Interestging study regarding asthma and allergies

Studies show 75% of asthmatics have allergies. However, a recent study shows that most people with allergies were not sick yesterday. This was the topic of a recent blog entry at MyAsthmaCentral.com

Were You Sick With Allergies Yesterday?

As reported here in the Los Angeles Times, Gallup released a poll "while you were sleeping" that showed that 85 percent of Americans were not sick yesterday with allergies.


What might make this poll most interesting is "perhaps, because it has nothing to do with politics," the times reports.

So 15 percent of you were sick yesterday, and only 17 percent were sick last September. That's a percentage about the same as the approval numbers for Congress.

Gallup has been keeping track of who is sick with allergies since 2008, and has specifically been asking, "Were you sick with allergies yesterday?"

The report notes these results are self reported, and not based on medical diagnosis. So the results could actually be higher or lower, or mistaken for cold or flu symptoms.


"Further," the report notes, "Americans who treat their allergies with medication and thus are not 'sick' with allergies would also not be included.


To learn how to differentiate between cold, flu and allergy symptoms, click here.

Despite my personal opinion I wrote about here, this fall allergy season (2010) compares statistically with 2008, and is slightly worse than 2009 (see graph here).

Overall, the report shows that even during the winter months one in 10 (or 10 percent) Americans are sick with allergies. While 10 percent is a poor showing when it comes to political popularity, it's a significant showing when it comes to health.


This shows that allergies may have a significant effect on many of our lives, and is an important "diagnosis" to be funded, researched, and hopefully cured some day.
In our asthma community we are especially concerned because other studies show 75 percent of us asthmatics have allergies.


Likewise, according to the American Academy of Allergy, Asthma and Immunology (AAAAI.org), 54.6 percent of Americans tested positive for at least one allergen, and this adds up to about 40 to 50 million Americans. At least 50 percent of homes had at least six detectable allergens.


Yet despite advancements in allergy treatment and wisdom, there still isn't very much that can be done for many allergy sufferers, including myself. The best way to treat allergies is by avoidance of triggers, yet this is easier said than done as I wrote here.


Do you have allergies? How are your allergies this time of year? What time of year are your allergies worse? Discuss.
Facebook
Twitter

Less government equals less healthcare costs

Here's a perfect example of why healthcare costs so much. I went into the patient's room and she said the following:

I have no insurance. I have all the stuff to take a breathing tx at home. I know as soon as you start the treatment it's going to cost me $100, and I'm going to have to pay it. If you can talk to the doctor and have him write me a prescription for Albuterol solution, I can get it for $4 and I can give my self treatments for free at home."

You see, she is paying for her own medicine, and so she questioned what the doctor ordered. Because she was paying on her own, she didn't want to pay for it.

Now if she had health insurance, and if she had medicaid or medicare, and she never saw the bill, then she wouldn't care what the cost of that treatment was. She wouldn't have questioned the order.

This is a perfect example of why we need to have a healthcare system where there is an incentive to question the order. The truth is, at present, most of us don't. And that's why healthcare costs so much. It costs so much because people keep getting, and they don't pay. Since someone else is paying, they don't question the order.

Think about it. If you give something away for free, everyone is going to come running to buy it. So while supply of hospitals, doctors and medical equipment stays the same, demand for it goes up because it's free. Per basic economics 101, the price has no choice but to go up.

The best way to get the price of medicine to go down is to force people to pay for it themselves. Back in the 1960s this is how it was, and medicine was affordable. Ever since the advent of Medicare and Medicaid and HMOs and third party payers, healthcare has skyrocketed.

It's not a coincidence. The way to get healthcare costs down is to get the government out of it. The way to get healthcare costs down is to get Jane and John Doe to question the therepy they are being provided.

That way, what isn't needed won't be given. What's needed they will pay for. And yet the healthcare reform bill passed 6 months ago does exactly the opposite of that. It places more patient's on the government dole, which means more free (but it's not free) medicine for more people.

Look, there are some people who really, truly cannot work and really, and truly could use a helping hand. I'm all for them getting help. Yet that system of helping out the needy, or our retired parents, has gotten out of hand or out of control.

It's time we had more patients like I had today. The patient who says, "Hey, before you open that and charge me $100 bucks..."

Crossfire appreciated, yet no flames aloud.

Performance surveys: 90% is the new bad

So we had our monthly meeting this week. One of the things that comes up at each of them are various performance surveys. And the ironic thing is that no matter how good they are the bosses are never happy.

I know never is a generalization, but in this case it seems to be true. Shoreline contracts out a company to interview random patients to see what they thought of services provided, and the results showed for the caradiopulmonary department (or the RT Cave) were 95%.

"I know that sounds good," the RT boss said, "but that still means that 5% of the people are not happy with our services."

This is the kind of stuff we deal with at just about every meeting. Good is never good enough, as 95% is good. In essence, good is the new bad. To an idealist that might be a good thing. But to a realist like me it's simple insanity.

So at today's meeting I said, "You know what, Gary, that 5 percent are probably people who wouldn't be happy if you scratched their backs and picked their noses for them. We sit here and listen to you guys every month complain about really good performance reviews. Can we not find anything better to do?"

Of course then you get your political response, "It's always good to have a goal; to continue to strive for better."

"Yes, I know," I said, "and I think we all do that here. Everyone in this department gives 110 percent with every single patient. It's not just good, it's great to try to make things even better. I just think we can find better things to do with our time than deal with this stuff every month."

That was when my co-workers chimed in to back me up. Dale said, "Come on, Gary! Here we are doing stress tests, making people run on a treadmill until they're about to puke, and then we ask them, 'so what did you think of the stress test.' Well, some of them will simply say, 'it sucked.' Does that mean we provided a bad service. No! It means what we did wasn't any fun.

"We do ABGs," he continued. "We poke a patient where it ain't fun to be poked. And then we expect them to say, 'Excellent!' Come on! Let's get real here."

So the rest of the meeting played off this theme. Our intent was not to be negative or pessimistic, and I don't think we were. It was simply all of us RTs, who do all the work, who have to sit in these meetings every month, trying to make sense of why do we continue to do these performance surveys.

A similar session happened before and we were called complainers and whiners. I didn't say this yet I wanted to, so since this is my blog I'm going to write it here and pretend I said it to my boss: "There's an old saying: The truth hurts, and then it makes you better."

Spiriva may be good option for asthma

I thought it was interesting to learn that a new study published in the New England Journal of Medicine, and reported by the AP here, showed that Spiriva worked as well as Serevent to treat hardluck asthma, and better than the technique of doubling the dose of inhaled corticosteroids.

When a patient is diagnosed with Hardluck Asthma, which means they have difficult to manage asthma despite being Gallant Asthmatics on all the best asthma medicines, the asthma guidelines recommend using a higher dose of steroids (often doubling the dose) or adding Serevent to the routine.

Usually Serevent and the inhaled corticosteroid Flutocinase are used via the Advair discuss, which offers three different doses of the steroid (100/50, 250/50, and 500/50). Most often the 250/50 dose is provided to patients, yet those who require more steroids may be prescribed the 500/50 dose.

Yet, according to AP:

Researchers found Spiriva worked better than a double steroid dose and was as effective as Serevent. When the study first began, patients on average had 77 asthma-free days a year - days in which they had no symptoms and did not have to use their rescue inhaler.

Doubling the steroid medicine gave patients an extra 19 asthma-free days; taking Spiriva gave them an additional 48 days with no symptoms, and taking Serevent gave them an extra 51 days.

Spiriva is a promising alternative asthma treatment and some doctors are already using it in people who don't respond to steroid medicine, but more study on drug safety is needed, Dr. Lewis Smith of Northwestern University wrote in an accompanying editorial.

I used to take Atropine as a kid, and later Atrovent. Yet for some reason this medicine was phased out of my asthma medicine routine. I do know some asthmatics on Spiriva, and my doctor did ask me if I wanted to try it.

