Lung Disease Threatens Big City Residents

Lung Disease Threatens Big City Residents - Besides the heart, lungs is one of the vital organs for human life. The lungs play an important role in the respiratory system. This organ exchange oxygen from air with carbon dioxide from the blood. Without lungs, you will be disturbed oxygen demand.

Not only that, there's more work the other lung. The lungs selecting and removing bad particles that enter through the respiratory tract, such as dust or chemicals from pollution.

Unfortunately, we often pay less attention lung health. In fact, lung health indicators disturbed quite easily seen. For example, difficulty breathing when walking quickly or frequently experience coughing. Smokers and people who often sleep late at night was not immune from the threat of decline in lung function.

In order for the health of our lungs to stay awake, Internal Medicine Specialist Hospital Mochtar Riady Comprehensive Cancer Centre (MRCCC) Siloam Hospitals, Jakarta, Martin Rumende advised us to check the condition of the lungs.

"So we know what happens in the lungs. Do not know-know you have been exposed to chronic diseases," said Martin.

Prepare contained breathing

Diseases that damage the health of your lungs is a disease that includes the category Chronic Obstructive Pulmonary Disease (COPD). Chronic lung disease is characterized by the presence of air flow resistance in the airways that is progressive non-reversible or partially reversible.

The cause of airflow obstruction in COPD are chronic bronchitis, emphysema, or a combination of both. Chronic Bronchitis is a respiratory disorder characterized by chronic cough with phlegm for at least three months in a year without the influence of other diseases.

While the anatomic pulmonary emphysema is characterized by dilation of distal airspaces and terminal bronchioles accompanied by alveolar wall destruction. Guidelines for Asthma Diagnosis and Treatment of Lung Association Physician Indonesia mention, often, people with chronic bronchitis showed signs of emphysema.

Not only that, tuberculosis or TB disease caused by mycobacterium tuberculosis bacteria are also a threat. This disease is transmitted through saliva splashes when the patient coughs. There is also a pneumonia which is caused by infection of the lung tissue (parenchyma). Generally, the infection is caused by mycoplasma bacteria peneumoniae.

Lung cancer is the most frightening specter for the body. Therefore, based on medical data, including lung cancer cancer that causes many deaths worldwide, as well as cervical cancer in women.

It had been so, this cancer, as he entered the advanced stage, can grow and spread to other parts of the body. According Suhanto Kasmali, Head of Medical Services Mediros Hospital, Jakarta, lung disease is a serious threat for those who live in big cities with high pollution levels, such as Jakarta.

Therefore, everyone needs to prepare a tool that can protect the respiratory system, such as masks. In fact, the mask is obligatory for motorists as well as those working in the field of construction, such as painters, or a chemical factory workers. Well, did you care about your lungs?

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The world revolves around social people (extroverts)

There's this old saying that the squeaky wheel gets the grease.  I think it's common wisdom that extroverts tend to be squeaky wheels more so than introverts.  Therefore, I've concluded that the world revolves around extroverts.

Consider singing in school.  Many extroverts love singing, so they think everyone should sing.  Yet you have the introvert or shy kid who doesn't feel comfortable, yet he's still pressured into singing. You can see him way in the back, if you look close, and he's probably lip sinking.  His face might be red.

The introvert may have allergies and asthma, and this coupled with his shyness has other kids picking on him, maybe pounding him in the chest or something like that.  This happens because he's not talkative, and not social as the extroverts are.

You have TV shows like iCarly and all the actors are extroverts.  They make fun of people who have allergies and might be, well, shy.

Looking at our history we only had one president who was an introvert, and he only became president because he was vice president when Warren G. Harding was killed (or committed suicide).  The president I'm referring to was Calvin Coolidge, or silent Cal.

Extroverts in Washington don't have time to read their history or their economics 101 courses, so they make laws without really knowing what their doing.

You have doctors who do things they were taught (like not oxygenating COPD patients) based on theories from the 1930s, and even though we know better now the old methods are still worshipped.  We introverts try to stop this, yet it continues to go on.

The world is run by extroverts, I surmise, and introverts are just along for the ride, forced to live in an extrovert world.  You dance, we watch.  You talk, we read and learn.  We know, yet you feel and believe. 

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The human aspect of working in a hospital

I'll be honest that I'm not the best respiratory therapist.  Obviously there's a lot of respiratory wisdom and experience stuffed in my cranium, yet sometimes it takes a moment to sort through it all and come to a decision.  That's why I never would make a good doctor.

Yet, I suppose, it takes all kinds to make an institution run smoothly.  I'm usually silent when there's a lot of people around, and my voice is soft.  Yet one on one with my patients and the patient's family is where I excel.  I also have a knack for fine tuning machines so they work well for patients and keeping them comfortable.  I often go out of my way and use my soft skills keep people happy. 

So I'm good at PR.  I think that's a good asset because many RTs and RNs and most doctors tend to lose the human aspect after so many years of doing this job.  I've had many patients and family members thank me wholeheartedly for taking the time explaining things, or taking the time to give a patient on a BiPAP a break from the mask even though the doctor didn't order it.  One time I even brought a patient a burger, and another patient one of my books because she looked bored and said she loved to read. 

Just recently we had a patient who needed the BiPAP to take a deep enough breath to blow off CO2 and to oxygenate.  The doctor ordered not to take mask off no matter what.  Yet that doctor isn't sitting by the side of the bed with the crying patient whose face is aching and sweaty under the mask.

So I gave her a break.  The doctor later told me I wouldn't have done it if I had seen the x-ray.  Yet I said I did see the x-ray and I wasn't taking her off with the intention of keeping her off.  I did it for three reasons:

1.  To give her a rest
2.  To prove to her she needed it, because she quickly got short of breath.
3.  To allow her to rest her face, take a drink of water, blow her nose

You see, that's where I excel.  Then I explain to the patient the BiPAP is not long term, and while it's uncomfortable, it's much better than a tube in your throat.  If you had a tube in your throat you wouldn't get any breaks.

I think some folks become apathetic and lose sight of the human element.  Doctors order for Q4 breathing treatments without considering the patient also needs to sleep to get better.  They order for no breaks of the BiPAP mask, and they put catheters in patients who can just as easily pee in a can.

They rip the patient's gown down right in front of the family, and they say what's going on without making sure the patient and the family understands what's happening, or they blow up at you right in plain view of the patient. 

The family and the patient are stressed, and then I come into the room and explain everything in a simple method that boosts my ego a bit and has everyone in the patient's room feeling better -- a little better anyway.

You can shut the door, or pull the curtain, or explain things.  You can listen to the patient's stories or you can watch a ball game with the patient.  You can ask the patient if he needs anything and actually go out of your way to get it or do what they want.  You can fetch a nurse and reassure the patient.  You can make sure the patient's not in pain or the patient is breathing fine.  Yet you can't be assured anything will get done unless you do it yourself.

You can check on a COPD patient every two hours instead of every 4-6 just to assure the patient that you're right there and available -- that you're keeping an eye on him.  Family likes this too.  You can be proactive by assessing the patient and preventing the patient from crashing.

When you're at a code for a patient in bed one you can talk to the patient in bed two.  You can assure her that her room mate is a little sick but will be okay.  And then you can do a follow up with the patient in bed two to let her know what happened.  A little reassurance goes a long way.

All it takes to make someone happy sometimes is just a little notice of the human element.  Sure you have a job to do.  Sure that patient becomes just another part on the human assembly line, yet a person is still a person no matter how small as Horton the Elephant would say.  People get scared and anxious.  Hospitals are scary.  And I have the ability to take some of that edge off -- all of us can take that edge off.

