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07-25-2023, 04:17 PM (This post was last modified: 07-25-2023, 04:17 PM by cmpman1974.)
RE: IVAPS vs Vauto BPAP - Tidal Volume Question
Sleeprider, I picked up the results of my overnight pulse-ox report from 10+ days ago. This was on 17/9 BPAP-S w/o supplemental O2. That previous medical facility/sleep doctor who said I had no desaturations on this treatment simply using BPAP-S is questionable. This PROVES the CheckmeMax O2 wrist watch is certainly accurate enough. There is some serious correlation in the O2 chart between the medical-grade Nonin oximeter and my home one. This was wonderful to see, but the results are very concerning as well. 80+ min under 88% on BPAP is no joke. There is no question why I deal with so much fatigue given this.
The doctor has decided not to update the lung perfusion scan in light of a normal chest x-ray. I suspect they'll find out 2L of supplemental SPO2 doesn't bring me where I should be. Seems like a losing battle. Something isn't right. I see my cardiologist this week too for a 4 month follow-up.
The problem is an imbalance between volume and perfusion. That does not show up on X-Ray. Ask your doctor’s rationale in not continuing with the radioactive dye to measure perfusion. This imbalance can be metabolic, physiological, blood or other causes. To say you don’t have physical lung anomaly by X-Ray is any thing but conclusive and is outright neglectful in view of your inability to maintain good oxygenation.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
07-29-2023, 10:12 PM (This post was last modified: 07-29-2023, 10:26 PM by cmpman1974.)
RE: IVAPS vs Vauto BPAP - Tidal Volume Question
Bumped back to 3L supplemental O2. I am guessing 4L is the magic number. Leaks looking good too the last week. 95% leak rate was 4L/min. Time under 90% SPO2 was 6 min, 6 sec at this level of O2.
Sleeprider, I'm cleaning the mask as you suggested. Gently hand rubbing Dawn on the silicone areas, rinsing off immediately and hand drying for the most part. The new mask cushion is only 10 days old so early to say how it'll fare over time. I also am doing all I can to be clean shaven nightly.
Regarding your other points, I will address them at my next appointment with the pulmonologist. I agree depending solely on a chest x-ray seems wrong. Especially given the picture shown. The doc's medical assistant clearly sees supplemental SPO2 is needed. 2L is not enough. It's helpful, but it's obvious even a 10-15 second apnea causes BIG drops in my oxygen levels while textbook literature claims an apnea should be 30-45+ seconds minimum to result in the type of drops I see. I'm obviously running on a defective gas tank the whole time.
I went looking for the pulmonary study you posted earlier and struck out. I think your next appointment needs to feature a discussion of that test to determine if it has progressed or miraculously improved. Also ask your doctor to explain what looks "visibly" better or more resolved in your recent X-ray which was incapable of showing V/Q mismatch. Taking a duck call is optional, but it may be a helpful expression of skepticism when you hear the next lie.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
07-31-2023, 04:25 PM (This post was last modified: 07-31-2023, 04:31 PM by cmpman1974.)
RE: IVAPS vs Vauto BPAP - Tidal Volume Question
(07-31-2023, 07:46 AM)Sleeprider Wrote: I went looking for the pulmonary study you posted earlier and struck out. I think your next appointment needs to feature a discussion of that test to determine if it has progressed or miraculously improved. Also ask your doctor to explain what looks "visibly" better or more resolved in your recent X-ray which was incapable of showing V/Q mismatch. Taking a duck call is optional, but it may be a helpful expression of skepticism when you hear the next lie.
This thread has the perfusion study you were looking for (page 2):
I spoke to my cardiologist at length last week regarding the oxygen issue. He said it could be a complication of multiple things. One could be V/Q Mismatch. He was trying to focus on problem that would occur only at night given that's where the issue is showing primarily. He brought up an interesting point about my pulmonary hypertension and nightly fluid shift from my lower extremeties to my heart in a supine position. He said the extra fluid in my lungs that shifts here at night may upset the balance and cause oxygenation issues. He mentioned a few other tests that he was considering but may be difficult as I'm on the borderline of the weight limit for a few of them. Waiting to hear back.
08-01-2023, 08:57 AM (This post was last modified: 08-01-2023, 08:57 AM by cmpman1974.)
RE: IVAPS vs Vauto BPAP - Tidal Volume Question
I keep wondering why apnea events of relatively small duration magnify the low SPO2 issue to much. It seems consistent. It is quite obvious high leaks lead to ineffective treatment (apneas return) which then leads to magnified oxygen desaturations relative to a normal person with the same issue.
08-05-2023, 08:13 PM (This post was last modified: 08-05-2023, 08:24 PM by cmpman1974.)
RE: IVAPS vs Vauto BPAP - Tidal Volume Question
This just gets weirder and weirder. Had a perfect night leak wise. Average leak rate for the whole night was 2.59 L / min. 0% large leaks. Total of three apneas for the entire time (longest 13 sec). I was on 3.5L supplemental O2. Well here's my nightly result per the CheckmeMaxO2. Never seen a O2 score like this. Scary. My lower back is really hurting lately so I'm in a lot of discomfort if I move the wrong way. Hey, at least that chest x-ray looked OK Sleeprider. SMH. I'll see tomorrow how my recent echocardiogram looks as I have a follow-up visit with the doctor.
I'm going to push my Pulmonary Hypertension specialist harder for explanations as well. Something isn't right obviously. If anyone should be on the Resmed nonin pulse oximeter add-on, it's me. My pulse rate seems to be running mid to low 50s most of the day. Months ago, my cardiologist reduced by Metoprolol dose from 250 mg per day total to 150 mg per day. He thought that would help with the occasional brachycardia readings. Daytime oxygen is 94 - 97% per my clip on oximeter.
08-08-2023, 09:30 PM (This post was last modified: 08-08-2023, 09:32 PM by cmpman1974.)
RE: IVAPS vs Vauto BPAP - Tidal Volume Question
Last night's results. Easy to see, things go to hell when the mask leaks. I have wondered something. I know AHI figures become meaningless when the leak rate is over 24 L/min on a ResMed machine. Anyone know if Tidal Volume and Minute Volume numbers are reliable when leak rates are excessive?
Oximeter said with the 3L Supplemental Oxygen, my total minutes this night under 90% was only 4. Seems weird with that period of high leaks and low Vt. The rest of the night the leaks were extremely well-controlled.
My oxygen desaturations are starting to catch some of my doctors' attention more. My Pulmonary Hypertension doc wants me to have a repeat cardiac catherization test to assess right side pressures and most likely also do a left heart cath.
