So you woke up in the middle of the night due to sneezy, stuffy, head, and a downright miserable feeling in your nose. Your breathing feels tight, chest aching, itchy eyes, and you feel congested. Perhaps you have a headache that won't go away. You may feel like you have a cold, but chances are you're suffering from Hay Fever.
You were hot and put the fan in the window, with it blowing right on you. So your first inclination was to blame the fan for your misery. Yet it wasn't the fan per se: it was what the fan was blowing your way -- ragweed pollen. It's also referred to as ambrosia, and you can see some picures here.
The sumer of 2012 was an excessively dry summer, and this is prime weather for weeds to grow. Plus shorter days and cooler nights "stimulate pollination in the ragweed plant," according to a report by Dayton Daily News.
These weeds hit their prime in August, with August 15 being the peek of ragweed pollen season. The pollen start to fall from the weeds and the wind blows them where they are used for pollenation.
With all this pollen in the air, much of it blows into your open window. The fan helps it reach your airway, and you inhale it without thinking. Your immune system recognizes it as an enemy, and generates an all out attack. Your blood vessels dilate and your airway tissues become inflammed. If you have asthma this means increased inflammation, and possibly worse asthma.
Either way, you feel miserable. To get relief you'll have to get out of bed and walk to the bathroom or kitchen where you keep your benadryl. Yet this makes you tired, so you might be better off with Claratin or Zyrtec. In some cases, your allergies may be so bad you might want to try both. You'll also want to make sure you take your Singulair if you have it.
It'll take 30- mintues to an hour for this medicine to start taking effect, if it takes effect at all. So it's 2 a.m. and you have to sit on the couch watching reruns of Everybody Loves Raymond until you finally feel enough relief to go back to bed.
One study (as you can read here) shows that of people sensitive or allergic to pollen, 75 percent are allergic to ragweed pollen. One expert notes that more people are allergic to ragween than any other pollen.
The pollen count generally starts to settle down around labor day, with September and October bringing relief to allergy sufferers.
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Wednesday, August 31, 2011
Tuesday, August 30, 2011
Why is asthma sputum white?
Your humble question: Why is asthma sputum white?
My humble answer: Asthma is a condition that often results in an increase in the number of goblet cells that line your lungs. Goblet cells are cells that produce sputum. During an exacerbation of asthma these cells increase production of sputum.
It's important to know your lungs are normally sterile. It's normal for your body uses sputum to trap particles that you inhale to prevent them from getting to your lungs and to keep the lungs germ free. This sputum makes it's way to your oral airway for you to swallow or spit up. Usually this sputum is so scant you won't even notice it, and if you do notice it it's clear or white.
If you are sick with a lung infection your sputum produciton may increase as a natural mechanism to rid your otherwise sterile lungs of the infecting microbes. Depending on the infecting agent, this sputum will come in a variety of colors. To learn what colors represent what condition check out the sputum lexicon.
Asthma sputum is unique in that it is not produced to fight off an infection. Actually, the ironic thing about asthma is it's a disease whereby your immune system works too well. It's your body thinking something you inhaled that is normally considered safe (like dust mites for example) is an enemy bacteria. Or it's your immune system attacking your own body.
For this reason, the increased sputum will not contain bacteria, and it will not contain viruses. It will be sterile. In other words, it was not produced to kill off an infection (that is, unless an infecting agent triggered the attack). For this reason, asthma sputum is sterile. It is white.
My humble answer: Asthma is a condition that often results in an increase in the number of goblet cells that line your lungs. Goblet cells are cells that produce sputum. During an exacerbation of asthma these cells increase production of sputum.
It's important to know your lungs are normally sterile. It's normal for your body uses sputum to trap particles that you inhale to prevent them from getting to your lungs and to keep the lungs germ free. This sputum makes it's way to your oral airway for you to swallow or spit up. Usually this sputum is so scant you won't even notice it, and if you do notice it it's clear or white.
If you are sick with a lung infection your sputum produciton may increase as a natural mechanism to rid your otherwise sterile lungs of the infecting microbes. Depending on the infecting agent, this sputum will come in a variety of colors. To learn what colors represent what condition check out the sputum lexicon.
Asthma sputum is unique in that it is not produced to fight off an infection. Actually, the ironic thing about asthma is it's a disease whereby your immune system works too well. It's your body thinking something you inhaled that is normally considered safe (like dust mites for example) is an enemy bacteria. Or it's your immune system attacking your own body.
For this reason, the increased sputum will not contain bacteria, and it will not contain viruses. It will be sterile. In other words, it was not produced to kill off an infection (that is, unless an infecting agent triggered the attack). For this reason, asthma sputum is sterile. It is white.
Monday, August 29, 2011
How to prepare your asthmatic child for school
So you have an asthmatic child. Are you doing everything you can to prepare your child for the challenge of having asthma in school? What follows are some tips created in a recent post at MyAsthmaCentral.com
It's Time To Create An Asthma Action Plan For School
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It's Time To Create An Asthma Action Plan For School
I'd like to take this opportunity to introduce you to Jane Gallant. She's the asthma mom who does everything right when it comes to her 5-year-old daughter Jessie's asthma. She's likes to be proactive and prevent.
Jane remembers her grandma saying something like, "It's important to be proactive. If you're proactive you prevent something bad from happening. If you wait until something happens before you respond, you're being reactive. If you're reacting, it means something bad already happened. It's too late to stop it. So it's better to be proactive."
So when it came to Jessie's asthma Jane was definitely proactive. She spends a lot of time right here on this site, and she reads books, and she makes sure to take Jessie to her pediatrician at least once a year.
She also makes sure to assist her daughter in taking her medications, and makes sure she takes them every day, especially when Jessie is feeling well. Jane has also worked with Jessie's pediatrician in creating a good asthma action plan.
Her doctor mentioned something about working with Jessie's teacher and principal on creating an asthma action plan for school. So, reminded by the daily onslaught of back-to-school ads, she's decided there's no better time than right now. She set up a meeting with the principal, and asked that Jessie's teacher and gym teacher are all present.
Jane knows Jessie's early warning signs of asthma, and what to do when she observes them. And she wants to make sure Jessie's gets the same good care at school that she would get at home. So she plans on creating a list of Jessie's early warning signs and making sure anyone who cares for Jessie (like her teachers) knows what they are, and also what to do.
She especially wants to make sure her child is able to participate in gym class, as it's important for everyone, especially asthmatics, to stay physically active. Exercise has many advantages, including making your heart and lungs stronger.
The gym teacher will need to be taught how to pre-treat Jessie before exercise, and to be especially vigilant regarding Jessie's early warning signs. Jessie needs to exercise, yet there may be days when she may need to take it easy. It's important for the gym teacher to know when to encourage Jessie to exercise, and when to encourage her to take it easy, or when to stop.
Jessie learned through her many readings it's very important for those responsible for her daughter at school need to be on the same page as Jane and Jill's doctor. This will allow for Jessie to get the best asthma care.
That's why she's created an asthma action plan for school. She also purchased from her pharmacy an extra Ventolin inhaler and plans on giving it to the principal to keep in his office just in case Jessie forgets her own inhaler and needs it.
Likewise, Jessie will have to make sure she tells the teacher when Jessie is using her inhaler a lot, because sometimes hyperactivity can be a side effect of using lots of this medicine. Likewise, the principal will have to call Jane when Jessie needs her inhaler at school. Good communication is essential.
National Jewish Health's "Back to school health tips, notes that if your child misses school, or assignments, the teacher will have to be helpful and patient in helping and encouraging Jessie to get caught up so she doesn't get behind. A plan needs to be in place just in case.
Likewise, if Jessie has been having trouble breathing, and perhaps up late, she "may be tired and have difficulty concentrating the next day at school," National Jewish notes. So this is yet another instance where good communication is a must.
Although some hospitals don't allow kids to carry their own medicine, so she needs to make sure she knows what the policy at Jessie's school is. That's part of the goal for this meeting.
She also bought an extra peak flow meter that she will keep with the inhaler. In fact, she's decided to buy a small box and put the list of early warning signs, the asthma action plan, the Ventolin inhaler, and the peak flow meter in it. This will be Jessie's asthma emergency box for school.
It's important she's being proactive, because asthma is a very treatable disease. With good care, asthma attacks can be prevented, or at least nipped in the bud.
So if you're responsible for a little asthmatic, be it as a mom, a parent, guardian, teacher, or even a grandparent, are you proactive like Jane Gallant? Are you a gallant asthma mom or dad?
If so, right now's the time to start thinking about creating an asthma action plan for school.
FacebookDo Antibiotics Cause Asthma?
We're learning as we progress through out "things that cause asthma" series that asthma may be caused by more than just genetics. Our own use of antibiotics may be one of the other culprits.
Parents Beware! Antibiotics Might Cause Asthma
From MyAsthmacentral March 21, 2011
Parents and doctors beware! Antibiotic use during the first year of life probably does cause asthma!
There is enough research now that we can definitely say probably. General thinking for years has been that if a child has an infection it should be treated with antibiotics. Yet newer evidence is leaning in the direction that while antibiotics cure an acute infection, it may cause asthma later on.
The most recent study was completed by Yale University researchers, and they interviewed women during pregnancy and when the child was 6-years-old. Of the 1,401 studied:
Back then 13,116 infants were followed to age 7, and the conclusion was that infants who received antibiotics were at a much greater risk of developing asthma. Likewise, the more rounds of antibiotics the greater the risk.
At present there are two educated guesses that scientists are keeping an eye on to help explain this phenomenon:
Hygiene Hypothesis: Lack of exposure to bacteria causes your immune system to get bored and attack things that aren't supposed to be bad. Thus, newborns must be exposed to certain bacteria in order to develop properly. Since antibiotics kill the bacteria it needs to develop, such infants develop asthma.
Micro Flora Hypothesis: Lack of normal bacteria in the intestinal tract causes a response that leads to an increase in inflammatory markers, which then leads to asthma and allergies. Thus, certain antibiotics may wipe out the good bacteria along with the bad.
If we go by the Hygiene Hypothesis, all antibiotics should be avoided. However, if we go by the Micro Flora Hypothesis, it appears the main culprit is broad spectrum antibiotics such as erythromycin, azithromycin and clarithromycin.
Again, broad spectrum antibiotics wipe out the good bacteria with the bad. However, narrow spectrum antibiotics will target only the bacteria causing an infection.
So, in the past, a mom brings in an infant that is sick with nasal congestion, runny nose and an ear infection, the doctor would instantly thinks, "I have to do something. Since it takes 48 hours for cultures to get back, let's prescribe a broad spectrum antibiotic! When cultures come back and we determine what specific bug is causing the problem, then we can switch to a narrow spectrum antibiotic."
Yet that thinking might have to change in lieu of modern wisdom. In the absence of a life threatening situation, it might be better to forgo the antibiotics and let kids under the age of one tough it out.
As a matter of fact, I presently have a child under a year in my house with eczema, and he developed an infection on his face. Yet knowing I have the asthma gene, we simply toughed it out -- just like they did in the olden days. And guess what? We all survived.
Rest assured, though, because there was already a plethora of evidence that antibiotics are over-prescribed. Consider the following:
Quite often antibiotics don't do any good anyway
Many infections are viral and not bacterial (antibiotics do nothing for viral infections). Many times doctors have no clue what's causing the infection, yet antibiotics are ordered anyway (broad spectrum).
Many times antibiotics are only prescribed so mom's think something is being done. Or sometimes they're ordered just so the doctor can make sure he covers all his bases.
Likewise, abuse of antibiotics has lead to antibiotic resistant bacteria.
So the bottom line here is antibiotics may not even be necessary for your infant anyway. If they're in need then they should be used. But just beware! Antibiotics may, cause asthma.
Parents Beware! Antibiotics Might Cause Asthma
From MyAsthmacentral March 21, 2011
Parents and doctors beware! Antibiotic use during the first year of life probably does cause asthma!
