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Thursday, April 1, 2021

If you are vaccinated, take off your mask (if you won't get into trouble that is)

Look, I got my vaccine. I was told if I got the vaccine I couldn't get covid. And now people are telling me I need to keep wearing my mask because I could still be a carrier. 

What? This is crazy. Someone just made that up. I understand wearing a mask in the hospital. But why am I wearing a mask when I go to Walmart. There is no reason. Why is the CDC now telling people who got the COVID vaccine that they can now meet with people if they wear their masks and social distance. That is crazy. 

Quite the contrary. If you got your vaccine, you should take off your mask (if doing so won't get you in trouble). Because, as studies out of Israel show, those who have the covid vaccine cannot get and cannot carry the virus. There is your science. 

Biden keeps saying, "Follow the science." Yet the science says take off the mask if you are vaccinated. 

I think Biden could set a good example here. You have so many people refusing to get the vaccine for one reason or another. I think Biden should take off his mask. He should say, "Fear not. If you have the vaccine, take off your mask. You are now able to do all the things you want. Get this economy going again. If you are too stupid to get your vaccine, well then that's your problem. If you get covid, that is your problem. Take off your mask if you have the vaccine and live your life." 

You'd have record numbers of people getting their vaccine. And the economy would skyrocket. But, be it as it is, that won't happen. The leaders of our country love the power that covid gives them. Covid is the new global warming. 

Thursday, March 25, 2021

I am not an anti-masker. In fact, quite the contrary

I had a friend challenge me recently. He asked me if I had changed my views on being an anti-masker. And I said, "When did I say I was an anti-masker? I never said it! Find anywhere in my blog or Facebook page or anywhere where I said I was an anti-masker." 

Of course, he couldn't. Because I never said it. All I did was challenge the premise. All I did was ask questions. All I did was question the CDC which said, on its website, that masks prevent covid. And I still ask that question. How can they say that masks prevent. It would be fine if they said, "The premise is that if you wear a mask, it may help reduce your risk for getting covid." 

That would be fine by me. But to say they prevent is poppycock. And I'm talking about surgical masks. They do not prevent. And, of course, my friend came back to me. He said, "They have worn surgical masks in surgery for years because they prevent the spread of disease." 

And I said, "That is not why they wear surgical masks in surgeries. lol. The reason people wear surgical masks in surgery is to help reduce the spread of germs from the nurses and surgeons to the patients. It's in case they cough or sneeze. It's to keep the patient safe." 

But even that did not satiate my friend's haste to judge and cast me as an anti-masker. He was persistent and continues to nag me to this day. And I never really understood this until I watched CNN one day. And then I figured it out. I'm not saying everyone on CNN thinks masks prevent. But, the session I watched, all the people were pro-masker in a way that they believe if everyone wore a mask then we could end covid. 

And even that is not true. If everyone wore a mask, we would slow the spread for a while. But as soon as people started wearing masks again, covid would come back. A virus takes the course it takes. They run their course. 

I will give you a good example tomorrow. In the meantime, I encourage people to wear a mask until 2 weeks after the covid vaccine. Once you are vaccinated, there is not a reason to wear your mask anymore. If you still have to wear a mask, then what is the point of getting the vaccine? More on. this the days to come.  And I will also offer evidence. 

Tuesday, March 23, 2021

Science -VS- Scientism

Medicine is an art that is based on science. Art basically means you take the wisdom you have and use it to help your individual patient. And since every patient is different, how to help individual patients will be different. 

Science is a part of medicine that seems to be confusing for some. I walk around town and I see these signs that say, "We believe in science." Or, "Thank You Science." And I can't help but think these people do not know what science is. 

Those signs say something about our country's cult of scientism. What is scientism: It's an excessive belief in the power of scientific knowledge and techniques.

I can give you some examples.
  1. Asthma is a nervous disorder
  2. The hypoxic drive theory is true
  3. The earth is flat.
  4. The earth is the center of the universe.
  5. Global cooling is caused by man.
  6. Global warming is caused by man
  7. Climate change is caused by man
  8. Masks prevent the spread of COVID-19
  9. Vaccinated people can still spread the disease they were vaccinated against.
These are all examples of theories that have become truths to some people. The truth is that some of these theories have been proven false, while others are still being studied. 

Scientism is blindly believing in a theory that is created by science so much so that you forget what science really is. 

So what is science?

Science, by its nature, is an argument. It's debate. It’s controversy. It is attempting to disprove or prove a theory. Science is not blindly adhering to one theory.

Science gives you the scientific method. It gives you ways to do unbiased studies of theories. And from there they either prove or disprove them. And, for the record, science can never be fully proved. For example, how do you prove global warming is caused by man when the climate has been warming and cooling naturally for 4.5 billion years now.  So, the only proof of the global warming theory is computer modulated data. And computer modulated data is only as good as the data entered into it. And, which, there isn't much data, considering we have been studying our climate for less than 150 years. So, there really is no way to prove man-made global warming. We should respect a theory, perhaps, But to worship it seems folly.

