CPAPtalk.com

As briefly as I can:

1. No clue where this guy is coming from on the credit cards. We see all patients and practically all insurance. The one time credit card up front comes into play is when someone has a huge deductible and we ask for coverage in that situation beforehand. Or, we also ask for VIP patients to give us credit card info because they don’t intend to use their insurance.
2. Why didn’t somebody tell me to buy stock in RESMED? I could’ve paid for the kids’ college tuition. No contracts ever with RESMED. We did use their original research Autosets for several years, but they’ve never funded our projects.
3. Ironic isn’t it that Respironics has funded us for a study on insomnia and sleep-disordered breathing, but we still use RESMED’s ASV device. Gotta be some sort of conspiracy there!?.
4. The S9 ASV device is awesome; just amazed at the comfort and the results. Dream baby dream.
5. Have a manuscript in submission on ASV use in 56 insomniacs who couldn’t adapt to any other machine. Remarkably 70% now using ASV device. Hoping it gets published this year or next, but you never know about these things.
6. Wish I had more time to converse, but I need to dredge up some nefarious plots about myself that will spark conspiracy theories so that people will talk about me, which in turn will boost my self-esteem.
7. Oh wait, I’ll be speaking in September at two regional sleep conferences. St.Petersburg, Florida Sept 2nd and 3rd, and Peabody, Maine Sept 16th. Topics include PTSD Sleep Clinic and PAP-NAPs. Definitely will be discussing ASV. Come visit and say hello or take your best shot, whichever one helps you sleep!

Barry Krakow, MD, sorry my sig is old and i don't see how to change it.

Currently on ASV S9 platform, Quattro FFM, Large, Breathe Right Nasal Strip, Multiple layers of REMZZZ mask liners

Thank you for the informative and highly entertaining post, Doctor! Class act; well done.

BarryKrakowMD wrote: . . . Why didn’t somebody tell me to buy stock in RESMED? . . .

Allow me: BUY STOCK IN RESMED!!!

BarryKrakowMD wrote: . . . Have a manuscript in submission on ASV use in 56 insomniacs . . .

Look forward to it. Feel free to give us teasers and sneak previews, please.

BarryKrakowMD wrote: . . . Wish I had more time to converse . . .

Yer welcome here any time. Say hello. Let us know where you're speaking. Etc.

BarryKrakowMD wrote:. . . but I need to dredge up some nefarious plots about myself that will spark conspiracy theories so that people will talk about me, which in turn will boost my self-esteem. . . .

Don't worry. I think we've got you and most respected pros well-covered on that one around here.

BarryKrakowMD wrote: . . . I’ll be speaking in September at two regional sleep conferences. St.Petersburg, Florida Sept 2nd and 3rd, and Peabody, Maine Sept 16th. Topics include PTSD Sleep Clinic and PAP-NAPs. Definitely will be discussing ASV. . . .

Thanks.

BarryKrakowMD wrote: . . . sig is old . . .

"User Control Panel" (at upper left on my page), then "Profile," then "Edit Equipment."

Again, stop by any time. Yer on Rested Gal's "good uns list" ( viewtopic.php?f=1&t=48527&p=442957#p442957 ), which makes you honorary royalty on this board. Be assured you have fans here.

-Jeff

Dr. Krakow, your ears must have been burning, huh?

Actually, I was thinking of coming to see you and did ask my out-of-state insurance provider (First Health) if you were a provider, but they said no.

While we await your publication, what can you tell us about the use of ASV in patients who don't have central sleep apnea or other conditions for which an ASV is usually prescribed? Are other cutting-edge institutions using it in such a fashion or would they balk at a patient inquiring about it for OSA? I am curious because I have severe OSA in REM only, but FLs in NREM, and am essentially "failing" C/APAP because I cannot get to my prescribed pressure due to aerophagia.

Also, is it typical for patients to require FFMs while using ASV? If so, I'm not a candidate for ASV, as there's never been a FFM that liked me.

Thanks for your participation and information.