I responded I didn't see a need at the present time. Yet it seems it might be justified trying Spiriva if other medicines do not control your asthma.

Changing habits works to control lung disease

One of the things that finally allowed me to gain control of my asthma was changing my lifestyle. So it only makes sense that as I'm educating my asthma and COPD patients one of the things I emphasize is the importance of them changing some of their habits.

In our smoking cessation discussion, I emphasize the importance of changing your habits. For instance, if you have a cigarette while drinking coffee with your friends in the morning, do something else once you quit. If you think about smoking when you're out drinking with your friends, then perhaps it's time to find an alternative form of entertainment.

Turns out that what I learned by common sense was the topic of a recent Anderson Analytics market research study, reported on at Medscapes today in this post, "Study Finds Habit Changer Twice As Effective Than Popular Methods In Overcoming Cigarette Smoking Habit."

The article reminds us that over 9.2 million smokers attempt to quit every year. In the study, some of the participants completed a 42 day program that taught participants to quit smoking by changing their habits, and the other half just used nicotine replacement therapy and/ or medicine like Chantix as a means to quit smoking.

The results of the study were conclusive, as Medscapes reports:

"Overwhelmingly, twice as many respondents (80%) who completed the "Quit Smoking" Habit Changer program reported a positive change in their smoking behavior versus the control group (42%) that employed popular methods other than Habit Changer. A positive change shows that respondents reported quitting smoking entirely or reduced their smoking. On average, Habit Changer respondents reduced their smoking by 13 cigarettes versus eight cigarettes by the control group per day. If an average pack contains 20 cigarettes, on average the Habit Changer group would smoke 1,800 fewer cigarettes or 90 packs less annually than the control group. Looking at the population as a whole, this translates into 95 million less cigarettes."

Other key findings in the study:

• More than one third of those in the Habit Changer group (34.1%) believed they would stay smoke-free for 12 months versus the control group (6.5%).
• More than double (65%) in the control group believed that they would return to smoking in the next 12 months versus the participants in the Habit Changer group (29.5%).
• On average, both groups agreed to a moderately high degree that their likelihood of suffering from a smoking-related chronic disease is 56%, and both groups were equally aware of the health risks caused by smoking and internalized them to a high degree.

Changing your habits is not easy, especially if you've been doing something the same way most of your adult life. For me I suppose it was a bit easier because I grew up with asthma, and was still in my early 20s when I came to the realization I needed to change my habits.

The other advantage I had was that I had my disease early enough, and knew that smoking was not an option for me.

Still, the evidence is overflowing. If you want to gain control of your illness, if you want to quit smoking, then chances are you're going to have to change your some of your habits.

Chest Trauma

Thankfully we don't see traumas too often at Shoreline Medical -- not near as often as big city trauma centers -- yet unfortunately we still get one from time to time, and we need to be prepared.

The major concern with chest traumas is, according to emedicine, "Blunt Chest Traumas," is "derangements in the flow of air, blood, or both in combination. Sepsis due to leakage of alimentary tract contents, as in esophageal perforations, also must be considered."

Chest Trauma Statistics

After head and spinal injury, chest trauma is the third most common cause of death from chest trauma. Likewise, chest trauma is responsible for 20-25% of all deaths in the U.S., which makes it the third most common cause of death. It is also a major contributing factor in 50% of all other deaths.

Of all chest traumas, 33% require hospitalization, and the mortality rate is about 10%. The most common cause (70-80%) of chest traumas is motor vehicle accidents.

Actually, according to emedicine, "Trauma is the leading cause of death, morbidity, hospitalization, and disability in Americans aged 1 year to the middle of the fifth decade of life. As such, it constitutes a major health care problem. According to the Centers for Disease Control and Prevention, approximately 118,000 accidental deaths occurred in the United States in 2005."

So these statistics are pretty significant, and a major reason why members of any emergency room -- including respiratory therapists -- need to be familiar with what we might have to treat in a trauma situation.

While broken bones are a serious concern, the most serious injury are chest injuries from blunt trauma, such as smacking into the steering column at high forces. Thankfully seat belt laws and air bags have significantly reduced morbidity and mortality, yet chest traumas continue to be a significant source of emergency room visits.

I'm not going to do this in any particular order, yet here I will briefly discuss all the complications we RTs will be concerned about and treating.

Brief History

As you can read here, "History of chest trauma," treatment for chest trauma was first described about 1600 BC in the Ancient Egyptian Edwin Smith Papyrus that was prepared by Inhotep in 3000 BC.

The article notes the first trauma centers were established during the Trojan War in the 1st century AD. "With the development of more effective management of injuries, the concept of a flying hospital or ambulance volante was developed by Napoleon's army surgeons when it became obvious that rapid transfer, together with early active management, produced the best results."

When De Chauliac, the "Father of Surgery" wrote his Chirurgia Magna in 1365, he was actually surprised to see so little written about trauma considering all the wars, the article notes, "Only Hippocrates had mentioned the association of chest wall injuries and haemoptysis as a result usually of rib fracture."

Likewise, the article notes:

"The importance of pneumothorax and haemothorax was realized in the 18th Century and many devices were devised to suck wounds out of the chest, sometimes using the mouth of a specialist to use his own inspiration to suck air or fluid from that of the injured. Later devices such as the Arel Syringe were developed which certainly improved the hygiene of this technique. Although trocars had been developed, caution in the use of these instruments was urged as early as the 18th Century and it was felt, even then, that the insertion of a finger in a carefully made incision was preferable to introducing a sharp pointed trocar which may damage the lung and other intra-thoracic structures."

Invention of the Arel Syringe allowed for more sterile technique, and it was soon "insertion of a finger in a carefully made incision was preferable to introducing a sharp pointed trocar which may damage the lung and other intra-thoracic structures."

Chest tubes (which we'll discuss in another post) and underwater seal systems owe their creation to English physicians during the Civil War. Giovanni Battista Morgagni (February 25, 1682 – December 6, 1771) was the first to describe lung contusions.

Chest trauma gained national recognition during WWI and WWII due to pulmonary contusions due to blasts. An increase in trauma from traffic accidents resulted in greater recognition of pulmonary contusions in the 1960s.

In fact it was chest trauma from steering column impaction that lead to modern seat belt laws, which has greatly diminished incidences of chest trauma.

Diagnosis of chest trauma: This can be relatively easy, as in most cases you'll know the cause of the injury, otherwise symptoms may entail any or all of the following:

• Coughing up blood
• Chest pain
• Possible bruising (but not always) on the sternum
• Cyanosis
• Low SpO2

Further confirmation can be made by x-ray and ct scan.

Yet the initial workup of the patient should involve the ABCDEs of trauma, which include first making sure the patient has an Airway, second making sure the patient is Breathing, third making sure the patient has Circulating blood, making sure the patient is neurologically intact (Disability), and make sure the patient is completely undressed so you and the physician can fully assess the patient (Exposure).

To view a good slide that describes the ABCDEs of trauma click here.

Once that's all taken care of (or quite often while all that is going on), the following tests and procedures performed (according to emedicine):

1. Xray: Very important 1st line therapy for any blunt trauma to identify many conditions, such as broken ribs, pneumothorax, hemothorax, injuries to great vessels, damage to other organs or bones. It should be noted here that treatment of suspected pneumothoraxes and other such critical injuries should not have to wait for any test, including an x-ray, if they are life threatening.

2. CT Scan: Can be performed on the hemodynamically stable patient to more specifically diagnose a patient than an x-ray can.

3. 12 Lead EKG: Can help determine new cardiac abnormalities. Plus it can show other underlying problems. To learn more about what an EKG can be used to determine, click here.