There is enough research now that we can definitely say probably. General thinking for years has been that if a child has an infection it should be treated with antibiotics. Yet newer evidence is leaning in the direction that while antibiotics cure an acute infection, it may cause asthma later on.
The most recent study was completed by Yale University researchers, and they interviewed women during pregnancy and when the child was 6-years-old. Of the 1,401 studied:
- 40 percent of infants given just one dose of antibiotics developed childhood asthma and allergies.
- 70 percent of infants given two rounds of antibiotics developed asthma
Back then 13,116 infants were followed to age 7, and the conclusion was that infants who received antibiotics were at a much greater risk of developing asthma. Likewise, the more rounds of antibiotics the greater the risk.
At present there are two educated guesses that scientists are keeping an eye on to help explain this phenomenon:
Hygiene Hypothesis: Lack of exposure to bacteria causes your immune system to get bored and attack things that aren't supposed to be bad. Thus, newborns must be exposed to certain bacteria in order to develop properly. Since antibiotics kill the bacteria it needs to develop, such infants develop asthma.
Micro Flora Hypothesis: Lack of normal bacteria in the intestinal tract causes a response that leads to an increase in inflammatory markers, which then leads to asthma and allergies. Thus, certain antibiotics may wipe out the good bacteria along with the bad.
If we go by the Hygiene Hypothesis, all antibiotics should be avoided. However, if we go by the Micro Flora Hypothesis, it appears the main culprit is broad spectrum antibiotics such as erythromycin, azithromycin and clarithromycin.
Again, broad spectrum antibiotics wipe out the good bacteria with the bad. However, narrow spectrum antibiotics will target only the bacteria causing an infection.
So, in the past, a mom brings in an infant that is sick with nasal congestion, runny nose and an ear infection, the doctor would instantly thinks, "I have to do something. Since it takes 48 hours for cultures to get back, let's prescribe a broad spectrum antibiotic! When cultures come back and we determine what specific bug is causing the problem, then we can switch to a narrow spectrum antibiotic."
Yet that thinking might have to change in lieu of modern wisdom. In the absence of a life threatening situation, it might be better to forgo the antibiotics and let kids under the age of one tough it out.
As a matter of fact, I presently have a child under a year in my house with eczema, and he developed an infection on his face. Yet knowing I have the asthma gene, we simply toughed it out -- just like they did in the olden days. And guess what? We all survived.
Rest assured, though, because there was already a plethora of evidence that antibiotics are over-prescribed. Consider the following:
Quite often antibiotics don't do any good anyway
Many infections are viral and not bacterial (antibiotics do nothing for viral infections). Many times doctors have no clue what's causing the infection, yet antibiotics are ordered anyway (broad spectrum).
Many times antibiotics are only prescribed so mom's think something is being done. Or sometimes they're ordered just so the doctor can make sure he covers all his bases.
Likewise, abuse of antibiotics has lead to antibiotic resistant bacteria.
So the bottom line here is antibiotics may not even be necessary for your infant anyway. If they're in need then they should be used. But just beware! Antibiotics may, cause asthma.
Sunday, August 28, 2011
Here's what I believe...
For one thing, I believe any of us could be wrong.
I believe facts are facts and cannot be disputed (like 2+2=4). I believe a theory is a theory, yet sometimes we treat theories as facts. No opinion is wrong.
I believe it doesn't matter what religion you are, so long as you believe.
I think that even those who murder can get to Heaven if they truly change inside.
I believe (and studies confirm) true believers are more likely to handle adversity. For example, a religious patient recently diagnosed with cancer is more likely to be a happy and pleasant patients than one who doesn't believe.
I believe there is a place like purgatory where our souls can remain on earth. I believe these souls are the Angels of Heaven. While I'm a Catholic the church can and is wrong on some issues.
I believe that Western Society was the result of Christianity. I believe this because this was the first religion that encouraged people to be good to one another and do your best to make the world better as a means of getting to Heaven. This philosophy resulted in the Magna Carta and then the U.S. Constitution and, hence, freedom.
I believe that you can be wrong and still be my best friend. Ah, but that is the Christian way.
I believe you can be wrong and still get to Heaven.
I believe you can be other religions too and get to Heaven.
I believe you can disagree with everything I write and still enjoy my philosophy, and vice versal.
I believe their is a doctor somewhere and someplace who reads my blog and agrees with my view that bronchodilators are the most abused medicines in the hospital (Maybe second next to Tylenol, yet that's open to debate).
I believe decisions should be made based on facts as opposed to feelings, and that most of the wrongs in the world are the result of decisions made on feelings and ignorance as opposed to fact.
I know the U.S. Founding fathers -- people like Thomas Jefferson, Alexander Hamilton, George Washington, John Adams, James Madison, Benjamin Franklin, Samuel Adams and Thomas Paine -- knew democracies always ended in tyrany and that's why they chose to make America a republic. If you don't believe me you should study Ancient Rome and Ancient Greece.
Considering this fact, I think it's funny most people think the U.S. is a democracy.
I believe some ignorance is a product of laziness, yet most ignorance is a product of other responsibilities (like the need raise a family and spend time with your kids).
So if the U.S. were a democracy every voter would be expected to show up and be informed. The founders knew this type of system never works, that more and more people quit showing up to discuss policies and vote, and one tyranical dictator -- See Augustus as one example --of one political affiliation is the result.
The founders didn't want the U.S. to fall to dictatorship. They knew most of us don't have time to be truly informed, so they created a republic. In this way, politicians are expected to stay informed. If they don't, we -- the voters -- hold them accountable.
I believe if you are a politician you ought to read and make yourself wise. Well, I believe we all ought to do that, but especially politicians. I believe politicians should not be allowed to buy votes, and that includes signing bills that only benefit their constituents at the expense of the rest of us. By golly, why should I have to pay for a bridge in Alaska? Why would I care about the sexual behaviors of shrimp? I don't, and therefore -- I believe -- my tax dollars shouldn't go there.
I believe all Americans ought to learn as much as possible about American history, lest we are doomed to return to the old ways the founders sought to get away from.
I believe schools ought to teach all points of views, especially those of which the teachers might disagree with, and let the kids decide. I believe -- strongly so -- that teachers ought not teach theory as fact.
I believe we ought to lead by example as opposed to other methods.
I believe if we force our kids to do things our way we will stifle creativity. I believe we ought not convince young impressionable kids their parents are wrong.
I believe if Washington forces hospitals to run their business the same way, that we will stifle creativity, and we will stifle imaginations, and we will prevent progress. I believe if we force every hospital to do it the same way we prevent competition that results in innovations that would make our health care system better than it is right now.
I believe freedom breeds innovation, as we can see by the 1920s and 1980s.
I believe in God.
I believe people ought to prioritize: God, wife, kids, other people, other things.
I believe those adults who speak the most know the least.
I believe those who are silent appear to be the wisest, although they may not be.
I believe we ought to read and think before we speak.
I believe we ought to read and think before we make laws.
I believe every law results in one freedom taken away, so we ought to have few laws and enforce them with a heavy stick.
I believe it is better to do nothing than to do something stupid.
I believe the Internet should remain free.
I believe that freedom is fragile.
I believe that every tax dollar given to the government is one more job lost that we will not even see because what we do see is that dollar being spent by the government.
I believe people ought to be open minded as opposed to dogmatic in their views.
I believe people should be open to change.
I believe stupidity is the result of pride, ignorance or dishonesty.
I believe if our health care system gets worse it's because of pride, ignorance or dishonesty.
If you believe you have the solution, and you force your solution on everyone else, they you better -- by God -- hope you are right. I say this because once a new government program is enacted -- i.e. social security, Medicare -- it becomes a Holy grail of politics that no politician will want to touch.
I believe in Natural rights, such as we are all born with the right to speak, the right to breathe air, the right to eat, the right to sleep, the right to defend ourselves, the right to enter into a contract, the right to life, the right to liberty, the right to pursue happiness, and more. I believe -- as did our founders -- that these rights cannot be taken away except for by government policy.
I believe if America faces another revolution, no matter how small, it's because of pride, ignorance or dishonesty.
I believe that Ventolin does not treat anything but bronchospasm, and that most people have no clue how to diagnose bronchospasm due to pride, ignorance or dishonesty.
I believe stupidity breeds stupidity.
I believe kids ought to look around the table tonight at dinner and see what they will be when they grow up, because most of us will end up just like our parents unless we choose not to. I believe it takes an intelligent and strong willed child to see the flaws of his or her parents and step up and become better.
I believe a wise person will read material he does not agree with, and listen to people he does not agree with. I believe all ideas should be debated in the arena of ideas, and this should be done in a sensible fashion with level heads (and that this is easier said than done, because most people don't like to hear opposing viewpoints and would rather shut other people up than listen to them).
I believe everyone should have one vote, yet I think the way to euphoria is for everyone to do their homework before they cast that vote.
I believe we should reach for euphoria yet have the wisdom to know that we cannot reach it or ever achieve it. We must know there will always be bad guys to defend ourselves against. We must know there will always be stupid people. We must know there will always -- either by choice or chance -- be impoverished folks. We must know we cannot give everyone a job even in the most ideal society -- although we can strive to end poverty.
I believe every American will have at least one opportunity to improve his or her lot in life, if he or she chooses to take the effort to make that choice.
I believe everyone should take responsibility for their own actions that have either good or bad results.
I believe people should get their news from more than one source, lest they risk getting brainwashed.
I believe no two people have the same opinions on any subject.
I believe everyone should learn the truth, even when the truth hurts.
I believe even two people who agree disagree.
I believe opinions are just that, opinions.
I believe the secret to life is to follow each expiration with an inspiration.
I believe facts are facts and cannot be disputed (like 2+2=4). I believe a theory is a theory, yet sometimes we treat theories as facts. No opinion is wrong.
I believe it doesn't matter what religion you are, so long as you believe.
I think that even those who murder can get to Heaven if they truly change inside.
I believe (and studies confirm) true believers are more likely to handle adversity. For example, a religious patient recently diagnosed with cancer is more likely to be a happy and pleasant patients than one who doesn't believe.
I believe there is a place like purgatory where our souls can remain on earth. I believe these souls are the Angels of Heaven. While I'm a Catholic the church can and is wrong on some issues.
I believe that Western Society was the result of Christianity. I believe this because this was the first religion that encouraged people to be good to one another and do your best to make the world better as a means of getting to Heaven. This philosophy resulted in the Magna Carta and then the U.S. Constitution and, hence, freedom.
I believe that you can be wrong and still be my best friend. Ah, but that is the Christian way.
I believe you can be wrong and still get to Heaven.
I believe you can be other religions too and get to Heaven.
I believe you can disagree with everything I write and still enjoy my philosophy, and vice versal.
I believe their is a doctor somewhere and someplace who reads my blog and agrees with my view that bronchodilators are the most abused medicines in the hospital (Maybe second next to Tylenol, yet that's open to debate).
I believe decisions should be made based on facts as opposed to feelings, and that most of the wrongs in the world are the result of decisions made on feelings and ignorance as opposed to fact.
I know the U.S. Founding fathers -- people like Thomas Jefferson, Alexander Hamilton, George Washington, John Adams, James Madison, Benjamin Franklin, Samuel Adams and Thomas Paine -- knew democracies always ended in tyrany and that's why they chose to make America a republic. If you don't believe me you should study Ancient Rome and Ancient Greece.
Considering this fact, I think it's funny most people think the U.S. is a democracy.
I believe some ignorance is a product of laziness, yet most ignorance is a product of other responsibilities (like the need raise a family and spend time with your kids).
So if the U.S. were a democracy every voter would be expected to show up and be informed. The founders knew this type of system never works, that more and more people quit showing up to discuss policies and vote, and one tyranical dictator -- See Augustus as one example --of one political affiliation is the result.
