Opening Hours : Monday to Friday - 8:30am to 5pm | Sleep Clinic Hours: Monday to Sunday: 7:30pm – 6am
  Contact : 407-898-2767 | Toll Free 866-383-0556

Expectations

WHAT TO EXPECT AT YOUR APPOINTMENT

This section gives you a general guideline as to what to expect when you come for your appointment. This section does not discuss the actual disorders but provides you with an expectation for the appointment and also gives you an idea of what you should bring along and what will be asked of you. This guideline is by no means complete but allows you to prepare for your appointment.

PULMONARY

ASTHMA
COUGH
ALLERGIC RHINITIS
PNEUMONIA
CYSTIC FIBROSIS
VENTILATOR DEPENDENT CARE

SLEEP

SLEEP APNEA/SNORING
INSOMNIA
HYPERSOMNIA/NARCOLEPSY (EXCESSIVE SLEEPINESS)
PARASOMNIAS: NIGHT TERRORS, CONFUSIONAL AROUSALS, SLEEP WALKING, NIGHTMARES, REM BEHAVIORAL DISORDER
MOVEMENT DISORDERS IN SLEEP: RESTLESS LEG SYNDROME, PERIODIC LIMB MOVEMENT IN SLEEP, RHYTHMIC MOVEMENT DISORDER
NOCTURNAL ENURESIS

APPOINTMENT SPECIFICS

Setting up appointment:

Once a referral is received from the primary physician, the schedulers call the client to set up the appointment with one of the providers. All appointments must be scheduled to be completed within tow weeks. We take all insurances and do not set quotas or discriminate against any clients.

Once appointment is scheduled: Once your appointment has been set, you are encouraged to go to our website and file out/print out the new patient questionnaire and registration forms. This will reduce your wait time at the appointment.

We would also suggest that you come in with any relevant test results that you have including radiology studies. Preferably the studies on disk or the actual films.

On arrival, you will be asked for your insurance card as well as proof of identity (Driver’s license/passport). Any co-pays due will be collected at the time. For patients with deductibles and co-insurances, this will be collected at the end of the appointment as those costs will not be known till after the patient has been seen based on level of clinical visit and any procedures done.

 FOR PATIENTS WITH ASTHMA, COUGH, ABNORMAL PFT’S, PRIOR PNEUMONIA AND CYSTIC FIBROSIS

At the appointment:

All patients receive a full history and physical examination as well as demonstration of equipment, such as a spacer device, as needed.

Less than three years old:

In children less than 3 years of age, this marks the extent of in-office evaluation for asthma and a determination of diagnosis is based on history with emphasis based on number of wheezing episodes, duration of symptoms, effectiveness of interventions such as bronchodilators and corticosteroids, and a family history of asthma and or atopy. For children with cough, pneumonia and cystic fibrosis, they may require further evaluation including radiology studies, allergy tests as well as further studies including bronchoscopies.

Greater than three years old:

As with the younger children, a full interview and examination is done and pulmonary function testing is undertaken to better define presence or absence of abnormal lung function, airway reactivity and to establish a baseline and goals of treatment. For children with cough, pneumonia and cystic fibrosis, they may require further evaluation including radiology studies, allergy tests as well as further studies including bronchoscopies.

Pulmonary function testing:

Three years to six years.

Impulse oscillometry: This allows us to determine airway obstruction and reactivity by measuring resistance and changes in resistance with the use of bronchodilators. This is a passive test, very easy to reproduce and requires minimal effort on the part of the patient.

Six years and above.

Complete pulmonary function testing on first visit;   Spirometry, lung volumes, diffusing capacity and airway resistance.

At subsequent visits, spirometry and or impulse oscillometry are used.

Once a diagnosis is made/confirmed, the severity classifications and control classifications are then applied and a treatment plan is set.

Allergy testing:

For children greater than five years of age with suspected allergic asthma, skin testing is done. We have 9 panels that we use including: Tree, grass, mold household and various foods and animals.

Follow up:

Once a plan is made, the expectation is that the patient will follow up in a month to 6 weeks to assess initial plan and to make adjustments. After that, visits are spaced out to 2-6 months out depending on stability of the patient. Follow up appointments can be made sooner when needed, in the case of exacerbations.

Costs of those appointments will vary depending on what level of visit is done and the PFT or other tests done.

 ALLERGIC RHINITIS

At the appointment:

All patients receive a full history and physical examination. If necessary, the patient will have an allergy skin test done with results available at the time of the appointment. Patients typically have to be off all antihistamines for at least 10 days prior to the skin test. Patients may also require pulmonary function testing if their allergic symptoms are suspected of causing pulmonary complications.

Allergy testing:

For children greater than five years of age with suspected allergic asthma, skin testing is done. We have nine panels that we use including: Tree, grass, mold household and various foods and animals.

Pulmonary function testing:

Three years to six years.

Impulse oscillometry: This allows us to determine airway obstruction and reactivity by measuring resistance and changes in resistance with the use of bronchodilators. This is a passive test, very easy to reproduce and requires minimal effort on the part of the patient.

Six years and above.

Complete pulmonary function testing on first visit;   Spirometry, lung volumes, diffusing capacity and airway resistance.

At subsequent visits, spirometry and or impulse oscillometry are used.

Once a diagnosis is made/confirmed, the severity classifications and control classifications are then applied and a treatment plan is set.

CYSTIC FIBROSIS

At the appointment:

All patients receive a full history and physical examination as well as demonstration of equipment, such as a spacer device, as needed. Use of airway clearance device is discussed and demonstrated.

Bring to appointment: All radiologic studies done prior to the first appointment for review. Also bring all lab results and most recent medical records.