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Don't blow up at your RT

Noting the nurses in the ER were busy, and noting the patient had a CPAP and a bunch of other stuff than needed to go to his room, I inquired to the nurse what room the patient was going to be admitted to. 

She said, snarly, "Look!  If we knew what room he was in he'd be admitted already.  We don't know any more now what room he's going to as we did a half hour ago when you asked!"

Surely my natural instincts were setting in and I wanted to blow up at the nurse, yet I humble gained control, set my hand on her arm, and said, calmly, and with the most realistic smile I could muster, "Relax, I was just trying to help you guys out."

She mumbled a few things and was on her way. I decided never to offer my services in such a fashion again., at least when she's working.

RT Cave Rule # 54:   If you want your RT to help you out in the future, don't tick him off today.

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The true meaning of Christmas

I remember going to Grandma and Grandpa Frea's house on Christmas Eve and seeing a million presents scattered from the Christmas tree to the fireplace mantle, alongside the fireplace and lined up all the way along the wall and up the staircase. I remember the excitement as we kids looked over all the boxes looking for something that was ours.

Of course in the end, after a long, long wait, there was only one box sitting alongside me when the gifts were handed out. Then Santa would show up and bring another small gift. I remember opening the package and receiving a great big firetruck with ladders and all. The excitement was real.

Then we'd ride home. It was dark and the stars were abounding. On the way home we listened to Christmas tunes on the radio, and listen as dad talked about how neat it was to see all the stars, "A great night to see Santa Clause," he said. And we kids were rushing to get as close to the window as we could to see the sleigh.

"I see it right there," dad said.

"I don't see it," I said with my face plastered against the cold glass, my brother David half way on my lap with his face pressed on the glass too.

Then we'd rush into the house, through squishy snow, pull our snow pants and boots off, and rush to get our pajama's on. The goal was to fall asleep as fast as we could so we could get up and see how many presents we had.

Of course then I wouldn't be able to sleep. I lay there looking on my dresser at the firetruck. I lay there past midnight. "What was that!" I'd jump up and look out the window. "Was it Santa?"

Then finally, after the longest night ever, waking up and rushing to the living room. Bobby and David were already up and sitting under the Christmas tree. Mom had said last night not to touch anything until she got up, yet Bobby and David already had the presents sorted by person.

There were a ton of presents, and this time instead of the entire Frea family, there was only THIS frea family of a mom and a dad and five boys. So the chances of many of these toys belonging to me was pretty good.

There were big toys. There was a wagon and a tricycle that more than likely belonged to Dan and Tony. And there were big boxes and little boxes. Then we looked at the fireplace mantle and there were five big stocks stuffed full of stuff. And Bobby handed each one of us ours.

I sat on the couch with mine next to me, salivating at the candy cane sticking out of the top. Little Danny already had his open and sticky white saliva dribbling down his chin. Finally mom came out carrying little Tony, and she said, "I guess I wasn't sleeping past 7 a.m. today with all this commotion.

Before I knew it all my presents were open, and I wasn't completely satisfied. I wanted to get Star Wars figures and what I got was a stiff statue of a Star Wars figure. I wanted little Hot Wheels, and I did, but I was upset that my brother David got better ones. He got a big Hot Wheels truck. In fact he got two.

Later mom said she made a mistake, because I was supposed to get one. Yet David would not give me what was mine. He claimed them both for himself.

As I got older the presents became fewer. I would get one box and that was it. David and Bobby would also get one. Dan and Tony would also get one or two little things. Grandma and Grandpa went to Florida. So the Christmas of 1978 seemed to be one of my best Christmas memories ever.

Until 2010. Now I have my own family, and I woke up and saw all the Christmas presents under the tree and was the happiest man in the world because I knew not one of the gifts was for me. They were all from me, but not for me. I learned that the gifts themselves was not the purpose of Christmas, but the happy looks on the people who received them.

The greatest gift was not material possessions, but humility and family. And I also realized for the first time since 1978 why there seemed to be so many presents under the tree that year and not so many later on. I realized that it was not the gift but the age of the kids.

As kids grow older they prefer electronics and games and even clothing, and this results in fewer gifts. Likewise, as kids get older they realize the true meaning of Christmas, and don't expect as much (well, sorta). When kids are little we parents find joy in giving the first Tricycle to the little ones, and the first Wagon.

It was those BIG toys that made this year seem like there were so many gifts. Yet the same amount was spent on the BIG toys for my two little kids 2 and under, as on the really tiny boxes for the bigger kids of seven and 12.

And then my kids put two little boxes in front of me, and I understood why it was that my parents always said not to give them presents. And why it was that they always waited until last to open their gifts.

This was because I didn't need any gifts. In fact, it mattered not that I even opened mine, except I knew it would make my kids happy and my wife happy. They bought me a radio because they knew that would make me happy. And it did.

Yet what really made me happy was that every one in this room was here today and was happy because of me. It was because of my hard work as an RT and my dedication to my wife and kids. It was because of humility and Jesus.

I made a video of my seven year old opening up her package, and when she found out Santa gave her a DSI her joy was unquestionable. She was ecstatic. My 2 year old was excited about a simple sucker she got in her stocking, even though she had several other larger packages yet to open.

My 12 year old was upset that my daughter got a DSI and he didn't, even though he already had one. He was unhappy. Truly, he had yet to realize the purpose of Christmas. To him, Christmas was getting stuff. Yet I said nothing, because I remember how happy I was when I was his age to get stuff and I still grew up to realize the true meaning of Christmas.

This year, at 40, I realized the true meaning of Christmas. It's not materialism: it's family. (This was written on Christmas Day 2010).

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Faux priorities of RTs and how I prioritize

The following are the priorities in most hospitals:

1. Charting
2. Doing EKGs in ER whether they're needed or not
3. Doing order set EKGs on the floor
4. Donig STAT EKGs so the doctor can go home (or so patient can go to surgery)
5. Making patient happy so hospital gets a good review
6. Doing scheduled treatments on time and as ordered (not necessarily when needed)
7. Taking care of the patients who actually need your services

Here's how I prioritize therapies

1. Respiratory and cardiopulmonary arrest
2. Patient doesn't look right
3. Shortness of breath (treatment) and chest pain (EKG)
4. Making patient happy
5. Doing non emergent, non chest pain EKGs
6. Doing STAT orders so doctor can go home or patient can go to surgery
7. Doing scheduled therapies (Q4, Q6)
8. Doing QID and TID and BID therapies
9. Charting

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RT Idealists versus RT Realists

Some of my coworkers get annoyed that I'm always questioning need.  I'm always asking patients if they're really short of breath, and I'm always asking if they feel better after a bronchodilator.  And when a patient says he feels the same after a treatment and has never been short of breath, I chart as much.  I chart:  No difference with bronchodilator therapy.

When I have a patient with an SpO2 of 86 percent and the doctor orders for me to decrease that patients oxygen based on the hypoxic drive hoax, I ask why?  When I proposed a breathing treatment protocol to the staff and they cast it aside based on fear it would result in loss of work, I asked why they came up with that belief?  I asked if they have any proof protocols result in loss of work?  

One of my coworkers said a protocol would just result in more paperwork, and I asked why he thought that?  Another said doctors would never go for it anyway, and I asked why not?  Why do you think that?  

My coworkers seem to know everything?  They know what will pass and what will fail before we even propose it.  They should be our public leaders, because then the world would be perfect.  We would just do things because...  why?  Well they happen to know all the answers. 

The truth is they don't have all the answers.  The truth is they are idealists, and the reason they are annoyed with me is because I'm a realist.  Idealists do things based on feelings and emotion, and
realists ask questions and do things based on the truth and proven facts.  Idealists throw everything at every problem and hope something sticks -- order sets. Realists solve problems with protocols that encourage point of care critical thinking.

