Pre-Op Roadblock- WWYD?

[bandsmom74 21]

Hi There! I am looking for a little insight- I am curious is this situation has happened to others, and if so how it was resolved.

I am pre-op for a Sleeve Gastrectomy. I have completed all of my requirements (3-month medically supervised diet, Psych consult, Nutrition consults, Fitness consults, lost the 10 lbs my surgeon was requiring) and my final weigh in is this Tuesday. My issue is I am caught in a loophole of sorts regarding the sleep Apnea testing.

I had my first Sleep Apnea test (in-home) done in September. I came back diagnosed as having Obstructive Sleep Apnea. So my surgeon called and said I had to contact my PCP to order the 2nd test- this In-Lab titration, which I am reading is when I would receive my CPAP and they would monitor my sleep to determine the proper therapeutic settings. My PCP- while definitely being onboard for the surgery will not (cannot?) prescribe the titration, and that they would refer me to a pulmonologist. So I called my surgeon's office to tell them that and they basically said that they've never heard of this happening before, etc etc. and to instead call the office of the Dr. who read the first test and did the diagnosing. SO I did that- and that Dr. won't refer me for the titration either and instead referred me to a sleep specialist. I called my surgeon at that point and the person I spoke with wasn't very helpful, just basically said I had to "get it done" in order to get the surgery. I'm also a bit salty because I have great insurance and don't even require referrals for specialists so I suspect that if I could somehow contact the titration center that I could schedule it myself. Its also frustrating since I am so close to surgery and the situation resolving itself with the weight loss. I'm definitely not resistant to getting the CPAP though if that's what it takes (even though extra expenditures are definitely a concern- which is why I'd rather not get roped into a treatment routine with yet another specialist).

So...my question is, has this happened to anyone else? How did you resolve it? If you were me, which route would you choose? I'm leaning towards the sleep specialist over the pulmonologist but then wonder if I'll get flak from my PCP. And I suppose this may delay my surgery now because I'm reading that once I finally get the CPAP I will have to do 30 days with it? (My surgeon hasn't confirmed this).

Any experience, insight, or advice would be greatly appreciated! Thanks so much!

[Bustyphemale 11]

Hi There! I am looking for a little insight- I am curious is this situation has happened to others, and if so how it was resolved.
I am pre-op for a Sleeve Gastrectomy. I have completed all of my requirements (3-month medically supervised diet, Psych consult, Nutrition consults, Fitness consults, lost the 10 lbs my surgeon was requiring) and my final weigh in is this Tuesday. My issue is I am caught in a loophole of sorts regarding the sleep Apnea testing.
I had my first sleep Apnea test (in-home) done in September. I came back diagnosed as having Obstructive Sleep Apnea. So my surgeon called and said I had to contact my PCP to order the 2nd test- this In-Lab titration, which I am reading is when I would receive my CPAP and they would monitor my sleep to determine the proper therapeutic settings. My PCP- while definitely being onboard for the surgery will not (cannot?) prescribe the titration, and that they would refer me to a pulmonologist. So I called my surgeon's office to tell them that and they basically said that they've never heard of this happening before, etc etc. and to instead call the office of the Dr. who read the first test and did the diagnosing. SO I did that- and that Dr. won't refer me for the titration either and instead referred me to a sleep specialist. I called my surgeon at that point and the person I spoke with wasn't very helpful, just basically said I had to "get it done" in order to get the surgery. I'm also a bit salty because I have great insurance and don't even require referrals for specialists so I suspect that if I could somehow contact the titration center that I could schedule it myself. Its also frustrating since I am so close to surgery and the situation resolving itself with the weight loss. I'm definitely not resistant to getting the CPAP though if that's what it takes (even though extra expenditures are definitely a concern- which is why I'd rather not get roped into a treatment routine with yet another specialist).
So...my question is, has this happened to anyone else? How did you resolve it? If you were me, which route would you choose? I'm leaning towards the sleep specialist over the pulmonologist but then wonder if I'll get flak from my PCP. And I suppose this may delay my surgery now because I'm reading that once I finally get the CPAP I will have to do 30 days with it? (My surgeon hasn't confirmed this).
Any experience, insight, or advice would be greatly appreciated! Thanks so much!

Hi

I was also told I needed a Cpap machine prior to surgery, However I haven't received it yet.i however have a date in 2 weeks. The anesthesiologist said during surgery she will have to breathe for me, then a critical care nurse after, so I'm still waiting

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[AZhiker 2,253]

All my sleep apnea followups are done through a sleep specialty doctor, not a pulmonologist. Ask your insurance for the names of sleep doctors on your plan, call them and see how far out they are booking, pick one, get the referral from your PCP if needed (they can just FAX it over), and then get your appt set up. I know it is a real PITA, but you just gotta jump through the hoops.

BTW - all my insurance needed was the actual diagnosis of sleep apnea. They did not need to see that I had started on treatment or had even purchased a machine yet.

Edited November 16, 2019 by AZhiker

[JessLess 1,163]

I'd try to talk to your surgeon and get your surgery and deal with it later. I've never heard of someone having to wait for it.

[JRT Mom 920]

IMO it's counterproductive for the surgeon to postpone your surgery. Obviously your obesity is causing you problems and if they delay your surgery that also delays your weight loss progress. And chances are good that after you lose enough weight the apnea will resolve itself.

[GreenTealael 25,593]

I believe my path my was exclusively through a sleep Center/Specialist (no doubt pulmonary docs on board). Call your Surgeon, PCP and insurance for possible referrals.

Good Luck 💙

[Kimberly3 71]

I have sleep apnea. My sleep specialist is a Pulminologist. His specialty is sleep disorders as opposed to asthma, copd, or allergies. I am on CPAP treatment. I got to he equipment first visit with Pulminologist after my sleep study.

I was required to bring my machine to the hospital to use after my surgery. Your anesthesiologist needs to know because you will stop breathing during surgery.

Call your insurance for information they after all should refer you where to go and they are the ones who ultimately approve the surgery. Best of luck!

[bandsmom74 21]

Oh my gosh thank you all for the wonderful responses, sounds like I am correct in thinking that the sleep Specialist is the way to go! Its so encouraging to read that it may not delay me after all! Thank you!