The founders didn't want the U.S. to fall to dictatorship. They knew most of us don't have time to be truly informed, so they created a republic. In this way, politicians are expected to stay informed. If they don't, we -- the voters -- hold them accountable.
I believe if you are a politician you ought to read and make yourself wise. Well, I believe we all ought to do that, but especially politicians. I believe politicians should not be allowed to buy votes, and that includes signing bills that only benefit their constituents at the expense of the rest of us. By golly, why should I have to pay for a bridge in Alaska? Why would I care about the sexual behaviors of shrimp? I don't, and therefore -- I believe -- my tax dollars shouldn't go there.
I believe all Americans ought to learn as much as possible about American history, lest we are doomed to return to the old ways the founders sought to get away from.
I believe schools ought to teach all points of views, especially those of which the teachers might disagree with, and let the kids decide. I believe -- strongly so -- that teachers ought not teach theory as fact.
I believe we ought to lead by example as opposed to other methods.
I believe if we force our kids to do things our way we will stifle creativity. I believe we ought not convince young impressionable kids their parents are wrong.
I believe if Washington forces hospitals to run their business the same way, that we will stifle creativity, and we will stifle imaginations, and we will prevent progress. I believe if we force every hospital to do it the same way we prevent competition that results in innovations that would make our health care system better than it is right now.
I believe freedom breeds innovation, as we can see by the 1920s and 1980s.
I believe in God.
I believe people ought to prioritize: God, wife, kids, other people, other things.
I believe those adults who speak the most know the least.
I believe those who are silent appear to be the wisest, although they may not be.
I believe we ought to read and think before we speak.
I believe we ought to read and think before we make laws.
I believe every law results in one freedom taken away, so we ought to have few laws and enforce them with a heavy stick.
I believe it is better to do nothing than to do something stupid.
I believe the Internet should remain free.
I believe that freedom is fragile.
I believe that every tax dollar given to the government is one more job lost that we will not even see because what we do see is that dollar being spent by the government.
I believe people ought to be open minded as opposed to dogmatic in their views.
I believe people should be open to change.
I believe stupidity is the result of pride, ignorance or dishonesty.
I believe if our health care system gets worse it's because of pride, ignorance or dishonesty.
If you believe you have the solution, and you force your solution on everyone else, they you better -- by God -- hope you are right. I say this because once a new government program is enacted -- i.e. social security, Medicare -- it becomes a Holy grail of politics that no politician will want to touch.
I believe in Natural rights, such as we are all born with the right to speak, the right to breathe air, the right to eat, the right to sleep, the right to defend ourselves, the right to enter into a contract, the right to life, the right to liberty, the right to pursue happiness, and more. I believe -- as did our founders -- that these rights cannot be taken away except for by government policy.
I believe if America faces another revolution, no matter how small, it's because of pride, ignorance or dishonesty.
I believe that Ventolin does not treat anything but bronchospasm, and that most people have no clue how to diagnose bronchospasm due to pride, ignorance or dishonesty.
I believe stupidity breeds stupidity.
I believe kids ought to look around the table tonight at dinner and see what they will be when they grow up, because most of us will end up just like our parents unless we choose not to. I believe it takes an intelligent and strong willed child to see the flaws of his or her parents and step up and become better.
I believe a wise person will read material he does not agree with, and listen to people he does not agree with. I believe all ideas should be debated in the arena of ideas, and this should be done in a sensible fashion with level heads (and that this is easier said than done, because most people don't like to hear opposing viewpoints and would rather shut other people up than listen to them).
I believe everyone should have one vote, yet I think the way to euphoria is for everyone to do their homework before they cast that vote.
I believe we should reach for euphoria yet have the wisdom to know that we cannot reach it or ever achieve it. We must know there will always be bad guys to defend ourselves against. We must know there will always be stupid people. We must know there will always -- either by choice or chance -- be impoverished folks. We must know we cannot give everyone a job even in the most ideal society -- although we can strive to end poverty.
I believe every American will have at least one opportunity to improve his or her lot in life, if he or she chooses to take the effort to make that choice.
I believe everyone should take responsibility for their own actions that have either good or bad results.
I believe people should get their news from more than one source, lest they risk getting brainwashed.
I believe no two people have the same opinions on any subject.
I believe everyone should learn the truth, even when the truth hurts.
I believe even two people who agree disagree.
I believe opinions are just that, opinions.
I believe the secret to life is to follow each expiration with an inspiration.
Saturday, August 27, 2011
Hypoxic Drive: Here's a new theory
Here's something interesting to think about. Now, for simplicity purposes, let us assume that the hypoxic drive is real, that if a COPD retainer is given too much oxygen he will stop breathing.
So, that in mind, many doctors do not want to give a COPD patient oxygen even when his sats are low, and even at the risk that his heart won't get enough oxygen.
Yet, think of this. The hypoxic drive is based on arterial PO2. If you give a COPD patient 100% oxygen, and his sat is still in the 80s, that means that oxygen isn't getting to the arterioles anyway. Hence, it shouldn't effect the hypoxic drive.
Thus, if you have a CO2 retainer, and assuming the hypoxic drive is real, you should be able to give as much oxygen as is needed to maintain an appropriate PO2, like say something around 88% would even be nice.
This is just something one of my coworkers brought to my attention. Thoughts?
So, that in mind, many doctors do not want to give a COPD patient oxygen even when his sats are low, and even at the risk that his heart won't get enough oxygen.
Yet, think of this. The hypoxic drive is based on arterial PO2. If you give a COPD patient 100% oxygen, and his sat is still in the 80s, that means that oxygen isn't getting to the arterioles anyway. Hence, it shouldn't effect the hypoxic drive.
Thus, if you have a CO2 retainer, and assuming the hypoxic drive is real, you should be able to give as much oxygen as is needed to maintain an appropriate PO2, like say something around 88% would even be nice.
This is just something one of my coworkers brought to my attention. Thoughts?
Friday, August 26, 2011
How to suction a patient with thinning blood
Your RT question: Can you or have you done nasotracheal suctioning on a patient on blood thinner like coumadin, or is it contraindicated? Can you suction a patient in DIC?
My humble answer: You are right to suction with reservation and to question any suction order. Yet if a patient absolutely needs to be suctioned, then you have no choice in the matter. I was taught a method that should always be followed when NT suctioning that makes the process easier for you and for the patient, and prevents trauma to tissues.
Follow the following technique and you shouldn't have to worry if the patient is a bleeder or not:
1. Always insert a nasal airway prior to NT suctioning. Nasal airways are soft and easy to insert. They actually make it easier to insert the suction catheter, and also prevent the catheter from nicking the nasal passages (you'll have to lubricate the suction catheter before inserting it).
2. Never go all the way down to the corina. Hitting the corina with the suction tubing can cause trauma, bleeding, and if done often enough it can cause necrotizing tissue.
I hope this helps
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My humble answer: You are right to suction with reservation and to question any suction order. Yet if a patient absolutely needs to be suctioned, then you have no choice in the matter. I was taught a method that should always be followed when NT suctioning that makes the process easier for you and for the patient, and prevents trauma to tissues.
Follow the following technique and you shouldn't have to worry if the patient is a bleeder or not:
1. Always insert a nasal airway prior to NT suctioning. Nasal airways are soft and easy to insert. They actually make it easier to insert the suction catheter, and also prevent the catheter from nicking the nasal passages (you'll have to lubricate the suction catheter before inserting it).
2. Never go all the way down to the corina. Hitting the corina with the suction tubing can cause trauma, bleeding, and if done often enough it can cause necrotizing tissue.
I hope this helps
Thursday, August 25, 2011
Stem cells may lead to new wisdom about lung disease
New evidence that scientists are working overtime to find better treatment for lung disorders comes from a recent study that concludes scientists have found a stem cell "that plays a part in the repair mechanisms in the large airways of the lungs," Daily News and Analysis reports.
Mucus glands are important because they produce mucus that traps particles and brings them to the oral cavity to be swallowed. This is one of our bodies natural defense mechanisms to keep our lungs sterile and free of infection.
Diseases like COPD, Asthma and cystic fibrosis often result in increased mucus production that further complicates their breathing. In the case of COPD and cystic fibrosis, this increased mucus can become trapped in the lungs and increase the risk for lung infections like pneumonia.
So far most of the studies have been completed on lab animals, so it's not yet sure how this will translate to humans.
And while it's not likely this will lead to any new treatments or a cure for any lung diseases in the near future, it does provide scientists with an opportunity to further study mucus glands and the "mechanisms" for diseases of the upper airway.
Just another post to show there is hope for the future for all those folks suffering with lung illness.
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Mucus glands are important because they produce mucus that traps particles and brings them to the oral cavity to be swallowed. This is one of our bodies natural defense mechanisms to keep our lungs sterile and free of infection.
Diseases like COPD, Asthma and cystic fibrosis often result in increased mucus production that further complicates their breathing. In the case of COPD and cystic fibrosis, this increased mucus can become trapped in the lungs and increase the risk for lung infections like pneumonia.
So far most of the studies have been completed on lab animals, so it's not yet sure how this will translate to humans.
And while it's not likely this will lead to any new treatments or a cure for any lung diseases in the near future, it does provide scientists with an opportunity to further study mucus glands and the "mechanisms" for diseases of the upper airway.
Just another post to show there is hope for the future for all those folks suffering with lung illness.
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Wednesday, August 24, 2011
Michigan VAP rates on steep decline
I wrote earlier how the Keystone Collaborative in Michigan has been so successful at improving patient outcomes and reducing costs that the Fed is recommending other states come up with a similar program. New evidence shows that the Keystone Collaborative has helped to significantly lower the rates of ventilator acquired pneumonia (VAP) in Michigan Intensive Care Units.
The new study on at the U.S. Department of Health and Human Services, "Rates of Pneumonia Dramatically Reduced in Patients on Ventilators in Michigan Intensive Care Units," In fact, rates of VAP in Michigan hospitals has declined by 70 percent since the Keystone Collaborative was started. The study included data from 112 ICUs in Michigan.
This is interesting considering I wrote this post about a presentation I gave about how Keystone Policies helped shoreline significantly reduce the rate of readmission rates for pneumonia patients.
The Keystone Collaborative is significant because it pools resources and wisdom from leaders from hospitals in Michigan and some surrounding states to decide what methodologies are needed to implement best practice medicine to improve outcome and reduce costs. The Keystone Collaborative then recommends certain core measures for each hospital to try to achieve.
The Core Measures include measures that are proven to work for a specific diagnosis to speed the time from admission to discharge, reduce readmission rates, best practice medicine, and to make sure intensity of service is met in order to make sure the patient meets reimbursement criteria.
I have to note here that I'm not particularly happy that many redundant and unnecessary procedures are the result when hospitals resort to cook book medicine (which is what I think order sets are), in that it basically treats all patients the same. Yet while this may be a side effect, the overall result for the hospital IS improved outcomes and reduced costs.
This recent study is proof again that that Michigan hospitals like Shoreline are taking steps in the right direction. This is good for the patients, and it's good for RTs like you and me in that it helps to keep our hospitals financially sound so we can continue to get our paychecks.
The Keystone Committee at Shoreline has created order sets and some protocols that are aimed at accomplishing the core measures designed to implement best practice medicine, evidenced based therapies, prevent complications (like infections due to catheters being inserted too long and ventilators and central lines), and reduce the risk of patient's dying in the ICU.
When it comes to core measures, the study shows an increase from 32 percent to 84 percent in Michigan hospitals that have successfully implemented the core measures. The study also showed a sharp decline in blood stream infections from central lines and has reduced the number of patients who die in the ICU (see sepsis protocol and extubation protocol).
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The new study on at the U.S. Department of Health and Human Services, "Rates of Pneumonia Dramatically Reduced in Patients on Ventilators in Michigan Intensive Care Units," In fact, rates of VAP in Michigan hospitals has declined by 70 percent since the Keystone Collaborative was started. The study included data from 112 ICUs in Michigan.