4. Blood type and crossmatch: Should be done quickly if you suspect bleeding so you can give a transfusion as needed.

5. Cardiac enzymes: When a muscle is damaged it releases certain chemicals into the blood stream. CK greater than 200 indicates muscle damage somewhere in the body, CKMB indicates cardiac muscle damage, and troponin greater than 0.1 indicates heart muscle damage.

6. Coagulation profile: Especially important if the patient needs blood. It can tell a doctor how well a patient is clotting. PTT greater than 33 (greater than 60 is critical) and a PT greater than 12 (40 is critical) can be an indicator a patient is not clotting efficiently, or can be an indication of liver damage. An INR greater than 1.2 can indicate an acute bleed (greater than 6 is critical). A Fibrinolin level less than 160 is abnormal and may be indicative of an acute bleed (less than 70 is critical)

7. Complete blood count: Helps gage blood loss and gives a blood cell count.

8. Arterial blood gas: Can provide information about ventilation and oxygenation and acid base status, and therefore may act as a guide for need to intubate (To learn more about ABGs click here).

9 Lactate and Lactic Acid: These can indicate tissue death or damage. When these are out of range, this can indicate the patient is in big trouble. Critical levels are: LDH greater than 350, Lactic acid greater than 19.5, and Lactate greater than 4 can indicate tissue death.

10. Other: Aortogram, thoracic ultrasound, contrast esophogram, transesophogeal echocardiogram, transthoracic echocardiogram, flexible or rigid esophascopy and bronchoscopy are also tests commonly used to diagnose certain conditions in the chest trauma patient.

Now for the dreaded trauma related injuries.

(For more lab values click here)

Clinical history:

Along with your initial assessment, good questioning will help you get an idea of possible injuries. Often times this can be obtained by interviewing EMTs who were on the scene, family members, or other people who were a witness to the trauma event.

Important information to determine is:

• The time of injury (how long ago did it occur)
• Mechanism of injury (what exactly happened)
• MVA velocity \
• MVA deceleration
• Evidence of associated injury to other systems (eg, loss of consciousness)

Now for the dreaded chest trauma injuries:

1. Rib Fractures: Pain from this can be excruciating, and this may cause the patient to take rapid and shallow breaths due to this pain. While rib fractures in and of themselves are not life threatening, there is the risk that they might puncture the lung and cause a pneumothorax (collapsed lung) or be pressed up against the lungs and cause a pulmonary contusion.

Your basic rib fracture is rarely of any consequence, and is generally treated with pain medicines. These patients must be encouraged to take an occasional deep breath regardless of the pain in order to prevent pneumonia, and should probably go home with incentive spirometers (You can read more about how to prevent pneumonia here).

2. Pulmonary contusions: This occurs in 30-75% of chest trauma incidences, according to Wikepedia, and is the most common type of potentially lethal chest trauma. It has a mortality rate of 14-40%, and are thought to be the cause of death of 25% of trauma deaths. The other 75% of trauma deaths are due to other complications (which we'll review below).

Pulmonary Contusions are the most common injury when it comes to chet trauma. When someone is hit hard on the chest wall (blunt trauma), this can result in damage to capillaries, which causes blood to accumulate in lung tissue, which can interfere with gas exchange, and leading to inadequate oxygen levels (hypoxemia and hypoxia), according to Wikepedia.

Contusions may resolve on their own, and in this case supportive measures -- such as supplemental oxygen -- may be all that's needed.

However, if breathing is further compromised, intubation and mechanical ventilation may be needed and fluid through an IV to ensure adequate blood volume (although carefully because we want to avoid fluid overload).

Pulnonary contusions may result in blood being shunted away from the lungs and areas of the lungs that are poorly ventilated, resulting in poor oxygenation (hypoxemia and hypoxia) and increasing carbon dioxide levels, impending acidosis (pH less than 7.35) and impending respiratory failure. . When this is severe enough, intubation and mechanical ventilation may be required.

Complications from pulmonary contusions can be ARDS and pneumonia. Complications from further blood loss may result in loss of blood volume and sepsis.

Flail chest: This occurs when several ribs (chest wall) break under extreme stress and the chest wall moves independently of the lungs. This occurs in about 30% of blunt chest trauma.

This increases work of breathing and is very painful. Half of people with this will die. It is often accompanied with pulmonary contusion, and it is believed the contusion and not the flail chest is That ultimately results in respiratory complications, according to Wikepedia.

Treatment includes quick care and thinking and, as needed...

• Pain killers (try to avoid narcotics because they decrease respiratory drive)
  Positive pressure ventilation (low tidal volumes to avoid barotrauma)
• Chest tubes if suspected pneumothorax (collapsed lung)
• Position adjustment for patient comfort

In the case of Shoreline Medical, we usually stabilize these patients and ship them to the closest trauma center.

Pneumothorax: Another common injury, and this occurs when an object, such as a rib, bullet, knife, shrapnel, or other object pierces the lung, causing air to enter into the pleural cavity, or space between the lung and the chest wall.

This decreases forced residual capacity, or the amount of air that can enter the lungs, and decreases the lungs ability to expand, which results in decrease oxygen to the blood (hypoxemia). It can also be extremely painful and may result in extreme shortness of breath.

Diagnosis can be made by observation, such as unequal expansion of the chest wall on inspiration, and a deviated trachea, which usually moves toward the side of the lung with the pneumothorax. Diminished lung sounds and rubs are often heard over the collapsed lung upon auscultation.

Sometimes pneumothorax's resolve on their own, yet when more severe, or when they interfere with respirations, a chest tube is requires.

When severe, and in a small percentage of patients with a pneumothorax, this may lead to hypoxia, low blood pressure, and even death. And therefore, in some situations, a chest tube must be inserted based on initial assessment alone, before further diagnostic tests can be done.

Other diagnostic tests include chest x-ray and ct scan, and usually there is plenty of time to do one or both.

Insertion of a chest tube into the pleural space allows for air to escape, and the lungs to re-expand. I will describe chest tubes in further detail in a future post, yet if you want further reading now you can click here.

Tension Pneumothorax: This is a more serious complication, and this is where air continues to exit the lungs into the pleural space, building up pressure in that area. This pressure may squeeze the superior vena cava and can result in decreased blood return to the heart, circulatory compromise and shock, according to emedicine.

Hemothoraces: Blood in pleural spaces surrounding the lungs and/ or heart.

Hemopneumothoraces: Blood and air in the spaces surrounding the lungs and/ or heart

Other factors: Medpedia further notes that:

At the molecular level, animal experimentation supports a mediator-driven inflammatory process further leading to respiratory insult after chest trauma. Following blunt chest trauma, several blood-borne mediators are released, including interleukin-6, tumor necrosis factor, and prostanoids. These mediators are thought to induce secondary cardiopulmonary changes. Blunt trauma that causes significant cardiac injuries (eg, chamber rupture) or severe great vessel injuries (eg, thoracic aortic disruption) frequently results in death before

adequate treatment can be instituted. This is due to immediate and devastating exsanguination or loss of cardiac pump function. This causes hypovolemic or cardiogenic shock and death.

Medpedia also notes that sternal fractures are rarely of any consequence, except when they result in blunt cardiac injuries

Should I try Xolair for my asthma?

Every day at MyAsthmaCentral.com we get lots of asthma related questions. Below are some questions I thought my readers at the RT Cave would enjoy.

Your question: I have just read several articles concerning the FDA' warning about Xolair and heart attacks etc. I am wondering if there is any additional information from Jan 2010 to present about the EXCELS Study being conducted concerning these accusations.

My wife will begin treatment with this drug next week and we are gathering information on it now in order to make our decision. She has had asthma for 34 years.

