The Case of Clancy

Remember by comparison to other specialties, sleep medicine is a relative newcomer. It is important to make potential patients aware they must at times be very persistent in seeking answers. Consider this as you read the following true story of a patient and his long road to get the intervention needed.

Clancy is a 69-year-old male who is 5’10” and weighs 300 pounds. He has a 19.5″ neck circumference. He has a history of hypertension, type 2 diabetes, loud snoring and excessive daytime sleepiness.

His past medical history shows abnormalities on a 24-hour Holter monitor test (heart tracking). When in the recovery room following multiple surgeries over the years, he routinely would have difficulty maintaining his blood oxygen level and would require supplemental oxygen.

Past health care interventions include a right radical nephrectomy for renal cell carcinoma in 2003, placement of a cardiac stint in 2003, a bowel resection in 2005 and a total knee replacement in 2006.

It would be safe to say through all of this, Clancy had interaction with a litany of health care professionals. It is clear he was assessed by numerous physicians, nurses, respiratory therapists, home care providers and others on the health care team. Despite that, no one ever suggested he should be screened for sleep disordered breathing.

Clancy’s family intervened and persuaded him to seek more answers. He went to his family physician who told Clancy he simply needed to lose weight. A few weeks followed, then on his own, Clancy secured an appointment with a pulmonologist. He was finally scheduled for a sleep study. But when seeking the outcome, the family was told the pulmonologist had the results, however the pulmonologist’s office refused to set a follow-up appointment until they were actually in hand.

After another several weeks and multiple phone calls, the results were located. Clancy had an AHI of 85, and his oxygen level desaturated into the 70 percentile range. He was of course ordered PAP therapy and, subsequently, supplemental oxygen nocturnally.

The challenging question to this story is, what would most people have done following the first encounter with the PCP? Far too many would accept the news at that and not pursue anything further. That is why this is an important message to deliver.

Clancy had a compelling reason for his (and his family’s) tenacity in pursuing diagnosis and treatment. He had a new bride, and he wanted to live, to be able to enjoy time together riding their Harley, gathering blackberries or tending to the favorite family pet.

That bride is my mother.

Clancy’s story is, unfortunately, not unusual. Our industry can and should work to make a difference in the lives of others like Clancy by raising awareness of the prevalence of SDB as well as processes in how patients can take the necessary first steps toward improved health.

Become passionate about the goal, and watch your business grow.

With more than 25 years of respiratory experience in both institutional and home care settings, Kelly J. Riley, CRT, RCP, is director, National Respiratory Network, for The MED Group, Lubbock, Texas. Previously, she served as COO for At Home Medical (formerly Via Christi at Home) in Ponca City, Okla. You can reach her at [email protected].