Idealist doctors solve problems by covering their bases by ordering everything -- cook book medicine.  Realists don't waste their time doing things that aren't proven to work for that patient, or that don't make sense; or at least they get annoyed when forced to do something they know isn't useful or scientifically proven to work.

Idealists are your political people who say things just to make people happy, and they do things that they know don't make sense just to keep a smile on a doctor's face -- and to boost that doctor's ego.

Realists questions doctors.  Realists question stupid orders.  Realists are hated because they are always asking questions instead of keeping their mouths shut and doing their job the way idealists
do.

Idealists solve problems based on feelings and emotion which results in doing things that aren't proven and are often useless, such as creating order sets where every patient is given Albuterol.  Realists don't waste their time doing things that are needless because they take the time to think.

Instead of thinking, idealists call respiratory or order breathing treatments.  This results in useless procedures and causes the RT to run around ragged all day to get all this work done.  It results in burnout and apathy or RATS.  Since Idealists control the world right now because their ideas sound good on the surface, the healthcare system is in trouble.  

I would consider myself a realists.  It's why people get annoyed with me.  We grumble and gripe at new breathing treatment orders because we know Idealist in the healthcare system order things for no  other reason than ignorance.

Idealist:  See idealism.  A person who believes perfection is possible.  They believe a euphoric world is possible.  They are always making rules and policies in an attempt to create an ideal world, even if there is no proof their rules and policies will work -- even if there are facts that what they want to do won't work.  They believe if there is a problem something must be done, even if that means taking away personal rights and discouraging individual thought and choice.  They believe one or two experts can decide what's best for everyone, and it's these experts who create ordersets, policies and guidelines that everyone has to follow.  Even if they are wrong they won't admit it.  They may have screwed the heck out of the healthcare industry with their policies, but they won't admit it.  They are the ones who passed Obamacare in an attempt to create equality in healthcare.  They are the ones who created DRGs that resulted in the boom in the diagnosis of asthma and pneumonia. They are the 
ones who decided to give away free healthcare to the poor and have caused ERs to become flooded with people who don't need to use the ER.  Their policies have improved patient care and reduced the cost of Medicare and Medicaide, yet it's increased hospital costs and caused apathy and burnout among the masses.  They are the reason for increasing healthcare costs and the nonexistent healthcare crisis.  Idealists don't like it when you come up to them and are truthful (yes, the truth hurts). If you go to them with the truth they will get angry and toss vitriol at you and make you out to be the enemy.  They say that when you question their realist ideals you are cconfrontational. You are causing confrontation. Yet if you're afraid of confrontation you're an enabler.  The idealist at the bedside sees a patient who's short of breath with an audible wheeze and thinks bronchodilator before even assessing the cause.  Their goal is euphoria in the healthcare industry; an ideal system by their definition of ideal.  A scientist will not take this route.   Perfection.

Realist:  See realism.  Judgemental.  Basing decisions on proven fact and science.  They ask questions like:  Does this make sense?  Is this science we're dealing with?  Does this patient really need a bronchodilator?  Is the U.S. healthcare system really as bad as they say it is?   If the answer is no, then we don't do it or don't mess with it or don't waste our time.  If it's moronic and doesn't make sense, we try to find a better solution such as protocols.  They are the ones at the bedside doing the clinical assessments and critical thinking to determine the cause the the best solutions.  They base their solutions on science and proven facts as opposed to feelings and "it sounds good."  They are often feared and hated because the truth hurts before it makes you better.  

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Heart Attacks increase during Christmas season

By far I am behind in my blog reading, yet I happened to check out COPD News of the Day to learn what I had already suspected, that the risk of heart attacks are up by 5% around the Christmas season.

She sites this article from Health.com which states that while ERs tend to be relatively slow on Christmas day, and patients opening presents don't even know they are at high risk for a heart attack. Yet many are.

The article notes that December 26 is one of the most hazardous days of the year for people "vulnerable" to cardiac problems such as heart attacks, arrythmias and heart failure (CHF).

The article also sites a 2004 study that showed heart related deaths increased about 5% around the Christmas season, the article notes, " perhaps because patients delay seeking treatment for heart problems or because hospital staffing patterns change."

I personally don't think it has anything to do with hospital staffing patterns. I think it has to do with modest patients thinking they are impervious and humble and delay seeking treatment for their seemingly life threatening condition.

I have written on my blog before how people simply don't want to be inconvenienced by doctors and medical stuff. It's not abnormal at all.

I've also noticed how the hospital tends to be ironically slow during the Christmas season. And while I'm working the days following the Christmas until after the New Year's Celebrations I expect there to be one or more cardiac patients being wheeled through the ER doors.

It's just a fact of life.

The resolution to this problem is the same as any other, and involves education. The more people are educated the more likely they will seek treatment.

Yet sometimes even us well educated delay seeking help, and in this case a good supporting cast of family members is essential to getting the good health care you need.

Just remember it's your life. It is up to you to take care of yourself. When you notice any of the following signs of heart problems call your doctor immediately, or have yourself taken to an emergency room ASAP:

Signs of heart problems include:

1. Chest discomfort. It can stay or go away and come back. Generally it goes away and comes back.
2. Uncomfortable pain in chest
3. Dull pain in chest
4. Squeezing pain in chest
5. Full feeling in chest
6. Jaw pain
7. Left arm pain (most common)
8. New onset back pain
9. Stomach pain
10. Right arm pain
11. Nausea
12. Heart Palpitations
13. Shortness of breath
14. Breaking out in a cold sweat
15. Light headedness
16. No symptoms at all

If you even notice one or a few of these symptoms you best be getting your heart to the emergency room. It's best to come in and be told you are fine than to stay home and hope you are fine.

We will not make fun of you for coming into the ER. In fact, just the opposite: we will respect you for taking the proper action when your body is feeling or acting funny.

I believe it is very rare for someone simply to drop dead of a heart attack without that person first showing and then perhaps ignoring the signs and symptoms. Take care of your body and your heart, and know the signs above.

Do this even if you are in good health. If you don't save your own life, perhaps you can use this information to save the life of a friend or loved one.

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Can I take albuterol orally if my neb is broke?

The following question is from healthcentral.com/asthma. 

Your humble question:  My nebulizer just stopped working.  Can I take albuterol neb solution orally for an emergency until I get a new nebulizer?


My humble answer:  No.  If swallowed the medicine will simply be broken down by stomach acid and will have no effect. I would recommend recommend using your albuterol inhaler, or calling your doctor and asking for an inhaler so you can use that until your nebulizer if fixed.  Most studies show that using an inhaler with a spacer works just as well as a nebulizer. 

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Santa working on new medicine

Santa is trying to help us asthmatics out. Learn what he's up to by reading my latest post from MyAsthmaCentral.com

Santa's Elves Working on New Asthma Medicines

Last year we wrote santa a letter which included A pragmatic Asthmatics Christmas List. Over the past year Santa and his little elves have been working hard, mixing molecules and liquids in search of the ideal asthma medicines.

"Experimenting with Albuterol and Levalbuterol molecules in this was was fun for my elves," said Santa in a recent email to me. "And knowing we might provide humor for asthmatics is very rewarding for us all."

The following are some of the fake medicines he's presently working on:

1. All-Bettero-ol: Makes lungs "all better." Oh, what the heck, no matter what is ailing you these days, this medicine makes it "all better."


2. Preventolin: One puff and it miraculously prevents asthma from happening.


3. Soapenex: This inhaler suds up in your lungs in cures all ailments in there.


4. Openex: It opens the airways and keeps them open for 365 days. Take one puff on January 1 and you're good for the year.


