like we could really use a self-titration protocol and some loaner / rental ASV machines, if each of us tried for a month or two, we could generate awesome data. If it works for someone, it's totally worth them buying a machine. If it doesn't, well, that rules out something for them. I wonder if it is possible to replicate what his techs do in one night in a full sleep lab with a procedure that takes a month or two and uses just the data from the machine? Even partially.

patrissimo wrote:I wonder if it is possible to replicate what his techs do in one night in a full sleep lab with a procedure that takes a month or two and uses just the data from the machine? Even partially.

I've been trying to do this (with the help of a good friend). I'm probably not a great example, though, as I'm apparently limited on every PAP device, including ASV, by my $&#(!*#% aerophagia.

patrissimo wrote:. . . replicate what his techs do . . .

That process might include quite a bit of education about sleep hygiene and customized support for sleep in general. One theory is that much of the good done in the high desert involves those things as much as the titration with, and the subsequent use of, the central-apnea-treatment machine for UARS.

I, of course, never take a personal position on such things. Such matters are way over my head. But that never prevents my posting my wishy-washy opinions about them.