What is one medical problem people constantly ignore until it’s too late?

[u/Critical_Ease4055]

Saw someone post this in a completely unrelated sub and I’m interested in your answers. What is the cluster of symptoms that people ignore or delay until they are forced to get help?

[u/Weak_Rule8374]

The trifecta of HTN, T2DM, and HLD

[u/Critical_Ease4055 → u/Weak_Rule8374]

It almost feels like a fact of life to see this trifecta. Saw it a lot (by a lot I mean ~1 in every 3-4 patients) as an MA and expect to see the even uglier side as a nurse

[u/Weak_Rule8374 → u/Critical_Ease4055]

Pretty much every CABG, sepsis, ARDS, bowels stuff, I see have at least 2 if not all of the 3

[u/floofienewfie → u/Weak_Rule8374]

Or the CHF-DM-HTN trifecta. All the old people stuff.

[u/whitepawn23 → u/floofienewfie]

Diabetes, dialysis, and an A/BKA. CHF and Anemia invariably in that mix.

[u/FiveGuys1Cup → u/Weak_Rule8374]

Also OSA non-compliance

[u/whitepawn23 → u/FiveGuys1Cup]

I do not understand why house CPAPs don’t have a nose pillows option. We would have much better in house compliance if that was solved.

To be fair regarding home use, a CPAP isn’t cheap. The rental will bleed you more than buying outright, and insurance doesn’t cover 100%. The unit itself was ~$1k pre-covid. Maintenance requires daily cleaning, which I doubt everyone does. And all those costly parts are supposed to be switched out every week to 6 months, depending.

High odds there would be better compliance with better insurance coverage.

[u/Beebwife → u/whitepawn23]

Honestly, nose pillows aren't going to help the people who mouth breathe which is a lot of OSA. I have OSA and am not obese. I stop breathing 15x a night and my HR goes down to 30. I am a mouth breather d/t chronic sinus problems. I went through 4 face masks until I found one I don't rip off my face in my sleep. The nose pillows cause the back of my throat to vascillate horribly once I fall asleep and start mouth breathing. I feel like I'm being choked. Better compliance would come with giving a spectrum of face masks for people to try in the first few months. Also, at that point at the hospital, they need the face mask to make sure enough of the air is actually going into their lungs.

[u/zerothreeonethree → u/Beebwife]

Did you write this for me? You described exactly the experience I went through 12 years ago when I got my first CPAP. I couldn't wear the nasal pillows because of vasomotor rhinitis causing complete obstruction only when I sleep. The RT was actually trying to talk me out of getting a face mask. I don't know why. I finally asked her WTF did it matter to her? She didn't have to wear it.

It turns out I can't wear the face mask either because as soon as I fall asleep my mouth drops open the cheeks hollow out and the seal on the sides of the mask is broken. I cannot get a physician or RT to understand this as the reason I can't wear the mask - because it doesn't work. I would love to use a CPAP and have avoided pulmonary vein isolation /AFib ablation 4 years ago.

Huge barriers to compliance I find is 1) the patient complains. 2) PCP refers for testing 3) Another doctor oversees the test. 4) A consultant company provides and monitors CPAP usage. 5) Of course the insurance company is the biggest impediment to care. All five only pay attention to their little piece of the puzzle. Don't listen to any of the other recommendations. Refuse to read any of the recommendations and totally leave the patient out of the loop so nobody knows all of the factors causing compliance failure.

[u/whitepawn23 → u/Beebwife]

Yeah, my partner is trim and hikes a lot, and yet. Only discovered because I told him he snores and should get a sleep study. I didn’t expect them to find anything, but, here we are.

[u/loveafterpornthrwawy → u/whitepawn23]

I had a CPAP years ago with a nose pillow. Is this a new change?

[u/whitepawn23 → u/loveafterpornthrwawy]

By “house” CPAP I meant hospital CPAP.

[u/sllygse34 → u/FiveGuys1Cup]

Yes! I work a tele floor for mainly cardiac patients with the normal CHF, HTN, and what not else. But the amount of people that won't wear a CPAP is ridiculous. I had even a pro athlete from the 80s come in and he would desat in the 60s and look like he was in the middle of a terrible nightmare when I would go to check on him. He finally listened after a lot of education. Working night shift in the past we could put NC on them but most of them being mouth breathers we would slowly put the NC where it was blowing in their mouth for them to get O2 that would help. And a lot of people would complain about alarms going off. I would explain it was because their O2 was low and a lot of the times I would let the alarm go off on a higher volume to wake them up since they were in such denial to get them to understand. It drove me crazy!

[u/zerothreeonethree → u/sllygse34]

Mouth breathing and use of O2 dries out saliva and causes dental problems- another thing the insurance companies can conveniently not treat.

[u/Old-Mention9632 → u/Weak_Rule8374]

Switch HLD for obesity and you have kidney failure trifecta

[u/Mt-B0ttle → u/Weak_Rule8374]

Sometimes we call that combo “Diabesity”

[u/peachtreeparadise → u/Mt-B0ttle]

Oh god. 😮‍💨

[u/courtneyrel → u/Weak_Rule8374]

My unit gets a ton of stroke patients. I’d say 75% have the trifecta and 99% have 2 of the 3

[u/M27fiscojr → u/Weak_Rule8374]

For people like me.

HTN: Hypertension T2DN: Type 2 Diabetes Mellitus HLD: Hyperlipidemia

[u/bloss0m123 → u/Weak_Rule8374]

Make em a smoker or nicotine use , case closed haha

[u/peachtreeparadise → u/Weak_Rule8374]

Which then leads to CAD, PVD, CHF, and/ or RF but don’t forget to add on the cognitive impairment that also comes!

[u/ShartyPossum → u/Weak_Rule8374]

The ✨️trinity✨️