5. Bronchodilitator: Just by spelling bronchodilator wrong means it must work better than what's currently on the market. Oh, and it must have fewer side effects too.


6. Scrubbing Bubbles: Works similar to Scrubbing Bubbles bathroom cleaner in that it suds up in the lungs and gives them a good scrubbing, and therefore cleans out any ailments that might be in there. It cures asthma, but is also cures pneumonia, pulmonary edema, lung cancer, COPD, cystic fibrosis, and a whole lot more.


7. No-side-effex-onex: It has all the powers of Albuterol and Levalbuterol with no side effects at all (no risk of increased heart rate and no increased shakiness).


8. Happinessolin: Has magic ability to cross the blood brain barrier so not only does it make breathing better it eases stress and anxiety


9. Faitholin: It seems to enhance the effect of prayers, meditation and faith. Exact methodology is mystical. It seems to have greatest effect on happy, religious people. Squirting an amp on nurses may cause laughter.


10. Do-all-olin: It has omnicient powers like Faitholin, yet cures anything from COPD, asthma, heartfailure and even hangnails. And yes, it has been proven that if you sprinkle a little of this on your nose it will remove unwanted nose hairs.

Feel free to add any of the above to your Christmas Wish List. Also, if you can think of any other fake (or real) medicines you'd like to receive for Christmas, let us know in the comments below and we'll be sure to tell Santa.

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Keep track of cancer in the brain - MRI

Keep track of cancer in the brain - Ratings (staging) of cancer needs to be done to determine the type of treatment will be applied. In my case, of five of the most common cancer in the rating, already among the other four are known, the cell type, primary tumor location, size and number of primary tumor and spread to nearby lymph nodes. Just one thing that is not yet known metastasis or spread to other organs.

I think track cancer cells throughout the body more easily done with a PET Scan (Positron Emission Tomography Scan). In this way cancer cells baited charged radioisotopes that can be tracked using a special camera. With one scan of the cancer cells wherever it can be immediately traced. Unfortunately examination with PET scan cost is still very expensive, and time (year 2007) PET Scan not exist in Indonesia. Tracking cancer in my body starts with MRI (Magnetic Resonance Imaging) to track the spread in the brain. It is said that for soft tissues such as brain, the use of MRI is more effective than CT scans.

Unlike the X-ray-based CT Scan, MRI uses magnets and radio waves, the way it works is too complex to be understood. Tools like CT scans, only longer so resembles a large tube with a bed in the middle.

Before the examination I had to fill out a form that contains several questions including whether the installation of metal had to undergo surgery such as bone connective pen, a pacemaker, clip etc.. I have to change clothes with the mantle that has been provided, leaving watches, belts, rings and wallet in a locker. Because this tool uses a powerful magnet, then objects made of metal can be sucked towards him. After the ears are covered head-phones and head-like device inserted into the cage, the officers left me lying alone in the tube.

Of head phones sounded soft instrumental songs. Shortly after the officer gave orders to keep me moving, sounding tubes started humming, growing louder and louder and even then overlaid also with clanking sound. I was afraid, lest the tool is broken and suddenly exploded. But apparently correct paramedic was familiar with these signs. I heard through head phones he told me to remain motionless, and explained that the voice which I heard a tumult was normal.

I think the examination was over when the noises began to subside, but apparently not. A paramedic entered the room and injected with fluid to make the image more contrast. Proses repeated. MRI examination is finished I returned to the ward, because it still needed some more checks.

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Bone scan - Tracking cancer in the bone

Bone scan - Tracking cancer in the bone | Tracking of cancer in the bones using the Bone Scan. This tool is part of the development of nuclear medicine. As far as I am in Jakarta only in four hospitals, including Pertamina Hospital Center, where I was referred for bone scanning performed. It seems to work similar to a bone scan PET Scan (Positron Emission Tomography Scan), in terms of detection of cellular metabolism. Difference if the PET Scan cancer cells fed glucose-charged radio-isotopes for metabolic activity (eating), on the radio isotope bone scan (tracer) is used to track metabolic activity of bone cells.

At a certain incident that resulted in damage to the bone, the bone cells will be busy divide to replace damaged cells. This activity makes bone cells absorb the tracer-laden foods are more than the cells of healthy bones. Tracer that emits radioactive signals is then to be monitored using a special camera (gamma camera). Which found high concentrations of tracer (hot spots), you can bet there are abnormalities of bone.

Cancer cells found in bone also will reveal a hot spot, because cancer cells divide faster and eat more than normal cells. Tracer that was caught on camera in order to actually comes from the bone, then the required time (3 hours) and plenty of water to dissolve the tracer in soft tissue. In soft tissue tracer is more soluble than in the bone. Although the activity of bone cells can also be caused by other things such as arthritis and various infections, but if it has previously found the existence of cancer cells such as my case, it should be suspected spread of cancer to bone.

The main tool bone scan consists of a pair of gamma cameras mounted on two arms of the movable track throughout the body. While other equipment in the form of a set of computers that will change the signal from a gamma camera images. Before the scan was performed, first radioactive substance is injected through a vein in the arm. In order to percolate into the bone takes about two and a half to three hours.

During that time I have a lot to drink so that radioactive substances are not needed immediately dissolve. Shortly before the scan is done I have to pee, so radioactive that collects in the bladder does not give the wrong picture. Scanning process begins by creating a pattern of following the trajectory of the gamma camera's curves, so that the camera came with a distance less than 5cm from the surface of the body. The scanning process lasts approximately 20 minutes.

After waiting for about 15 minutes, then the result can be seen that there are activities in which the ribs 8 and 9 (costae VIII and IX). In the ambulance that took me back to the hospital where treated, though had joked with the nurse who drove me, I feel sad that in fact the cancer had spread to my ribs. [cancer]

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Theory: Nice patients are those who believe

I wrote a while back that good patients are the best patients and good patients go to be with the angels. If you have a patient who is downright miserable upon learning of his fate, or extremely depressed, those are the patients who believe they are going to die and just be gone.

Those patients who are happy even up to the moment their heart stops the flow of blood through the bodies pipes are, more often than not, those who believe in the afterlife. And I would surmise these same patients had a very good life they are leaving behind, and a better world because of it.

Of course this is just my theory, yet I do believe it to be true just based upon my own observations. One of the things I do upon reviewing charts is check to see if the patient has a religion, or I simply ask, or I simply observe the Bible or other such elements, and determine the patient is a believer.

Then I get to know the patient by default. If I find the patient is grumpy, or demanding, or cantankerous, I notch this up as another bit of evidence my theory is in fact true.

I recently stumbled upon another blog called Christian with a view. I have my own view on religion as all people do, yet I found this blog very thought provoking, and intelligent discussion provoking, which is something I love.

I'm one of those people who simply love an intelligent discussion. I don't care if it's with someone I agree with or other. Actually, I find that no two people have the same opinion, which I suppose explains why even conservative christian republicans even disagree among themselves.

Anyway, this blogger reminded me of my theory of the good patient. And I'm not implying that all people who don't believe in God are crabby either. I just think all people have a tendency to be good. Yet, as a rule of thumb, I've observed most happy patients are religions to some degree, and believers.

Your thoughts.

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Q4ever Treatments

There's a saying that company and fish stink after three days.  The same may be true of breathing treatments.

Q4ever is a term to describe patients on Q4 hour breathing treatments until discharge.  Some hospitals have a policy that treatment orders expire after three days, yet hospitals that need extra money don't allow such a policy. Thus the result is Q4ever treatments.

The patient's been in the hospital a month and the patient's still on treatments. The doctor doesn't even know they're ordered half the time, yet they also don't want us questioning their judgement. Therefore therapy never gets adjusted as patient progresses.