This is interesting considering I wrote this post about a presentation I gave about how Keystone Policies helped shoreline significantly reduce the rate of readmission rates for pneumonia patients.
The Keystone Collaborative is significant because it pools resources and wisdom from leaders from hospitals in Michigan and some surrounding states to decide what methodologies are needed to implement best practice medicine to improve outcome and reduce costs. The Keystone Collaborative then recommends certain core measures for each hospital to try to achieve.
The Core Measures include measures that are proven to work for a specific diagnosis to speed the time from admission to discharge, reduce readmission rates, best practice medicine, and to make sure intensity of service is met in order to make sure the patient meets reimbursement criteria.
I have to note here that I'm not particularly happy that many redundant and unnecessary procedures are the result when hospitals resort to cook book medicine (which is what I think order sets are), in that it basically treats all patients the same. Yet while this may be a side effect, the overall result for the hospital IS improved outcomes and reduced costs.
This recent study is proof again that that Michigan hospitals like Shoreline are taking steps in the right direction. This is good for the patients, and it's good for RTs like you and me in that it helps to keep our hospitals financially sound so we can continue to get our paychecks.
The Keystone Committee at Shoreline has created order sets and some protocols that are aimed at accomplishing the core measures designed to implement best practice medicine, evidenced based therapies, prevent complications (like infections due to catheters being inserted too long and ventilators and central lines), and reduce the risk of patient's dying in the ICU.
When it comes to core measures, the study shows an increase from 32 percent to 84 percent in Michigan hospitals that have successfully implemented the core measures. The study also showed a sharp decline in blood stream infections from central lines and has reduced the number of patients who die in the ICU (see sepsis protocol and extubation protocol).
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Tuesday, August 23, 2011
Why is dose of Albuterol same for all ages?
Your RT question: Why is the adult dose for bronchodilator solutions the same as the pediatric dose?
My humble answer: The main reason is because most of the medicine is wasted, as you can read here. When you give nebulized medicine to an adult 12 percent will get to the bronchial tubes where it relaxes them (if there is bronchospasm present). The smaller the airway the greater the degree of impaction in the upper airway, and the less medicine gets to the air passages. So while 12 percent looks bad, it might look more like 5 percent in a pediatric airway. Now that's assuming you give the medicine via a mask or mouthpiece. If you give the medicine by blowby you can decrease that 5 percent by another 75 percent. So you can safely assume most of the medicine is wasted in any patient.
Another reason is because Albuterol is safe and effective at the given recommended dose of 0.5cc or 2.5mg. Even higher doses are effective and safe. While no clinical studies were ever done as far as I've ever seen, best practice evidence suggests (as most RTs have witnessed) several back to back Albuterol breathing treatments tends to be very effective at relaxing airways with minimal side effects. For this reason, epinephrine has pretty much been phased out as a top line medicine for asthma in the emergency room. Albuterol is as effective and safer even while giving the same dose to adults and pediatrics.
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My humble answer: The main reason is because most of the medicine is wasted, as you can read here. When you give nebulized medicine to an adult 12 percent will get to the bronchial tubes where it relaxes them (if there is bronchospasm present). The smaller the airway the greater the degree of impaction in the upper airway, and the less medicine gets to the air passages. So while 12 percent looks bad, it might look more like 5 percent in a pediatric airway. Now that's assuming you give the medicine via a mask or mouthpiece. If you give the medicine by blowby you can decrease that 5 percent by another 75 percent. So you can safely assume most of the medicine is wasted in any patient.
Another reason is because Albuterol is safe and effective at the given recommended dose of 0.5cc or 2.5mg. Even higher doses are effective and safe. While no clinical studies were ever done as far as I've ever seen, best practice evidence suggests (as most RTs have witnessed) several back to back Albuterol breathing treatments tends to be very effective at relaxing airways with minimal side effects. For this reason, epinephrine has pretty much been phased out as a top line medicine for asthma in the emergency room. Albuterol is as effective and safer even while giving the same dose to adults and pediatrics.
Monday, August 22, 2011
How to prepare your asthmatic for College
Parents. If you have a kid with asthma you'll want to take that slight extra effort to help them make the transition. Here are some tips from a recent post from MyAsthmaCentral.com
Tips For Parents of College Bound Students
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Tips For Parents of College Bound Students
So you are the parent of an asthmatic who is soon heading off to college, or perhaps is already off on that journey. Yes it's true you have to let your child go at some point, and hope he uses the wisdom you provided wisely.
Yet it's also important to know that your role as a parent has not ended. Even if he or she won't admit it, he will still rely on mom and dad for help. If your child has relied on you for help controlling his asthma, he will be especially vulnerable, and in continued need of your help.
Even if you and your child's doctor have managed to get his asthma under control, it's a proven fact that changing environments, plus the added stress of a new school, can result in worsening asthma control.
Thus, poor asthma control may result in:
- Days of school missed
- Poor grades
- Less exercise
- Increased obesity
- Increased sluggishness
- Loss in confidence
- Loss in self esteem
- Dependence on rescue inhalers
- Excuses for poor grades
- Increased drop out rate
To prevent worsening asthma control, it's important you keep in touch with your college-bound asthmatic. However, you'll want to be reasonable.
When I was younger, and when my dad wanted to give me his advice, he would almost always start this way: "You do whatever you want, but if I were you I would....( fill in blank).
Of course he would also limit his advice to 30 seconds and move on. Of course I didn't always listen to dad, but more often than not I did.
So, here are the tips:
1. Allergy Free Room: Help him find an allergy free place to live. Most college dorms are fine, if an apartment house smells musty, it's not a good choice. Be picky.
2. Vaccines: Make sure to remind him to get his flu and pneumonia vaccines. If he doesn't do it, at least it will be off your chest.
3. Reminders: Occasionally ask him, "Are you taking your asthma controller medicine?" He may shun you, but this simple reminder will still be taken to heart and heeded.
4. Alcohol: College is about learning, but it's also about discovering yourself. I did it, and you know your child will too. Just make sure to remind your son that alcohol is an asthma trigger (and to drink responsibly if he chooses to take that course).
5. Dr. Visits: Occasionally remind him he still needs to see his doctor at least once a year.
6. Technique: Watch him when he uses his inhaler. Is he using his spacer? Is he still using proper technique? He may need a humble reminder.
7. Money: All college kids need money. It may be a good idea to buy your son's prescriptions for him, or at least offer than if he needs you to you are available. That way he won't feel uncomfortable if he has to ask. And you can be sure if he isn't taking his medicine, it's not because of money.
8. Asthma Action Plan: Again, a simple reminder from time to time might be nice. Is he using his peak flow meter. He may feel awkward using it in front of his friends. Yet he should at least know his early warning signs of asthma and what to do.
9. Asthma wisdom: He's going to be too busy getting good grades to keep up on his asthma wisdom. At least for a while, it will be your job to do that for him.
10. Friends: Many asthmatics like to keep their asthma a secret. They like to puff in private. Yet make sure your son tells at least one friend about his asthma. He should also have access to a ride to the hospital if he needs one. Did you buy him a car? Or does he have a friend with a car? Or does the dorm RA have the ability to help in this regard?
Going to college should be an education and a fun time in your son's life. With the latest asthma wisdom and modern medicine, most asthmatics should be able to live a normal active life college life.
With some discreet help from you, he should be able to maintain control of his asthma, and prosper.
FacebookWhat are good breathing exercises for asthmatics
Back in 1982 my doctor recommended I spend an hour each day blowing up balloons to build up lung strength. I'm not sure there were any studies to show this did any good, yet it didn't matter because I didn't spend much time doing it anyway. I was a kid sheeese -- I had better things to do.
Of course I was also educated about the infamous diaphragmatic breathing. So what is that? Well, read on and you'll learn about "diaphragmatic breathing" and other exercises proven to benefit asthmatics.
Breathing Exercises to Control Asthma
From MyAsthmaCentral.com, March 14, 2011
I remember the first time a respiratory therapist talked to me about the importance of breathing exercises to control my breathing. I was 11, and the year was 1981. Several years later, 2006 to be exact, a study was completed to confirm that breathing exercises really do help us asthmatics.
In fact, the study was completed in Australia and first reported inThorax, and showed that asthmatics who used their rescue inhalers regularly for mild asthma, and who performed breathing exercises on a regular basis, reduced their need for rescue inhaler use by 86 percent. Also, inhaled corticosteroid use dropped by 50 percent.
Likewise, the study confirmed that it does not matter what breathing exercises you do, all that matters is you do one or the other. Other evidence already confirmed, as the RT back in 1981 already knew, that breathing exercises during asthma episodes can help make breathing better.
How does the way we breath affect our asthma?
Experts now believe that asthmatics tend to breath faster than people with normal lungs, and many also have a tendency to be mouth breathers. This exposes the lung to cooler and drier air which is an asthma trigger. This results in increased need for rescue medicine.
So it only makes sence that breathing exercises that encourage shallow breathing at a controlled rate may actually reduce asthma symptoms and the need for rescue and preventative medicine.
What are good breathing exercises for asthmatics?
1. Diaphragmatic breathing (belly breathing): (Click here for video) This is what I was taught back in 1981, and what I was encouraged to teach in RT school. It's a basic and simple breathing technique that maximizes air distribution in your lungs.
5. Buteyko: According to the Mayo clinic this is a a breathing technique that teaches asthmatics to "habitually breathe less." Click here for the Buteyko website.
6. Papworth method: Similar to diaphragmatic breathing and Buteyko method. You can read more about it here.
These breathing exercises are believed to be beneficial to patients with mild asthma that is caused by rapid breathing and mouth breathing, and may not necessarily benefit those with more severe asthma, or those asthma episodes caused by other asthma triggers, such as colds and allergies.
There are other methods of controlling your asthma:
7. Pursed lip breathing: This can be used when you are having an asthma attack. Since asthma causes air to become trapped in your lungs, this may help you get more air out and may make breathing easier. This is where you inhale slowly through your nose and then exhale through pursed lips, or exhale slowly as though you were going to whistle. You should exhale twice as long as you inhale. This should be done while using diaphragmatic breathing as described above.
8. Progressive Relaxation Technique: This is a technique I was taught while I was a patient at National Jewish in 1985, and it works great. In fact, I think this works so great that I might dedicate an entire post to it some day.
The recommendation of the researchers is that asthmatics incorporate breathing exercises to go along with asthma preventative medicine. The recommendation is first thing in morning, and last thing at night (the same as most asthma controller meds are taken).
Likewise breathing exercises should be incorporated into your asthma action plan. If you're feeling mild asthma symptoms slow down and concentrate on your breathing. Do this and you may find you won't need your rescue medicine.
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Of course I was also educated about the infamous diaphragmatic breathing. So what is that? Well, read on and you'll learn about "diaphragmatic breathing" and other exercises proven to benefit asthmatics.
Breathing Exercises to Control Asthma
From MyAsthmaCentral.com, March 14, 2011
I remember the first time a respiratory therapist talked to me about the importance of breathing exercises to control my breathing. I was 11, and the year was 1981. Several years later, 2006 to be exact, a study was completed to confirm that breathing exercises really do help us asthmatics.
In fact, the study was completed in Australia and first reported inThorax, and showed that asthmatics who used their rescue inhalers regularly for mild asthma, and who performed breathing exercises on a regular basis, reduced their need for rescue inhaler use by 86 percent. Also, inhaled corticosteroid use dropped by 50 percent.
Likewise, the study confirmed that it does not matter what breathing exercises you do, all that matters is you do one or the other. Other evidence already confirmed, as the RT back in 1981 already knew, that breathing exercises during asthma episodes can help make breathing better.
How does the way we breath affect our asthma?
Experts now believe that asthmatics tend to breath faster than people with normal lungs, and many also have a tendency to be mouth breathers. This exposes the lung to cooler and drier air which is an asthma trigger. This results in increased need for rescue medicine.
