Tuesday, April 15, 2014

Joe Goofus and the empty inhaler

I'm going to violate the patient confidentiality code and give you an update on our good friend Joe Goofus.  He's not informed enough to know about laws, so I'll take a risk here and assume I'm right.

He has been showing up in the emergency room a lot recently, requiring me to give him a boatload of Ventolin, and the nurse to give him bursts of corticosteroids to open up his lungs.  The medicine works every time, although as soon as it's out of his system he's right back in the ER.

It's frustrating, I'm telling you.  I educate him on how to care for his asthma, and it goes in one ear and out the other.  To be honest with you, it gets kind of annoying.  This guy is his own worst enemy.

I think this guy is in a world of hurt.  One of these days he's going to pick up a virus, like the flu virus, and he's going to end up with an asthma episode so severe we will not be able to save him.  I'm serious.  This guy is a quintessential example of a low informed asthmatic.

As a concerned asthmatic respiratory therapist, I screen out guys like Joe.  I ask all my asthmatics the following questions:
  • Do you have an asthma doctor
  • Do you take your asthma medicine as prescribed
Joe Goofus answers NO and YES.  Whoa, that may have surprised you there, but not me.  I don't fall for the "yes I have an inhaler bit." 

I say, "You been using your inhaler a lot, haven't you?"

"Well, yeah, I guess I do." He says, nodding his head, rolling his eyes.  

A bronchodilatoraholic can't fool me.  I know them like I know the backs of my formerly Ventolin stained fingers.  

After a few hours in the emergency room, his breathing is better.  The nurse reads him his discharge instructions knowing he's not going to follow them.  

I'm telling you his story because I don't want you to be a Joe Goofus.  I want you to take care of your asthma so you don't have to keep seeing guys like me.  I do not want YOU to be a goofus asthmatic.  

If you are a Goofus -- and most of us are, actually, so don't be embarrassed -- you'll want to get on the path to being more like Jake Gallant.  Ah, our friend Jake Gallant even makes me look like a Goofus he's so perfect.  

Yet Joe has some advice for us:
  1. See your asthma doctor at least once a year
  2. Take your asthma medicine exactly as prescribed
  3. Create and utilize an asthma action plan
There, how's that for keeping it simple?  

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Monday, April 14, 2014

What is pulmonary wasting?

The following is from the COPD community at healthcentral.com.

Your Question:  What is pulmonary wasting?

My answer:  I believe what you're referring to is the wasting of muscles due to inactivity as a disease like COPD progresses. A significant reason for inactivity may be progression of the disease, which may be indicitive of incresased shortness of breath, decreased energy, and depression. Muscles that may become wasted are those used for walking, standing, and eventually breathing. This is one of the reasons why the medical community encourages all people diagnosed with COPD to stay as active as possible, such as can be done at a pulmonary rehabilitation program. Another reason it may occurr is the loss of ability of your body to absorb necessary nutrients. For this a physician may refer a patient to a dietician, who may recommend eating smaller meals more often, and eating food high in nutrients (such as protein) that your body needs for muscle growth.

Thursday, April 10, 2014

Brief history of mesothelioma

If it wasn't bad enough that mesothelioma offers its victims a grim prognosis, even worse is that people knew that asbestos caused it and did nothing about it.

In fact, while the public was made aware of this in 1980, asbestos manufacturers and distributors knew about it as far back as the 1950s, and "made a concerted effort to hide the dangers of asbestos from the public, while at the same time profiting heavily from the sale and manufacture of harmful asbestos products," according to mesothelioma.com.

The cancer was first reported in the middle of the 19th century, although it wasn't until the 1950s, when there was a rise in incidence of the disease, that the cancer was further investigated, and a link between asbestos and mesothelioma was discovered.

According to asbestos.com, Dr. Rene Laennec, the same person who invented the stethoscope, discovered tumors in the pleural cavity, and he suggested that it could arise there.  However, in 1843, Dr. Karl Frieherr von Rokitansky said pleural cancer was never formed in the pleural cavity, and must have metastasized from cancer that formed elsewhere in the body.  It was Rokitansky's theory that was best accepted by the medical community.