NotMuffy wrote:

Bright Choice wrote:So then, for a person who has been unable to tolerate or get good results from cpap, bpap, or abpap; CBT or the Placebo or Hawthorne Effect alone would have more of an influence than the ASV itself might have on problems with aerophagia, EDS, arousals, the CAP phenomenon, and poor air flow signals that Dr. K is postulating in the video?

Well "IMHO", that's a much better explanation than

Bright Choice wrote:It must be the "magic sleepytime fairies" they put into the S9 vpap adapt.

BarryKrakowMD wrote: The S9 ASV device is awesome; just amazed at the comfort and the results. Dream baby dream.

Oops! Yes, it looks like I misspoke. there is a much better explanation. It is not "magic sleepytime fairies" - it's the "Dream Baby Dream" machine

This makes me want the Dream Baby Dream Machine, but I can't do a FFM! My craniofacial abnormalities (that I didn't know I had until recently) are not conducive to a FFM!

dsm wrote:So in this thread your intentions may be good but may also have got lost in the flow.

I've reviewed the whole thread again, and can see where I made some mistakes. Happy to admit to them.


DR. PARK

Mike6977 wrote: 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.

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.

Hardly a "bagging" of Dr. Park.

But then I considered why I had met with him so early.

I was a complete SDB newbie. I didn't even know enough to have a sleep study for Dr. Park to look at.

But Dr. Park did know I didn't have a sleep study. I told him so on the phone.

To me, this is like a cardiac surgeon accepting an appointment from a patient who hasn't even seen a working stiff cardiologist, and hasn't had a single cardiovascular test performed on him.

Without any tests to show whether the patient has massive cardiac disease—or just indigestion, no cardiac surgeon should accept a $400 initial consult from a new patient.

Equally, without a sleep study in hand, how would Dr. Park properly advise me? Or even know if I had SDB?

I was asked by a guest to give my opinion of my consult with Dr. Park, and I gave it honestly.

Dr. Park posts here regularly, he can post why I'm mistaken any time he wishes.




THE MONKEY ON MY BACK

I am addicted to sleeping pills, and I can't sleep without them.

By the numbers (AHI <3.0), I'm a successful patient on CPAP and AutoPap.

But in reality, I am tired and sleepy much of the time.

My current sleep doctor has no answers for me, except for "get off the sleeping pills".

Over the years, I've tried a number of times and I can't.



DR. KRAKOW: A SEEMING LIFE RAFT IN A STORM

The main reason I created this thread was Dr. Krakow's audio interview, and the mixed feelings it created in me.

Near the end of that audio interview, the first caller was a sleeping pill addict, like me.

Dr. Krakow said: "We see a patient like you every single week" and could help him.

Dr. Krakow also said: "The only way you'll get off the sleep meds is to so radically upgrade your sleep quality that you'll have confidence to get off the medications..."

Naturally, this got my full attention.

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

Still speaking to the same caller (49:36 min:sec into the interview),

Dr. Krakow says: "...don't go back to your sleep lab and say you spoke to Dr. Krakow, because that's not diplomatic and it gets people up tight."

"...If you want to come to our center in Albuquerque it's up to you, we take pretty much all insurance and would be happy to treat you."

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



If I can't go back to my sleep lab and discuss what Dr. Krakow is advocating (because it's not "diplomatic"), that doesn't leave me with many options, does it?

Dr. K made it seem to the caller like it's Albuquerque or bust.

That's pure bullsh*t. It's also pretty good salesmanship.

Then, four minutes later, Dr. Krakow changes his mind on what's diplomatic:

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

53:29, Dr. Krakow:" . . we would give you feedback to see if it's valuable to see us in Albuquerque, or maybe you want us to do some 2nd opinion work, working, you know, with your doctor in another state."

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



So if you really can't make it to Albuquerque, it's actually OK to talk to your doctor about what Dr. Krakow said, and Dr. Krakow will do a second opinion consult.

Win / Win. That's excellent salesmanship.

It's why I titled my thread: "Dr. Krakow, salesman extraordinaire?"

___________________________________________________________________________________


THE RETURN OF BARRYKRAKOW.MD

Dr. Krakow hasn't posted here for three years.