So it only makes sence that breathing exercises that encourage shallow breathing at a controlled rate may actually reduce asthma symptoms and the need for rescue and preventative medicine.
What are good breathing exercises for asthmatics?
1. Diaphragmatic breathing (belly breathing): (Click here for video) This is what I was taught back in 1981, and what I was encouraged to teach in RT school. It's a basic and simple breathing technique that maximizes air distribution in your lungs.
- You can lie down or sit.
- Concentrate on your breathing
- Preferably you should breathe in slowly through your nose
- When you inhale your abdomen should go out (not your chest)
- Exhale slowly with your abdomen going inward
- Ideally exhalation should be twice as long as inhalation
- Sit upright, relax, focus on posture feet on floor with legs uncrossed
- Relax chest and belly muscles while breathing
- Focus, close your eyes and look up
- Breath through your nose gently (keep mouth closed)
- Breath slowly and shallow
- After exhaling slowly until you feel their is no air left in your lungs
- Hold your breath as long as you can and then return to gentle breathing (do not hold breath so long that you feel urge to inhale through mouth)
- Focus on good posture (sitting in firm chair with feet on floor, legs uncrossed with your back straight)
- Relax (Tense all muscles, and then relax, paying particular attention to muscles in shoulders and belly. This should release all tension) This makes breathing easier. This is rest position
- Concentrate on breathing (close eyes)
- Focus on breathing while relaxed in rest position
- Focus on breathing with shoulder rotation
- Focus on breathing with Forward curl
- Focus on breathing with arm raises
- Rest position with focus breathing can be done anywhere
5. Buteyko: According to the Mayo clinic this is a a breathing technique that teaches asthmatics to "habitually breathe less." Click here for the Buteyko website.
6. Papworth method: Similar to diaphragmatic breathing and Buteyko method. You can read more about it here.
These breathing exercises are believed to be beneficial to patients with mild asthma that is caused by rapid breathing and mouth breathing, and may not necessarily benefit those with more severe asthma, or those asthma episodes caused by other asthma triggers, such as colds and allergies.
There are other methods of controlling your asthma:
7. Pursed lip breathing: This can be used when you are having an asthma attack. Since asthma causes air to become trapped in your lungs, this may help you get more air out and may make breathing easier. This is where you inhale slowly through your nose and then exhale through pursed lips, or exhale slowly as though you were going to whistle. You should exhale twice as long as you inhale. This should be done while using diaphragmatic breathing as described above.
8. Progressive Relaxation Technique: This is a technique I was taught while I was a patient at National Jewish in 1985, and it works great. In fact, I think this works so great that I might dedicate an entire post to it some day.
- Lie down and close your eyes
- Concentrate on breathing through your nose
- Use Diaphragmatic breathing
- Tighten muscles of right foot and hold for 20-30 seconds, relax, feel tension release
- Do same for right upper leg, left foot, left upper leg, right hand and forearm, right shoulder, left hand and forearm, left shoulder, jaw area, mouth chin, and forehead.
- Continue to concentrate on your breathing this entire time.
- When done your body should feel "heavy and warm... weightless."
- Stay in relaxed state for as long as you want or need
9. Other: Work with your doctor and use whatever method that works for you.
Likewise breathing exercises should be incorporated into your asthma action plan. If you're feeling mild asthma symptoms slow down and concentrate on your breathing. Do this and you may find you won't need your rescue medicine.
Saturday, August 20, 2011
Learning from old wisdom
Very few people had the ability to write, let alone get a proper education 2,000 years ago, and this resulted on many sayings becoming lost to the ages.
This, to me, makes the writings of Epictetus and Marcus Aureleus all the more impressive.
It may be true that many of these sayings are not truly theirs, but they wrote them for history’s sake, and they are thus credited with them.
Parents, grandparents, role models, politicians and even, perhaps, yourself, have repeated one or another of these not even knowing where it came from.
For example, who do you think came up with the following?
“Nature gave us one tongue and two ears so we could hear twice as much as we speak.”
Mary Kay repeated this saying so many times you would have thought she’s the one who created it. But she didn’t. It was Epictetus.
He also wrote this:
“A man that seeks truth and loves it must be reckoned precious to any human society.”
I think it’s better to get every side of history and current events and to decide for myself, than to get one side and be ignorant.
“Be careful to leave your sons well instructed rather than rich, for the hopes of the instructed are better than the wealth of the ignorant,” and “Control thy passions, lest they take vengeance on thee.”
How many different ways have these been stated over the years?
“First learn the meaning of what you say, and then speak.”
I love that one.
I think it was Dale Carnegie in his book “How to Meat Friends and Influence People” who wrote that one should focus on never saying “I.”
Try that for a day: never saying I. I have. It’s hard. It’s neat, though, because the focus of conversation is shifted to the other person.
Carnegie wrote that when one person tells a story, it’s only natural for you to want to one-up that person’s story with a better one of your own. Doing this only shows how selfish we are. Thus, we are better off never to say “I.”
“Freedom is the right to live as we wish.”
We are all born free. We are all born with the right to protect ourselves from our enemies, to speak out against those who rule us, to choose our own religion, to peaceably assemble, to form a militia, to a fair and just trial of our peers. Only a government can take these rights away.
It is a common fallacy that the U.S. Constitution grants us our freedom. It simply protects the freedoms we are born with. Its purpose is to prevent the government from taking away what is justly, inherently and inalienably ours from the beginning.
We are born with these rights, but few governments prior to July 4, 1776, respected this right. Sometimes we forget that.
Or, in the case of the college student who had no clue who the President of the United States was, sometimes we are ignorant of our past.
Which brings me to a great quote by Marcus. It’s a long one, so bear with me:
"Remember how often you have postponed minding your interest, and let slip those opportunities the gods have given you. It is now high time to consider what sort of world you are part of, and from what kind of governor of it you are descended; that you have a set period assigned you to act in, and unless you improve it to brighten and compose your thoughts, it will quickly run off with you, and be lost beyond recovery."
I guess you have to grow up sometime. For most of us guys it either takes place when we get married (our wives tame us), or it never happens.
Epictetus: “God has entrusted me with myself.”
A big responsibility that is.
Which reminds me of a coworker saying, “The patient always comes first,” when I asked her why she didn’t take 15 minutes from her busy night to eat.
I told her, “If you don’t take care of yourself, and you get sick, what good will you be to that patient?”
Marcus Aurelius wrote, "The object of life is not to be on the side of the majority, but to escape finding one’s self in the ranks of the insane."
It’s far easier to wait until a majority decides on a Presidential candidate than it is to choose the one who best represents your views now and vote for that person regardless of what the majority thinks.
Sure, your candidate may stand no chance of getting elected, but it’s far better to vote for the better candidate than to join the ranks of the insane, which most independants do because it makes them feel good to be a part of the majority.
It’s far easier to join the ranks of the insane than to vote against socialized healthcare, higher taxes for the rich, environmental regulations that punish the economy, or feel good pork bills that benefit one at the expense of the many.
It's easier to join that ranks of the insane, than to question the global warming advocates. I'm just saying.
Epictetus wrote, "He is a wise man who does not grieve for the things which he has not, but rejoices for those which he has."
Or, as Ben Franklin wrote in his autobiography, "Frugality: Make no expense but to do good to others or yourself; i.e., waste nothing.
Epictetus wrote, "If evil be spoken of you and it be true, correct yourself, if it be a lie, laugh at it."
Laughter is a cure all.
"If you wish to be a writer, write."
Thank God these guys did. We are a better people for it, and getting better all the time because these old thinkers wrote so we could learn from their present to better ours.
Even though we don’t always know the source, we never stop learning from old wisdom. Because old philosophy, wisdom from the ages, still rings true.
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This, to me, makes the writings of Epictetus and Marcus Aureleus all the more impressive.
It may be true that many of these sayings are not truly theirs, but they wrote them for history’s sake, and they are thus credited with them.
Parents, grandparents, role models, politicians and even, perhaps, yourself, have repeated one or another of these not even knowing where it came from.
For example, who do you think came up with the following?
“Nature gave us one tongue and two ears so we could hear twice as much as we speak.”
Mary Kay repeated this saying so many times you would have thought she’s the one who created it. But she didn’t. It was Epictetus.
He also wrote this:
“A man that seeks truth and loves it must be reckoned precious to any human society.”
I think it’s better to get every side of history and current events and to decide for myself, than to get one side and be ignorant.
“Be careful to leave your sons well instructed rather than rich, for the hopes of the instructed are better than the wealth of the ignorant,” and “Control thy passions, lest they take vengeance on thee.”
How many different ways have these been stated over the years?
“First learn the meaning of what you say, and then speak.”
I love that one.
I think it was Dale Carnegie in his book “How to Meat Friends and Influence People” who wrote that one should focus on never saying “I.”
Try that for a day: never saying I. I have. It’s hard. It’s neat, though, because the focus of conversation is shifted to the other person.
Carnegie wrote that when one person tells a story, it’s only natural for you to want to one-up that person’s story with a better one of your own. Doing this only shows how selfish we are. Thus, we are better off never to say “I.”
“Freedom is the right to live as we wish.”
We are all born free. We are all born with the right to protect ourselves from our enemies, to speak out against those who rule us, to choose our own religion, to peaceably assemble, to form a militia, to a fair and just trial of our peers. Only a government can take these rights away.
It is a common fallacy that the U.S. Constitution grants us our freedom. It simply protects the freedoms we are born with. Its purpose is to prevent the government from taking away what is justly, inherently and inalienably ours from the beginning.
We are born with these rights, but few governments prior to July 4, 1776, respected this right. Sometimes we forget that.
Or, in the case of the college student who had no clue who the President of the United States was, sometimes we are ignorant of our past.
Which brings me to a great quote by Marcus. It’s a long one, so bear with me:
"Remember how often you have postponed minding your interest, and let slip those opportunities the gods have given you. It is now high time to consider what sort of world you are part of, and from what kind of governor of it you are descended; that you have a set period assigned you to act in, and unless you improve it to brighten and compose your thoughts, it will quickly run off with you, and be lost beyond recovery."
I guess you have to grow up sometime. For most of us guys it either takes place when we get married (our wives tame us), or it never happens.
Epictetus: “God has entrusted me with myself.”
A big responsibility that is.
Which reminds me of a coworker saying, “The patient always comes first,” when I asked her why she didn’t take 15 minutes from her busy night to eat.
I told her, “If you don’t take care of yourself, and you get sick, what good will you be to that patient?”
Marcus Aurelius wrote, "The object of life is not to be on the side of the majority, but to escape finding one’s self in the ranks of the insane."
It’s far easier to wait until a majority decides on a Presidential candidate than it is to choose the one who best represents your views now and vote for that person regardless of what the majority thinks.
Sure, your candidate may stand no chance of getting elected, but it’s far better to vote for the better candidate than to join the ranks of the insane, which most independants do because it makes them feel good to be a part of the majority.
It’s far easier to join the ranks of the insane than to vote against socialized healthcare, higher taxes for the rich, environmental regulations that punish the economy, or feel good pork bills that benefit one at the expense of the many.
It's easier to join that ranks of the insane, than to question the global warming advocates. I'm just saying.
Epictetus wrote, "He is a wise man who does not grieve for the things which he has not, but rejoices for those which he has."
Or, as Ben Franklin wrote in his autobiography, "Frugality: Make no expense but to do good to others or yourself; i.e., waste nothing.
Epictetus wrote, "If evil be spoken of you and it be true, correct yourself, if it be a lie, laugh at it."
Laughter is a cure all.
"If you wish to be a writer, write."
Thank God these guys did. We are a better people for it, and getting better all the time because these old thinkers wrote so we could learn from their present to better ours.
Even though we don’t always know the source, we never stop learning from old wisdom. Because old philosophy, wisdom from the ages, still rings true.
Retirement accounts
Two friends of mine were sitting around discussing retirement accounts.
Friend A said he has money in a retirement account but was considering taking it out because he was afraid of the market.