Science is never fully settled. It is constantly being verified, challenged, and debated. 

And, furthermore, science is not up to a consensus. So many times you hear people talking about science as though it were up for a vote. I often hear people saying, "Since 99% of scientists believe in global warming, that makes it so." 

No. That is not how it works. Science either is or is not. It is not up to a vote or a consensus. You could have 100% of scientists say they believe in global warming, that does not make it so. The same with any other theory you have out there. 

If I had a choice how I'd die, I'd do not want to just drop dead

How is that for a controversial headline. I mean it too, though. I know a lot of people say they just want to drop dead when they die. And that makes sense. It would be quick, as the guillotine. I hate to sound morbid, but that's the topic of the day here. 

No. If God lets me choose, I want to get a terminal disease. I want to die a slow death. This will give me plenty of time to deal with it. It would give me plenty of time to say goodbye to my friends and family. And you guys are my family too. I want to blog about it. I want to blog until the day I die. 

I get a terminal disease, I can come here every day for therapy. I can share what it's like. I can be an advocate. Maybe others will want me to write for them. And I can advocate on behalf of my disease and make money for my estate in the process. And I can help get the word out. 

Sure, my final few posts may be different. I might be drooling on the keyboard. I might say things like, "Gasp!" 

I am being serious here. I don't want to get a terminal disease. But worse, I don't want to just drop dead. I want time to finish my affairs. I want to know the end is coming so I can speed up the process of wrapping up the ends. Does that make sense? Truthfully, I have never found anyone who agrees with me. Most of my friends want to drop dead when the time comes. Not saying I want the end to come. Life is great. I love life. I love doing this. 

And I'm not afraid to die, as I know this life is not the end. 

What do you think? 

Thursday, March 18, 2021

Stupid Doctor Orders: Yes! They happen

I attended a conference once. I was there with an older therapist named Doug. This was way back when I was a green therapist. So, it was quite a few years ago. The instructor was asking us questions. She said, "Can you name anything good doctors do?" 

Doug raised his hand. "Doug! The teacher said.

Doug said, "Doctors orders." 

So there was a discussion. Then the instructor said, "Name something bad that doctors do." 

Doug raised his hand. "Yes, Doug!" The instructor said.

Doug said, "Doctor's orders." 

A rush of laughter made its way through the room. So funny and so true. Lots of great doctors' orders. And lots of stupid doctors' orders. I think most of us know what a good doctor's order is. I thought it would be neat to list some examples of stupid doctors' orders here. The following are stupid orders sent to me by readers like you. 

1. You have a patient coming in by ambulance. Over the speaker, the ambulance driver reports the patient is in respiratory distress. The doctor looks at me and says, "As soon as they get here, start a continuous breathing treatment and BiPAP." Yep. Even before looking at the patient. 

2.  You have an 88-year-old patient. The patient is completely out to lunch and is totally incapable of using an inhaler. Still, without looking at the patient, the doctor orders BID Symbicort. 

3.  You have a patient on a ventilator. The doctor orders an ABG. The results show respiratory acidosis. The doctor orders for you to increase the rate from 14 to 18. You explain to the doctor that the patient is breathing over the vent at a rate of 20. But, he still insists on increasing the rate. An hour after the ventilator change, the rate is still 20. And the doctor orders a repeat ABG. And, lo and behold, the doctor is perplexed why the CO2 did not come down. 

4. Stupid is giving 6-8 puffs of inhaler to COVID patients in ER. Why the hell are we doing this? Albuterol is for asthma, not COVID. I have never had any covid patient say they can breathe easier after using an inhaler. What a waste of time? The only time COVID patients benefit from albuterol if when they have a diagnosis of asthma. Stupid is that we actually had a shortage of inhalers because of this. And it was absolutely avoidable.  

Sunday, March 14, 2021

Care of COVID-19 Patients in the Critical Care Unit

These pictures were taken from the free domain on the Internet. 

Patients with COVID-19 who are in the Critical Care Unit, or CCU, are under the care of a hospitalist, a physician who specializes in the care of hospitalized patients. Many of our COVID-19 patients over the past year were in the CCU. COVID-19 patients in critical care have a higher risk of needing a ventilator because their ability to get enough oxygen on their own is compromised. Low oxygen levels over too long a period of time cause strain on body systems and put the patient at risk of many complications.

Prior to a patient being placed on a ventilator, respiratory therapists are responsible for assessing the need for intubation. Intubation is when a hollow plastic tube, called an endotracheal tube, is placed in the patient’s trachea or “windpipe” through the mouth. This allows oxygen to get into the patient’s lungs and helps the patient to breathe when he cannot breathe adequately on his own.