My humble answer: I'm presently not aware of any further studies regarding xolair, although I'll continue to look into it. In making your decision just keep in mind that when to use a medicine is best determined if the benefits outweigh the risks. While a medicine like Xolair has side effects, the FDA has obviously determined that the risks for many asthmatics do outweigh the risks (which are generally rare). You also should know that the FDA has to note cautions, even if they tend to scare people away from the drug. This is basically erring on the side of caution. I actually wrote a post regarding this recently (click here). While my post is about Advair, I would think the same principle would apply to other asthma meds as well. Ideally, continue your quest for wisdom, and work with your physician on making the best decision for you and your wife.If you have any further questions email me, or Visit MyAsthmaCentral.com's" Q&A section.

Cold or Allergies: Learn how to tell the difference!

It's difficult to tell the difference between a cold and allergies. Yet it's important you learn how because they are both treated differently. Learn more by reading a recent post from MyAsthmaCentral.com

Is It Cold Or Allergies Triggering Your Asthma?

So you're curious whether your sniffles, sneezes and wheezes are caused by allergies or the common cold. Since both are treated different, it's important for you -- or at least your doctor -- to be able tell the difference.

This is important because both allergies and colds are common asthma triggers. And cold and allergy symptoms are early warning signs of asthma, and indicators that you need to take some form of action to prevent worsening asthma.

The Mayo Clinic (as you can read here) offers the following tips to help you determine if it's allergies or the common cold:

Allergy symptoms:

• Sometimes a cough
• Never aches and pains
• Sometimes fatigue
• Usually itchy eyes
• Usually sneezing
• Sometimes sore throat
• Usually runny nose
• Usually stuffy nose
• Never a fever

Common cold:

• Usually a cough
• Sometimes general aches and pains
• Sometimes fatigue
• Rarely itchy eyes
• Usually sneezing
• Usually sore throat
• Usually runny nose
• Usually stuffy nose
• Rarely a fever, if there is a fever it's a low grade fever

Colds are generally caught (but not always) when the temperature gets cold (as I write here) and people are indoors more with the doors and windows closed. In close proximety to infected sniffers and sneezers, you're more likely to catch a bug or a virus.

Allergies can be seasonal too, but you can't catch an allergy. Pollen (as noted here) is a common trigger in the spring, mold counts (as noted here) may be up during humid summers, and ragweed counts (as I write here) are high in the fall.

Once you determine (or make an educated guess) that you have a cold, you'll want to determine if it's viral or bacterial, because they are both treated differently.

Allina Hospitals and Clinics offers some tips to help you tell the difference:

Viral Symptoms:

• Runny nose is common
• Muscle aches is usual
• Headaches often
• Dizziness often
• Low grade fever often (up to 101° F or 38.5° C)
• Cough often
• Dry cough often
• Coughing up phlegm (mucus or sputum)
• Hoarseness is common
• Antibiotics will not help

Bacterial symptoms:

• Runny nose is rare
• Muscle aches are rare
• Headaches are rare
• Dizziness is rare
• High grade fever is common (102° F or 38.6° C and higher)
• Cough is present occasionally
• Dry cough is rare
• Coughing up phlegm
• Hoarseness is rare
• Antibiotics will help

Generally speaking, according to dukehealth.org, a viral infection lasts less than 10 to 14 days. If it lasts longer chances are it's bacterial. High fevers are also usually an indication it might be bacterial.

Allina also notes that most of the time the common cold is caused by a virus, yet occasionally it can be caused by a bacteria. The flu is caused by a virus, yet ear infections and strep throat are caused by a bacteria.

Another great way to differentiate from a viral or bacterial infection is by examining your sputum, as I write about in my sputum lexicon. If it's light yellow, you probably have a virus. If it's dark yellow, brown, or if it smells putrid, then it's probably a bacteria.

Dukehealth.org also notes that many bacterial infections are secondary infections, whereas a virus started the job and a bacteria snuck in and made matters worse. Sinusitis is a common secondary infection for asthmatics. Ear infections and pneumonia are also secondary infections.

To prevent a secondary infection, and to prevent the worsening of your asthma that may be the result, you're better off calling your doctor as soon as you notice symptoms. If nothing else, it can't hurt to see your doctor -- especially if you have asthma.

If you're wavering as to what to do, you can follow these tips. Or, better yet, you can simply follow your asthma action plan.

If allergies are causing your symptoms, treatment generally includes antihistamines like Benadryl or Claritin, Leukotriene blockers like Singulair and Accolate, allergy shots and avoidance of allergens (for more information about allergy medicine click here).

Bacterial infections are treated with antibiotics. Your doctor might try you on a broad spectrim antibiotic because they tend to kill many bacterias. Yet if that doesn't work, he may have you try narrow spectrum antibiotics, which kill specific bacteria.

To determine what bacteria is causing your symptoms, and what antibiotic works best against that specific bug, your doctor may have you spit some phlegm in a sterile cup for testing in a lab. At least this is what he should do, otherwise he's just guessing.

However, if you have hardluck asthma your doctor might simply put you on an antibiotic until it's proven otherwise. While this isn't good practice for most patients, it can be in this case because bacterias can hit chronic lungers really hard.

Other than allergies, viral infections are the most common asthma trigger. Yet, despite a common myth, antibiotics do not kill viruses. Therefore, treatment of viral infections is generally based on treating symptoms.

For example, if you have nasal congestion, you take nasal decongestants. If your asthma is effected, your asthma should be treated. This is why it's important you have an asthma action plan and follow it to a tee.

It's also important you see your doctor regularly, take all your asthma controller medicines as prescribed, and exercise regularly. All of these will help to keep your lungs, heart and immune systems strong so your body is better capable of withering the storm.

With your new wisdom, and by following your asthma action plan, you should be fully prepared to wither the storm, regardless of whether the cause is allergies, a virus, or a bacteria.

Facebook
Twitter

The stick of Moses

Most of the time when we face a conundrum the answer is in our hands.

Moses said to the Lord: "The Red Sea is before me, and the Egyptian Army is behind me. What am I going to do?"

God said, "What do you have in your hand?"

Moses said, "All I have is my staff." So he set his staff in the Red Sea, and it parted, making a path for him and his men. The Red Sea was parted by a simple stick. The Israeli's escaped the Egyptian King.

The moral here is that we all have a "stick" to make our way through life's obstacles. We all have our own unique abilities to make it through life, and to make life better. We all have a gift. We all have a unique gift.

It is up to us what we do with that gift. We all have a stick. My stick is my ability to write. My stick is my ability to communicate by words. My stick is my knowledge about respiratory therapy. My stick is the wisdom I've obtained through my life as an asthmatic, as a respiratory student, as a believer, and my experience as a respiratory therapist.

My stick is my wisdom as an American, and as a thinker, a philosopher, as...

Have you found your stick yet?

If it proves their own theories, the study is believed

Have you ever noticed that doctors pick and choose what study they want to believe in?

There was a study a few years back that showed that Ventolin, if used long term, may actually cause underlying bronchospasm, or otherwise known as paradoxical bronchospasm. Yet in the hospital setting this has never stopped a doctor from ordering Ventolin.

Yet there was another study that showed that Ventolin enhances sputum production, however minute, and so they order Ventolin for patients they want to spit up more, or when the patient has pneumonia (even though it doesn't get to the alveoli).

In fact, I debated a doctor about this here.

Xopenex was originally believed to be stronger than Ventolin, and to produce fewer side effects. Yet more recent studies show neither claim is true. Yet many doctors choose to believe the former and not the later studies.

So they choose to believe one study, while ignoring the other. If it proves their own theories, the study is believed. If the study contradicts their theories, it's ignored. Just a thought.

Do new RTs have to work nights?

Here's a good RT Question in my search of the net:

Your Question: Do RTs always have to start out on night shift? I'm interested in respiratory therapy, but I've been told you must start out on the graveyard shift. I'm not sure I want to do this as I hate working nights.

My humble answer: The answer to this kind of depends. You can get lucky and get hired onto the day shift. I've seen it happen a few times. Yet most of the time new RTs get hired to work nights, because generally, as a day post comes up, those RTs with seniority will want that new day spot.