Friend B said she does not have money in a retirement account because she is afraid of the market. She's afraid she will lose her money if the market crashes.
Friend C invested in a 401K and his work matches up to a certain point. Any extra money invested is in a Roth IRA account.
Friend A asked friend C: "Why do you invest so much? What if the market crashed? What would you do?"
Friend Cs answer was simple, "If you do not invest in your retirement, there is a 100% chance you will have to keep working until the government says you can retire. Historically, the stock market has doubled during any 10 year period, and that includes the Great Depression. So, if you invest in the stock market, there is a 90% chance you can retire when you want."
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Friend A said he has money in a retirement account but was considering taking it out because he was afraid of the market.
Friend B said she does not have money in a retirement account because she is afraid of the market. She's afraid she will lose her money if the market crashes.
Friend C invested in a 401K and his work matches up to a certain point. Any extra money invested is in a Roth IRA account.
Friend A asked friend C: "Why do you invest so much? What if the market crashed? What would you do?"
Friend Cs answer was simple, "If you do not invest in your retirement, there is a 100% chance you will have to keep working until the government says you can retire. Historically, the stock market has doubled during any 10 year period, and that includes the Great Depression. So, if you invest in the stock market, there is a 90% chance you can retire when you want."
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Friday, August 19, 2011
What happens when RT is not in ER during an Emergency?
The following are my answers to search engine queries that landed a person on my blog.
1. Why is susphrine no longer used: For those who don't know what it is, susphrine is a long acting version of epinephrine that was used primarily in the 1970s and 1980s in emergency rooms for asthma. It was used mainly because it would get the asthmatic breathing better fast and then it would continue to work for 3-4 hours. This length of time would be enough to allow the systemic corticosteroids to start working. In this way, instead of having the patient sit in the ER for this length of time the doctor could send the patient home. The idea is that as soon as the asthmatic gets home the steroids should start taking effect and breathing should be better. The medicine is no longer used because Albuterol is an alternative that's safer and works just as well according to studies. In the ER a doctor can 3-4 Albuterol breathing treatments.
2. Why do some RTs continue to smoke: RTs are people too. There is no reason that an RT cannot smoke. The U.S. is a free nation and each person has a right to do as he chooses so long as he doesn't infringe on the natural rights of other people. An RT - like all Americans - even has the right to choose things that other people view as wrong or even stupid. Yes, YOU too have a right to be stupid if you want. Yet your definition of stupid may be different than another persons.
3. What kind of problems are encountered without an RT in the ER setting: I think ER physicians and RNs are perfectly qualified to handle an emergency situation without an RT. They are all ACLS qualified, should be able to do ABGs, and breathing treatments. An ABG is a procedure and should not take precidence to treating the patient anyway. As an RT who often works nights, if there was a code on the floor and in ER I'd go to the floor code because I have faith the ER staff can handle things on their own. I don't mean any disrespect for floor nurses, I just think the ER staff deals with emergencies more often than floor nurses. However, in the case of an emergency, the RT is usually the first person called -- and often STAT.
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1. Why is susphrine no longer used: For those who don't know what it is, susphrine is a long acting version of epinephrine that was used primarily in the 1970s and 1980s in emergency rooms for asthma. It was used mainly because it would get the asthmatic breathing better fast and then it would continue to work for 3-4 hours. This length of time would be enough to allow the systemic corticosteroids to start working. In this way, instead of having the patient sit in the ER for this length of time the doctor could send the patient home. The idea is that as soon as the asthmatic gets home the steroids should start taking effect and breathing should be better. The medicine is no longer used because Albuterol is an alternative that's safer and works just as well according to studies. In the ER a doctor can 3-4 Albuterol breathing treatments.
2. Why do some RTs continue to smoke: RTs are people too. There is no reason that an RT cannot smoke. The U.S. is a free nation and each person has a right to do as he chooses so long as he doesn't infringe on the natural rights of other people. An RT - like all Americans - even has the right to choose things that other people view as wrong or even stupid. Yes, YOU too have a right to be stupid if you want. Yet your definition of stupid may be different than another persons.
3. What kind of problems are encountered without an RT in the ER setting: I think ER physicians and RNs are perfectly qualified to handle an emergency situation without an RT. They are all ACLS qualified, should be able to do ABGs, and breathing treatments. An ABG is a procedure and should not take precidence to treating the patient anyway. As an RT who often works nights, if there was a code on the floor and in ER I'd go to the floor code because I have faith the ER staff can handle things on their own. I don't mean any disrespect for floor nurses, I just think the ER staff deals with emergencies more often than floor nurses. However, in the case of an emergency, the RT is usually the first person called -- and often STAT.
Thursday, August 18, 2011
Active surveillance not stopping spread of MRSA
It sometimes seems a stretch that we are gowning, gloving and wearing masks in many patient rooms when the patient is not even diagnosed with a contagious infection. Yet it is commonly believed this type of "active surveillance is needed to prevent the spread of infections such as MRSA and VRSA.
In case you're not familiar, MRSA is an acronym for methicillin-resistant Staphyloccocus aureus and VRSA for vancomycin-resistant enterococcus. These are bacterial strains that have developed resistance to methicillin and vancomycin respectively.
Those infected are usually people who have a weakened immune system, such as a patient who is sick in the intensive care unit (ICU). In fact, according to MRSA Still Spreading in ICUs, thousands of Americans die from one of these two infections every year.
An attempt to prevent the spread of MRSA is called active surveillance which, as described by the above article, "includes screening patients admitted to ICUs to see if they carry the bacteria adn then implementing barrier precautions that require health care providers to wear gloves and gowns when handling these patients."
It often seems we are wearing all this stuff for no reason. Yet many times a person is not in isolation and then all of a sudden they are diagnosed with MRSA. So even while we've been in and out of the room for three days, all of a sudden we have to gown up.
So there are obvious flaws in the system. It may come soon the day we have to gown up on any patient until MRSA is ruled out. Or it may be proven that nothing we do prevents the spread of MRSA, in which case barrier precautions would prove futile.
I personally think patients with weakened immune systems infect themselves. Staphylococcus aureus is a bacteria commonly found in humans. So it only makes sense if your immune system is weakened you'd be unable to fight off this bug. A MRSA infection is the end result.
So you can gown up to your hearts content and still not prevent that person from getting it. Likewise, you also won't spread it if you don't gown up, because we all have the bacteria we are trying not to spread.
That's my opinion anyway. Much of what we do in the healthcare industry is based on minimal research and feel good strategies. If one person thinks it feels good to do it we do it even if the science doesn't prove it's needed.
Thoughts.
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In case you're not familiar, MRSA is an acronym for methicillin-resistant Staphyloccocus aureus and VRSA for vancomycin-resistant enterococcus. These are bacterial strains that have developed resistance to methicillin and vancomycin respectively.
Those infected are usually people who have a weakened immune system, such as a patient who is sick in the intensive care unit (ICU). In fact, according to MRSA Still Spreading in ICUs, thousands of Americans die from one of these two infections every year.
An attempt to prevent the spread of MRSA is called active surveillance which, as described by the above article, "includes screening patients admitted to ICUs to see if they carry the bacteria adn then implementing barrier precautions that require health care providers to wear gloves and gowns when handling these patients."
It often seems we are wearing all this stuff for no reason. Yet many times a person is not in isolation and then all of a sudden they are diagnosed with MRSA. So even while we've been in and out of the room for three days, all of a sudden we have to gown up.
So there are obvious flaws in the system. It may come soon the day we have to gown up on any patient until MRSA is ruled out. Or it may be proven that nothing we do prevents the spread of MRSA, in which case barrier precautions would prove futile.
I personally think patients with weakened immune systems infect themselves. Staphylococcus aureus is a bacteria commonly found in humans. So it only makes sense if your immune system is weakened you'd be unable to fight off this bug. A MRSA infection is the end result.
So you can gown up to your hearts content and still not prevent that person from getting it. Likewise, you also won't spread it if you don't gown up, because we all have the bacteria we are trying not to spread.
That's my opinion anyway. Much of what we do in the healthcare industry is based on minimal research and feel good strategies. If one person thinks it feels good to do it we do it even if the science doesn't prove it's needed.
Thoughts.
Wednesday, August 17, 2011
Pneumothorax and Hemothorax
It is a normal function of life for air to enter and exit the lungs, yet it is abnormal for air to leak out of the lungs and into the spaces surrounding the lungs.
When air leaks out of the lungs it is generally referred to as a collapsed lung, or scientifically referred to as a pneumothorax.
Defined, a pneumothorax is when air enters the space the surrounds the lungs called the pleural space. Air can enter the pleural space either from a small hole in the lungs (leak), or from the chest wall, as in what might occur from a trauma or bullet or knife wound.
Many times during the course of life a person may have small pneumothoraces that go un-noticed. This can cause pain, but not always. Larger pneumothoraces, however, pain may be the result, but the patient will also become dyspneic (short of breath.).
A patient becomes short of breath because air in the pleural space makes the lung involved much smaller, and the effected part of the lung won't be able to participate in air exchange.
What are causes of an air leak?
1. Spontaneous: No particular reason (idiopathic)
2. Spontaneous: Rupture of bleb (emphysema), cyst or bulla
3. Rupture of esophogus that causes air to leak into pleural region
4. Chronic lung disease: Severe asthma, Severe COPD, Pulmonary Fibrosis (interstitial lung disease)
5. Positive Pressure Ventilation: PEEP or too high volumes
6. Trauma
7. Side effect of thorocentesis or lung biopsy
8. Side effect of insertion of central venous catheters
How to detect an air leak?
1. Patient agitation: Pain, general misery, dyspnea
2. Reduced chest expansion: with each breath
3. Increased resonance with percussion
4. Breath sounds: diminished over leak, or pleural rub (grating sound on expiration)
5. No tactile fremitis over air leak
6. Chest x-ray: The line of the pleural sac can be seen inside the lung where it doesn't belong
7. Low pulse ox (SpO2) or ABG PO2
8. Trachea shift away from the affected side (air pushes mediastinal contents away). This is most evident of a tension pneumothorax (see below)
How do you treat a pneumothorax?
1. Spontaneously: if small the air will be reabsorbed naturally. About 70 percent of pnneumothoracies are of this nature.
2. Chest tube: usually needed for large air leaks, or about 30 percent of pneumothoracies. I have a post about this coming up soon, so stay tuned.
3. Thorocentesis: Inserting a large bore needle into pleural sack to let air out (temporary relief)
Tension pneumothorax: This is where air enters the pleural space on inspiration but cannot escape during expiration. The air in pleural space keeps increasing with each successive breath, and the lung gets more an more squished with each breath. This is most common in ventilated patients when too much pressure is used causing an air leak. This must be relieved immediately with a chest tube. If no time to insert chest tube, a large bore needle should be inserted into pleural space (thorocentesis).
Hemathorax: This is when blood gets into the pleural space. What can cause blood in the pleural space:
When air leaks out of the lungs it is generally referred to as a collapsed lung, or scientifically referred to as a pneumothorax.
Defined, a pneumothorax is when air enters the space the surrounds the lungs called the pleural space. Air can enter the pleural space either from a small hole in the lungs (leak), or from the chest wall, as in what might occur from a trauma or bullet or knife wound.
Many times during the course of life a person may have small pneumothoraces that go un-noticed. This can cause pain, but not always. Larger pneumothoraces, however, pain may be the result, but the patient will also become dyspneic (short of breath.).
A patient becomes short of breath because air in the pleural space makes the lung involved much smaller, and the effected part of the lung won't be able to participate in air exchange.
What are causes of an air leak?
1. Spontaneous: No particular reason (idiopathic)
2. Spontaneous: Rupture of bleb (emphysema), cyst or bulla
3. Rupture of esophogus that causes air to leak into pleural region
4. Chronic lung disease: Severe asthma, Severe COPD, Pulmonary Fibrosis (interstitial lung disease)
5. Positive Pressure Ventilation: PEEP or too high volumes
6. Trauma
7. Side effect of thorocentesis or lung biopsy
8. Side effect of insertion of central venous catheters
How to detect an air leak?