Rokitansky, by the way, was also the first person to report cancerous cells inside the peritonial cavity, and was, therefore, probably the first person to report a case of peritonial mesothelioma.

curemeso.org notes that the disease was first discovered in the lymph nodes, and a theory developed that the disease started in the lymphatic system and made it's way to the mesothelial layer around the lungs.  In 1891 it was discovered that the opposite twas true, that the cancer developed in the mesothelium.

In 1909 Dr. J.Gl Adama coined the term mesothelioma, although it was not until 1921 that the term mesothelioma was used to describe the cancer. In 1931 Dr. P. Klemperer and C.B. Rabid devised a series of tests and procedures that were used to properly diagnose the disease, and this allowed for better diagnosing occurred. With proper diagnosis, physicians and scientists were better able to investigate this disease.

As an increasing number of cases of the disease were reported during the 1930s and 1940s, more research was done on the disease.  By asking questions of the victims, a link soon developed between asbestos exposure and mesothelioma.

curemeso.org reports:
It was (Dr. H.W.) Wedler in 1943 who reported a connection too high to be coincidental between asbestosis and pleural malignancy in a population of German asbestos workers. The analysis, which factually reported the connection but made no attempt to stamp the disease with a label, was widely accepted in Germany and ignored in the rest of the world. It wasn’t until the early 1950’s that additional evidence rescued the observations of Wedler and began to build an irrefutable connection between the development of cancer from asbestos exposure.
So by the 1950s this link was confirmed and well known by the manufacturers of the produce, but nothing was done about it.  Some speculate that because of such negligence some 2-3,000 people are diagnosed with mesothelioma each year.

It is for this reason that you hear so much from lawyers letting people know that if they or a loved one is diagnosed with mesothelioma they may be able to hire a lawyer and seek compensation.

Dementia now linked to cigarette smoking

Several years back on this blog a study was discussed that proved a relationship with COPD and dementia.  I haven't seen much else on this subject until a March 3, 2014, post "COPD and Cognitive Loss," by Valerie Neff Newitt, at Advance: Respiratory Care and Sleep Medicine.

The article suggests that, if telling a patient that COPD is now the #3 cause of death isn't enough to convince them to quit smoking and make the necessary lifestyle changes necessary to improve lung function.

The article is based on a recent study by the Mayo Clinic that confirmed the earlier findings, adding that, acccording to  Newitt, people with COPD are twice as likely to develop mild cognitive impairment (MCI), which is a fancy way of saying early dementia.

So now we can pretty much add dementia to the long list of co-morbidities associated with COPD, diseases which are linked to smoking cigarettes, which include the top four causes of death in America: heart disease, cancer, lung disease, and stroke.  It also includes diabetes, allergies, infertility, gum disease, and ulcers.

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Wednesday, April 9, 2014

What is mesothelioma?

Image from mesothelioma.com
The public first learned of the dangers of asbestos exposure in 1980, the same year that Steve McQueen died of the disease.  The problem now was that the material was in nearly every home, every business, every military ship, and every submarine in the United States.  Yet it was in this year that the public first learned that asbestos was linked to a deadly form of cancer called mesothelioma.

Anyone involved in the production, transportation, or handling of the material is at risk of inhaling the tiny fibers of the material that get into the air and are inhaled or ingested.  The thin layer of cells lining the bodies internal organs, known as the mesothelium, becomes inflamed, and then scarring forms that can later lead to the development of cancerous cells.

This is a significant form of cancer because mesothelial cells produce materials that help the organ function.  For instance, pleural mesothelial cells produce a slippery, non-adhesive covering for the organ, although it also has other functions, which include the transportation of cells and fluid, inflammation and cell repair, among others.  Cancerous cells may disrupt this function.

There are three places in the body this type of malignant cancer forms:
  1. Pleural Cavity: The protective covering that wraps around the lungs. This is the most common form of the cancer, as it occurs in about 70% of cases.  It is generally called Pleural Mesothelioma.
  2. Peritonial Cavity: The protective covering that wraps around the intestines. It is generally called Peritoneal Mesothelioma.
  3. Pericardial Cavity: The protective covering that wraps around the heart. It is generally called Pericardial mesothelioma. 
Symptoms of mesothelioma generally do not appear until many years after exposure, so it would not be uncommon for a Vietnam veteran working in the boiler room of a ship or submarine to be diagnosed today with the disease.  