However, I also see a lot of new RTs getting hired in the pool, otherwise known as the on call or prn spot. This new RT will be the fill in RT, and he or she will work all days. If someone retires, or quits, he will scoop up the new position that opens up, which is almost always the night spot.

Since turnover rates are low in small town hospitals, and new positions rarely come up, that's an added incentive for senior RTs to scoop up the day posts when they do come up. That's what happened with me. I loved working nights, yet I knew if I didn't scoop up the day job that just came up, I might be years before I had another chance.

However, there is another way of looking at this. Some RT bosses believe that new RTs should gain confidence on day shift when they will rarely work alone. Working with other RTs, if they come across a stressful or unfamiliar situation, they have someone to help them out. Then, once the RT boss gains confidence in this new RT, he can be moved to the night shift.

I actually agree with this, to a point. I think most new RTs should work days for a while to gain confidence. Yet I also believe that you can't keep bear cubs in the den all their lives. There comes a point when you have to send them out into the real world.

I say this because when I was a new RT I worked for three years in the pool for three hospitals, and was trained right away to work nights. I was very uncomfortable at first, yet being forced to act, I learned quick. I also learned quick to realize that I didn't know everything, and that my co-worker's wisdom was only a phone call away.

Working nights is what separates the big boys and girls with the button pushers. If you can work nights and succeed, you will be that much better of an RT. This is especially true if you get hired at a small town hospital like Shoreline where the night shift RT works alone.

I think the best answer to this question should be: Rarely do RTs get hired in on day shift.

Breathalizer to screen for lung cancer?

One of the main reasons there is such a high mortality rate for lung cancer is because usually by the time it is discovered it's too late to do anything for it, or it has metastasized to other parts of the body.

Yet, according Lynn Eldridge, "Breath Test to Detect Lung Cancer a Possibility," at lungcancer.about.com, researchers in Israel Researchers in Israel "have developed an "electronic nose" - that is, an instrument that can 'smell' the breath of individuals who are healthy or have cancer, and know the difference. They found that the test could not only detect cancer, but could tell the difference between 4 different types of cancer, those being cancers of the lung, breast, colon, and prostate."

She continues, "How could a sample of exhaled air be useful in looking for cancer? Changes in genes and proteins that take place in cancer cause a change in the surface of cancer cells (the cell membrane). These changes result in the emission of volatile organic compounds (VOCs) that can be detected when someone exhales. A sensitive nanoparticle array is then used to distinguish the different VOCs found in the 4 cancers studied and in healthy individuals.

She notes that 30% of lung cancer is found in the early stages, and this test would make it so more cancer can be discovered earlier. It's possible the test could be performed at a regular annual office visit.

"As it stands," she writes, "only 30% people are diagnosed in the early stages (stage 1 and stage 2) of lung cancer; 40% have already progressed to stage 4 (metastatic) lung cancer at the time of diagnosis. And that is for non-small cell lung cancer. For small cell lung cancer, the chance of finding cancer in a curable stage is even lower."

A quick breath at an office visit may not only allow doctors to screen early lung cancer, yet monitor the course of those with the disease, and especially those in remission.

Rapid Response Teams

Studies show that most people do not have spontaneous heart attacks or strokes or go into sepsis without first showing early signs that something is going on. Therefore, the vigilant nurse or respiratory therapist who picks up on these signs can save a life and prevent a prolonged hospital stay.

In this way, we might prevent a catastrophe we might not even ever get credit for. And that, in my opinion, is the greatest job of working in the medical profession. We like to call it being proactive.

Thus, being proactive is the purpose of Rapid Response Teams. It's about educating nurses and respiratory therapists on what signs and symptoms are worrisome, and when to call the doctor. To learn when to call the doctor, click here.

According to "Respiratory Therapists Play Unique Role on Rapid Response Teams," by Steve Babyak (RRT) in the AARC Times (June 2007), studies performed show the following:

• 66-84% of patients exhibit abnormal signs and symptoms within 6 hours of an arrest, including altered mental status, chest pain, fluctuations in heart rate, respiratory rate and blood pressure, tachypnea (58%), tachycardia (54%), hypotension (46%) and decreased urine output (29%)
• Elevated respiratory rate is an indicator of muscle weakness and fatigue. 54% of patients requiring CPR had at least one documented increase in respiratory rate above 27 breaths per minute within 72 hours of arrest.
• 65% drop in cardiac arrests and 56% decrease in deaths from cardiac arrest following the placement of a medical emergency team (rapid response team)

Babyak notes rapid response teams were first "pioneered" in Australia in 1990 and were found to be so successful (see statistics above) that they quickly found their way to hospitals around the world.

Rapid Response Teams generally consist of one critical care nurse, the nursing supervisor, respiratory therapist, and the patient's nurse. In some hospitals it would also include a physician, yet Shoreline does not have an inhouse physician. So this makes it even more important for us, because it allows us to use our skills to save a patient using the guidelines and policies created for the team.

For instance, we are allowed to do EKGs, ABGS, give certain medications, and even order X-Ray and labs even before the doctor is notified, all in an attempt to get the patient fixed and to prevent the patient from getting worse.

We are also allowed to place patients on oxygen, give beta-agonists, morphine and initiate BiPAP if needed. Actually, we aren't allowed to initiate BiPAP, although some hospitals allow for this.

Another advantage of RRTs is that they decrease the number of patients transferred to critical care, and decrease length of stay. I imagine they also increase patient outcomes and satisfactions.

As a nurse is doing rounds, or the RT is doing his rounds, we assess the patient. If we notice mental changes, vital signs that are critical, low oxygen saturations, altered breathing patterns or cardiac rhythms, changes in blood pressure (too high or too low), or simply if we think something is wrong and don't know what, then we can trigger the team.

Thus, as Babyak writes, rapid response teams are a great "opportunity for respiratory therapists to bring their experience and expertise to a progressive format that is rapidly improving the safety and well-being of the hospitalized patient."

(Too learn what signs and symptoms are critical, and when to trigger the team, and when to call the doctor, click here)

To learn more, check out the AARCs Rapid Response Team Page

Is there a test that shows overuse of Ventolin?

The following is an asthma question I was asked recently.

Your Question: What happens if I use my inhaler too much? Is there a test a doctor can use to determine if I used my inhaler too much? After my doctor showed me my x-ray and said my lungs were swollen, he said I won't last long if I don't take care of myself. I've been to the ER quite a bit recently. Is there a test so he knows I use my inhaler a lot?

My humble answer: When I was a kid I used to worry that my doctors or RTs or nurses would know I was over using my rescue inhaler by some lab test or x-ray or something. Yet the truth is there is no such test. The only way they can tell if you abuse your inhaler is if you tell them, or if your doctor monitors your prescription drug use. Of course, a wise doctor WILL monitor your prescription drug usage.

Another way to know you've been using your inhaler too much is a medical 6th sense. Sometimes we can just tell by interviewing you. Sometimes the fact you have an empty inhaler in your hand is sign enough that you are using it too much. A 6th sense quite often comes in handy because quite often asthmatics are too embarassed to be honest about abusing their rescue medicine.

That said, if you are using your rescue inhaler too often, or a lot, that may be a sign that you do not have good control of your asthma. Thanks to modern wisdom and medicine, asthma can be prevented. If you find a good asthma doctor, work with him on finding a good medicine regime, and you are compliant with your medicines (take them as prescribed), you shouldn't need your rescue inhaler. In this way, asthma can be controlled and prevented. I bet this is what your doctor was referring to.

So, if you want to learn more about how you can gain control of your asthma, check out this post.

It's also important you be a perfect asthmatic. Check out this link on how to become a better asthmatic.

Good luck

Are you forgetful or honest about your asthma?

One of the things I notice about humans is we tend to forget the past, although we should not. For those who forget the past are doomed to repeat it. This is especially true -- I've learned the hard way -- of asthma.