1. Patient agitation: Pain, general misery, dyspnea
2. Reduced chest expansion: with each breath
3. Increased resonance with percussion
4. Breath sounds: diminished over leak, or pleural rub (grating sound on expiration)
5. No tactile fremitis over air leak
6. Chest x-ray: The line of the pleural sac can be seen inside the lung where it doesn't belong
7. Low pulse ox (SpO2) or ABG PO2
8. Trachea shift away from the affected side (air pushes mediastinal contents away). This is most evident of a tension pneumothorax (see below)
How do you treat a pneumothorax?
1. Spontaneously: if small the air will be reabsorbed naturally. About 70 percent of pnneumothoracies are of this nature.
2. Chest tube: usually needed for large air leaks, or about 30 percent of pneumothoracies. I have a post about this coming up soon, so stay tuned.
3. Thorocentesis: Inserting a large bore needle into pleural sack to let air out (temporary relief)
Tension pneumothorax: This is where air enters the pleural space on inspiration but cannot escape during expiration. The air in pleural space keeps increasing with each successive breath, and the lung gets more an more squished with each breath. This is most common in ventilated patients when too much pressure is used causing an air leak. This must be relieved immediately with a chest tube. If no time to insert chest tube, a large bore needle should be inserted into pleural space (thorocentesis).
Hemathorax: This is when blood gets into the pleural space. What can cause blood in the pleural space:
- Trauma
- Tuberculosis
- Pulmonary infarction
Tuesday, August 16, 2011
Who controls your life: You or the system?
I would like to think I've worked hard my during the 24 years I've been working to make myself self reliant. My parents and grandparents instilled in me this idea that if I work hard, if I prepare for my future, and if I spend and allocate my money frugally and wisely I should be able to control my own destiny.
There are many people I work with, a majority perhaps, who contend that they won't be allowed to retire until they reach the so called retirement age. You know, the age the government sets as to which you can receive social security payments.
Many of these same people laugh when I tell them I have worked hard to control my own destiny. I have set aside money in a retirement account for a long time now, and when I'm 58 I'm going to retire.
"Well, you can't do that," they say. "You can't retire until you're 70."
Now I don't know where they get the idea I "can't" retire. There's no law that says a person "has" to work until the government says so.
The truth is, if you are 18 and you put aside $1,000 a year for five years and put it into a retirement account, you will never have to put any more money in the rest of your working years and by the time you are 62 you will have a million dollars in your retirement account.
If that's true, of which many financial experts contend it is (it may not be exactly as I write here, yet something like that), imagine how much money you'd have if you continue to put aside money the rest of your working years.
The point here is that if you take responsibility for your own life, you can have more control of it. YOU can decide when you retire. You can decide how long you have to work, or even how hard you have to work.
Yet there are obviously many people in our society who don't want you to know this, because it's obviously not taught in schools. It's not taught in schools, I think, because politicians want you to spend your money unwisely. The more of the money you spend, they think, the better off the economy is.
Yet it's this same thinking that leads to forclosures and bankruptcies. THEY -- the powers that be -- want you to spend your money when you make it, and save little. THEY want you to work as long as you can, because --they think -- this will keep the economy going.
Yet when the economy collapses, those who continue to live the way THEY want are the ones most affected by the economic downturn. Those of us who prepare and plan ahead and are smart with our money, we don't feel the recession as much.
Yet I also belieive it's ignorance that's responsible for economic upturns and downturns. If people would continue to spend their money wisely when after they got raises, or when the economy was good instead of buying a bunch of stuff, then there wouldn't be ups and downs in the market.
Plus if we spend our money wisely, the government will get less of it. So the more you spend, the more the government makes. The more money you waste on stuff you don't need, the more the government makes.
And the more of your money the government has, the more control over you they have. Thus, instead of you deciding how to spend your money, the government decides. Instead of you choosing the charity of your choice, the government decides.
That's just my frivolous theory. Of course I'm not the first to come up with such a theory. Ben Franklin wrote about it. Other wise people thousands of years ago wrote about it. Yet many teachers STILL don't teach about it. Many do, yet still many don't.
The funny thing is, many of those same teachers are among the same people who spend all their money and hope HOPE and Hope and Hope they don't get fired or laid off. Yet when they do get fired or laid off, they are screwed. They go bankrupt. They go into foreclosure. Or they get darn lucky.
Believe it or not, there are those among us who don't want us to take responsibility for our own lives. Then there are those who don't want that responsibility. Then there are those who don't know how to manage their own lives. They rely on others and just assume something will be there when they need it. These are your fools.
So it's been my career objective to take care of myself. I don't show other people much how I plan to do it, because I get tired of explaining it. One person had me explain it twenty times, and he still asks me how I do it. It's as though I'm talking to a wall. So it's easier to keep my mouth shut and just not tell anyone about my secret. Yet it's not a secret. It's awareness of wisdom. It's awareness of a fact.
If you are responsible, frugal and if you prepare, you can have control of your life. The alternative is THEY control you. What about you? Who do you want to control your life: the government or YOU?
You know what it comes down to is this: the more stuff you want, the more money you are going to spend. Yet when you want something bad enough and you don't have the money right now, you borrow it. And what is the borrower to the lender? That's right: A slave.
So by not educating you, you are a slave to the system.
Yet if we do our homework, we can escape the system. And anyone who becomes self sufficient and self reliant is a huge threat to the system.
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There are many people I work with, a majority perhaps, who contend that they won't be allowed to retire until they reach the so called retirement age. You know, the age the government sets as to which you can receive social security payments.
Many of these same people laugh when I tell them I have worked hard to control my own destiny. I have set aside money in a retirement account for a long time now, and when I'm 58 I'm going to retire.
"Well, you can't do that," they say. "You can't retire until you're 70."
Now I don't know where they get the idea I "can't" retire. There's no law that says a person "has" to work until the government says so.
The truth is, if you are 18 and you put aside $1,000 a year for five years and put it into a retirement account, you will never have to put any more money in the rest of your working years and by the time you are 62 you will have a million dollars in your retirement account.
If that's true, of which many financial experts contend it is (it may not be exactly as I write here, yet something like that), imagine how much money you'd have if you continue to put aside money the rest of your working years.
The point here is that if you take responsibility for your own life, you can have more control of it. YOU can decide when you retire. You can decide how long you have to work, or even how hard you have to work.
Yet there are obviously many people in our society who don't want you to know this, because it's obviously not taught in schools. It's not taught in schools, I think, because politicians want you to spend your money unwisely. The more of the money you spend, they think, the better off the economy is.
Yet it's this same thinking that leads to forclosures and bankruptcies. THEY -- the powers that be -- want you to spend your money when you make it, and save little. THEY want you to work as long as you can, because --they think -- this will keep the economy going.
Yet when the economy collapses, those who continue to live the way THEY want are the ones most affected by the economic downturn. Those of us who prepare and plan ahead and are smart with our money, we don't feel the recession as much.
Yet I also belieive it's ignorance that's responsible for economic upturns and downturns. If people would continue to spend their money wisely when after they got raises, or when the economy was good instead of buying a bunch of stuff, then there wouldn't be ups and downs in the market.
Plus if we spend our money wisely, the government will get less of it. So the more you spend, the more the government makes. The more money you waste on stuff you don't need, the more the government makes.
And the more of your money the government has, the more control over you they have. Thus, instead of you deciding how to spend your money, the government decides. Instead of you choosing the charity of your choice, the government decides.
That's just my frivolous theory. Of course I'm not the first to come up with such a theory. Ben Franklin wrote about it. Other wise people thousands of years ago wrote about it. Yet many teachers STILL don't teach about it. Many do, yet still many don't.
The funny thing is, many of those same teachers are among the same people who spend all their money and hope HOPE and Hope and Hope they don't get fired or laid off. Yet when they do get fired or laid off, they are screwed. They go bankrupt. They go into foreclosure. Or they get darn lucky.
Believe it or not, there are those among us who don't want us to take responsibility for our own lives. Then there are those who don't want that responsibility. Then there are those who don't know how to manage their own lives. They rely on others and just assume something will be there when they need it. These are your fools.
So it's been my career objective to take care of myself. I don't show other people much how I plan to do it, because I get tired of explaining it. One person had me explain it twenty times, and he still asks me how I do it. It's as though I'm talking to a wall. So it's easier to keep my mouth shut and just not tell anyone about my secret. Yet it's not a secret. It's awareness of wisdom. It's awareness of a fact.
If you are responsible, frugal and if you prepare, you can have control of your life. The alternative is THEY control you. What about you? Who do you want to control your life: the government or YOU?
You know what it comes down to is this: the more stuff you want, the more money you are going to spend. Yet when you want something bad enough and you don't have the money right now, you borrow it. And what is the borrower to the lender? That's right: A slave.
So by not educating you, you are a slave to the system.
Yet if we do our homework, we can escape the system. And anyone who becomes self sufficient and self reliant is a huge threat to the system.
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Sunday, August 14, 2011
The parable of the seeds
At the turn of the 19th century many experts predicted that with modern science and wisdom religion would go the way the horse and buggy eventually would. Yet that didn't happen. In fact, poll after poll shows over 90% of Americans say they believe in Jesus.
I know this isn't a religious blog, yet in the medical field we deal with religion in one way or another on a daily basis, as we deal with death, and end of life preparation, and we see Bibles and religious pamphlets with prayers in most rooms.
I've also made the observation that patients that believe in God are the better patients, at least when it comes to the end of their lives. I think patients who believe in God know this life might end soon, and they may even still get depressed, yet they almost always maintain a pleasant demeanor.
We watch baseball games and see baseball players crossing themselves before stepping to the plate (Pudge Rodriguez did this all the time), and pitchers crossing themselves before they jump up and down to celebrate after throwing the final strike to end a game.
Yet how many of these people who purport to believe in God really BELIEVE in God? It's one thing to say you believe in God, it's yet another actually humble yourself and actually live up to that believe. Are all these folks truly humble?
Recently I've been reading the Bible for the first time since I was a kid, and came across this old parable told by Jesus:
Are you the person who believes and yet gets burdened by the pressures of life and fights your siblings for land your mother left when she died? Are you the person who expands his business to make extra money at the expense of spending time with your children?
Are you the person who thinks little of other people, and yet at the end of your life you go to church every day in the hopes of getting to Heaven?
I remember as a kid attending catechism classes with 20 other kids, and some of those kids weren't exactly nice to me. They most certainly weren't nice to the teachers, making fun of them any time the opportunity presented itself.
I'd like to think I'm growing a crop of 100 times what is sown, yet it's difficult to know for sure. I'm certainly humble. I don't earn more than I need. I'd like to think I spend quality time with my kids. I'm not a material person like my neighbors. I appreciate history and what little I have. I try to be wise, yet I know I know so little.
I'd like to think I'm one who should get to Heaven. And yet Jesus also says that the doorway to Heaven is narrow, while the doorway to hell is wide. So it's easy to become like everyone else. It's easy to become a material person. You could be a material person and not even realize it.
I could be wrong. You could be wrong. We all could be wrong. Yet we are all sinners, and those of us who try the hardest will continue to be unprofitable servants.
I know this isn't a religious blog, yet in the medical field we deal with religion in one way or another on a daily basis, as we deal with death, and end of life preparation, and we see Bibles and religious pamphlets with prayers in most rooms.
I've also made the observation that patients that believe in God are the better patients, at least when it comes to the end of their lives. I think patients who believe in God know this life might end soon, and they may even still get depressed, yet they almost always maintain a pleasant demeanor.
We watch baseball games and see baseball players crossing themselves before stepping to the plate (Pudge Rodriguez did this all the time), and pitchers crossing themselves before they jump up and down to celebrate after throwing the final strike to end a game.
