Thank You All and Goodbye!

jnk wrote:Since that didn't seem to pan out for him, they agreed to start with a clean slate and move on, it seems.

I would sign off on that. Of course, naturally, I would have to forge someone else's signature for it to mean anything if I ever tried to sign anything medical. But I'd still sign it. With disappearing ink. Like they did.

I do not believe that the rescoring involved anything sinister. If they originally used the alternative definition for hypopnea (which allows a desaturation or an arousal to score hypopneas), but used the recommended (desaturation only) on the rescore, then all hypopneas could have disappeared, and explanation allowing this is perfectly acceptable.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2635578/

deltadave wrote: . . . I do not believe that the rescoring involved anything sinister. . . .

In all seriousness, I don't either, despite my flippant posts. I rather admire it, in fact. I believe it was likely all about putting the patient first, every step of the way. And that's what medicine should be all about, regardless of what the insurance bean-counters may believe. And I truly hope Mr. Monk feels welcome to hang around here, if he feels like it, in case his perspective based on his experience is helpful to others who come to this board in the future.

jnk wrote:I believe it was likely all about putting the patient first, every step of the way.

OTOH, "IMHO", going ahead to CPAP titration was FedU. The diagnostic NPSG was completely worthless, physical exam was essentially normal, and patient history was not only negative for OSA but positive for insomnia. NPSG then supported this, but they insisted on shoving the square peg into the round hole.

IF they wanted to pursue SDB, then they should have repeated NPSG with a pharmaceutical aid or gone to HST.

HOWEVER, with no evidence of SDB (at least in the information provided by the poster), it would seem as though they should have starting treating insomnia first (and NPSG is NOT indicated for insomnia).

Just one asteroid.

Is that really too much to ask?

Coming in at 25,000 miles an hour it really needn't be all that big.

'Speshilly if it hits the ocean.

I mean like, surf's up or what?

deltadave wrote:. . . OTOH . . . they insisted . . .

I think of it as "hey, let's see if stabilizing the dude's airway helps him sleep."

But I do see your point. And I learn from it. As usual.

And it isn't every day we get a so-long-and-thanks-for-all-the-fish thread.

But then I never was a Dolphins fan.

I guess that if no asteroid hits, people can always hope for a hyperspace bypass.

jnk wrote:I think of it as "hey, let's see if stabilizing the dude's airway helps him sleep."

While airway stabilization would tend to improve sleep continuity I don't believe it should be used as the first line of attack in improving total sleep time (quality).

However, your point about helping sleep refocuses our attention to an important point. If the scoring methodology used got rid of hypopneas because they did not meet criteria because of desaturation, then that means they all had associated arousals. And again, careful analysis of the RIP belts would be needed to confirm that the RERAs were truly such (as well as seeing some flow limitation), but "IMHO" I would question if any of the RERAs are RERAs.

However2, if the above is true, then what that leaves us with now is a TON of arousals.

Why not just ask the doc what criteria they used at Time 1 and Time 2 to score the respiratory events?

SleepingUgly wrote:Why not just ask the doc what criteria they used at Time 1 and Time 2 to score the respiratory events?

Cause I don't know who he is.

deltadave wrote:

SleepingUgly wrote:Why not just ask the doc what criteria they used at Time 1 and Time 2 to score the respiratory events?

Cause I don't know who he is.

I meant the OP.

SleepingUgly wrote:

deltadave wrote:

SleepingUgly wrote:Why not just ask the doc what criteria they used at Time 1 and Time 2 to score the respiratory events?

Cause I don't know who he is.

I meant the OP.

I think he split.

Must have something against Transylvanians.

jnk wrote:. . . then I never was a Dolphins fan . . .

J-E-T-S; Jets, Jets, Jets!