slideshow widget

Wednesday, January 2, 2019

Happy New Year!!!!!

The times have changed. Independent blogging isn't as huge as it once was. Most of us are now writing for other health communities, is the reason. But, I've managed to keep this blog going. It's still here for anyone to enjoy.

Something I struggled with is who to make as my general audience here. Initially I wrote to respiratory therapists and patients. So, it was a unique situation to be in. It would have been easier just to focus on the  respiratory therapy profession. Here I share wisdom, but also poke fun at some of the unique situations we find ourselves in.

But, I started out also telling my story about asthma. So, this sort of spawned my asthma writing career. And I also wrote about COPDers. There are the types of patients we RTs take care of nearly every day. So, it's kind of hard to have an RT blog and not focus on the patients we get to know on a daily basis.

So, here we are going into our going into our 12th year. So many things have happened in that time. So many people have turned to the RT Cave for a tip or for a laugh. It's neat that we are still around. And it's neat that you're still popping in once in a while.

So, Happy New Year! We're going to make this the best ever!

Friday, December 14, 2018

The Dim Stethoscope

You see them in isolation rooms. They are usually referred to as Fake Stethoscopes. They are made by Fake Incorporated.

Sometimes they are referred to as "Dim Stethoscopes." It's because you can't hear lung sounds for crap. So, you find yourself just writing or clicking, "Diminished."

And sometimes you don't even bother using it. I mean, it's been in the same room as a MRSA patient for a week now. And the lung sounds have been the same since the patient arrived.

And so you just scan the patient. You start the treatment. And you just (if no one is looking, that is) go right to charting. And, without even touching the Dim stethoscope, you click: "Diminished."

There is one exception. If the patient is wet. That's the exception. Because, if that's why the doctor ordered it, it's mainly because of that audible cardiac wheeze. You don't need a stethoscope to here it. So, you can then click on "Wheeze"

So, that's your prototypical dim stethoscope. The patient is dim whether you use it or not, so you might as well just not. But, usually you do. But, still, it's dim and dimmer. Thoughts?

Wednesday, November 7, 2018

A Consensus Is Not Science

You cannot vote on science. Science either is or is not. So a consensus is not science.

In 2010, The CDC's Advisory Committee On Immunization Practice voted. They voted that everyone over the age of 6 months should be vaccinated against the flu. (1)

Personally, I'm in favor of the flu vaccination. But, I will admit this is my opinion and not science. It is not science that the flu vaccine will prevent you from getting the flu. In fact, the flu vaccine, in the years researchers are the most accurate at guessing what viruses will be in the air in a given season, is only 40-60% accurate. (2)

This is because there are many, many, many different flu viruses. It's also because the flu virus can mutate. So, even if you are vaccinated against the H1N1 influenza A virus, you can still get the H1N1 virus.

This happened in 2009. The H1N1 flu virus is one of the most popular flu viruses. You are vaccinated against it every time you get a flu vaccine. But, in 2009, the virus mutated as it passed from birds to chickens to swine. It picked up swine DNA. This made it a different H1N1 virus. Even if you were vaccinated against H1N1, you could still pick up this virus. (3-4)

Another good example of how a consensus is not science is global warming. Ninety-seven percent of scientists are said to agree with global warming. But, a consensus is not science. Science either is or is not. So, just because 97% of scientists vote in support of global warming does not make it so. (5)

This is compounded by the fact that their same data suggests there has been no increase in global temperatures since 1998. (6)

I'm just saying.


  1. "Key Facts About Seasonal Flu Vaccine," CDC,, accessed 11/7/18
  2. "Vaccines Effectiveness: How Well Does the Flu Vaccine Work," CDC,, accessed 11/7/18
  3. "The 2009 Influenza Pandemic: Summary, Highlights, April 2009-April 2019," CDC,, access 11/7/18
  4. Micklos, John, Jr., “The 1918 Flu Pandemic: Core Events Of A Worldwide Outbreak,” 2015, Capstone Press, Canada, pages 10, 12-13
  5. "Scientific Consensus: Earth's Climate Is Warming,", accessed 11/7/18
  6. Lindsey, Rebecca, "Did Global Warming Stop In 1998,", accessed 11/7/18

Monday, November 5, 2018

My Health Insurance Company Called Again!

Those dog gone suckers just won't leave me alone. My health insurance company, that is. They called me for the 4th time to talk to me about talking to a pharmacist to review my medicine.

I actually tried to be nice this time. So, I just said, "Why do I need it?"

To be honest, I think me asking this threw the person off her script. She didn't know what to say.

After a long pause, I said, "I already talk to my doctor about my medicine. Why do I need to talk to a pharmacist."

"Well," she said, "It's nice just to have your medicine reviewed by a second person."

I said, "Why would I need that. Like I have said every other time someone has told me I need to review my medicine. I already review my medicine with my doctor. I'm also a respiratory therapist. What more is there for me to gain?"

Once again I threw her off script. And, allow me to add again that I tried to be very pleasant with my tone. I was a nice boy. I was hoping to get a good answer that satisfied me. I was hoping she would tell me that it was required or something. But she didn't.