Eeeks.  This policy reeks.

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A BiPAP case study-ethics case

I just want you to know that if a doctor ever orders me on a BiPAP or Ventilator and refuses to give me anything to relax me -- like Ativan, I'll kill him if I get off. 

So here's the patient's ABGs on 40% vm:

• pH 7.2
• CO2 77
• PO2  82
• HCO3 29

The patient's wob is labored.  He has a history of end stage COPD, possible CHF.  The BiPAP is working well for the patient.  His VT is approximately 700-1000 and respiratory rate 39 on settings of IPAP 12 and EPAP 5.  I now have his FiO2 down to 30% and his SpO2 is holding at 98% and so I could actually decrease his FiO2 even further.

Yet the patient tells me he feels panicky, like he's not getting any air, and feels like he wants to pull the mask off.  I give him the speal that the BiPAP is working well and that it's preventing him from needing a tube in his throat so we can breathe for him that way.

So after my speil he says he can tolerate the BiPAP.  Yet I get on the phone and call the doctor and ask for something to relax this guy.  The doctor says, "Do you know what you're asking me to do?"

"Yes, " I said, "And you have to understand that I think if we can keep him on this BiPAP we can also keep him off the ventilator.  Even if we suppress his respiratory rate by 10, he's still getting twice the tidal volume he was getting before the BiPAP, so he'll still be blowing off CO2."

He said, "I'm sorry, but I just can't do it." 

My only thought at this point is, "I'm glad this guy's not my doctor.  Because this could be me some day. The next day I came to work and learned about the dream doctor.  

Your thoughts???

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Breast Cancer Chemotherapy

The most common treatment for any type cancer is chemotherapy. Even when surgery is required in a cancer treatment, it is accompanied by a dose of chemotherapy before as well as after the surgery. Chemotherapy is also prescribed in breast cancer. Since chemotherapy kills the rapidly dividing cancer cells in the body, it also affects those healthy cells that divide rapidly (includes cells of intestine track, nose, mouth, hair, etc).

These healthy cells repair the damage caused to them by chemotherapy but it takes time. In the mean while the body may show some side effects due to the administration of chemotherapy over these healthy cells. Especially in case of breast cancer, a woman may show various side effects that may range from nausea, weight change, anemia to menopause.  We have discussed some of these chemotherapy side effects along with helpful tips to combat the same.

Menopause

In breast cancer chemotherapy, menopause is the most common symptom, as the cells in the ovaries grow rapidly. As a result a woman may experience temporary menopause as long as the chemotherapy treatment continues. But, there is an exception to this situation. If a women is near the age of natural menopause, then after going through the  treatment, she may experience the permanent menopause. This may not happen in the case of a woman who is far from her age of natural menopause..

Anemia/weakness

Chemotherapy affects the red blood cells, due to which one may suffer from anemia and consequently weakness. The red blood count which lowers down due to the treatment must be refilled with natural diet that is rich in iron. Vegetables like carrot, spinach, etc are rich in iron. One can also take milk and eggs. It is very important that one must take good care of diet at this time. Even if you are unable to have full meal at one time, take small meals but frequently. Sufficient rest must be accompanied along with the diet.


Weight change

This is one of the most common breast cancer chemotherapy symptoms. Due to stress, effect of medicine and change in diet, a person may experience weight gain or loss. If a woman feels that she has lost too much weight, it is suggested that she must follow a high protein diet. If the woman is experiencing weight gain, then she must go to the doctor to seek some medical advice for the same. A registered dietician may also help her in the same situation.

Hair fall

In breast cancer chemotherapy, hair fall is the most serious problem that women face. The best way to deal with this situation is to apply an ice pack on the scalp half an hour before the chemo treatment starts. You also need to continue the ice pack half an hour after the treatment.

Chemotherapy side effects are quite common in the treatment. If one is facing severe side effects that is causing concerned discomfort, please seek medical advice immediately.

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The balance of sodium and potassium: part 2

So when either sodium or potassium are our of whack a slew of problems can occur.  So let's examine the conditions of high and low potassium and high and low sodium and what a doctor and nurse might do to remedy the situation.

Hyponatremia:  This is when sodium is below 135. 

Causes:

1. Profuse diaphoreses (sweating
2. Profuse wound drainage
3. Excessive diarrhea
4. Vomiting
5. Trauma (excessive blood loss)
6. Low sodium intake
7. Addison's disease (hormonal changes)
8. Hypothyroidism (hormonal changes)
9. Overuse of thiazide diuretics (lasix and bumex)

When sodium is low in extracellular fluid it is therefore high in intracellular fluid.  Since water follows sodium, this causes cells to swell.  When this happens in the brain it can cause central nervous system problems such as altered mental status.  In the abdomin this can cuase nausea, vomiting and diarrhea. 

When sodium is below 115 it's considered severe.  This can result in muscle twitching, tremors, seizures, increasing intracraneal pressure, coma, and death.

The treatment is to eat. Those who can't eat must have an IV inserted and be given lactated ringers or 0.9 percent sodium chloride solution.  Water restriction may also be essential.

Hypernatremia:  This is when sodium is above 145.

Causes:

1. Low fluid volume (inadequate fluid intake)
2. Excess sodium ions (too much salt intake such as with tube feedings)
3. Diarrhea
4. Steroid use (cushing syndrome)
5. Hyperaldosteronism
6. Diabetes
7. Kidney failure
8. Excessive use of bicarbonate

This condition results in the following due to fluid leaving cells resulting in cellular dehydration:

1. Muscle weakness
2. Twitching
3. Personality changes
4. Agitation
5. Hallucinations
6. Decreased levels of consciousness 
7. Low cardiac output (causes muscle weakness)
8. Heart failure
9. Dry mouth
10. Thirst
11. Tachycardia
12. Fever
13. Brain bleed (if severe due to fragile capillary membranes)

Treatment is to slowly give hypotonic solutions such as 0.45 percent sodium chloride to restore the balance.  Rapid infusions of sodium may cause cerebral edema

Hypokalemia:  This is when potassium is below 3.5

Causes:

1. Diahrrea
2. Vomiting
3. Diaphoresis (sweating)
4. Laxitive use
5. Diuretic use
6. NG tubes
7. Alkalosis
8. beta adrenergics (Epinephrine, Albuterol, Xopenex, etc.)

Critical level is below 3.  This can result in:

1. Cardiac arrythmias due to weak heart muscle (flat T wave, depressed ST segment, U waves)
2. Decreased neuromuscular function (muscle weakness)
3. Weakened respiratory drive due to muscle weakness
4. Absent bowel sounds due to weakened GI muscles
5. Depresses insulin release from pancreas
6. Cramps
7. Cardiac arrest
8. Respiratory arrest

Treatment is to treat underlying cause and give IV potassium or high potassium diet. 

Hyperkalemia:  This is when potassium is above 5

Causes:

1. Renal failure
2. Too much potassium intake (IV intake)
3. Salt substitutes containing potassium
4. Infections (cause potassium to move from intracellular to extracellular fluid)
5. Trauma (same as above note)
6. Burns (same as above note)

Critical levels may cause disturbances in cardiac function that result in peaked T waves, prolonged PR interval, and wide QRS complex that may result in arrythmias and cardiopulmonary arrest.

Treatment is to fix underlying cause and by either restricting potassium intake or giving sodium polystyrene sulfonate or something similar to it or IV diuretics to make he patient pee out extra sodium ions.  IV calcium chloride or calcium gluconate may also be sued in emergent situations. 

