The Doubting Thomas Asthmatic

Some adults just contribute the gradually increasing shortness of breath to aging.  So when they present to the emergency room, and you offer an asthma remedy, they doubt they have a need for it.  They probably would not even have sought help if not for the insistence of their wives.  They are, no doubt, your prototypical Doubting Thomas Asthmatics.  While I came up with the idea, it was my publisher who came up with this name.  You gotta love it!  You can probably throw COPDers into this category as well.

You can read the accompanying article: "Doubting Thomas Asthmatic: The Modest Asthmatic."

The Doubting Thomas is an adult with asthma symptoms or who has recently been diagnosed with asthma who just doesn't believe that asthma is their problem, and they may avoid treatment because of their doubt. But Rick Frea knows what to do with them. Illustrated by Dash Shaw.  Originally published at healthcentral.com/asthma. 

Medicine based on consensus, not science

Medicine is an art based on science.  Much of medicine is based on flawed science. Or, as Richard Feynman once said, science is the belief in the ignorance of experts. 

Much of science is not even science: it's consensus.  It's basically the world's leading experts voting on what they think is fact, rather than waiting for the evidence to reveal the truth.  It's creating theories and voting on which ones should be in the forefront of our minds.  So when deciding on what to believe, we must never forget that "science is about evidence, not consensus."  

It is so hard in the medical profession to separate consensus from science.  In fact, one of the things that fascinated me most about the medical profession is it's loose relationship with science.  In fact, early on in my studies I learned that medicine is loosely based on science, and more so based on consensus, which is not science at all. 

Look at the hypoxic drive theory.  It was based on a study of four COPD patients, and became a gold standard based on a presentation by EJM Campbell to pulmonologists in 1960 about the results of a study based on only four COPD patients.  So basically the hypoxic drive theory, or hoax as I like to call it, was based on a consensus of experts, and had nothing to do with science. 

So basically physician's under oxygenated their patients for over 70 years, and many still do, based on a consensus.

Look at all the breathing treatments we give based on a consensus that albuterol cures every lung ailment you can think of. Our new healthcare law insists that a lung patient must be sick enough to need 3 breathing treatments for reimbursement criteria to be met. This includes COPD, CHF, Asthma, Pneumonia, etc. So 3 breathing treatments are ordered on all these patients, and it's assumed they are needed. What's wrong with this picture? It certainly has nothing to do with science. 

Other examples of consensus over science include:

• BiPAP pushes fluid out of lungs
• The earth is flat
• Man made global warming
• The continents cannot drift
• Stress causes ulcers
• Asthma is one of the seven pychosomatic disorders
• Phlogiston was necessary for combustion to take place

All of these theories are, or were, so widespread, and so well accepted, that they caused people to focus on treatments and therapies that probably did more harm than good (like under oxygenating COPD patients). As in the case with asthma, consensus caused experts to focus so much on a dead end path that it prevented the advancement of knowledge to the detriment of those who suffered from it (i.e., experts focused on treating asthma with psychosomatic medicines when they should have been looking treatments for inflammation and bronchospasm). 

So when you're thinking about whether or not you want to believe something is true, consider the evidence and not the consensus.  The fact that a majority of people believe something to be true does not make it so. In other words, it's okay to oppose the majority opinion, so long as the evidence is on your side. 

When a doctor orders something, it's your job as a therapist, or a nurse, to do as you are instructed.  For instance, if a doctor orders you to give a breathing treatment, then you must give it regardless that you know it is a waste of time.  As the old saying goes, "It can't hurt." 

Still, it really does hurt, because you're putting medicine into someone that doesn't need to be there, and, even though we can't always see them, all medicines come with side effects.  And then there's also the side effect of second hand ventolin on those who are doling it out all day long.

However, when a doctor orders for you to maintain an SpO2 in the low 80s because of the hypoxic drive myth, it's time to rise up and challenge the consensus for the benefit of the patient, because, Lord knows, oxygen is beneficial to the living heart. Thankfully the hypoxic drive consensus/hoax is slowly fading, and COPD patients are actually being oxygenated these days. 

Further reading.

• Rush Limbaugh: Peer Reviewed Science Exposed as Fraud
• NY TIMES:  Many Psychology Findings Not As Strong As Claimed, Study Says
• Wall Street Journal: Science is About Evidence, Not Consensus
• RT Cave: Second Hand Albuterol

Invention ideas I have

This is the new design I came up with for a set of keys,
They are simple, and cost less than a buck to copy. 

I have been doing a lot of thinking lately of ways I can make the world better.  Here are some of the ideas I have come up with.

1.  Cord on phones.  I just thought it would be a neat idea.  How many times a day I have to search for the phone, I can't even count.  If phones had cords on them they'd be on a leash, sort of, and easy to find.

2.  Dials on TV.  Like cordless phones, how many hours a day do you spend searching for the remote control?  Way to many, I'd have to say -- especially if you have kids.  I say that we just put a dial on the TV, and if you lose the remote control so what: you lose a few pounds getting up to turn the knob.  Bottom line: when you can't find the remote you can still watch the channel you want.