She just said, "Sorry to bother you." She pleasantly hung up. Unlike the last time they called. That lady abruptly hung up on me. They probably think I"m a jerk. They fail to see why this would be annoying to me.

Keep in mind this happens every year. My insurance company calls me. My pharmacist bugs me every time I go to pick up a prescription. Like, this gets annoying.

This leaves aside my other frustrations with my insurance company. Like, I used to be able to get prescriptions filled when I needed them. Now they limit me to one a month no matter what?

So, what if my Symbicort gets lost? For the past 30 years I've always had spare inhalers. Now I can only have one. So, what if I lose it.  I ask that rhetorically, because i know the answer.

In fact, I think I know what I"m going to say the next time they call me (which will probably be next week). If I answer the phone, I'm going to say, "I will talk to your pharmacist if you allow me to get an extra Symbicort. If I lose one then at least I have a spare."

Tuesday, October 30, 2018

Who Died And Made Insurance Companies Doctors?

I usually stay pretty cool about things. But, I'm getting rather annoyed that insurance companies have more control now than doctor's do. I'm just beside myself at how annoyed I am about this.

For starters, my pharmacist insists he needs to sit down with me and review my medicine. The past two years I have adamantly resisted this. I don't need to review my medicine. It's something I do with my doctor when needed.

Why would I need to sit down with my pharmacist so he can tell me what I already know. Besides the fact I'm a respiratory therapist who is a writer who specializes in asthma. Like, I read up on asthma every day. Asthma is my specialty. Not saying I know it all, but I certainly don't need to be lectured by my pharmacist.

So, today I get a call from my insurance company. It's a call I have not taken until today. But, considering they are persistent and keep calling frequently, I finally took the call today.

And, lo and behold, a nice lady is on the other end. She says, "It's time for your yearly pharmacy review."

I said, "I don't need to review my medicine."

She said, "Okay, did you already do your yearly medication review with your pharmacist?"

I said, "Why would I need to do that when I know more than the pharmacist about the medicines I'm taking?"

To my dismay, she hung up. Was my tone too rude? Perhaps. That's not what I intended. I actually wanted to continue the conversation, because I wanted to inquire as to why they insist on continuing to bother my about this.

Look, I have worked hard to get to the point where I am with my asthma control. Like, I know what medicines I take and why I take them. And, quite frankly, I use my medicines, sometimes, in ways the FDA does not approve of yet.

For instance, Symbicort is used as a rescue inhaler in Europe. The idea here is that, if you're having a flare-up, you should be getting the extra steroid along with the beta adrenergic. I find this works great for me.

But, I say this to the pharmacist and I get a lecture. It's like, "You know, you can't use it that way."

And I say, "Do you know they use it as a rescue medicine in Europe. The only way it's not approved for use this way in the U.S. is because the FDA lags long behind Europe in this regard."

Of course, I usually catch them off guard with such statements like this. And so, they read from the script they were trained to memorize: "You should use your medicine only as directed by your physician."

I think that most doctors agree that asthmatics are better at managing their medicine than most physicians. That's why, for most of my life, my doctor has allowed me to do this. So, I don't need a pharmacist doing this for me. I certainly don't need a person sitting in a leather chair who never has seen an asthmatic reviewing my medicine with me.

I understand pharmacists are just doing their job. They are told what to do by the insurance companies. That's why they bother me. So, I'm usually nice to them. I make it quite clear that I know it's the insurance company that I'm irritated with, not the pharmacists.

So when the insurance company itself called me, that set me off. Like, I don't think insurance companies should have more power than doctors. My doctor writes the prescriptions he thinks I need. The pharmacists roll is to fill those prescriptions. My insurance company's role is to pay whatever they agree to pay. And that's it.

I imagine, since the person hung up on me, this might come back to haunt me somehow. I suppose, the next time my pharmacist wants to sit down with me, or when my insurance company calls, I might have to indulge them. But, I'm not sure I will be able to do that without sounding so annoyed -- because I am annoyed.

So, frustration lingers long in my mind about this insurance company having too much control thing. I don't want to start repeating myself. If you want to read more on this check out my post, "Are Insurers Smarter Than Doctors?"

Sunday, October 28, 2018

Now Hospital Policy Requires Goggles When Reading

RT Boss displaying new goggles.
You heard it here first. The Federal Agency for Efficiency (FAKE) has created a new regulation requiring goggles. They must be worn by employers who are on the clock when reading magazines.

I was kind of confused when I learned of this policy. It came down to me via the respiratory care manager at Shoreline Medical Center. He said he was required to write a hospital policy for Goggle Management.

I inquired as to why this policy was created. He said it passed the FAKE board by a vote of 8-1. The policy is expected to prevent wisdom from magazines from splattering off the pages of said magazines and offering wisdom to readers.

The goal here is to prevent workers from getting smarter. If they remain dumb, it's easier for said individuals to become brainwashed by top management officials. Ditto for government officials.

I called Mike Wisdom, the chair of the Fake Committee. He said "This is just the beginning. You can basically call this the test phase. The next step is to create a Goggle Regulation for students attending public schools. This goal, henceforth, is to prevent students from obtaining too much wisdom."