Bicarb, dextrose or insulin administration may shift bicarb into cells and are considered temporary treatment.  Dialysis may also be considered. (Some studies indicate that 5-20mg of Albuterol may be tried, although this treatment is often contested as grasping at straws.)

Source for the above material:

*Crawford, Ann, "Balancing Act:  Sodium and Potassium," Nursing 2011, July, pages 44-50

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Is asthma curable?

The following questions I've answered from healthcentral.com/asthma

Your humble question:  Is asthma curable?

My humble answer:  There is no cure for asthma.  However, with proper treatment you can control and prevent asthma symptoms so you can live a relatively normal life.  Here are some tips

Your humble quesiton:  Is there a cheaper substitute to spiriva?

My humble answer:  Not at this time.  Spiriva is a relatively new medicine and it is patented, which means no other company can use the same formula.  I'm not sure how long the patent is good for

Your humble question:  Is it safe to use singulair and prednisone at the same time?

My humble answer:  Yes it is safe to use prednisone with singulair.  Just make sure you follow your doctor's instructions to a tee.

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Excessive Perspiration | Lung Wet

Excessive Perspiration | Lung Wet - Many people think a lot of sweat is healthy. In fact, the phrase is actually directed at those from sub-tropical countries, it was in winter and snow. So the phrase is not relevant for use in the tropics as in this country.

In fact, in tropical countries, without any exercise, the body is sweating. In case of sweaty bodies feels uncomfortable, can even lead to falling ill.
One of the diseases that may come as a result most of the sweat is pneumonia. Pneumonia or inflammation of the lungs or pneumonia is so popular, because it often appears as a complication of causes of death especially in patients with bird flu.

Pneumonia is also a trigger complications and causes of death from measles and influenza, especially in young children. The occurrence of pneumonia as a complication of other diseases and causes of these deaths can be prevented, if the body is not disturbed in performing one task importance. That is, the work is usually done the cells that line the inside of the respiratory tract. Each cell has about 200 cilia (a type of hair is very fine) and issued a watery liquid on its surface.

Cilia that move on a regular basis 10-20 times per second without stopping, fluid sweeping velocity of 1 cm per minute to the throat, and then unwittingly swallowed. Normally, dust, germs, smoke, and the like will be attached to the liquid, then wiped from the respiratory tract.

In addition, the liquid is also keeping your airway is always wet. Well, too much sweat, it will cause the liquid to become dry and sticky, so it can be streamed and clump together into phlegm, plus clogging the airways. Airway is blocked causing shortness of breath and coughing. Then, the proliferation of germs can cause bronchitis and pneumonia.

For short-term healing by diluting and removing phlegm and drug use, or commonly known as steam inhalation. There is a more rational and long-term, physiological and easily, namely by preventing excessive perspiration.

Drinking too much will be in vain if the room was still stuffy, because it will come out again through sweat. Understandably, the air is very humid tropical countries (many contain water vapor), so we are very easy to sweat. Water vapor coming out when exhaling reached 11 times more than the air that is inhaled when a breath.

So, in less ventilated room, the air will increasingly humid, CO2 increases and decreases oxygen, so the body becomes very weak, the disease was widespread. To overcome this, the room is not air-conditioned to be always open for fresh air from outside can enter. The fan is useless if there is no fresh air from outside into the room. Avoid cigarette smoke contains many monoxide that can not be cleaned by the air conditioner and beat the oxygen into blood cells.

__read other article about lung health: Tips to keep heart

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The balance of sodium and potassium

It's neat how the body works to maintain homeostasis (balance) within the body.  When things get out of whack all sorts of bad things can happen to a person.  A good example of this is the body's effort to keep potassium and sodium balanced within the body.

Sodium and potassium are both cations, which is an ion with a net positive charge.  An ion is a group of atoms that have an electrical charge.  Sodium is the main cation of extracellular fluid and potassium the major cation of intracellular fluid.

The Sodium Potassium Pump is what keeps maintains the balance.  It's constantly working to maintain a normal potassium level of 3.5 to 5 mEq/L in extracellular fluid and to maintain a normal sodium level of 135 to 145 mEq/L in intracellular fluid.

Ann Crawford in her article "Balancing act:  Sodium and Potassium" in the July issue of Nursing (pp. 44-50) describes the pump as the main mechanism of moving sodium "from inside cells to the extracellular compartments, and returns potassium from the extracellular compartments into cells using adenosine triphosphate (ATP) as an energy source."

She likewise explains that electrolytes tend to move from areas of high concentrations to lower concentrations.  So the body naturally works to maintain potassium inside cells 35 times greater than outside cells so potassium has a tendency to want to get out of cells.  Likewise, sodium outside cells is kept 14 times greater than inside cells so sodium has a natural tendency to want to go into cells.

Sodium attracts water. So if sodium levels inside the cell were to get too high the cells would absorb water and would swell and ultimately explode.  Obviously this wouldn't be good.

Rene Fester Kratz in his book "Molecular & Cell Biology for Dummies" explains the pump as a protein in cellular walls and "for every round of action, the sodium potassium pump moves three sodium ions out of the cell and two potassium ions into the cell.  Thus the pump creates a higher concentration of sodium outside the cell, a higher concentration of potassium inside the cell, and a greater positive charge outside the cell.  These differences in ion concentration and electrical charge are important in the functioning or nerve and muscle cells in animals."

Sodium is controlled by a hormone called aldosterone secreted by the adrenal cortex, write By Michael Roberts, Michael Reiss, Grace Monger in their book "Advanced Biology" (2000, U.K, page 290).  Aldosterone increases the absorption of sodium ions by the gut, and this causes the sodium concentration in the blood to rise.

When sodium in the blood is high the adrenal cortex is sent a signal to decrease aldosterone production.  If sodium in the blood is low the adrenal cortex is sent a signal to increase aldosterone production.  When sodium levels in the blood falls less fluid is absorbed into the blood and the blood pressure falls. 

When this happens renin is released into the blood stream where "it catalyses the conversion of one of the plasma proteins into a substance called angiotensin.  This then stimulate the adrenal cortex to secrete aldosterone," according to Advanced Biology.

A rise in sodium has the reverse effect, where less renin and angiotensin are produced and less aldosterone is produced. 

It should likewise be noted here that as the concentration of sodium in the blood rises the potassium concentration in the cell falls.  The sodium potassium pump then works hard to maintain a balance of sodium and potassium inside and outside cells and a positive charge outside cells.  This is important for normal body function.

Sodium works to maintain acid base balance by combining with an anion such as chloride to form sodium chloride or bicarbonate to form sodium bicarbonate.  These act as buffers to absorbed hydrogen ions to help maintain a normal cellular and blood pH of 7.35 to 7.45. 

Crawford further explains that sodium also functions to:

1. Promote transmission of nerve impulses
2. Maintain intracellular osmality
3. Activate several enzymatic reactions
4. Assist with regulation of acid base balance
5. Promote mycardial, skeletal, and smooth muscle contractility

One neat thing about sodium is you don't have to worry about taking in extra sodium because your body is very efficient at preserving it, and plus your body gets all the sodium it needs from small amounts of just your basic foods.


Potassium, along with working with sodium to maintain electrical neutrality, plays a major rol in cellular metabolism, "especially in protein and glycogen synthesis and in the enzymatic processes necessary for cellular energy, according to Crawford.

It's critical to maintain many body functions, such as:

1. Acid base balance
2. Nerve impulse conduction
3. Maintenance of normal cardiac rhythm
4. Skeletal smooth muscle contraction

While little sodium is needed from food, potassium is not stored efficiently by the body, so you need to supply your body with an adequate amount daily.

Other than the sodium potassium pump, potassium levels are regulated by the kidneys and the adrenal cortex, and any excess potassium is excreted by the feces and sweat.