When necessary, respiratory therapists assist physicians when placing and securing the endotracheal tube in the patient’s mouth and throat. The tube is attached to the ventilator, which gives the patient oxygen and breathes for him. This allows the patient’s body to rest, not having to work so hard just to breathe.

When we have a CCU patient on a ventilator with COVID-19, they are in an isolated room all by themselves. Respiratory duty is to maintain the airway and monitor and adjust the mechanical ventilator. We adjust the ventilator based on the patient’s atrial blood gases. Respiratory therapy is responsible for drawing these gases, which can show us that we are adequately ventilating the patient. We also are suctioning out the airway and proning patients, which means to put the patient on their stomach. This helps with air exchange and mucus removal. We also monitor the patient’s vitals while on the ventilator, especially their oxygen saturation, which tells us that the ventilator is working well and allowing the body a better chance to heal.

Sunday, February 14, 2021

A day in the Life of an RT in 2021

I was recently asked to write: Day in the life of a respiratory therapist during COVID 10. This was for a local newspaper.

How respiratory therapists care for patients has not changed throughout the COVID-19 pandemic. However, COVID-19 has changed the way we approach patients and has changed a lot of the procedures we use in our everyday jobs. We are more cautious than before about the pandemic and have implemented safety precautions in keeping with a virus that is spread through respiratory droplets. Many of our non-clinical colleagues are working offsite remotely, in order to stay away from others and keep themselves and others safe. Meetings are often held via virtual meeting applications; at Spectrum Health, we use Microsoft Teams. There are not as many people in the hospital as there typically are. Visitors have been restricted, and staff members who can work at home must work at home, so the hospital—while never empty—is less populated. It can feel odd since we are used to passing people in the hallways and seeing more people in our department and on the nursing units.

Although respiratory therapists, as with most health care workers, have always taken safety seriously and have employed what is called “universal precautions,” meaning that we assume patients could be infectious so we employ safety precautions such as gloves and masks, those precautions have amplified in the face of COVID-19. In 2021, we wear masks all day, even when we are not with patients. As soon as we walk in the doors to our workplace, we use hand sanitizer and put on surgical masks. That's just the beginning.

A typical day for me begins by arriving at our department and punching in. The phone I carry to help me communicate while I am mobile at work begins to buzz with messages. A text shows I am needed in the emergency department. I arrive to find that a patient is short of breath. Before COVID-19, I would enter the room without hesitation and begin talking to the patient to determine how they are feeling and do an assessment of what is needed. Today, I operate with the assumption that everyone has COVID-19. That allows me to keep safe and it allows me to ensure my patients are safe. I pause before I go into the room to replace my surgical mask with an N95 mask or what is called a PAPR, a device that allows your breath to be s.

Before COVID-19, we gave lots of breathing treatments. These allow people with asthma, Chronic Obstructive Pulmonary Disease (COPD), and other conditions that make breathing more difficult to breathe easier using inhaled respiratory medicine. This medicine helps open up airways. COVID-19 has changed our practice regarding nebulized breathing treatments. Breathing treatments aerosolize medicine. They can also aerosolize germs like COVID-19. So now, until a patient is proven COVID-19 negative, we give inhalers instead. Like nebulizers, inhalers allow patients to inhale respiratory medicine. But they do not aerosolize germs into the room. So, anyone suspected of or diagnosed with COVID-19 now receives an inhaler instead of a nebulized breathing treatment.

For this particular patient in the emergency department, I first put on a PAPR device before going into the room. I assess how he is doing and begin the process of administering his treatment. The patient will be observed in the emergency department to see how he progresses and based on that, he may be released home or may be admitted. If he is admitted and continues to need assistance with his breathing, the respiratory therapist team will assist with his care throughout the time he is a patient.

Before the COVID-19 pandemic, respiratory therapists provided care for some of our patients in critical condition, but many of these patients were transported to Grand Rapids so they could be under the care of specialty physicians such as pulmonologists. Throughout the pandemic, some of the larger hospitals were filled to capacity, and some of our patients were too ill to be transported. We kept many more patients at the Ludington and other regional hospitals but were able to use telemedicine to ensure the same specialty physicians were involved in each patient’s care.

Telemedicine is a technology Spectrum Health has used for years, but during the pandemic, its use for critical patients became very important. With a monitor wheeled into the patient’s room in Ludington, a pulmonologist in Grand Rapids can see the patient via a camera and talk to the hospitalist on duty about the patient’s condition and care. The specialist can work directly with our local hospitalists to confer on patient care and offer insight on the best course of treatment for each patient. It’s a valuable tool for both physicians, patients, and families.

*This article was edited and published in the Ludington Daily News on March 11, 2021, as an aside to the article: "Fighting COVID 19: 
Healthcare workers share stories from frontlines; talk protocol changes, safety, mental health,"