Personally, I think there is an underlying agenda here. You have government officials that try to tell people that raising their taxes will somehow prevent global warming. Like, I'm skeptical of the idea that raising my taxes will somehow prevent hurricanes and prevent ice glaciers from melting.

I think this is how they prevent doctors from questioning cook book medicine. Doctors, for years, treated every patient on an individual basis. If something wasn't need it, they didn't do it. This makes sense both in a medical fashion and for financial purposes. Now, however, doctors have accepted cookbook medicine. I think one of the reasons is because of Goggle Management. By keeping them stupid they don't question authority. They, in essence, become sheep.

The kind of thinking that I just did in the last two paragraphs is the exact kind of thinking the powers that be want to prevent, hence the Goggle Regulation and Goggle Policy at Shoreline Medical Center.

Punishment for not complying is a 10% wage cut. So, you can try not wearing goggles when sitting in your RT Cave. If you're like us, your cave is in a closet in the dark corner of the hospital basement. So, like, we risk not wearing the goggles.

And the fact that we do this is why I write this post sort of facetiously. Like, we don't want to be busted. But, if you can read between the lines, you know what I mean.

Monday, August 13, 2018

Best Sleeping Positions with Asthma

The following is a guest article by Sarah Cummings.

By Sarah Cummings
Guest Writer to RT Cave

Unless you have to live with asthma, it probably won’t really occur to you that the condition which has a profound effect on the respiratory system of the body can result in difficulty finding sound slumber on a regular basis. It’s not until you think about it that this actually makes sense and becomes clear.
Wheezing, coughing, and feeling breathless, are all symptoms that can create a hostile environment for mind and body to relax and settle in for a good night’s sleep.
What’s more, there are also people who can be diagnosed with a condition known as night-time (nocturnal) asthma. This has the potential to make asthmatic symptoms even more severe in the night-time.
What happens to our breathing at night?

When you head into the night, particularly as bedtime approaches, changes occur in conjunction with your ‘body clock’ or natural circadian rhythm.
For those who are healthy, these nightly changes aren’t anything to think about, but for people with asthma, it can cause the condition to worsen; obviously not what you want when you are trying to get a solid night’s sleep!
Examples of the issues you can endure are:
·      Your Airways becoming slightly inflamed and closing up to an extent
·      A decrease in your airflow
Making things even more of an issue is the fact that most bedrooms have an unhealthy quantity of allergens such as dust mites and pet fur, hair feathers or dander (similar to dandruff). You can become increasingly irritated by problematic things such as these, so, therefore, want to eliminate them as much as you can.
But, what about sleep positions?

Once you’re in bed and you’ve done everything else you can, it’s time to look at which sleeping positions will best suit the alleviation of asthma.
·      Prone position
The US National Library of Medicine National Institutes of Health claims that lying with your front or face downward, also known as the prone position has the ability to lessen the gravity effect on the upper airway and subsequent collapsibility.
Obviously, this will assist those with asthma as the airways will remain open for longer as they’re not at risk of the gravity effect, so by lying in prone position, you are much more likely to enjoy a good night’s sleep.
·      Supine position
This is a position you can try because your breath is unrestricted when lying in the supine position (sleeping on your back).
While it’s argued that the prone position might offer more benefits, lots of people find it unnatural to sleep on their front because they want to use their pillows for comfort, but having your face down in your pillow, or even to the side, can make it difficult to breathe.
One to avoid
·      Reclining Position
Opting for a reclining position may not also predispose you to night-time asthma problems.
A range of aspects can bring this about, including the build-up of secretions in the airways as a result of drainage from your postnasal drip or sinuses. There’s also the fact that this position increases blood volume in the lungs and bigger resistance on the airways
Finding the right sleeping position for you comes down to trial and error. You can try one thing and it won’t work so well, but then you try another and you’re back to easy-breathing relaxed nights of sound sleep that will help you to go to bed with much more confidence each evening.
You might want to take on board these additional tips that will help to influence how consistent, successful and worthwhile your sleep is:
Vacuum often

Dust mites afore setting up camp in carpets at home, so vacuum no less than twice a week to help shift them from your room.
For asthma sufferers, it is advisable to double bag, and as an extra precaution, you can wear a mask to avoid inhaling dust that’s sent into the air from vacuuming. You may well have one already, but you can use a good asthma-specific face mask for this job too.
Curtain call

If you own some heavy curtains, then it’s a good idea to switch them out for a more asthma-friendly option. Heavy curtains tend to be a breeding ground for dust and general bits and bobs, such as dead skin, and other airborne cells to gather.
A better option would be to have either lighter-style curtains fitted, or have blackout blinds installed.
Make Your Bedroom A Pet-Free Zone

Cats, dogs and birds make wonderful pets, but they’re prime allergy triggers, so allowing them in the bedroom should be an instant no-no.

If you think that your pet may be a trigger, get an allergy skin test to determine your sensitivities. To help you rest easy, make your bedroom a no-pet zone and then the risk is eliminated.