3.  Antennas. Rather than pay countless dollars to satellite and cable services, I think every house should come equipped with an antenna that allows people to pick up channels for free.  Isn't that the point of advertising in the first place? It seems the way it is now, we pay for TV and we still have to put up with boring commercials.

4.  Paper Charting.  Electronic charting is slow and makes it so you have to pay attention to your charting more so than your patient.  I would like to see someone come up with a piece of paper that allows us to chart on it.  Maybe even a pencil or a pen for writing on.  This would be nice because then we could chart after we are done assessing, treating and educating the patient.  Gomer Blog agrees with m;e on this one.

5.  Metal Hangers.  Today hangers are made of plastic that easily breaks and is useless when not supporting a shirt or a pear of pants.  I think hangers should be made of metal.  That way, when you lock yourself out of your car, you have a tool to help you get in.

6.  Easy to pick locks on cars.  Modern locks are so complicated that, when you lose your keys, you can't get in your car.  Sure the thief can't get in, but my cars are so dilapidated that no thief would come close to my car anyway.  I would like to use my metal hanger to pull open the locks when (I say when) I lose my keys (which usually happens once or twice a month.

7.  Regular Keys.  Modern car keys have so much electronic junk inside them that they cost over $400 each.  I would like to see a key that is merely a piece of metal in a particular shape that it only fits in your car. You turn it and the car turns on.  Simple enough.

Definitions to be added to our lexicons

BDCHF = BiPAP Deferred Congested Heart Failure. BiPAP will prevent fluid from entering the lungs. Indicated for patients with poor kidney function who require large fluid boluses (i.e. for low blood pressure). A bonus is the BiPAP might cause the anxiety needed to raise blood pressure. Note: Ignore silly RT rants about BiPAP decreasing venous return and possibly lowering blood pressure).

DCHF = Deferred Congested Heart Failure. The patient was wet when admitted, but the doctor won't figure it out until the patient has been treated with bronchodilators for three days.

Diagnosis: PACHF = Physician Induced Congested Heart Failure.

Float away:  Pulmicort/ Albuterol dilate airways so foam pneumonia just floats away.

Nosocomial COPD. A fake diagnoses in order to meet criteria for reimbursement.  Requires Q4 breathing treatments regardless that patient is breathing normal and has clear lung sounds. 

Nosocomial CHF.  a.  Fluid overloading patients who don't look quite right but need to be admitted.  b. loading patients with fluid during surgery and sending them up to the floor claiming they are fine.

Schnockered:  Drug induced sleep

Hearing loss similar to asthma

So Rush Limbaugh went completely deaf, and he described, or attempted to, what it's like to go deaf. He attempted to explain the emotions involved in going deaf.  Basically, he said that if you do not have hearing loss you cannot know what it's like.  He said that because of this it is not possible to describe hearing loss to someone who can hear.

He told his story, how he lost his hearing, and then he said.

The most fascinating thing to me about all this, honestly, is not what's happened to me. The most fascinating thing to me about all this is how other people deal with it, not me. That has been the most mind-opening thing about all this that I could ever... The last thing I would ever think would be the big experience of, the big experience has been the way other people react to it, or don't. It has been a real eye-opener. It has taught me so much about people, various types of people, various human characteristics.

That has been the real fascinating thing. And I know you're saying, "Well, what do you mean?" Well, I'll give you an example, just one. All of my close friends obviously know that I can't hear. But they don't know it. They don't know it, because I can. I have these implants, and they can talk to me. So they have no concept. A person that can hear cannot conceive of deafness. You can't manufacture it. Total deafness, I mean. You can't create it.

You can cover your ears. You can put cotton in your ears. You can do everything to plug them, but you cannot create total deafness. And, as such, you can't understand it. You can pretend to be blind and know what that's like. And you can pretend that you can't walk. You can put yourself in a chair and imagine not being able to move and what that would entail. But you cannot imagine not being able to hear, unless you can't.

And I mean total deafness, not hearing loss, and not hard-of-hearing. I mean total deafness. You can't relate to it.

As he's saying this, a light bulb turned on inside my head about what I have learned about asthma.  If you do not have asthma then you cannot explain it to anyone else.  You can breathe through a straw, but you cannot recreate asthma.  You can see that a person has a broken leg, you can see a person is blind, but you cannot see asthma; you cannot see allergies.

It was for this reason that asthma was all but ignored for most of history, even though Hippocrates described it as far back as 400 years before the birth of Christ.

Surely you can breathe through a straw, but you cannot recreate, you cannot manufacture, what it is like to constantly live with knowing that at any moment you will lose your breath, or lose the ability to breathe normal due to inflamed airways.  You never know what might set off sniffles and sneezes and wheezes.

So for most of history asthma was shrugged off as nothing more than an annoyance -- like a cold.  So it ws ignored, not paid attention to.  As a matter of fact, barely any money was allocated to asthma research until long after the medical community gained control of more serious, more deadly, diseases like tuberculosis, like dyptheria, like influenza were controlled.

Before that time, asthma was treated like nothing more than a cold.  It was an annoyance.  It was one of the seven psychosomatic disorders, and treated by inhaling dried and crushed herbs like stramonium and belladonna that worked like canibis and eased the mind more so than relaxed the airways.