Early symptoms generally mimic other diseases, such as those present with common colds and flues.  

There is no cure.  However, if discovered early enough, treatment includes chemotherapy, radiation, and removal of the affected lung portion. There are also some clinical trials going on with experimental medicine that might also help reduce mortality and morbidity.

The bottom line here is that if you suspect that you or someone you love or care for has been exposed to asbestos in the past, it's a good idea to communicate this with a physician so the situation can be monitored.  The best chance for treatment is an early diagnosis.

A great place to begin learning about this disease and what you can do is to check out mesothelioma.com.

References:
  1. Mesothelioma.com
  2. Matsaers, Steven E., "The Mesothelial cell," The Internal Journal of Biochemistry & Cell Biology, January, 2004, Volume 36, Issue 1, pages 9-16, http://www.sciencedirect.com/science/article/pii/S1357272503002425, accessed 4/26/14

Tuesday, April 8, 2014

Asbestos linked to mesothelioma

Mesothelioma is one of the deadliest forms of cancer, and one of the most common causes is exposure to microscopic particles of asbestos that make it into the air and are inhaled by those who handle it.

According to mesothelioma.com, asbestos was used as early as ancient Greece, and in ancient Rome as a building material.  It was also used in the fabric to make clothing.

The material became popular again during the industrial revolution because it was found to have fire and heat resistance properties.  It was found useful as an insulator, especially around pipes.  According to mesothelioma.com:
During the Industrial Revolution, asbestos found new uses in factories and other heavy industries throughout the United States and abroad. Asbestos found use not only in factories, but also in oil refineries, chemical plants, on railroad cars, and in shipyards. Asbestos materials were used to insulate pipes and boilers in steam locomotives, to line tanks and ovens in refineries, and could be found literally everywhere aboard the nation’s ships, from engine rooms to galleys. As the twentieth century progressed, more uses for asbestos were found. It was used in the brakes and clutches of automobiles, insulated America’s new skyscrapers, and was used extensively in the construction industry, where it was used in asbestos products like joint compounds, cements, roofing shingles, ceiling and floor tiles, siding, stucco, plaster, and much more. Those workers at risk included any that worked in an asbestos-heavy industry or frequently handled these products.
Any person who comes into contact with the material is at risk for developing mesothelioma, including electricians, plumbers, boilermakers, carpenters, mechanics, and machinists.  The material was also used during WWII and the Vietnam War, particularly on warships and submarines.  While anyone in the military -- army, navy, air force and marines -- may have been exposed, those in the Navy were at the greatest risk.

On December 22, 1979, Steve McQueen, one of the best guy actors of all time, and the top box office draw during the 1960s and 70s, was diagnosed with pleural mesothelioma. It was later revealed to him that asbestos was used in the auto racing suits he used during his car racing days.

Asbestos was wrapped around pipes in homes and schools.
The material was also used in material that wrapped around pipes in homes and schools, so women and children were also at risk of exposure.

Likewise, housewives, or anyone washing the material that contained asbestos , are also at risk of second hand exposure to asbestos, and therefore are also at risk for developing mesothelioma.

By the time the public became aware of the dangers of asbestos exposure in 1980, it was too late: the material was everywhere.

Monday, April 7, 2014

Asbestos awareness week begins

Today begins asbestos awareness week.  Asbestos is a product commonly used in work areas and households.  Exposure to it can cause a form of cancer called mesothelioma, an aggressive and deadly form of cancer.

I am reminded of the dangers of asbestos by Heather von St. James, who is one of the more recent victims of the disease.  She said:
Eight years ago, I was diagnosed with mesothelioma; a rare and deadly cancer caused by exposure to asbestos. I had just given birth to our daughter Lily, and was only given 15 months to live. After a life saving surgery that included the removal of my left lung, I made it my life’s mission to educate people about this deadly disease and it’s cause.
This week on the RT Cave we're going to learn about asbestos and how it became linked with one of the most deadly forms of cancer.

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