Chris O'Callaghan in his book "The Renal System at a Glance" (2006, UK, page 53) writes that other than the sodium potassium pump, potassium levels are regulated by the kidneys and the adrenal cortex, so abnormally high or low potassium is a sign of adrenal cortex or kidney abnormalities.

Callaghan writes that a rise in potassium ions in extracellular fluid of the adrenal cortex directly stimulates aldosterone release which ultimately leads to an increase in sodium re absorption by the kidneys and potassium excretion into the bloodstream by the kidneys.

Crawford explains that there is no mechanism to notify your kidneys of a potassium deficit, so it may continue to excrete potassium even when levels are low. 

Crawford also explains that sodium is exchangeable with hydrogen ions, and therefore changes in acide base balance will effect potassium levels.  "Acidosis causes an increase in hydrogen ions in extracellular fluid; to maintain pH, some hydrogen ions shift to intracellular fluid.  To maintain intracellular electrical neutrality, some potassium ions shift to the extracellular fluid, which may cause hyperkalemia.

"Conversely, in alkalosis, more hydrogen ions are present in teh intracellular fluid, so some hydrogen ions move to the extracellular fluid to buffer and maintain pH.  This again produces inequities in teh intracellular ion electrical charges; potassium ions compensate by moving from the extracellular fluid to the intracellular fluid, causing hypokalemia.

Next Wednesday (click here) I will explain what happens an imbalance of sodium and potassium occurs.  I will delve further into hypokalemia, hyperkalemia, hyponatremia, and hypernatemia.

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Admit you're wrong and set things right

Genesis
Romans 5: 12-19
Matthew 4: 1-11

We are all tempted to sin, and often we give into these temptations due to pride and selfishness. Then we have a tendency to blame other people for our sins like Adam blamed the woman, and Eve blamed the Serpent.  The only one in the story of Adam and Eve who was honest was the Serpent.  He connived Adam and Eve to commit a sin, and he was proud of his act.

When we do evil things our lives are not as we would like them.  In Matthew (4: 1-11) Jesus is tempted by Satan to do evil things, and he does not give into the temptation.  After fasting for 40 days and 40 nights he is starving, and Satan tries to convince him to create a miracle and make bread, and Jesus tells the Devil to go away.

Paul tells the Romans (Romans 5:12-19) that the sins of one man, or the selfish decisions made by one man, can effect the entire world in a negative way.  One man's decisions can cause havoc on all the rest of society, yet all it takes is one man making an unselfish and honorable decision to set things right.

He writes, "Sin came into the world through one man, and his sin brought death with it.  As a result, death has spread to the whole human race because everyone has sinned.  There was sin in the world before the Law was given; but where there is no law, no account is kept of sins."

He further describes that many people have sinned due to pride and selfish behavior, yet the benefits or gifts or rewards that come from all these sins is never greater than the rewards of the one person who puts himself after other people.  He writes that "one righteous act sets all mankind free and gives them life.  And just as all people were made sinners as the result of the disobedience of one man, in the same way they will all be put right with God as the result of the obedience of the one man."

Of course he was talking about Jesus, yet what he is writing can be symbolic of all mankind.  While we are suffering in this world due to the poor and selfish decisions of only a few men, all it takes is the unselfish works of one man to set things right again.

Likewise, Matthew tells the story (Matthew 4: 1-11) tells how after fasting for 40 days and 40 nights Jesus was starving.  He was tempted by the Devil, who said, "If you are God's Son, order these stones to turn into bread."

Jesus answers, "The Scripture says, 'Man cannot live on bread alone, but needs every word that God speaks."  What he is saying is that good things in life do not come from any material possession including food, good things in life come from virtues.

One of the most simplest of all virtues is to take responsibility for our actions.  We must admit when we sin, and not place blame on other people.  The things that happen to us are not by chance, but the result of our individual choice.  We either choose to have our priorities in the right order, or we do not..

When we have our priorities in the right order, things work right.  When we don't have things in the right order things may work right for a while, yet then they fall apart and getting them back in order can only be accomplished by accepting blame, returning to God (or virtues), and prioritising responsibility.

Lent is a time that we look at our lives and admit that we are sinners, and that we are the cause of our sins.  It is not your wife or your husband that causes you to sin, and it is not Satan, and it is not your mom or dad, it is yourself.  You

Lent is a time when you look at yourself and find what is wrong with your life, and decide to take the wrong out.  Yet to truly accomplish this takes the courage to admit our mistakes, and then to ask God for guidance,  nurturing direction and courage.

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Insights from Dr. Kenneth Hardy

I had the privilege of listening to Ken Hardy as he presented at the NASW CT specialty conference on social justice. He focuses on oppression, which of course has a lot of overlap with trauma.

Dr. Hardy is a Professor of Family Therapy at Drexel University and the Director of the Eikenberg Institute for Relationships in NYC. He has written several books including Teens Who Hurt: Clinical Interventions to break the Cycle of Adolescent Violence (Guilford Press, 2005) and, with Monica McGoldrick, ReVisioning Family Therapy: Race, Culture and Gender in Clinical Practice (Guilford Press, 2008).

Dr. Hardy described people as divided into three groups: jailers, helper, and healer. Jailers value correction over connection. They protect the prevailing order even at the cost of crushing the human spirit. Their primary goal is to keep order, and they use the tactics of demanding obedience or ejection. Their words are: Not here! Out of here! Dr. Hardy pointed out that there is a lot of recruitment and rewards pushing people to become jailers in our current society.

The helper is well intentioned, and tries to intervene in the face of injustice and harm. They try to restore order, but do not focus on preventing injustice from happening. Many of us in the social services world find ourselves in this position.

The healer is a visionary who tries to challenge the established order and to rejuvenate the human spirit. He values connection over discipline. He establishes mutuality. His work is not just a job, it is a passion. He works on behalf of the human condition, to make a better planet. He is in the business of manufacturing hope.

Dr. Hardy suggested that the way to become a healer is by embracing one’s own suffering, turning towards one’s own pain instead of denying it. We have all been oppressed in some way. Look at your own invisible wounds, find and speak your own authentic voice.

In our programs, is there pressure to become jailers? Are we encouraged to become healers?

Shame was a central topic for Dr. Hardy. He spoke that we are even ashamed to admit we feel shame. Shame is a powerful force that cannot be named or spoken about, because it is associated with weakness. Shame arises from the devaluation of human dignity. The more a person’s basic dignity has been eroded and assaulted, the more that person will demand respect, and will be aggressive rather than suffer further degradation.

Further, Dr. Hardy described “learned voicelessness”. This is what happens to a person whose dignity has been degraded, and who has been unable to speak. Of course this applies to children who cannot speak of their abuse. The more a person has been silenced, the stronger their rage. The role of the healer is to help the person find and speak their voice, and transform their rage into outrage that is channeled into action to change the world.

I felt this description illuminated my thinking about effective action: that trauma with its inherent helplessness over time convinces the victim of the impossibility of effective action in their own life. Our job is to re-teach that effective action is possible. Add to that, trauma and its secrecy silencing the voice, and our job is also to help the person regain their voice. We have to be careful that our treatment programs do not themselves demand silence from the clients.

I was very moved by Dr. Hardy’s presentations, and I look forward to reading his books. Stay tuned for book reviews!

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My discussion with a quality assurance analyzer

Quality Assurance Analyzer:  "This patient doesn't meet criteria."

Me:  "So what do you have to do to get him to meet criteria, order breathing treatments?"

QA Analyzer:  "Yes."

Just another example of why RTs get so burned out.

Here's another discussion;

QA Analyzer:  "Did you do any breathing treatments on that kid today?"

