10 Jobs Risk in Lung Health

1. Construction
Workers can inhale the dust of demolition or renovation activities at risk of contracting lung cancer, mesothelioma and asbestos, which is a disease that causes scarring and stiffness in the lungs. For that necessary protective clothing including respirator (special masks) when working around the building and avoid smoking.

2. Manufacturing
Factory worker could be exposed to dust, chemicals and gases that can increase the risk of COPD (Chronic Obstructive Pulmonary Disease). Certain chemicals such as diacetyl flavorings used in microwave popcorn, wine factories, and food can cause a devastating disease, bronchiolitis obliterans ie.

3. Health workers
It is estimated that about 8-12 percent of health workers is very sensitive to the existing powder on latex gloves, which can cause severe reactions or trigger asthma, allergies.

4. Textiles
Byssinosis or known by the name of brown lung disease is a common condition among textile workers who make seats, towels, socks, sheets and clothing.

5. Bartender
Serving drinks in a room full of cigarette smoke placing bartenders at high risk of lung disease, particularly if regularly exposed to secondhand smoke and for many years.

6. Bakery workers
This work can trigger asthma due to flour dust at risk of a very significant develop allergic sensitization. Another common thing is the reaction of asthma to enzymes used in turning the dough, and other allergens are often found in flour.

7. Automotive Industry
Workers in particular automotive repair car body parts are very likely to develop asthma. This is because products such as spray paint and polyurethane isocyanate may cause skin irritation, allergies, shortness of breath and cause severe breathing difficulties. The use of a respirator, gloves, goggles, and good ventilation can be very helpful.

8. Transport Workers
Truck drivers, public transport and those who served in the loading and unloading at risk of COPD. This condition is often affected due to air pollution from motor vehicles, especially diesel exhaust.

9. Mining
The miners at high risk of a number of lung diseases like COPD and silicosis (scarring disease of the lungs due to silica Airborne). Meanwhile, coal miners at risk of lung disease called pneumokoniosis (black lung). This disease is a long term investment, hence the use of masks that can filter fine dust can help.

10. Firefighters
Firefighters at risk of inhaling smoke and various chemicals that may exist inside the burning building. Exposure to toxic materials and asbestos is a risk that often occurs after the fire goes out. For that respiratory protective equipment should always be used at all stages of fire fighting, including during sweep the debris to make sure the fire is not lit anymore.

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The once a day asthma medicine

All we asthmatics yearn for it:  a once a day medicine.  Thus was the topic of a recent post by me at myasthmacental.com

Asthmatics want once a day medicine

A few years ago I asked Santa for a medicine I called One Puff. It's an asthma preventative medicine you take once in the morning and then you're done for the day.

Needless to say, come Christmas 2010 this new asthma wonder medicine was not under my tree. It wasn't in my stocking either.

Actually, the One Puff does not exist. It remains a figment of my imagination. However, in light of a new survey of asthmatics, it appears I'm not the only asthmatic who yearns for such an ideal asthma medicine.

The survey (as you can read here) was completed by Decision Resources and revealed that as many as 55 percent of asthmatics would "eagerly" switch to a once-a-day asthma drug that had at least a "similar efficacy" to the medicine they are currently on.

In fact, the more likely someone is to request this switch increases with worsening asthma control. This could be because those with worse asthma tend to be those who require medicine more often and tend to miss doses.

This hits home with me because as recently as 1997 I was prescribed four puffs of Azmacort four times a day, 600 mg of Theophylline twice a day, Drixoral every four to six hours, and if I managed to be compliant with all that my asthma was still only so-so controlled.

Then my doctor introduced me to twice-a-day Advair and once-a-day Singulair and it's now much easier to control my asthma. Still, there are days when a dose is missed. Of course those are the days of diminished asthma control.

Still, none of this is enough medicine to make it so my asthma triggers don't trigger asthma. For instance, if I venture into the basement to work on a project I've had going on down there for several years now, my asthma acts up. There's no medicine available to prevent that.

However, thanks to new asthma wisdom, and modern asthma medicine, we asthmatics now have many options available to help us better control our asthma. Yet, as this study reveals, many of us continue to yearn for something like my fictitious One Puff.

The more often you have to use a medicine, the easier it is to miss doses. So if you could just take one puff in the morning while brushing your teeth, and have that control your asthma, then that would be ideal.

Of course the problem with modern medicine is cost, and that is a topic for another post.

The study also revealed that only 5 percent of asthmatics would request a switch to a new asthma treatment that would result in "improved" asthma efficacy, yet would require a once daily intravenous injection. In fact, greater than 50 percent said they would be very unlikely to request such a switch.

I just thought this research was interesting. It was probably done to help pharmaceutical companies and scientists determine how they should focus their research for new medicine to help asthmatics. Where should they focus their dollars?

According to this survey, the answer is on a medicine like One Puff.


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VT, Culture and Complaining

I have just returned from completing a Risking Connection® Train-the-Trainer training in Hawaii. I taught some great people who are going to be very good trainers and leaders in their agency.