My asthma was so bad I was admitted to an asthma hospital in 1985 for 6 months. This allowed me to get my asthma under control for over 10 years. Then I forgot, and the beast returned. So, are you like me and suffered at one point (or suffer right now) from asthma forgetfulness?

Or are you more into asthma honesty like I am now. Learn more by reading my latest Sharepost from MyAsthmaCentral.com

Asthma Forgetfulness And Asthma Honesty

Have you ever tried to forget your asthma past? Do you have an asthma story you've never shared with anyone? Do you have asthma forgetfulness? If you do, perhaps it's time to share your story.

Trust me. I know from first hand experience that asthma is no fun. I also know that asthma forgetfulness may be the easy route, yet it also leads to poor asthma control later on. If you bare with me I'll explain. I'll also explain why a little asthma honesty might be the cure youve been looking for.

One such experience came to light this morning. It was 6:00 a.m. and I was working as a respiratory therapist. I was paged STAT to the emergency room (ER).

Upon entering the ER I found one of our regular asthmatics sitting on the edge of the bed, slouched over, huffing and puffing to get air in. Her oxygen was so low when she arrived the nurse had put an oxygen mask on her.

I started up a breathing treatment and replaced the mask with a misting pipe in her mouth. The mist was Ventolin, the Godsend to asthmatics; the juice that gets the lungs moving air again. I could tell by the way she held the pipe firmly between her teeth -- the no hands technique -- she was an expert at this.

I sat in a chair the opposite side of the room while the nurses worked their magic: inserted an IV line, inserted Solumedrol into IV line, and asked a million questions. I couldn't help but remember the days of long ago when I was in her shoes, with a Ventolin Peace Pipe proficiently stuffed in my mouth.

Then the nurse asked this question: "So, how many breathing treatments did you give yourself at home before you came in?"

The asthmatic said, "Oh, more than enough."

That was more honest than any answer I ever gave, I thought. Then said, "When I was a kid and a nurse asked me that, I would just lie."

The patient, obviously breathing better now, said, a smile on her face, "You have asthma too."

"Oh yeah," I said, "I had it very bad too when I was a kid. In fact, I used to go through a Ventolin inhaler every day."

"You did what!" The nurse said, peering down at me, bug eyed.

"I would use an inhaler every day, and then I'd also take breathing treatments in between. In fact, back then you could only get one Ventolin refill at a time, so there were weeks when I'd have mom go to the pharmacy every day to get a new inhaler."

I wrote about this experience in more detail in my post, "Confessions of a bronchodilatoraholic."

The nurse gasped at my story, yet the patient smiled.

Years ago I wasn't able to be this honest, yet now asthma stories flow easy, and allow me to create a bond with my asthmatic patients. It also helps prevent asthma forgetfulness, as asthma forgetfulness only results in worsening asthma. Trust me: I know.

In fact, for many years I completely blacked out my severe asthma past. I'll be honest, there were days I used up my Ventolin inhaler, and then was so miserable, so afraid, that I never told my mom for fear she'd be mad at me. Then I'd suffer until about 2 in the morning when I couldn't stand it anymore and finally break down and wake her up.

Dad would take me to the emergency room having no clue how long I had suffered.

So then I'd be in the ER, shoulders high and scratching at the mattress to stretch out my lungs to get any extra air into them I could, and the respiratory therapist (perhaps one I work with now), gave me a breathing treatment.

Then came THE question: "How much Ventolin did you use at home?"

"A couple puffs," I'd say after a long delay. Yes it was a lie. A very bad lie.

My asthma -- my hardluck asthma -- was so bad my mom and dad and doctor thought I was going to die. And in 1985 they had me admitted to the asthma hospital in Denver Colorado (then it was National Jewish Health-National Asthma Center (NJH/NAC). I ended up staying there for six months (Yes, I wrote that right).

Once I was discharged my asthma was under better control than ever. I never missed school again due to my asthma, and I rarely ever needed the services of an ER. My asthma was under control -- finally.

All was great right? Well, all except for the fact asthma forgetfulness set in. After several years all the great wisdom I learned from NJH was lost.

The thing is, asthma forgetfulness only leads to worsening asthma because when you forget you have it, you forget to control it (something a gallant asthmatic would never do).

So 10 years after leaving the asthma hospital, my asthma was almost as bad as it was before I went there. I had to relearn everything.

Asthma is a very fragile and devastating disease when it's not controlled. If you don't control it, it controls you. Forgetting you have it, or pretending you don't have it, only makes matters worse.

What comlicates matters are myths that asthma goes away with age.

The best way to overcome asthma forgetfulness is with asthma honesty. Where I once had blacked out my past, I have since forced myself to relive it. I even wrote about it to some extent here. I realize now if I hadn't forgotten, my asthma never would have gotten bad again ten years later.

So my advice to other asthmatics is to never forget how miserable you were before your asthma was controlled. Don't ever forget how you gained control of your asthma. The best way of doing, the best way of being honest, is to share your asthma stories. Thankfully that's something I get to do at work and right here.

If you have an asthma story you've never shared, feel free to do so in the comments below, or create your own sharepost.

Facebook
Twitter

Anticipate and explain

Fear. Confusion. Anxiety. Stress. These are some of the emotions that roll through the minds of patients and their families while their loved one is lying in a hospital bed, perhaps near death, hooked up to an array of machines.

Most people are healthy most of their lives, and have no need to educate themselves on all the various diseases and disease processes that can slow down a life and even grab it and rip it into the other world. They have no need to know about the many devices and techniques used to treat illness either.

So this obliviousness can result in fear, confusion, anxiety and stress at the patient bedside. Why are all those lines in my mom? Why is that mask over her face? What the heck is sepsis? What's an ABG, CBC, PO2, SpO2, CO2 and all those other medical terms we often float around? What are all the bells and whistles for? Should I be concerned when I hear an alarm?

Fear not, because the roll of the respiratory therapist is to clear up the confusion. The proactive RT will introduce himself and explain any equipment he is using even before the person asks, "What is that?"

A good RN, a good RT, will stop for a moment, several moments, several times a day, to explain what is going on, and ask the patient, "Do you have any questions about what is going on here?"

Just asking that simple question shows that you care, and can allay the fears of a concerned family member. They know that it's not your fault their mom or dad is in that bed, and now they are pacified by knowing that you care to. That they are involved in every step of the healing process, or the moving along process.

I personally don't like to go overboard while doing this, and try to play it by ear. I don't want to confuse people more than they already are, and is usually why it's best to start by giving a very brief explanation of what I'm doing and simply asking if they have any further question.

If they don't, I drop the topic. If they do, I give the briefest answer I can.

Likewise, I never involve myself with any decision making, such as, "What should I do? Should I let my mom stay on the vent."

I never give my opinion on these matters. Usually I defer to the doctor or RN. Yet if, for instance, a family member is trying to decide whether or not to let us put their loved one on a ventilator, I'll say something simple like: "A ventilator is only temporary. It allows the patient time to heal. Usually it's only a day or so."

If the patient is a train wreck and has made no prior acknowledgement about end of life care, however, and intubating, putting the patient on a ventilator, and doing CPR will only delay the inevitable, my speech is altered as: "It's never an easy decision. You can always let us do what we're trained to do, and play it by ear. You can always tell us to stop at any time."

And I only say those lines when I'm asked directly, and have no way out of saying something.

Yet during most patient family-RT interactions, it's just me making an equipment check, or giving a breathing treatment. In these instances, I'll usually explain what I'm doing with the first visit, and play it by ear after that.

It's usually not hard to tell if a patient, or his family, has questions. When you get this feeling, you simply ask, "Do you have any questions."

And of course you shouldn't be afraid to say, "I don't know that answer to that, yet I'll find out," or, "How about if I have your nurse come talk to you. That's a question for her."