Yet how many of these people who purport to believe in God really BELIEVE in God? It's one thing to say you believe in God, it's yet another actually humble yourself and actually live up to that believe. Are all these folks truly humble?
Recently I've been reading the Bible for the first time since I was a kid, and came across this old parable told by Jesus:
"Behold, a sower went out to sow. And as he sowed, some seed fell by the wayside; and the birds came and devoured them. Some fell on stony places, where they did not have much earth; they immediately sprang up because they had no depth of earth. But when the sun was up they were scorched, and because they had no root they withered away. And some fell among thorns, and the thorns sprang up and choked them. But others fell on good ground and yielded a crop, some a hundredfold, some sixty, some thirty. He who has ears to hear, let him hear.”Yet what does this mean? Jesus went on to explain:
"Now listen to the parable of the sower. When a man hears the message of the kingdom and does not grasp it, the evil one comes and snatches away what was sown in his heart. This is like the seed sown by the road-side. The seed sown on the stony patches represents the man who hears the message and eagerly accepts it. But it has not taken root in him and does not last long - the moment trouble or persecution arises through the message he gives up his faith at once. The seed sown among the thorns represents the man who hears the message, and then the worries of this life and the illusions of wealth choke it to death and so it produces no 'crop' in his life. But the seed sown on good soil is the man who both hears and understands the message. His life shows a good crop, a hundred, sixty or thirty times what was sown."So you can see how 90% of Americans can believe in God and yet not truly believe. You can say you believe in God and yet not follow His words. You can cross yourself to your hearts content, and you can read the Bible every day, and yet still not live as though Jesus would like you to.
Are you the person who believes and yet gets burdened by the pressures of life and fights your siblings for land your mother left when she died? Are you the person who expands his business to make extra money at the expense of spending time with your children?
Are you the person who thinks little of other people, and yet at the end of your life you go to church every day in the hopes of getting to Heaven?
I remember as a kid attending catechism classes with 20 other kids, and some of those kids weren't exactly nice to me. They most certainly weren't nice to the teachers, making fun of them any time the opportunity presented itself.
I'd like to think I'm growing a crop of 100 times what is sown, yet it's difficult to know for sure. I'm certainly humble. I don't earn more than I need. I'd like to think I spend quality time with my kids. I'm not a material person like my neighbors. I appreciate history and what little I have. I try to be wise, yet I know I know so little.
I'd like to think I'm one who should get to Heaven. And yet Jesus also says that the doorway to Heaven is narrow, while the doorway to hell is wide. So it's easy to become like everyone else. It's easy to become a material person. You could be a material person and not even realize it.
I could be wrong. You could be wrong. We all could be wrong. Yet we are all sinners, and those of us who try the hardest will continue to be unprofitable servants.
Saturday, August 13, 2011
Getting along with RT bosses
Jimmy Thacker, RRT, and blogger of "In My Opinion" wrote a nice blog post about how to know if your boss is a jerk. I'm not so good at judging people in that manner. In fact, I don't even care if my boss is a jerk or not, because I'm an affable person who gets along with everyone.
Surely my boss has his faults, and reasonably so. I have my faults too. One of the main reason we hate some people is not so much that person is a bad person more so than we fail to see things from that person's point of view. Worded better, we don't take the time to walk in that other person's shoes.
While the main responsibility of us RTs is to save lives, the main responsibility of administrators (our bosses) is not just to save lives but to save money. If we save lives and go in debt in the process, not only do you risk losing your job but he may lose his job too.
So there's two sides of the street, while we often just look one way. So the next time you think your boss is being a jerk, perhaps it might be a good idea to put on his shoes and take a few steps. You may not want his job, yet you should at least consider why he's behaving as he is.
Some say if you get along with your boss your an ass kisser, or you have brown on your nose. Yet I think getting along with your boss is common sense. You have nothing to lose and everything to gain.
That said, just because you get along with your boss, and just because you empathize, doesn't mean you have to always agree with that person. I disagree with my boss almost as much as I agree. So judge me as you will.
Surely my boss has his faults, and reasonably so. I have my faults too. One of the main reason we hate some people is not so much that person is a bad person more so than we fail to see things from that person's point of view. Worded better, we don't take the time to walk in that other person's shoes.
While the main responsibility of us RTs is to save lives, the main responsibility of administrators (our bosses) is not just to save lives but to save money. If we save lives and go in debt in the process, not only do you risk losing your job but he may lose his job too.
So there's two sides of the street, while we often just look one way. So the next time you think your boss is being a jerk, perhaps it might be a good idea to put on his shoes and take a few steps. You may not want his job, yet you should at least consider why he's behaving as he is.
Some say if you get along with your boss your an ass kisser, or you have brown on your nose. Yet I think getting along with your boss is common sense. You have nothing to lose and everything to gain.
That said, just because you get along with your boss, and just because you empathize, doesn't mean you have to always agree with that person. I disagree with my boss almost as much as I agree. So judge me as you will.
Friday, August 12, 2011
How long can a patient be on BiPAP before needing intubation?
Occasionally I check my statcounter to see what searches are leading readers to RT Cave. Assuming the queries were not answered, I provide here my humble response.
1. bipap for hyperventilation: I've never heard of it being used for that.
2. what happens if you suddenly stop advair: I think it's such a small amount of steroid you shouldn't have to wean off it. Yet if that small amount of steroid is keeping down the inflammation and controlling your asthma, you might be setting yourself up for an impending asthma problem down the road.
3. quitting symbicort: Same. Don't just quit taking any medicine without consulting your doctor first
4. is morphine therapy for a copd person: It's used occasionally to help COPD patients cope with air hunger. It is a mild bronchodilator too. Generally it's used for severe, end stage COPD.
5. When does the therapist can give aerosol drugs for crying chi: It does little good to give a treatment to a crying child because a smooth, laminar flow is required to get the best drug distribution. A crying child also spends most of his (or her) time exhaling.
6. symbicort for rescue inhaler: What's the question?
7. What brand of ventilator is commonly used today in hospital: I work for a small town hospital, so what we use are collecting dust in larger hospitals. I'm not really sure. If any of my readers have an answer to this questions feel free to leave a comment below.
8. symbicort vs advair: The only difference I'm aware of is symbicort can be used as a rescue inhaler because it works fast to open up the lungs, while Advair takes a little longer. The Symbicort SMART program is used in some countries but not in the U.S.
9. how long can a patient be on BIPAP before needing intubation: I'm assuming here you're referring to how long can a mask be on a patient, as in hours, days, weeks. I believe the answer would be "it depends." Is the patient tolerating it? Is the patient able to come off it long enough to eat? Is it working as you expect it to? Does it look like the underlying condition is resolving? Ideally you'd want to use BiPAP in the hospital short term, just long enough for other medicines to fix the underlying condition. If the underlying condition is not resolving itself, then perhaps you can continue therapy. Does the patient want it? Does the patient have a DNR or no vent order. BiPAP may be your only option. So, again, it depends.
Ideally, however, if a patient requires continuous ventilation you might be better off intubating the patient so you can control his breathing a little better. Yet, still, you'll have to use common sense.
We did recently have a patient on BiPAP against his will, and the doctor even wrote an order: "Do not remove mask from patient no matter what." This I think is a bad idea. The patient had complete whiteout on x-ray and could not ventilate or oxygenate even during short breaks from the mask. Considering this patient wasn't getting adequate nutrition, and was highly anxious, I believed a better course would have been to intubate the patient.
Still, common sense is the best answer to this question. We must do what is best for the patient without violating the patient's wishes, and not what is most convenient for us.
1. bipap for hyperventilation: I've never heard of it being used for that.
2. what happens if you suddenly stop advair: I think it's such a small amount of steroid you shouldn't have to wean off it. Yet if that small amount of steroid is keeping down the inflammation and controlling your asthma, you might be setting yourself up for an impending asthma problem down the road.
3. quitting symbicort: Same. Don't just quit taking any medicine without consulting your doctor first
4. is morphine therapy for a copd person: It's used occasionally to help COPD patients cope with air hunger. It is a mild bronchodilator too. Generally it's used for severe, end stage COPD.
5. When does the therapist can give aerosol drugs for crying chi: It does little good to give a treatment to a crying child because a smooth, laminar flow is required to get the best drug distribution. A crying child also spends most of his (or her) time exhaling.
6. symbicort for rescue inhaler: What's the question?
7. What brand of ventilator is commonly used today in hospital: I work for a small town hospital, so what we use are collecting dust in larger hospitals. I'm not really sure. If any of my readers have an answer to this questions feel free to leave a comment below.
8. symbicort vs advair: The only difference I'm aware of is symbicort can be used as a rescue inhaler because it works fast to open up the lungs, while Advair takes a little longer. The Symbicort SMART program is used in some countries but not in the U.S.
9. how long can a patient be on BIPAP before needing intubation: I'm assuming here you're referring to how long can a mask be on a patient, as in hours, days, weeks. I believe the answer would be "it depends." Is the patient tolerating it? Is the patient able to come off it long enough to eat? Is it working as you expect it to? Does it look like the underlying condition is resolving? Ideally you'd want to use BiPAP in the hospital short term, just long enough for other medicines to fix the underlying condition. If the underlying condition is not resolving itself, then perhaps you can continue therapy. Does the patient want it? Does the patient have a DNR or no vent order. BiPAP may be your only option. So, again, it depends.
Ideally, however, if a patient requires continuous ventilation you might be better off intubating the patient so you can control his breathing a little better. Yet, still, you'll have to use common sense.
We did recently have a patient on BiPAP against his will, and the doctor even wrote an order: "Do not remove mask from patient no matter what." This I think is a bad idea. The patient had complete whiteout on x-ray and could not ventilate or oxygenate even during short breaks from the mask. Considering this patient wasn't getting adequate nutrition, and was highly anxious, I believed a better course would have been to intubate the patient.
Still, common sense is the best answer to this question. We must do what is best for the patient without violating the patient's wishes, and not what is most convenient for us.
Thursday, August 11, 2011
Apartment living may expose kids to 2nd hand smoke
I wonder if the 5.6 million Americans who live in apartments are aware of the fact that if anyone in any other apartment in the building in which they live is a smoker, so too are they smokers. If anyone in the building smokes, every one in the building is automatically a second hand smoker at risk for the same diseases as those of a smoker.
How's that for some stunning news. The reason is that smoke travels through the ventilation system, and is inhaled by anyone in the apartment building.
A new study conducted at the University of Rochester Medical Center, showed that a substance formed by the breakdown of nicotine called cotinine was found in the blood of over 5,000 youngsters 5-18 years old. The study concluded that 73 percent of kids are exposed to cigarette smoke, yet the levels of cotinine was much higher in kids who lived in apartment complexes.
Another study done in 2001 showed that of the 5.6 million Americans who live in apartment complexes, said they do so as a matter of choice because they like to rent. Yet they might want to reconsider, especially if they have children, because they may be inadvertently exposing their children to second hand smoke.
I have written many previous posts about the dangers of exposing kids to cigarette smoke:
How's that for some stunning news. The reason is that smoke travels through the ventilation system, and is inhaled by anyone in the apartment building.
A new study conducted at the University of Rochester Medical Center, showed that a substance formed by the breakdown of nicotine called cotinine was found in the blood of over 5,000 youngsters 5-18 years old. The study concluded that 73 percent of kids are exposed to cigarette smoke, yet the levels of cotinine was much higher in kids who lived in apartment complexes.
Another study done in 2001 showed that of the 5.6 million Americans who live in apartment complexes, said they do so as a matter of choice because they like to rent. Yet they might want to reconsider, especially if they have children, because they may be inadvertently exposing their children to second hand smoke.
I have written many previous posts about the dangers of exposing kids to cigarette smoke:
- Smoking in front of kids is stupid! Period!
- Smoking is hazardous to kids
- 20 reasons not to smoke if you have asthma
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