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Thursday, April 12, 2018

A Conversation With My Son

So, this is not respiratory therapy related. But, we all have families. And we all enjoy kids. So, here's a little conversation I had with my 7 YO a few days ago.

Son: "Dad, what does the F-word mean?"

Oh, keep in mind I have a teenage daughter. And my son will not say these words. He will only refer to them.

I said, "Ummmmm"

While I scratched my head in search of a good answer, he spared me. He said, "Does it have something to do with the S-word?"

"What S-Word?" I asked.

He sad, "You know: S-E-X."

I did not answer. After a short pause, he said.

"Say it day. Say the s-word."

"I said, "The s-word."

"No, say the actual s-word."

"The actual s-word."

"No. Say S-E-X."

"S-E-X."

"Dad, just say the word," he continued on, calmly, cooly.

"Fine," I said, "Sex." Pause for effect. Then I bravely added a question. I asked, "What does sex mean, anyway?"

He smiled, and said, "You know, it's short for sexy."

Monday, January 8, 2018

I won't remember you

"Hi, John! "How's it going?" The person says. I'm at Walmart. My mind races to find the gray matter where in my mind that brings forth a memory of this person. Nothing!

"Hi," I say, "How are you doing?"

"Great!" The person says."  Then she starts talking to me as though I know who she is and what she's talking about.

I am so guilty of this. My favorite part of my job is having conversations with patients. I've discussed many of these discussions on this blog. I am so willing to talk about God and politics even. I mean, you do so appropriately. But I have had such deep conversations with people.

So, this person is probably one of them. But there's so many of them. There's no way I can remember them all.

My wife remembers all her patients. She knows them all when she sees them. If she wanted to, if it weren't for HIPPA, she could entertain me with stories about people she meets. But not me. I don't remember.

That's just me. I just don't remember.

And it doesn't matter if you are readmitted to the hospital or if I meet you at Walmart. And it's even harder at Walmart because you won't have a robe on. There's a chance I might have a flashback if you have a robe on.

Monday, December 18, 2017

The Best Christmas Gift Is Time

A week before Christmas every year we walked across the street to the nursing home. This would have been in the 1970s. I would have been seven, eight, and nine. This would have been on Monday nights. That’s when we had Catechism classes at Manistee Catholic Central.

So, here it was December 1976. We were all to bring in some gift. My mom bought me a handkerchief. So, that was my gift. It seemed like a stupid gift. But I wrapped it as awkwardly as a seven-year-old might do this. I walked my gift with my class across the street.

My teacher opened the door to the nursing home. The redolent smell of bleach and urine. It was an old building, so there was also that old musty smell old buildings have. Back in 19th century, up until 1970, it was a hospital. It was Mercy Hospital. My grandma said it was one of the most beautiful hospitals. It had a huge Church cathedral in the middle. They tore the Church down left the rest to become this nursing home.

Immediately we saw old people. There was a crooked old man. There was another man who made awkward movements with his face. Another who made awkward gestures and movements with his entire body. There was another who was in a wheelchair and breathing funny. They were all looking at us. They all seemed to be happy.

Our group was split up into small groups. My group was introduced to a group of very, very old men sitting at a poker table. And I was introduced to one old man. He looked very plain. He had greasy hair and glasses. He wore a button down shirt. In the shirt pocket was a white hanky.

My teacher said, “This is your buddy.  I awkwardly handed my buddy my gift.

His lips turned into a smile. As a typical 7-year-old, I was quite taciturn around strangers. The old man asked me questions.

“So, how old are you?”,

“Seven.” I said, after a long delay.

“How do you like Catechism?”

“It’s okay.”

“What do you want to be when you grow up?”

“I don’t know.”

“Do you like firetrucks?”

“Yes.”

“I used to be a fireman.” His smile grew. “It was a fun job.

I said nothing. I looked at the ground. I looked at my shoes.

“Do you want to be a fireman, you think?”

“Yeah.”

“This is a nice wrapping job,” he said. I looked up and watched as he opened it.

“This will come in handy,” he said, pulling out the white hanky.  He pulled the old hanky out of his pocket. He set it on the table. He folded my hanky. I was impressed at how neatly he folded it. He put it in his shirt pocket so just the top was shown. He patted it slightly. He looked down at me. He smiled.

“This will do just great,” he said. He patted me on the head.

My teacher said it was time to leave. I left the nursing home with my class. We crossed the highway. We went into the school. We walked down the hallway to our classroom. I sat in my desk. When we were all seated, the teacher walked up to me. I looked up at him.

“How did your buddy like your gift.”

“I guess… he liked it.”

“What was your gift.”

“A stupid hanky.”

“That was a nice gift,” my teacher said. “But he didn’t care about that hanky.”

“He loved it.”

“Really?”

“But that’s not what made him smile.”

I said nothing.

“What made him smile was YOU. You were God’s gift to him.

“What do you mean?” I asked.

“Sometimes, the greatest gift of all is the gift of time.”

I think all of us in healthcare realize this eventually.