Sometimes, howver, the best thing to do is simply use common sense, which is why common sense is a good trait for respiratory therapists to have.

Ignorance about the medical community, and fear, can cause anxiety and stress. And that's why I think it's extremely important for

Are bloggers considered journalists

Yes I was a journalist in the past, but not a very good one. The reason I bring this up is if for some reason I wrote "as a journalist" something on the RT Cave that the courts thought was wrongful, or if they believed I might have more information on my computer, Federal law makes it legal for the courts to confiscate my computer without a warrant.

So recently a reporter published articles on his own personal blog about a future iphone he purchased for $5,000 from some random person he met in a bar. If you want to know the details of this case you can click here and read the New York Time's Post.

Of course it was a prototype iphone, and not only was it not supposed to be sold, it was not supposed to be reported on. So, the question of the day brought up by the defenders of the blogger are, "Are bloggers journalists?"

The "blogger" was suspected of committing a felony. Sure, that sounds like a noble charge, yet do the courts have a right to take his computer without the proper warrants it would take to seize property of other Americans suspected of crimes.

I just thought this was interesting because many of us are bloggers, and we are just in this for fun, and to share our thoughts and expertise with an audience. We don't consider this to be a defensible hobby.

Do parents really discriminate against obese kids

Yahoo News, "Obese Kids Face Bias From Parents," reports on a study that shows parents tend to treat obese kids different than those of "normal" weight. And while I've seen this poll discussed on many TV Networks, not one that I'm aware of asked the question, "Is this interpretation of the poll accurate?

First allow me to quote the article, and then I'll provide another possible interpretation of this poll. According to the article:

Studies have shown parents are less likely to help overweight or obese offspring pay for college but researchers from the University of North Texas in Denton have also found parents may be less willing to help their overweight child buy a car.

"No one is going to be surprised that society discriminates against the overweight, but I think it is surprising that it can come from your parents," researcher Adriel Boals told Reuters Health.

"Similar to college tuition, purchasing a car during the college years is a major expense and investment that parents can choose to provide assistance with or not."

Boals and fellow researcher Amanda Kraha's study, published in the journal Obesity, noted that more than two-thirds of U.S. adults are overweight or obese and heavier people are known to face discrimination on the job, at school, and in relationships. They tend to earn less and are less likely to marry

There is evidence that negative psychological consequences associated with overweight and obesity, such as depression and low self-esteem, could be a consequence of this type of prejudice.

As I noted above, this is one possible interpretation of the poll. Yet as with most poll data, there is often more than one interpretation of the data.

After watching Matt Lauer discuss this poll with an expert on this topic, my wife said this: "Matt never once questioned the poll. He never once asked, 'Isn't it possible that children from families with less money tend to weight more? He never asked, Doesn't this poll just verify that the more money you have, the more money you spend on your children?"

That's my wife, though: constantly questioning, and constantly looking at the other side of the coin.

Yet she does make sense. There was a book read when I was in college called "Class" by Paul Fussell. You can link to it here. In the book Fussell describes the prototypical middle class person as slightly overweight with a tendency to gain weight as he ages. The more money people have, the thinner they are.

I don't know if he made this observation by reading a poll someone paid millions of dollars to conduct, or if he simply made it by common sense observation. Yet it tends to make sense.

The less money people the less education they have. Also the less money the harder they have to work, and the more time working, and this results in less time to read and to exercise. They also tend to have more stressful lives, and this results in overeating and possibly even drinking to let off stress.

The more money people have the less stressful their jobs tend to be, and the more time they have to educate themselves and their kids, and the more time they have to take care of their bodies.

So, based on Fussell's observation over 25 years ago, it only makes sense that parents of obese children would be allocated less money for college. It only makes sense.

I also remember during the Clinton Administration where there was this big concern that some impoverished kids in school were too thin and therefore not healthy. So Congress passed a law that would provide free food at school.

Of course now that they "fattened" up the kids, now Congressmen are trying to pass laws to make food in school healthier. In our local school they removed all the junk food and pop machines and replaced them with water, juice and healthy foods.

Yet it never occurs to these same folks that they were the same ones who fattened up our kids with their "fast food" in the cafeteria in the first place. Few in the media question these people, they just let them provide their "good intentions" and bloviate.

Don't get me wrong, I think it's great to have healthy food at schools, I just notice the irony when those in the media who are "creating" the news with their polls don't.

Now I could be way off here, yet since it is a possibility, isn't it the job of the media to question authority. Isn't it Matt Lauer's job to hit the experts with hard questions.

I don't mean to just pick on Matt here, it's just he was the interviewer in this case. I have also observed similar instances on many occasions. In fact, when the media interviews many politicians they tend to agree with, those politicians tend to get soft questions too. If people like Matt disagree with the politician, they hit them hard with great questions.

In a sense, these interviewers tend to simply provide a platform for the interviewee to bloviate. Or, perhaps there is a greater agenda. Perhaps it is to show society that obese people are discriminated against by, well, society. Or perhaps there is a deeper motive here.

I remember Al Gore was on the Jay Leno show back in 1993 when that show first started, and he took a glass ashtray and set it up on Jay's desk. He said (and I'm paraphrasing here), "The government wastes a lot of money studying things that we already know. What do you think will happen if we drop this glass ashtray, Jay?" he said? "That's right: it will break into many pieces.

"Well, the government recently did a study to see exactly how the glass would shatter. They wanted to make sure it would shatter outward instead of bounce up. They ended up spending a million dollars on the study to show us what we already know: that if you drop a glass ashtray it will shatter."

I think Al Gore had a valid point. Yet I would take it even further. The media gains attention when things go bad. Bad news generates viewership. When their is nothing juicy going on, the media grabs some poll so it can create a front page story. And they interpret it however they want. In this case, the "idea" that parents discriminate against obese kids is "evil," and makes a good cover story, or, in the case of the Today Show, a good interview.

It is true that obese kids might just be discriminated against by their parents. Yet this study doesn't show this any more than it just shows us what we already know, that the less money the parent's have, the less money they have to spend on their kids.

Discovery may benefit CF patients

A new discovery by the Royal College of Surgeons of Ireland (RCSI) may help cystic fibrosis (CF) women live longer, according to Dara Kelly at irishcentral.com, "Irish team make cystic fibrosis discovery."

Kelly writes that Ireland has a four times higher incidence of cystic fibrosis than any other EU country or the U.S. Likewise, she notes that the life expectancy of women with the disease is much less than that of men (2-3 years less).

Yet researchers, she writes, from the RCSI have made a discovery that might explain the disparity in life expectancy between men and women with CF, and perhaps lead to further discoveries that will narrow the gap.

The RCSI "found that the estrogen hormone, which is found in much higher levels of which, prevents the release of a chemical signal that can help trigger white blood cells to fight infection in the lungs when bacteria attack cells."

The research may allow scientists to come up with methods to stabilize estrogen levels and to prevent infections in the lungs when estrogen levels are high.

Since CF is a disease that causes thick and sticky secretions in CF lungs that increases the risk for infection, and thus it is this infection that can worsen the disease, and ultimately causes the patient to die, this discovery may be a godsend to women with CF.

Further studies regarding this are ongoing, and the goal is to improve the quality of life and length of life of CF patients.

Dealing with the dying

We RTs often have to deal with the aging, and all too frequently we have to work with people who are dying. Therefore it's important we know at least a little bit about end of life issues, and how to approach these patients.

This was the topic of an article published in the AARC Times, "Coming of Age: Helping Ease Patient Concerns about the End of Life," (June 2007) by Melaine Giordano (MS, RN, CPFT).

Essentially she writes, "There are no rules one must follow in the journey of dying. It is the person who is dying that charts the course of their death; and the rest of us must respect their wishes and offer our assistance in facilitating their requests. As we care for our dying patients we should remind ourselves that the goal of care that we provide is aligned with the patient's wishes. We should be an advocate for those wishes to the health care team as well as others who are providing care."

