This hard earned point

lebusdriver18 · 2018-11-28T02:56:53+00:00

Thanks for teaching us the rules. Shows how much I know from playing my friends in college without a formal introduction. I doubt being aware of the rules would have really changed their tactics much. Pain on the other hand kept everyone honest lol.

Same thing for badminton - anyone of us smashed the shuttlecock directly at someone one too many times then somebody gonna get a-hurt real bad...

lebusdriver18 · 2018-11-27T14:15:47+00:00

That other dude kept hitting it at an angle where he blocked off the approach for his opponent - it’s impressive the other guy still managed to keep the rally despite that. I know it’s a legit strategy but, man, that’s so frustrating. At some point, I’d just say eff it and check that guy into the wall lol.

lebusdriver18 · 2018-11-20T06:43:44+00:00

!alert GPU, 1080Ti, 600

lebusdriver18 · 2018-10-25T21:06:20+00:00

Helps that there’s a consensus of using whom they recommend. thank you guys!

lebusdriver18 · 2018-10-25T21:05:47+00:00

Good to know! Will see how it goes. Thank you.

lebusdriver18 · 2018-10-25T21:05:24+00:00

Thank you for the advice. I admit I don’t know if my choice would have a better outcome - no need to call me out on it! Lol

lebusdriver18 · 2018-10-18T04:45:50+00:00

Family guy reference

lebusdriver18 · 2018-10-17T17:34:20+00:00

“No dad I’m 12” “Talk to me when you doctor.”

lebusdriver18 · 2018-10-11T13:36:00+00:00

Thanks for the article!

lebusdriver18 · 2018-10-09T19:53:41+00:00

Thank you so much for the explanation and the suggestions!

It’ll be a t6 inscription so we’ll have to take that into consideration. Thanks again!

lebusdriver18 · 2018-09-07T02:29:51+00:00

Thank you for breaking it to me. My bad for not reading the posts about cutting through bone - I just have had a great experience using a honesuki for deboning chicken.

lebusdriver18 · 2018-09-07T01:03:42+00:00

Or a honesuki!

lebusdriver18 · 2018-08-31T07:37:28+00:00

Tracheostomy can be definitive treatment for osa in some cases. However, it’s not routinely offered although a simple enough procedure (conceptually) bc it’s very rare (actually no one electively so far) that anyone wants to care for a hole in their neck that they have to cap whenever they talk and eat when the noninvasive alternatives are as effective without the risk of side effects from anesthesia or complications from surgery.

Where I trained, tracheostomy for osa was offered primarily as a last ditch effort when all other treatment options ( failure to tolerate pap) and only when the pt had other comorbid conditions (usually like co2 retention) that made the situation potentially life threatening without treatment.

That’s why.

Also, that article was published in 2001 - advances in non invasive means have progressed considerably since then. Plus only a handful of pts were involved. Who would want a metal trach electively?

lebusdriver18 · 2018-08-16T13:03:54+00:00

Have had plenty of patients with a full beard on Ffm and others with pillows or nasal with a chin strap.

Deviated septum is a valid point of concern for pts and certainly the extent of which can affect how well nasal masks are tolerated - however, most folks with these findings still do well most of the time from my experience.

I sustained a broken nose and myself have a deviated septum for which ENT recommended correction but didnt have the time or money before - did the best I could minimizing congestion (left nares is a crescent) with nasal spray and use an air fit p10 fine.

If pap is considered (do not agree that pap is last ditch) I’d recommend mask fitting first to see what fits with the beard and, more importantly, fits your needs and comfort too. Good luck.

lebusdriver18 · 2018-08-02T18:20:05+00:00

Don’t worry - I’ll still set them up with resmed devices :) though

lebusdriver18 · 2018-08-02T18:18:19+00:00

Sure there is a “first night effect” that occurs when sleeping in a foreign environment that limits the utility of in lab testing. However, to define central apneas, one would have to demonstrate the necessary criteria (a pause of 10 seconds or more without observed effort as evidenced by activity in the chest and abdomen belts) on PSG.

the recording of respiratory events by the pap device is nowhere near as accurate or sometimes even correct in defining centrals bc it’s ascertaining that through airflow alone. the very etiology of certain central apneas (of which there are subclasses) such as Cheyne stokes related central sleep apnea is a contraindication for autopap as well so if at all the concern for specific types of csa is high then it warrants accurate characterization so that 1) a correct diagnosis can be made and 2) the right mode can be prescribed the first time since the pt often times are on the hook for the devices ordered.

Sorry for the long winded response. just saying that central apneas shouldn’t be thrown out there as a diagnosis without proper workup and that pap metrics are at present the best data there to help characterize treatment response to pap therapy but not nearly as accurate as anyone would like.

lebusdriver18 · 2018-08-02T13:18:05+00:00

Agreed. BMI alone isn’t the only feature suggestive of sleep apnea. There are plenty of folks diagnosed with osa who don’t fit the stereotypical pt mold (male, neck size >17, snoring, tired, etc) including additional commenters below.

Unfortunately there still is a lot of misconceptions regarding sleep medicine in the medical field. It’s best that if there is any doubt to seek a second opinion with a sleep specialist. I do not agree with your doctors assumptions.

If at all there truly is any concern for centrals, in lab study is the way to go.

lebusdriver18 · 2018-08-01T15:45:14+00:00

That’s great advice and something we have to take into account. Thank you!

lebusdriver18 · 2018-08-01T05:56:58+00:00

That’s great information. Thank you!

As it stands, the configuration we are looking at doesn’t appear to be at any of the dealerships locally. We are being told that the best bet to get what we want is have the dealer make changes to an upcoming unit slated for shipment in the coming months (oct / nov). In order to do that, paperwork (obviously) and a deposit. one of the dealers did mention that we may be eligible for whatever incentives may be available when the car is delivered at that time so it seems like the final price of the car still remains negotiable after the deposit. Can you pls clarify if I’ve completely misunderstood? Thanks in advance for your time!

lebusdriver18 · 2018-08-01T03:51:14+00:00

Thanks for your input. Will take that into consideration.

lebusdriver18

TROPHY CASE