Sunday, December 17, 2017

So, they wanted to talk to us about VPAP. Their goal was to sell VPAP units. They kept talking over each other so you could see their excitement. VPAP units work. Studies show they prevent readmissions for COPD, so they said.

They said it's easy to qualify patients for VPAP. All they have to do is have one blood gas with a PaCO2 greater than 50. It doesn't matter when that ABG was done. It could have even been done in the ER when the patient was having a flare-up. 

One of the reps said that it's easy setting patients up on VPAP. All we had to do was notify them that a patient qualifies. Then they take over from there. They said that they talk to the doctor. They said that they talk to the patient. And then they set the patient us. 

One of the reps is the one who works with the patients. He said that he has been doing this for two years, and only had one patient reject the machine. He said they are tolerated that much. 

They made VPAP sound so good. They made it sound way better than BiPAP. And, as a bonus, it's hard to qualify a patient for home BiPAP from a hospital admission. 

So many times we have had people on BiPAP. They had high PaCO2 levels at one point. But when it came time to discharge the patient, we were unable to qualify them for home BiPAP. So, not getting the BiPAP that they needed at night, they ended up being readmitted within a week or two. 

So, the idea that VPAP works just as well as BiPAP. The idea that it is well tolerated. The idea that it's easy to set patients up with them for home use, was well accepted by the folks at the RT Cave. 

My question is: is this too good to be true. Are we too quick to accept this? After all, these reps aim to make money off this. They are making money by getting Medicare to pay for VPAP machines. And, I've been told that it's these types of people who funded all the research. So, is the research tainted? These are questions I aim to investigate. 

Anyway, I do see good about VPAP. I have seen a few patients using them who tolerated them well. But I'm still curious what the studies show. 

Thursday, December 14, 2017

When Someone Says, "Am I Going To Die!"

“Am I going to die?”

It’s a question I’ve heard many times over my 20 years as a respiratory therapist.

Yeah! Like, how do I answer that?

Here I was, fresh out of RT school, and I was posed with this question my very first day on the job.

I said nothing.

I just stood there at the edge of the bed feeling guilty that I did not know. I wanted so bad to give an answer. I wanted so bad just to get out of the room. I felt so guilty.

I was posed with the same question a few weeks later. She was 62-years old. She was recently retired. She was looking forward to enjoying her retirement. She had worked so hard to enjoy this benefit of life. She was recently diagnosed with end-stage COPD. She was also diagnosed with pulmonary fibrosis. It was a big double-whammy!

We had become friends, of sorts. We spent lots of time together due to her disease. I was with her in the emergency room. I was there when she was first put on a BiPAP machine. I gave her numerous Duoneb treatments before she was admitted to the floors.

I made sure she had a bedside table to lean on. I gave her a pillow to rest her elbows on. I saw that she had sweat beads on her head as she worked hard to suck in air. I found her a fan to help cool her off. It produced a smile on her face.

And then, every 2-3 hours, I was there to give her more Duonebs.

Once she caught her breath we talked. She had a bible on her bedside table. I asked her what her favorite passage was. I said, “If you were to meet someone right now who said he didn’t believe in God, what passage would you recommend.” She said, “John, Chapter 1, Verses 1-4.”

We talked about that for a long, long time. Our conversation segued to her children. It segued to politics. We talked about all sorts of things. Often, I found myself sitting in a chair next to her bed long after my task was complete.

Then she got worse. I was ordered to place her back on BiPAP. It got so bad that she didn’t want to go off the BiPAP. I’d ask, “Does this make your breathing easier?” She’d say, “Yes!” Or, since it’s hard to talk with a mask over your face, she’d just nod.

One morning, early in my shift, I took the Bipap mask off her face. I placed her on a nasal cannula. I did this so she could eat. She struggled mightily to breathe off the BiPAP. She looked up at me with her big blue eyes and humbly asked, “Is this what it’s like to die?”

What do I say to that?

I said nothing.

I stood there silent. I felt so horrible as she asked it again.

She must have thought I would have a good answer. I was her friend, after all. I should be honest with her. But I did not know the answer. I did not know. I felt guilty for not having an answer for her. So guilty!

In fact, I felt so awkward by the question that I just wanted to leave her room. Okay? Like, yeah! It was not a good moment for the 27-year-old version of me.

She did not die that night. I do not know whatever happened to her. But, the questions she posed to me still linger in the back of my mind. I still do not have a good answer. I do not have an answer even though I am now a seasoned RT with 20 years experience.

And it happened yet again! It was a few weeks ago. She posed the dreaded question:

“Am I going to die?”

She said, "“Is this what it’s like to die.”

She said this as she struggled to breathe at the bedside. She was leaning on the table. Her elbows were cushioned on a pillow I had given her. Her breathing seemed aided somewhat by the Duoneb breathing treatment misting over her face under the mask. She even managed a smile as she waited for my answer.

I said nothing.

The only difference between then and now is that I had 20 years experience in the middle. I had seen this numerous times. And here I was still not knowing what to say.

But, this time I did not feel guilty not having an answer. I read somewhere that, in such situations, silence is okay. Silence shows that you care.

