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Suggest treatment for Obstructive Sleep Apnea and hypertension

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Posted on Mon, 14 Apr 2014
Question: I was diagnosed with sleep apnea in 2011. I didn't know snoring really loud was a condition until the girl I was seeing, couldn't stand sleeping next to me. So I went in to see a doctor and a sleep study was performed. The results were that I have Obstructive Sleep Apnea. In 2006 I was diagnosed with hypertension and since then, I've been diagnosed with CHF and dilated cardiomyopathy in 2012. I've done the research referring to http://www.sleepapnea.org/learn/sleep-apnea.html. This particular page relates untreated sleep apnea to hypertension and I believe, I've had sleep apnea for years that has gone undiagnosed because of these facts; - I was diagnosed with hypogonadism in 2000, which I've been being prescribed Testosterone Replacement Therapy since 2000, as well. - The testosterone injections has caused me to gain a lot of weight. I was 160 lbs before I began treatment for my hypogonadism and throughout the years, I have continuously gained weight to where my weight is at 280 on average. IAW my medical records, my doctors state that I have high hips, making my waistline an easy 40 inches plus on average. - I was being prescribed 400 mg/ 2 weeks for 10 years before my doctors decided I was taking too much and decided to lower my dosage to 200 mg/2 weeks. - During treatment on TRT, I've had a heart attack, been diagnosed with insomnia, depression, PTSD, sleep apnea, CHF, Hypertension and Dilated Cardiomyopathy, amongst just a few of my conditions. - I am still being treated for all of these conditions & I wear a CPAP when I sleep at night. *My question is, can I have a doctor type a statement relating my sleep apnea to my hypertension? I am requesting this for VA Compensation Benefits. I feel that the VA Hospital works hand in hand with the VA Regional Office, so its hard to get any of my requests met without feeling like I'm asking them to go out of their way to assist me. If you believe my sleep apnea began while in service, do you believe it began before I was diagnosed with hypertension? I have more evidence to send if you can provide me with an email. I have tried sending you my complete medical history related to my service, but it is too large to upload. If you have any suggestions on how I can send it to you, I will be happy to do so. Thank you. I would also like to know your opinion about my heart conditions....Do you believe that they all stemmed from the time frame in my medical records, from the evidence you have and may have gone undiagnosed?
doctor
Answered by Dr. Arnab Maji (2 days later)
Brief Answer: Hypertension is a co-morbidity of OSA Detailed Answer: Hello, I admire your concern about your condition and it's very natural to have. Obstructive Sleep Apnea (OSA) and hypertension are co-related. Hypertension is the most common co-morbidity of OSA and even hypertension precedes the development of OSA in around 10%. Hypertension develops in OSA because of systemic inflammation associated with it. Not only hypertension but a lots of other heart diseases like hear failure, coronary artery diseases, arrythmia, pulmonary hypertension, cardiovascular accidents all may occur in OSA. I think your OSA is not properly controlled. You need to have a follow up sleep study to evaluate the condition. You need to have proper titration of your CPAP machine which can be assisted by the company people and also by the treating doctors and you need to apply it almost every night in a week. Your weight is high which needs to be reduced for proper control of OSA, else all the co-morbidities of OSA will rise as well as poor control of OSA. You can let me aware of your conditions through healthcaremagic or other social networking sites. OSA many a times remain undiagnosed and even 2 or more years have been elapsed in many a cases to diagnose it. Your heart condition is not well. You have dialated cardiomyopathy, hypertension that are not well controlled and that may lead to heart failure in near future. You may consult your endocrinologist and ask him to decrease the dose of testosterone otherwise weight will not be reduced and OSA will not be controlled and subsequently the co-morbidities. If you want to know more you can write back to me. Thank you, Regards, Dr Arnab Maji
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Follow up: Dr. Arnab Maji (6 hours later)
Is it possible for me to reverse my health problems through diet and moderate exercise?
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Answered by Dr. Arnab Maji (10 minutes later)
Brief Answer: Diet, moderate exercise will not be of much help Detailed Answer: Hi, Thanks for writing back to me. To be XXXXXXX I can tell you that it is not possible to reverse your health through diet and moderate exercise. Because you are morbidly obese and morbid obesity in an OSA patient is an indication to go for bariatric surgery to reduce your fat. Until or unless you reduce your fat there will be not much improvement on your health part. Don't be panicked. If possible consult a surgeon specifically gastro-enteric surgeon to consult for possibility of bariatric surgery in this respect. This much I can say. Reduction of testosterone dose may obviously be of some help. If you have further queries don't hesitate to ask me. If you are happy with my response kindly write a review for me. Thank you. Regards, Dr. Arnab Maji MBBS, MD Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Arnab Maji (23 minutes later)
I have gained so much weight because of testosterone injections and because of hypogonadism.. Is bariatric surgery my only option?
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Answered by Dr. Arnab Maji (6 minutes later)
Brief Answer: Bariatric surgery is the best option. Detailed Answer: Hi, Thanks for writing back. As your BMI is on the much higher side it fulfills the indication for bariatric surgery and it will rapidly and effectively reduce your weight. It is not the only option but the best option. As per your situation other procedures will not work much to reduce your problem. If you are happy with my response kindly write a review for me. Thank you, Regards, Dr. Arnab Maji MBBS, MD Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Arnab Maji (4 minutes later)
Do you think my OSA developed in the time frame indicated in the records I have provided to you?
doctor
Answered by Dr. Arnab Maji (10 minutes later)
Brief Answer: OSA has been developed in time frame Detailed Answer: Hi, Thanks again for your query. Yes I do think that OSA has been developed in the time frame indicated in your records. Kindly don't panic much because anxiety will harm you more. Something we always have to accept even if it is not easy. Keep faith on yourself and don't loose hope ever. Let's hope for the best. If you have further queries I am always here to help you. Thank you. Regards, Dr Arnab MAJI
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Arnab Maji (3 hours later)
If I cannot afford bariatric surgery, what are my other options?
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Answered by Dr. Arnab Maji (16 minutes later)
Brief Answer: Diet, exercise, calorie restriction Detailed Answer: Hello, Thanks for your query Then your other options will be diet control, moderate exercise and testosterone dose reduction and calorie restriction to a definite extent. But it will not help much. Thank you Regards Dr Arnab Maji
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Arnab Maji (16 minutes later)
Will you be willing to fill out a questionaire regarding my conditions? I am having trouble getting Veteran's Affairs to approve my disability and continue further treatment because they are stating my sleep apnea did not begin in the time frame of the records for which you have reviewed and given me your professional opinion on. The link to the questionaire can be found at http://www.benefits.va.gov/compensation/dbq_disabilityexams.asp . I am also going to upload it for you as well. I can upload my most recent medical records from within the past 2 years if this will help you with completing the questionaire.
doctor
Answered by Dr. Arnab Maji (4 minutes later)
Brief Answer: I am unable to do Detailed Answer: Hello, Thanks for your request. Sorry sir I will not be able to fill it up because it is an online consultation site and there is some legal boundaries which I cannot deny. I am extremely sorry not to help you out in this respect. Extremely sorry. Consult your treating doctor in this regard. Thank you. Regards, Dr Arnab Maji
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Arnab Maji (53 minutes later)
It's okay, I understand. I believe that the high dosage of testosterone replacement therapy led to my weight gain, and that plus issues with anxiety and depression caused my issue with sleep apnea, which went untreated for many years, leading up to CHF and dilated cardiomyopathy. All I really needed was a doctors statement backing me up, which is what you have given me. I can go ahead and schedule an appointment for a second opinion with another doctor and bring our discussion along with your credentials as back up for the answers for which I am seeking. Can you just do me one last favor regarding this issue and note the time frame as to when you believe my sleep apnea began in accordance with the records for which I have provided you?