Most people who are dying are often:

1. Depressed
2. Fatigued
3. Confused
4. Isolated
5. Scared
6. Suffer side effects of medicines
7. Have to deal with medical terminology and hospitals that they never had to deal with before and may be confused about it

Ah, so it's our job to make sure we not only introduce ourselves properly, and explain what it is that we do, but we also must help to educate the patient. We must make sure they know exactly what we are doing, and why, and how often they will need us.

Giordano describes a common situation where a doctor comes to the bedside, explains something, and the patient has to have her daughter or a nurse explain what the doctor just said. This scenario, although too common, should not play out.

Yet since it does, and we RTs are in the room to give breathing treatments and the like, it's our job to help to clarify their illness and help them to understand what's going on and what to expect in the future.

No, we don't have to relay the bad news, thank goodness, but once they know they are dying, they might ask you. It's your job to help the patient feel better about the "medical world."

Sometime it's just nice to have someone listen to you. I find that many COPD patients tend to like to tell you their whole life stories, as though they want to get it out before they die. Many COPD patients are really friendly and very talkative, and quite often don't want you to ever leave the room.

Therefore I think it's neat when you aren't being rushed so you can sit down on the other bed, or in a chair at eye level, and actually banter with the patient.

It's also neat to know the stages of dying:

1. Pre-active stage of dying: May last for weeks or months. Signs include:

• Withdrawal from their usual activities as well as socialization
• Increase in sleeping times
• Decrease in appetite
• Spending more time in bed
• Agitation and/ or restlessness
• Desire to put things in order
• Reports of seeing people who have already died
• Patient states that he or she is dying

2. The Active phase: Shorter and only lasts a few days but can last a couple week. Signs and symptoms include:

• Heart becomes weaker
• Circulation to extremities decreases (cold or blue fingers, toes and arms), yet often dying don't want additional weight or confinement of blankets
• Decreased mobility. May need pain medicine to move patient.
• Decreased alertness and then have surge of energy right before death
• Death rattle: secretions or saliva in throat due to the loss of ability to swallow. Painless and harmless, although may be difficult for family.
• Cheyne-Stokes breathing: rapid then slower and slower then cessation of breathing then faster and faster and rapid again... It does not cause distress to the patient, but may to the family

For more signs and symptoms check out hospicepatients.org.

Will losing weight make my asthma better

Your question: I'm 5"8, and weigh 230..i have severe asthma. will losing weight do anything to improve my asthma

My humble answer: Great Question. The answer is a definite yes. In fact, I actually have my own experience with weight loss as I wrote about in this post and also in this post. I'm the same height as you, and was up to 220 pounds, winded all day, and my asthma was poorly controlled. After dropping 40 pounds I felt like a new man, and my asthma was better than ever. When I stop eating right and exercising, and my weight creeps back up, my asthma gets progressively worse. So in that sense I've learned exercise and eating right is not an option for us asthmatics -- it's mandatory.

So, just based on my own personal experience, I'd have to say the answer to your question is YES!!!

Speaking of studies... and not that we asthmatics need to do a study to figure this out... Many studies have also linked obesity with worsening asthma control. I actually have an upcoming post about these studies, but in the meantime you can click here for more reading about the asthma/ obesity link. Or you can google it.

Other than losing weight, I wrote a post a while back (here it is) about other things you can do to improve your asthma. Click here to link to this post.

I hope this answers your question. If you have further questions, or need some tips how to lose weight with asthma, let me know. Rick.

GERD and Asthma

Can asthma reflux and asthma be related? The latest wisdom suspects the answer to be a resounding yes. Read on in my latest post from MyAsthmaCentral.com

GERD and asthma: What's the connection?

You wouldn't think there'd be a link between the stomach and asthma, yet even as far back as the 1970s asthma experts noticed a connection between asthma and gastrointestinal reflux (GERD).

What is GERD?

GERD is a condition where acid from the stomach works its way back up the esophagus. If this condition is left untreated long term, it can eventually lead to esophageal ulcers, esophageal cancer and even lung damage that can cause asthma.

According to the American Academy of Allergy, Asthma and Immunology (AAAAI.org), a sphincter at the bottom of your esophagus remains closed while food is being digested to prevent backwash. "However, sometimes it relaxes on the job, allowing stomach acid to flow back, or reflux, into the esophagus."

Studies, the AAAAI notes, show that as many as 70 percent of asthmatics have GERD, the same percentage of asthmatics estimated to have allergies. This is a significant percentage, especially when you consider only 20 to 30 percent of people who do not have asthma have GERD.

What is the Connection?

It almost seems asthma and GERD have a synergistic relationship, where some asthma medicines may worsen GERD, and GERD may worsen asthma. GERD has been proven to be an asthma trigger, yet recent studies show it may even cause asthma in some patients.

Actually, back in 2008, researchers at Duke University looked into this relationship. While studying mice, they discovered that "inhaling tiny amounts of stomach fluid... produces changes in the immune system that can drive the development of asthma."

If your asthma gets worse after meals, at night, or when lying down GERD may be considered as the likely cause.

Age and GERD

There are some children with GERD. In fact, when I was a patient of National Jewish back in 1985 my room mate had to sleep with the top half of his bed on stilts to prevent stomach backwash.

Usually, however, GERD is associated with adult onset asthma. If a 40-year-old, for example, all-of-a-sudden develops asthma symptoms, GERD is often considered to be the culprit.

The most common barium swallow, where you drink a chalky liquid and radiology equipment allows fluid in your esophagus to show up as gray or black on a screen. I actually did this test as a kid and failed. So my doctor had me do the more invasive pH probe.

The pH probe is where a tube is inserted into your nose down to your stomach, and, while you're sleeping, a printout shows if acid enters your esophagus. I actually passed this test, and GERD was ruled out back then.

Another diagnostic test is an endoscopy, which is where a scope is inserted into your mouth and the doctor can look at your esophagus and stomach. He can also take pictures and samples. I had this test done three times as an adult, and it's really not as bad as it sounds.

Treatments

So, what about treatment? Any of the following may be recommended, depending on the severity (this is what we'll call the anti-reflux protocol):

• Elevate the head of the bed 6-8 inches


• Lose weight


• Stop smoking


• Decrease alcohol intake


• Limit meal size and avoid heavy evening meals


• Do not lie down within two to three hours of eating


• Decrease caffeine intake


• Cut back on carbonated beverages (beer and pop)


• Avoid theophylline (if possible)


• Avoid chocolate


• Medicine, such as prevacid and prilosec to reduce stomach acid

You might be saying, why chocolate? Well, as you can see by this MSN health and fitness post, chocolate can relax the sphincter that normally blocks food from backwashing up the esophagus. Theophylline does the same thing, and so do caffeine and alcohol.

Carbonated beverages may increase stomach acid and cause bloating, both of which increase your risk for reflux, as do overeating and obesity.

While there is no conclusive evidence reflux therapy benefits asthma, it does control and prevent GERD. Actually, AAAAI notes a study that showed reflux therapy improved asthma symptoms in 69 percent of subjects, and reduced the need for asthma medicines in 62 percent of subjects.

I was diagnosed with GERD as an adult mainly due to poor diet and theophylline dependence. Newer asthma medicines have allowed me to be weaned off theophylline, yet my doctor says I'll be chronically dependent on Prilosec as a trade off.

Yet the best way I've found to control both GERD and asthma is a good diet and exercise routine.

Actually, whether you have asthma or not, most experts believe reflux is preventable, and is usually the result of choices we make. If you have asthma, your increased risk for getting GERD is just another incentive to eat well.

While not all people with GERD will develop asthma, if you have a family history of asthma this is an added incentive for you to eat well and exercise.

Facebook
Twitter