So, I'm genuinely pleased to see that Dr. Krakow has seen fit to return, to this thread, whatever his reasons.

BarryKrakowMD wrote:No clue where this guy (me) is coming from on the credit cards... The one time credit card up front comes into play is when someone has a huge deductible and we ask for coverage in that situation beforehand

Dr. Krakow, I'm "coming" from your website:

"Consultations: Most of these encounters are not covered through insurance, and the sleep patient pays our sleep center directly with a credit card."

http://sleeptreatment.com/consultations

Patients typically schedule about a month out from first contact, and during their 2 to 3 day stay in New Mexico, they usually have at least 2 nights of polysomnography and 1 to 2 clinic appts with Dr. Krakow.

Insurance typically does not cover these costs, so for most patients, these encounters are "out-of-pocket." Some patients do have out-of-state coverage for second opinions or expert consultations. Very rarely, insurance can cover a sleep study.

http://sleeptreatment.com/update/index. ... temid=1771

BarryKrakowMD wrote:No contracts ever with RESMED

I did indeed read Dr. K had a contract with ResMed (can't find the link), but it wasn't from an official conflict of interest disclosure source, like:

http://www.sleepmeeting.org/PDF/SpeakerDisclosure.pdf

(see pg 13 for a list of Dr. Krackow's conflict of interest disclosures in 2010)

So, I'll happily stand corrected on that one.



I also stand corrected on the ill-advised and poorly researched part of my post that speculated whether sales (or anticipation of sales) of ResMed ASVs drove up their stock price 100% in 2009, and that Dr. Krakow might have benefited.

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

From ResMed's investor section of their website:

"Our gross margin also expanded in Q3. This was a result of an increase in sales of our higher margin products . . .

"The launches of the S9(TM) AutoSet and Elite products, the Swift(TM) FX mask and the Mirage(TM) SoftGel mask are going especially well."

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

Just dumb and lazy on my part. My apologies, Dr. Krakow.



WE MAY MEET AGAIN, DON'T KNOW WHERE, DON'T KNOW WHEN . . .

BarryKrakowMD wrote:We see all patients and practically all insurance.

I'm sure you see all kinds of insurance plans. But do you accept what "practically all insurance" pays as full payment for your services?

World of difference between "see" and "accept", yes?

If, completely contrary to what your website says, you do "accept" (My insurance is GHI, btw), fantastic. I'll call your office this week and see what they have to say.

But you certainly should update your website, right?




Despite the big out of pocket cost, I really want to solve my sleep problem, so it's possible you'll meet CPAPtalk's resident Oliver Stone in person.

Even then, I might chide you for knowing ResMed products so well, yet not buying ResMed stock when it was cheap.



Mike

Mike

Thanks for your extensive response & what it does is allow us plebs to see alternative perspectives. We can all draw our own conclusions and undoubtedly that may vary between us. If this were a show about America's Most Talented (Cpap Therapists) I will award this bout to Dr K. But don't refrain from posting any honest & informative information.

Thanks

DSM

double post, sorry.

Addiction to benzodiazepines and other sleeping pills:
Lots of important reading for you on this site:

http://www.benzo.org.uk

http://www.benzo.org.uk/profash.htm

Bright Choice wrote:Oops! Yes, it looks like I misspoke. there is a much better explanation. It is not "magic sleepytime fairies" - it's the "Dream Baby Dream" machine

Actually, that would therefore qualify as Hawthorne Effect.

BarryKrakowMD wrote:Definitely will be discussing ASV. Come visit and say hello or take your best shot, whichever one helps you sleep!

WB BK!

For a second there, I thought you were still APOed about the "Expiratory Intolerance" thing (lemme know if you need those *.jpg images-- they seemed to have disappeared from your website).

Although I'm the best sleeper I know (aside from a little ASPS), I accept your offer.