doctor
Answered by Dr. Arnab Maji (9 hours later)
Brief Answer: diagnosed when sleep study was done Detailed Answer: Hi, Thanks for your query. Why shouldn't I favor regarding this issue? It's my duty to you as a patient. You can ask me without hesitaion. You can get hold of me in any social networking sites at any time. By the way it's very difficult to say exactly the time when your OSA had developed. Actually it had developed many years ago before people can understand it even doctors specially in the face of so much co-morbidities. But you had been diagnosed as a patient of OSA when your sleep study was done. Probably you had developed it one and half years ago from that time which was unrecognised by that time. This much I can say. I will be very happy if you make me aware of all these after getting a second opinion so that I can have a natural history of your disease because this is really a complicated OSA with which every doctors want to be involved enthusistically. Hope for the best and never panic. Have a good day. If you are happy with my answer you can write a review for me. Thank you. Regards, Dr Arnab Maji
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Arnab Maji (33 minutes later)
I am looking for an answer from the time range of 2003 to 2007 if you believe that's when it began, because that is when I started to have symptoms that i can recall. I'm sure you are right that it developed when doctors knew so little about it, that's why I feel as though it went undiagnosed and untreated, leading to my hypertension, which was diagnosed in 2005. There is a gap between 2007 and 2011 which is why they are denying further treatment, but as I said, I believe the issue began between 2003-2007 due to the symptoms in my medical record. I will not be able to schedule for a 2nd opinion until next week which will be later, but I am looking for more than one opinion which I am sure the opinions will be the same, which will work in my favor.
doctor
Answered by Dr. Arnab Maji (9 minutes later)
Brief Answer: Kindly answer my queries Detailed Answer: Hi. Please answer my following queries in this regard if possible. Since when you were feeling the following symptoms - 1. Excessive day time sleepiness 2. Choking during sleeping 3. Multiple awakenins during sleep 4. Sleep fragmentation 5. Snoring 6. Unrefreshing sleep 7. day time fatigue 8. Poor concentration and lethargy Actually OSA is a continuum of diseases starting from snoring to upper airway resistance to hypopnea to apnea to OSA although all cases do not follow it. If you can recall your memory about these symptoms with time frame then I will be able to answer you with a probable date. Only hypertension doesn't mean anything in this case as it may develop at any time during disease course even may precede the development of OSA. I am hoping a positive response here. Thank you. Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Arnab Maji (40 minutes later)
In 1999, I joined the military weighing 160 lbs. I began TRT in September of 2000 at 400 mg every 2 weeks, which was a high dosage according to my blood tests, but STILL was prescribed the same dosage throughout the years to follow. From 2001 - 2002, I was having issues with depression, which is common in my genes. I was also on high doses of TRT which i believe added to my dysthemic disorder as I recall it being named. In March 0f 2002 I witnessed a catastrophic event that caused me to have some issues with adjusting to normal everyday occurrences, for which i had minor problems with prior to that. After that, my pulse rate was recorded at high rates IAW my records. Ever since the catastrophic event which i witnessed, my quality of sleep started to decline in which I had issues with falling asleep at night, even after working intense long hours during the day. I had issues with snoring and continued to gain weight as the years progressed, which I believe was a result of the high doses of testosterone. I began to have major respiratory issues in 2003, which included pneumonia, and bronchitis. As time further progressed, I was diagnosed with GERD in 2005, gastroenteritis, and anxiety. Furthermore, in 2006 this led to me being treated for all of the previous issues mentioned,esophageal reflux,UTI, Sinusitus maxillary, insomnia and insomnia, plus issues with edema, which I felt I had the entire time anyways. At that time i was having issues with daytime sleepiness. I would show up late for work because I was so exhausted in the morning, I could not drive to work, snoring, and daytime fatigue. When I was at work, I would sneak out to my truck and take long naps, until my co-workers would come wake me up when they needed me, when things got too busy. My supervisors made it clear to me that they had an issue with me going to the doctor for treatment, because they believed I was trying to get out of work, so I rarely sought treatment. In 2007, I decided to discharge from the military, because i was having issues with my supervisors about my tardiness to work and always being too tired to work. After May 2007 when i discharged from service, I was never treated, but had issues with snoring and would stop breathing in my sleep for years, before one day in 2011, my new girlfriend at the time, suggested I see a doctor for the symptoms which you have named, because she believed I had this issue with sleep apnea, in which she was correct. She probably saved my life, because I would have never sought treatment, for my snoring being a health issue. When I discharged from service in 2007, I weighed approx, 280 lbs. That's 120 gain in 7.25 years from when I joined in December 1999 at 160 lbs. From about 2002 - now, I've had issues with concentration. It's gotten so bad, even with treatment, I have had to drop out of school because I have a hard time comprehending what is being taught and what I am reading in books. Is this the explanation you are seeking?
