Erik’s Six Week IOBS Follow Up

Now that his nose is working like it should, it's time to tackle the sleep apnea that's interfered with Erik's life for the better part of the last decade.

 

 

If you haven't read the last part of Erik's journey, check it out here.

Transcript:

- Hi, everybody. Erik here with an update on my patient journey with ADVENT. It's been a little over six weeks now, since my in-office balloon sinuplasty and turbinate reduction. Nose is working great now. The next step is to get the sleep apnea under control. Still tired all the time. Still drinking dangerous amounts of coffee. Hopefully today we'll get a plan to get that fixed.

- [NP] So, how are things?

- Good. Really good.

- [NP] You feel like you're breathing well at this point?

- Yes. Very well. Way better than I was before the procedure.

- [NP] Good. How has sleep been? Any changes there in terms of quality at this point?

- No. My wife said that my snoring changed a little, like the sound, the tone is a little different now. But that's about it.

- Fair enough. We don't expect the snoring to be different at this stage, or gone at the stage of the game. Let me take and see what you got going on in there. You still have some stuff to remove today.

- Cool.

- [NP] Looks like mostly just on that left side right now.

- Okay.

- [NP] Feel any different on that left side?

- Oh yeah.

- Good. Things look good. Rinses at this point can kind of switch to as needed. Increased frequency for allergy or cough or cold symptoms. We'd still probably have you use that Flonase twice a day. The ointment can be completely done at this point. Unless you're feeling dryness. That usually be used at night. Really, today we can kind of start talking about, hey, what's the next step in terms of dealing with the sleep apnea. What the note said is that you were kind of thinking about that mouth guard versus the CPAP. Have you made a decision on which way you like to go at this point?

- Yeah, I'm thinking CPAP.

- Okay. And you do have a CPAP at home right now?

- I do. It's a BiPAP. But I think the plan is to get a new CPAP.

- [NP] Okay. So, I can put in orders for a new CPAP device. We usually use an auto PAP device. So, I don't know if you're familiar, but basically instead of having to do an in-lab study we kind of hook up the machine and kind of see what happens. The machine has some intelligent stuff in it where it kind of adjusts pressure based than what it needs.

- Oh, awesome.

- What you need. So, it kind of does like a mini sleep study every night. If Erik needs more pressure you know, it gives you more pressure, needs less pressure, gives you less. So, that I'll put in, it usually takes a little bit of time for insurance companies to kind of get caught up with that.

- Matt got me up to speed. Things are going okay? Yep. Going great.

- [Doctor] He got a little bit of something out?

- Yeah.

- [Doctor] Do you notice a difference for that?

- Oh, absolutely.

- [Doctor] Oh, you do?

- Yeah, for sure.

- [Doctor] Did you get a sense that there was something in there or not?

- Not really. I thought I was doing pretty good, and now my left nostril is just wide open.

- A lot of times, at this stage of things, sometimes you have build, so things are opening up, I'll see what it looks like, but generally speaking things are opening up and so it's more open than it's been, which is good. Sometimes you'll get a little bit of buildup that's just kinda sort of tucked behind the scenes, when you rinse it's sort of going over top of that, it doesn't knock it off, cause there's space. Rinses kind of follow the pathway of least resistance. And so, if it's open around it it'll just kind of you know, just go around it. But then that's sort of why we get you back in to see what things are looking like. That stuff would come out eventually, but just get it out of there just to kind of get you up to speed is the way to play it.

- [Erik] Yeah, it's pretty great once you get one of those-

- The big chunks.

- Raisins to come out. Yeah.

- Probably, I mean we'll see, but I'd say generally, this sort of marks the point where you might get a little bit out moving forward, but not like all the junk that you got out right out of the gate, it isn't gonna be that. But you might get a little bit here and there but it should be just kind of fading down. Sleep, are you breathing through your nose when you sleep? Or hard to tell?

- I mean, I am, when I fall asleep. I'm consciously able to breathe through my nose in any position, which is awesome. But I'm still waking up with drool and stuff, so I know I'm dropping-

- You're dropping the mouth open?

- Yeah.

- [Doctor] Is sleep any better or not really?

- Not really. Like, it's easier to fall asleep and I'm more comfortable falling asleep, but still tired all the time.

- [Doctor] Okay, that's fine. Headachy, pressury, any of that sort of stuff?

- Headaches have not been bad. I think I may have one or two, but normally it's worse. So, I mean it's a small sample size, but maybe.

- Yeah. It's hard. Headache wise, and there's enough chatter going on in the backend of procedure, where, you know, how we get that stuff figured out is once everything settles and see, but I'd say, given how tight you were before, having things open the calm as good as we can be, nose and sinus wise. And so if there's any contributing factor to any of this stuff on that front this would be about when we, sort of the earliest time we sort of see, but next few months rolling forward, kind of pay loose attention to it. You just haven't have to have enough time on your belt to kind of sense this, you know, is that any different? The same? Kind of what you're noticing is good kind of early signs. Good. Yeah, that's great. Yeah, looks great. So yeah, both sides are wide open. Your left hand side, I mean he got the chunk out that's out, so it's not there anymore for me to see. But your septum kind of goes like this, does like this. On your left hand side there's a little, we call it a spur that sticks out. And so likely there is, it's a little bit of build up between that spur and then the side of your nose over here, and getting it out is good. It looks to be a good amount of space on both sides. It's just sort of unequally divided coming through, so my hunch is, as things continue to play out, I think both sides are going to be pretty darn good. You know, from a nose standpoint, you know, we'll keep an eye on things, but I think we're probably, I mean, you're still, you're about 95% healed in there. There's still, I can see a little rough areas on the surfaces that just need to finish their job. But you've gotten the big change or the big gain is there. And so, you know, kind of letting your body walk that last leg of the journey and then, you know, really sleep wise, and I know we had this conversation right out of the gate, nose, I think out of the equation, you know, which is good. And then really sleep wise, I mean, again the three options CPAP machine, oral appliance, procedures for your throat. Procedure is not really an option for you, just kind of how your anatomy is. So you know, you really, the question with our options would be between the CPAP machine and an oral appliance. Then I guess here's my lean would be to go ahead. Well, okay. I didn't ask you, but Matt asked you. But CPAP is what you want to do?

- Yes.

- Okay. Which is fine. So I think if that's fine, then I think, you know, what we'll do is we'll go ahead and put orders in and get you moving in that direction. From a nose standpoint, we'll typically get you back in a few months down the road to check in on that, but because you're doing the CPAP machine. So we're following the nose, we're following the sleep apnea. And so we're going to get you back in sooner to see how things are going with the CPAP machine. We'll obviously look at your nose at that point as well. So it's basically, usually what makes sense is once you've been using the machine hopefully successfully for about a month or so getting you back in. So it usually takes maybe a week to get into the machine, maybe a couple. So we'll usually be seeing back in that six weeks, see how things are going, go from there. And things are going poorly right out of the gates, then just let us know. So it's all going well, let us know.

- Yeah. And I was usually able to fall asleep with the BiPAP, even as crazy and intense as it was. So that gives me a little hope.

- [Doctor] Yeah, exactly.

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