I talked to a nurse about this once. She told me her answer: "I do not know! Only God knows." 

And this is true.

And this is true. But still, I personally find that silence is the best answer. That's how I answer the dreaded question.

Here's the truth we all know. You do not know when someone is going to die. It is true that only God knows. I have seen some people die hours after these moments. I have seen others recover and live another 10 years or so, maybe longer.

So, there is no correct answer, as far as I know. If you can think of something to say, I think that's okay. But, if you can't, just being there is all the answer that is needed. Silence is okay!

So, what do you say when someone says, “Am I going to die.” I read somewhere that it's okay not to have an answer. In fact, some experts say that the best answer is simple silence. It shows compassion. It shows you care.

What are your thoughts? What do you say when someone says, "Am I going to die? Is this what it's like?"

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Monday, December 11, 2017

Myth Buster: You Can Lose Weight And Gain Muscle At Same Time

Two friends were discussing dieting. Friend A said he wanted to lose weight and gain muscle. Friend B said, "You can't do both at the same time." 

I intervened: "That's a myth because you can.

Friend B said, "No you can't. It's impossible." 

I said, "It is possible, and I have. That's the entire premise of work out programs like the Body-For-Life." 

"Do you have proof?" he said.  

"Yes. As a matter of fact, I have loads of proof. I have articles. I have myself."

"What do you mean, you have yourself." 

"I am proof. I have lost weight and gained muscle lots of times. I have lost up to 40 pounds while gaining muscle. I mean, I'm no Arnold, but I do have some muscle tone that didn't exist."

See, that was the end of the discussion. But this highlights the difference between common sense and what they teach in colleges and universities. They teach conventional wisdom. They teach the same stuff that has been said over and over and over without citation. 

You have to eat breakfast. You can't eat eggs. You can't lose weight and gain muscle at the same time. Cholesterol causes heart disease. Salt causes high blood pressure. All of these are myths that do nothing but cause people to eat boring foods that are not satisfying. Foods that make it harder to lose weight.

So, just ignore them all. I mean, do your research. Sometimes the conventional wisdom people are right. When they right give it to them. Let them know they are right. But, when they are wrong, ignore them. You don't have to argue with them. But when it's your children, I think you ought to share what you know. 

Go to Hussmanfitness.com. John Hussman is a doctor. He's also a weight loss expert. He proves how you can lose weight and gain muscle at the same time. So, don't just take my word for it. I mean, I've done it. But, take the experts advice before mine. 

In fact, there are lots of people I know who have lost weight. They all look good. But those who participated in a muscle training program developed muscle tone while they lost weight. Anyone who loses weight looks nice. But those who also gained muscle look all the sharper. 

Further reading:

Monday, December 4, 2017

Myth Busted: Eggs Are Now Good For You

I started eating healthy in 1998. The diet I did was the Body-For-Life Diet. I still stick to this diet, although with my own moderations. One of the moderations I made is that I now eat eggs every day. I eat lots of eggs. I eat two for breakfast and then I eat 2 more as a snack for brunch. Sometimes I eat more than that.

I told this to my son the other day. He goes to the University of Michigan, so you know he's smart. But, a University education doesn't necessarily mean you are getting useful information. He said, "I bet your cholesterol is high."

I said, "That's a myth."

Actually, my cholesterol is normal. This is after eating 4 eggs nearly every day for over a year. So, if conventional wisdom were true, I'd be well on my way to having a heart attack. But, the truth is as it is, this is not the case.

I mean, I don't even have heart attack genes. There is no evidence of heart disease in my family. So, I'm certainly not going to worry about having a heart attack. But, I'll save that for a future post.

The truth is that I hated doing the BFL diet prior to when I started eating eggs. Sometimes I would get those fake eggs you get in a box. The ones that don't have the yolk. But they are expensive. My wife stopped buying them years ago. So, I've had to make do without eggs.

But that ended about a year ago when I discovered that saturated fat doesn't cause heart disease. Then, as I did my research, I learned that eggs are actually good for you. They have lots of protein. So, eat up!!!

Eggs fill me up. Eggs give me satisfaction. Eggs are yummy no matter how you cook them. They are now the main staple of my diet. They make it so much easier to diet. I can't believe I went all those years without eating eggs based on a myth.

And I'm not the only one. My nephew is trying to add weight. I noticed the definition on his arms when I saw him at hunting camp. We had a discussion about working out. He said, "Eggs are the staple of my diet."

I said, "Yeah! Same here. I suppose, if conventional wisdom were to hold true, we will both be dead of heart disease in about ten years."

But conventional wisdom, once again, is proven false.

The result is that I lost 30 pounds eating eggs. I did not gain weight. I also did not gain a high cholesterol. I'm not using myself as proof. The myth that eggs are bad for you was busted before I started eating them.

In fact, before I started eating eggs every day I had trouble getting enough protein into my system. Now weight loss experts like Jillian Michaels champions for eating eggs.

What's so good about eggs? I'll delve into that in my next post.

Further Reading: