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  • Experience

    Dr. Earl has practiced urgent care, occupational & family medicine for over 30 years, is an instructor and medical director for NADME - the National Academy of Medical Examiners, for DOT exams. He has been a practice management consultant and educator to individual practitioners and billion dollar healthcare organizations.

  • Consumers - Patients: Informational & Educational Only

    This service is provided as a convenient reference source of a general nature. Although any specifics you supply will be addressed as best as possible, responses are of a general nature and not intended to offer medical advice to a specific individual. There is no establishment of a physician-patient relationship and no HIPAA requirements will apply. Any questions posed here may be published on this or similar sites but will not identify any individual. Some questions may require additional research and documentation offline and included in the consultation fee.

  • For Physicians and Practitioners

    This service is provided as my expert opinion. Although any specifics you supply will be addressed as best as possible, for management issues, further analysis of your practice may be required to offer more specific advice. For clinical issues these are my opinions only, no physician-patient relationship as a consultant will be established with me, and you are wholly responsible for any diagnosis or treatment decisions. Some questions may require additional research and documentation offline and included in the consultation fee.

Consulting Session One Hour
$500
Consulting - half hour
$250

What Kinds of Questions Can I Ask?

I had a stroke in cortical/sub cortical portion of my brain does that disqualify me from a dot medical card?

I told the dr that did my DOT physical that I snore. He automatically said or interpreted that I have sleep apnea. I have no symptoms of sleep apnea. I did a home test for sleep apnea and it was inconclusive. I have never fallen asleep while driving nor had an accident from falling asleep. I don't have the money to pay for another test. I feel that they are discriminating against me because of my size.

wondering get if diagnosed with it sleep apnea that is will I get my machine ASAP or have to wait if I have to wait after being diagnosed with it I could have a heart attack or stroke while I'm sleeping how would that bring that up to him to get one ASAP

I had a massive stroke almost 5 years ago I wanted to know if I can drive a tractor trailer again?

I have certified a driver for 3 months and now he has returned with a appropriate treatment and documentation. My question is regulations have changed and Does this person need a New exam in order to now be given a year card.

Was wondering if peripheral neuropathy is an absolute disqualification for DOT clearance? My 67yo male pt has had neuropathy since 2003 from chemo for non-hodgekins lymphoma. Neuropathy has not progressed. lymphoma in remission since. has spatial awareness and pressure awareness, just 2/6 points absent on pin prick testing to plantar surface bilat feet. Otherwise in excellent health.

I have a case with where the patient is diabetic and his hemoglobin is 8.4 and he is on gabapentin for neuropathic pain which his primary MD states is very effective and he as good alertness with and she should not be restricted with driving as he has good results with this medication.  Next he has Sleep apnea.  This is where I am slightly confused. This is what his Sleep MD wrote:

1.Mild obstructive sleep apnea. Frequency of device use is good.., but his average duration of CPAP device use is poor; in fact, his duration of use is so short that he is essentially not receiving any objectively defined medical benefit. He was again advised that if he wishes to obtain any medical benefit, he needs to consistently exceed 4 hours of use on 70 % or more days.

  1. Use is ineffective. From a sleep medicine DOT perspective, his OSA is mild and so CPAP is not mandatory based upon his OSA severity from 2014. OSA severity, though, may change over time (rarely for the better).  With either ineffective duration of CPAP use or no CPAP use, sleep testing should be repeated every 2-3 years (which would be in 6-12 months at least).
  2. His sleep apnea is well controlled when he wears his CPAP and there is no indication for any setting changes.

He was seen on Jan 6th of this year. He did give me a compliance report but I am not sure what I am looking for but that we want them to wear it for 365 days and greater than 4 hours. I have been told this is what the DOT really want us to include. So I always ask for this along with a letter.

My question is do I certify him for 6 months and then he will have a sleep study done again and then he can come back? Or Do I disqualify his as he does not use his CPAP.  I am worried because he does not use it and if it is worse this could create a problem. The report says he uses it 7% of the time greater than 4 hours and 89% of the time less than 4 hours. The MD states right in his note that for DOT this is not a problem but it could have become worse, yet he also says he has no medical benefit from it either. His Epworth score is 3. What would be your thoughts?