* We are not a CF center and while we are happy to provide care, we encourage all of our patients with Cystic Fibrosis to follow at their closest CF center. We are happy to serve as a back up but feel strongly that CF patients are best served at a CF center.

CF routine and annual labs: Our patients with Cystic fibrosis require some routine and some urgent lab work which will be ordered at visits.

Weight checks/Nutrition: Weight checks are a routine part of CF management, and in the case where weight is being lost than a food diary is encouraged so we can better assess nutritional intake.

Pulmonary function testing:

3 years to 6 years.

Impulse oscillometry: This allows us to determine airway obstruction and reactivity by measuring resistance and changes in resistance with the use of bronchodilators. This is a passive test, very easy to reproduce and requires minimal effort on the part of the patient.

6 years and above

Complete pulmonary function testing on first visit;   Spirometry, lung volumes, diffusing capacity and airway resistance.

At subsequent visits, spirometry and or impulse oscillometry are used.

Once a diagnosis is made/confirmed, the severity classifications and control classifications are then applied and a treatment plan is set.

SICKLE CELL DISEASE

 At the appointment: All patients receive a full history and physical examination as well as demonstration of equipment, such as a spacer device, as needed.

Sickle cell disease has significant effects on the pulmonary system, as a result our management is very comprehensive

Pulmonary complications of sickle cell disease:

Pneumonia

Pulmonary hypertension

Lymphoid tissue hyperplasia

Pulmonary conditions complicating sickle cell disease:

Asthma

Pneumonia

Obstructive sleep apnea

Given the strong relationship between sickle cell disease and pulmonary disease, we have a proactive approach to identifying and managing these patients.

Goal:

Identify patients that will benefit from aggressive early involvement of pulmonology in their long term care as a way of reducing disease complications and improving care and quality of life.

  • Screen patients for Asthma and airway hyperreactivity and hypersensitivity
  • Screen patients for sleep apnea

Obstructive: Patients with snoring, tonsillar hypertrophy, adenoidal hypertrophy or swollen turbinates

Central apnea: Patients with prior cerebrovascular attacks (Strokes) , prolonged hypoxemia.

Evaluation:

A full interview and examination as well as pulmonary function testing (PFT) to define presence or absence of abnormal lung function, airway reactivity and to establish a baseline and goals of treatment. In children less than 3 years of age, PFT’s are not done and diagnosis of asthma is based on history.

Pulmonary function testing:

3 years to 6 years.

Impulse oscillometry: This determines airway obstruction and reactivity by measuring resistance and changes in resistance with the use of bronchodilators.

6 years and above

Complete pulmonary function testing on first visit;   Spirometry, lung volumes, diffusing capacity and airway resistance.

Sleep Studies:

This is used to diagnose sleep apnea and periodic limb movement in sleep but may provide information about nocturnal hypoxemia, abnormal EEG patterns and EKG tracings.

Follow up:

Once the initial assessment is completed, a follow up plan with visits spaced out over 1-6 months out will be made.

APNEA OF PREMATURITY

 At the appointment: All patients receive a full history and physical examination. If the patient already has an apnea monitor, then the device is downloaded in the office and other prior downloads received are reviewed.

Apnea of prematurity

This occurs in infants that are born prior to their due date and typically less than 35 weeks gestation. It is characterized by short pauses in respiration, usually 5-10 seconds followed by normal breathing patterns. Occasionally, these events can extend to more than 20 seconds in which case they are considered more serious and significant. Also if there is associated heart rate changes, most particularly bradycardia, this can also indicate increased severity.

Causes: Immature CNS, hypopharyngeal hypotonia, anemia, feeding problems and GERD, heart problems, lung problems, infections, hypoxemia and temperature dysregulation.

Apnea of infancy

This is defined as a cessation of breathing lasting greater than 20 seconds or an event lasting less than 20 seconds associated with bradycardia, cyanosis, pallor or hypotonia.

Apparent life threatening event (ALTE)

An episode that is frightening to the observer and is characterised by some combination of apnea (central or occasionally obstructive), color change (usually cyanotic or pallid, but occasionally erythematous or plethoric), marked change in muscle tone (usually marked limpness), choking or gagging.

*Apnea monitors do not detect obstructive apnea*

At the appointment: All patients receive a full history and physical examination. If the patient already has an apnea monitor, then the device is downloaded in the office and other prior downloads received are reviewed.

Evaluation: Patients are followed monthly/bimonthly.

Review of downloads, if available, may reveal apnea associated with bradycardia. These are typically more significant than when not associated with apnea. Apnea with tachycardia may be seen in patients with seizure activity. Also apnea with bradycardia may be seen in GERD cases. Several apneic runs without associated heart rate change may indicate artifacts or may indicate a true disorder of central control.

Tests: Upper GI series to assess GI anatomy in patients with suspected GERD.

pH probe studies/milk scans to rule out GE reflux. Sleep studies+/-Expanded EEG montage for patients with suspected obstructive sleep apnea +/- seizures.

In more severe cases we would consider doing an MRI of brain and brain stem, sepsis work up, CXR, flexible bronchoscopy, RSV screening, or PHOX2B genetic testing.

SLEEP DISORDERS

Sleep referrals will be expected to fill out a new patient questionnaire at the appointment. This can be filled out prior to coming for the test.

INSOMNIA

For patients with insomnia and hypersomnia, sleep diaries should be completed for the 2 weeks prior to the appointment when possible. Appointments may be with the medical provider only or may be with both a medical and psychology specialist

SLEEP APNEA

Patients with suspected sleep apnea and snoring conditions may require an office visit prior to having a sleep study scheduled

HYPERSOMNIA/NARCOLEPSY

Patients will require an office evaluation including a history and physical examination prior to a sleep study and multiple sleep latency test (MSLT) that will be scheduled on a different day than the clinic appointment