Me:  "No."

QA Analyzer:  "Oh!  If you did I could note him as meeting criteria.  Yet otherwise I don't think we can justify the visit."

Me:  "So do you want me to lie and chart that I did one?"

QA Analyzer:  "Yes."  She smiled.

Of course I was joking and I didn't.  Yet this is yet another example of why the government setting criteria is ridiculous. 

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Things that make our job easier/ harder

It seems to be my first 8 years as an RT saw many new things that made our job better. I'll list some examples here:

1.  Microprocessor ventilators:  work with patient instead of other way around
2.  Microprocessor BiPAPs:  easy to use, pts tolerate them, and they keep people off vents)
3.  Computer charting:  no longer have to hunt for charts, easy access
4.

However, in the past five years every thing added has made our job harder:

1.  Order sets:  RT procedures automatically ordered even so all bases are covered, increases workload
2.  Protocols called order sets:  increases workload
3.  Medicine locked up:  Inconvenient to get to medicine
4.  Obamacare:  Increased need for QA analyzers and order sets
5.  QA analyzers:  who constantly double check our charting (nit pickers, that's what I call them)
6.

Can you name any more things that have made our jobs easier or harder????

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The two types of pulmonary edema

Fluid can sometimes build up in the lungs, and we generally refer to this as pulmonary edema.  There are two types of pulmonary edema: 

1.  Caradiogenic:  Fluid backs up from a weakened heart.  Pulmonary pressure increases, and this fluid is forced into the parychemal tissue lining the bronchi and alveoi.

2.  Noncardiogenic:  The heart did not cause the pulmonary edema.  There is a simple pneumonic to remember all the disorders that fit into this category:  NOT CARDIAC.  As noted:

• Near drowning
• Oxygen therapy
• Transfusion or Trauma
• CNS disorder
• ARDS, aspiration or altitude sickness
• Renal disorder or resuscitation
• Drugs
• Inhaled toxins
• Allergic alveolitis
• Contrast or contusion

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No more mist tents

An old mist tent

About five years the infamous RT boss took all the mist tents and put them in the basement of the hospital because there was no room in the RT storage room.  This marked the end of the era of the mist tent for infants.

As a matter of fact, when oxygen was first introduced as a method of inhaling supplemental oxygen in the mid 19th century, the main technique was having the patient sit in a tent.  This was the main technique until the oxygen tank was invented.

During the 1920s oxygen masks and nasal cannulas became the best method of giving oxygen to adults, so tents were left to only a few adults but mainly kids.

Ultimately the tents were cooled by packing ice and water in the back of the device and a cool mist was added to the circulating air inside the tent.  This was one of the main methods of treating kids with inflamed upper air passages, or croup.

When I was 11 in 1981 my doctor wanted to put me in a tent once because I refused to wear a nasal cannula.  The RT was dilly-dallied for hours before complying with the order, yet eventually he talked me into sitting in it.  I remember watching TV through the blurry plastic.  After a few hours in was dinner time and I was allowed out.  I refused to get back in.

Yet even by 1981 using such tents on adults was rare as the grumbling RT implied.  By the time I became an RT in 1995 mist tents, or oxygen tents, were used for this purpose or simply to supply oxygen to kids.

It was to the point that doctors wouldn't even try allowing us to place a nasal cannula on a kid, it was just automatic a mist tent (or oxygen tent) be ordered.  It was our discretion whether we turned on the mist or left it off.  It was on for croup and off for asthma and RSV.  If the doctor had a preference he'd order either mist tent or oxygen tent.

Yet we RTs preferred to use a nasal cannula.  I have rarely met a kid who couldn't tolerate a nasal cannula.  Surely they might fight initially, yet once it's on they forget about it and tolerate it just fine.

The tents posed problems of their own.  For one thing, few kids wanted to stay in one.  Usually to get a kid to stay in the parent would cuddle in the tent-surrounded crib.  This made getting access to the kid difficult.  Plus toys were limited because some could spark and cause fires.

The reason I brought this up was because Advanced for RTs has reported that the CDC no longer recommends mist tents be used because they the mist enhances the spread of droplets in the air.  So this should mark the final farewell to the old and infamous mist tent.

Ironically the CDC has yet to outlaw nebulizers which equally spread droplets into rooms.  I'd like to see the CDC come out and recommend that one way valves or filters be used on all nebulizers, and, if possible, that nebulizers not be used at all unless indicated.

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Principles

We here a lot in this life that if we as humans live by the principles we set for ourselves that we will grow to be respected people living noble lives.  In this sense we as humans relate principles with good.

It is true that those among us who live under "good" principles tend to lead "good" lives, it is not necessarily true that all principles are all good.  For example, Stalin, Hitler and Mussolini all had certain principles that they followed, and with history as our testament that the principles these evil men followed were not all good.

Although it is true that when a child is born, that child is inherently good.  During the coarse of life he is often faced with prodigious forks in the road where he either can choose the "good" path to nobility and respectability, or he can choose the path to evil.

If you have ever read the Bible, you can look there for many examples.  One is the temptation of Adam and Eve, and another is the temptation of Jesus as described in Matthew (4:1-2): "Then Jesus was led by the Spirit into the desert to be tempted by the devil.  He fasted for forty days and forty nights, and afterwords he was hungry." 

He was starving, and that was when Satan tempted Jesus to turn rock into bread. And Jesus resisted the temptation, stating that the word of God is more valuable than anything on earth, including bread.  So he chose to take the path of goodness. 

Yet the first temptation may not even be mentioned in the Bible.  As is described by Catholic doctrine, Satan was initially created by God as a good angel.  Yet he was faced with a choice, and by his own choice he became evil.  And it is in this same way that many people since that day have decided to take the path of evil.  Although evil for a majority of us may be in a subtle way, it is still evil.

So what is it then is it that drives one to choose one route or the other:  evil or good?  The answer is the principles that we follow for ourselves.  Usually these are laid out for us by our parents, or those who raise us when we are children.  Yet it's actually simpler than that, as the basic principles of life are those of which we are born with:  we are all born inherently good, with the intent of being good.  We become "bad" only by choice.

Thus, the foundation of life is based on the principles we live by.  A principles, as defined by Dictionary.com, is "an accepted or professed rule of action or conduct."  Born as inherently good people with the inalienable right to make free and individual decisions, we, at some point during the early course of our lives, get to decide what principles we will live by.

The principles of good are generally based on virtues such as those that were written by Ben Franklin in his Autobiography:  Temperance (eat not to dullness), Silence (speak not what might benefit you or others), Order (let all you things have their place), Resolution (finish what you start), etc. 

It is my firm belief that most of us yearn to be good, because by being good people we are able to fit into society better.  However, some of us believe the opposite, and Hitler, Stalin and Mussolini are extreme examples of that, and so too is Satan if you be live in that beast.

So the principles most of us follow allow us to keep our natural course in life, and if you're a follower of a Faith, allow you to maintain your purpose in life as directed by God.  Or, by following the basic principles of life, allow you to maximize your ability to use the gifts you were given.

Examples of principles may include:

1. I will not speak too much, for my words can trap me
2. I will not take advantage of a drunken woman
3. I will not sleep with someone until I get married
4. I will not chart a breathing treatment I did not actually do
5. I will not let money control my life
6. I will not eat and drink to fullness or dullness
7. I will not waste my day away lying around, and instead accomplish something
8. I will control my anger
9. I will not complain
10. I will not disrespect my parents or other people
11. I will not hold grudges
12. I will smile as often as I can
13. I will use only positive words
14. I will pray often
15. I will be generous
16. I will be forgiving
17. I will treat other people with respect
18. I will keep my priorities in the right order

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