Future discussion points will include:

• ASV is only reimbursed if the patient has a diagnosis of Central Sleep Apnea or CompSAS. CSA would be a no-brainer for ASV, but CompSAS at most has an incidence of about 15%. Therefore, how can exclusive use of ASV in the treatment of insomnia be guaranteed reimbursement (not have to pay out-of-pocket).
• If people want to drop 4 or 5 grand for this thing, fine, that's their business. But if ASV is touted as a comfort measure, then that means it is used during wake. If one is awake, then chances are that they're not having any ASV-worthy respiratory events. Consequently, the comparison study would need to be optimized xPAP therapy using the ResMed waveform with and without the ASV backup for this claim to have validity.
• If treatment success in the SDB-insomnia group is due, at least in part, to correction (or at least amelioration) of the "central activation" phenomenon, there's a bunch of easier and cheaper ways to do that.
• CBT, CBT, CBT.

You have misrepresented Dr. Krakow on at least one point, and given that, I wouldn't be surprised if you were doing it all over the place.

Mike6977 wrote:Still speaking to the same caller (49:36 min:sec into the interview),

Dr. Krakow says: "...don't go back to your sleep lab and say you spoke to Dr. Krakow, because that's not diplomatic and it gets people up tight."

"...If you want to come to our center in Albuquerque it's up to you, we take pretty much all insurance and would be happy to treat you."

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



If I can't go back to my sleep lab and discuss what Dr. Krakow is advocating (because it's not "diplomatic"), that doesn't leave me with many options, does it?

Dr. K made it seem to the caller like it's Albuquerque or bust.

That's pure bullsh*t. It's also pretty good salesmanship.

I went back and listened to that section several times. So what Dr. Krakow ACTUALLY says is:

Dr. Krakow on mp3 wrote:it's not like I can sit here and say to you "go back to your sleep lab .... and tell them that you spoke to Dr. Krakow and this and that " because that's just something that's not diplomatic and it gets people uptight

He is absolutely right. You don't go to your regular doctor and phrase it that way. You either leave it out, or you have to phrase it in such a way that it is well-received. That is hugely different from the way you portrayed it.

On the issue of insomnia. I heard it get mentioned in the Respironics webinar linked to by Karen.\
It was cited as a distinct symptom when the Dr was talking of ASV & its use in Heart issues.

viewtopic/t66744/The-Nuts-and-Bolts-of-PAP-therapy.html

It caught my attention to hear the Dr in that pres mention ASV & insomnia. Go to 11:18 mins into the pres.

DSM

Guest wrote:You have misrepresented Dr. Krakow on at least one point . . .

Guest:

Here's exactly what Dr. Krakow said, word accurate, down to the "ums", "uhs" and "you knows"


Dr. Krakow says: " . . .in some cases, it's not like I can sit here, and say to you, well go back to your, uh, sleeplab—and I don't want any names mentioned here—and go back to them and tell them that, you know, you spoke to Dr. Krakow and this and that, because that's not something that 's diplomatic and it gets people up tight.

Uh, whether of not you want to come to our sleep center in Albequere you're more than welcome to consider that, we take pretty much, you know, all insurance and would be happy to treat you.

But let me just tell you what we would be doing if in fact we saw a patient like yourself..."

Guest wrote:He is absolutely right. You don't go to your regular doctor and phrase it that way. You either leave it out, or you have to phrase it in such a way that it is well-received. That is hugely different from the way you portrayed it.

But, you notice Dr. Krakow doesn't say "you have to phrase it in such a way that it is well-received" and then go on to say how to do that.

In fact he never speaks again on how to "diplomatically" approach your doctor.

Instead he instantly launches into a sales pitch: "Uh, whether of not you want to come to our sleep center in Albequere you're more than welcome to consider that, we take pretty much, you know, all insurance and would be happy to treat you."

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

As we see later in my post, "we take pretty much, you know, all insurance" is a clever but essential dishonest phrase.

As his website clearly states, most out of state insurance won't cover either his consults or the multiple sleep studies, so have your credit card ready.

Guest wrote:You have misrepresented Dr. Krakow on at least one point, and given that, I wouldn't be surprised if you were doing it all over the place.

Good way to get out of reading the rest of the post (or this thread for that matter) and actually having to think for yourself. But that's your prerogative.

Don't be anonymous, guest. Come into the light, it's safe here.



Mike