Talking to people with hearing loss

So on Sunday I instructed my RT Cave Facebook Page followers to read the transcripts from the August 30, 2015, Rush Limbaugh show where Rush explains how it felt to go deaf. Trust me, folks, this has nothing to do with politics and everything to do with how to deal with deaf people or people with hearing loss, people we deal with on a daily basis and still have to communicate with.  

Basically, what I wanted people to read was the following.

I was playing golf one day, and I ran into a guy I didn't even know. It was up at Jupiter Hills and I ran into a guy. I was coming off the practice range. The guy came up to me and said, "You know, I really admire what you're doing."

I had no idea what he was talking about. I said, "Why?"

"I don't know how you're still working. You're deaf, for crying out loud! You're deaf!"
I said, "Well, implants, this, that," explained to him.

He said -- and I've never forgotten this. He said, "Hearing loss, deafness is the only disability where the victim is blamed. Have you found that?"

I said, "What do you mean?"

"Do people get mad at you for not being able to hear them?"

I laughed. "All the time."

He said, "That's what I mean. You're the one that can't hear; they get mad at you. Because they can't relate to not being able to hear. And when they're around you and you're wearing your implant, you can hear them, so they think you can hear them all the time. They do not get it. They just don't," and he was right. He was dead-on right. And the way it manifests itself is... Well, let's say I'm on the golf course. I'm on the driver's side. Let's say before I got the implant on my right ear, so I can only hear out of my left.

I can't tell you how many times I have witnessed nurses or doctors get irritated with a person who can't hear because they can't hear.  Heck, I know that I have myself gotten annoyed from time to time. And this is what Rush is describing: the frustration of the deaf person because they are treated as the victim when the real victim is not them but you.  You are the victim because you don't know what it's like to be deaf, and you don't know how to communicate with deaf people.

The reminds me of when I was 15 and had a friend named Julie who was deaf.  She kept telling me over and over not to shout.  To me it made sense to shout what I said, thinking she'd be able to hear me better with the hearing aide and all.  But she would get irritated with me and tell me just to talk normal.  The reason she said this was because she was trying to read my lips and when I talked loud she couldn't read my lips.

I'll be honest with you: she corrected me a lot.  I remember many times she would touch the side of my head and aim it so that I was looking at her.  She would look annoyed or irritated, she would just just calmly give some kind of hint, or touch, indicating that I needed to look at her and talk normal.  She knew that I didn't know.  She had experienced this many times, and simply decided, at some point, that if a person is not deaf this is how they acted, and this is what needed to be done.

She was trying to help me understand what it was like to be deaf.  Then I would talk normal for a while, concentrating on making sure she was looking at me when I talked.  But then I would forget, and the next time we were having a conversation I would find myself shouting again.

I can't tell you how many times I have had to remind myself not to shout in a patient's room.  I can picture Julie as she constantly reminded me not to shout, that there was no need for me to shout.  But I still have to stop myself.  I can't tell you how many times I've told nurses or doctors not to shout.  But they just look at me annoyed.

Rush continued.

I'm on the driver's side (of a golf cart). My good buddy, whoever it is sitting on my right talking to me in a normal tone of voice as we're motoring along and the golf clubs are rattling and making noise and the wind is going through the microphone. I can't understand a single word. Two years later, same circumstance. The guy still doesn't speak up, doesn't aim for my left ear, just keeps talking. It's just... I don't know how to explain it.

As I say, it's been fascinating to study it and try to understand it, and I don't complain about it. You know, I just I'll stop the cart and I'll turn my head and get three inches from them and say, "Could you say that again," and it'll happen after I do that. Five minutes later they'll try to talk to me with all the racket again, and I'll stop the cart, and I'll turn my head and get three inches. They don't learn. And that has been the fascinating thing about it.

And this is not a criticism. It's human nature. It's just the way... I think it's all rooted in the fact that people simply can't relate to it, even people I've explained it to in great detail -- and I can't explain the acoustics.

You see, we don't know what it is like to be deaf, so we don't learn how to talk to deaf people even when they tell us.  We don't learn to get their attention and to make sure they know we are talking to them. We do not learn to be patient with them.  If we gain their attention, if they see us talk, they can, if they have hearing aides or know how to read lips, hear us.

But we forget.  We should not forget, but we do.  It's human nature.

Some asthmatics are good actors

Carrie would come into the hospital and every doctor, nurse and respiratory therapist knew she was exaggerating it for attention. What was it this time? Was she fighting with her husband? Was she getting our of some work she didn't want to do? Was she stressed? Regardless, we all knew she was exaggerating.

And, lo and behold, she was admitted with exaggeration of asthma.  My publisher preferred the name actor, and so it became actor asthmatics. Thus was the theme for cartoon #7.  You can read the accompanying article: "Exaggeration of Asthma."

Carrie would cough, wheeze and frown to get out of unpleasant tasks and make other people feel guilty. It worked, but her poor asthma care also hurt her lungs, permanently. Illustrated by Dash Shaw. Originally published at healthcentral.com/asthma.