doctor
Answered by Dr. Arnab Maji (22 minutes later)
Brief Answer: Started in 2003, XXXXXXX OSA in 2007 Detailed Answer: Hi Thanks for giving such a detailed history. You are really brilliant I must say. From your history it is quite clear that OSA started from the year 2003 onwards which had been pronounced in 2007 which compelled you to sick medical attention. As I said earlier about the natural history which in your case started in 2003 being progressed to XXXXXXX OSA in 2007. That's what I think. Regards. Dr Arnab Maji
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Arnab Maji (23 minutes later)
Thank you very much for answering my question quite clearly. I have done my research IAW my medical records and with reputable online sources, and now with your definite response I appreciate your honesty and will definitely refer back to you for further inquiry. I have another issue to discuss that concerns my father for the same issue. I will go ahead and rate you for this discussion, then refer back to you for the issue concerning my father. Thank you for your honest, professional opinion. Good luck to you in life and in your career. Best regards, XXXXXXX XXXXXXX
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Answered by Dr. Arnab Maji (12 minutes later)
Brief Answer: Thank you very much Detailed Answer: Hi Thank you very much and you are very educated and have knowledge about your disease which most of the Indian patients lack. Go ahead and find the best option for your disease. I am always here to help you as per my capability. Get Well soon. Regards, Dr Arnab Maji MBBS, MD Consultant Pulmonologist
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Arnab Maji

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Suggest treatment for Obstructive Sleep Apnea and hypertension

Brief Answer: Hypertension is a co-morbidity of OSA Detailed Answer: Hello, I admire your concern about your condition and it's very natural to have. Obstructive Sleep Apnea (OSA) and hypertension are co-related. Hypertension is the most common co-morbidity of OSA and even hypertension precedes the development of OSA in around 10%. Hypertension develops in OSA because of systemic inflammation associated with it. Not only hypertension but a lots of other heart diseases like hear failure, coronary artery diseases, arrythmia, pulmonary hypertension, cardiovascular accidents all may occur in OSA. I think your OSA is not properly controlled. You need to have a follow up sleep study to evaluate the condition. You need to have proper titration of your CPAP machine which can be assisted by the company people and also by the treating doctors and you need to apply it almost every night in a week. Your weight is high which needs to be reduced for proper control of OSA, else all the co-morbidities of OSA will rise as well as poor control of OSA. You can let me aware of your conditions through healthcaremagic or other social networking sites. OSA many a times remain undiagnosed and even 2 or more years have been elapsed in many a cases to diagnose it. Your heart condition is not well. You have dialated cardiomyopathy, hypertension that are not well controlled and that may lead to heart failure in near future. You may consult your endocrinologist and ask him to decrease the dose of testosterone otherwise weight will not be reduced and OSA will not be controlled and subsequently the co-morbidities. If you want to know more you can write back to me. Thank you, Regards, Dr Arnab Maji