We were discussing imbedding discussions of VT within their agency. First we had a very interesting discussion of the role of culture in staff willingness and comfort with discussing VT. Cultural rules such as not sharing one’s feelings, trying not to stand out or be noticed at all, and never complaining are hard to overcome when trying to discuss the effects of the work on the person. As one person said: “Why should I squeak? I don’t see anyone else around here squeaking and they are all working as hard as I am. Better to just keep on going.” A therapist stated: “If the staff see the therapist being affected by the work, what are they going to do? As the therapist I am expected to be able to handle my emotions.” I believe that many of us have one form or another of these beliefs, and our agencies take advantage of this. We just keep doing wore and more, and not complaining, taking pride in how much we can do. When we urged the supervisors to model talking about their feelings, they were afraid this would be scary to their staff, who rely on their strength. How can we encourage sharing the way the work effects us without feeling we are showing weakness, scaring our staff and betraying our culture?

When I asked what the current practice was about sharing feelings about the work, these supervisors described that staff constantly talked about their feelings, both on the job and afterwards. And their feelings were anger at a certain kid, hopelessness about another, complaints about management, discouragement about the system, and general pessimism. So this provoked a lively discussion about what the difference is between sharing VT and what I will euphemistically call a complaint session. We have all had the experience of negative complaint session that spirals downward and leaves everyone feeling worse. What is the difference between that and a productive sharing of the effect of the work on us? We came up with the following ideas for what would make such a discussion healthy:

1. A willingness to look at ones’ self and the role of one’s own history in the emotions.

2. A spirit of compassion towards the clients and an understanding that their symptoms are adaptive, and that our feelings are not their fault.

3. An acknowledgement that VT is an inevitable part of our work, as we share the pain our clients’ experience

4. Looking towards positive action: how can we take better care of ourselves and each other? What can we do to make our workplace more sustaining?

5. Understand that the pain of our work is also the source of our growth and change as people

6. A consideration of possibilities for transforming the pain.

There are times when one just needs to complain. But the addition of these elements could help to turn the conversation into a healing experience.

Still, I think there may be more to this. Any ideas? Click “comment” and let me know.

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The only thing to fear is... not being prepared!

Franklin D. Roosevelt catered to Fear in America in 1932 by giving his famous line, "There's nothing to fear but fear itself." Although I think history has taught us that FDR was wrong. I think the best lesson learned from the Great Depression is that fear is good.

I think it was overconfidence and lack of fear that lead to the Great Depression. People were so confident the good times would continue to roll that they did not prepare. When the times were good they spent all the money they made on material things (like the story of Babel tells). Instead of saving and preparing for worse case scenario, they lived as though the good times would never end.

After the Great Depression -- for generations -- people saved. When I went to my grandma's house I would grimace every time I walked into the bathroom because it smelled like pee and the toilet always had pee in it. The reason is because she only flushed the toiled after a bowel movement.

I cringed when I looked in the sink because there would always be a container with dirty dish water in it. She only replaced it once a day. In this way, however, she did not waste water. She did this because she lived in the Great Depression years and knew what it was like to have no money to purchase anything, even simple things like water and soap.

She canned everything that could be canned and stored these in the basement. There was always enough food down there to last a year. And she never bought anything except with cash. If she didn't have cash, she never bought anything. She lived within her means. She was humble. She didn't buy all the stuff (material things) she wanted, but she was happy nonetheless.

She lived this way because she REMEMBERED the past. She remembered how hard life was in the 1930s, and she wanted to be prepared in case it happened again. My mom and dad were not as parsimonious as grandma, but they still paid cash for any material item, and they did not waste anything. Mom flushed the toilet each time, yet still saved dishwater.

Mom and dad did this because the were told story after story when they were growing up around the dinner table of how hard it was during the Great Depression. They were taught the lessons of the past and how to be prepared in the event it ever happened again. They taught about how to save every penny.

Many people forget. I look around and I see many people in my neighborhood with all the best toys for their kids and all the best toys for themselves: snowmobiles, tractors, riding lawnmowers, hunting equipment, bounce houses, trampolines, expensive wood swing sets.

Instead of saving money and preparing for the worst they assume the good times will continue on forever. So instead of saving, they spend $40 a week to have someone else mow and fertilize their lawns and spend thousands of dollars each year on landscaping. Instead of living humbly, they spend thousands on remodeling their homes just for the sake of remodeling.

They have a new car in their driveways every couple years and they finance it instead of paying cash for one they can afford. They sometimes even refinance their homes and put all their material things on the mortgage so instead of paying off their stuff they pay for it over the period of 30 years.

In essence, they are more interested in material things than being humble. It goes back to the battle between greed and materialism versus honesty and integrity and humility.

Look in my yard and you'll see I don't fit in. My yard is dirt and sand and my house has holes in the siding. It's not that I can't afford to do landscaping or to fix my house, it's that I find I don't NEED those things and chose to spend my money in more useful ways.

In a sense, if my neighbor lost his job he'd feel the recession full tilt. If I lost my job my life wouldn't change much because I'm living now the same as if I didn't have a job. I'm prepared and he is not. I read the story of the Tower of Babel and I do not forget the lesson learned. I did not live in the Great Depression, yet I don't take for granted it will never happen again.

If you always live as though you are in a recession it will matter less to you when it occurs. Why? Because you are prepared.

Fear is good. You should FEAR the Lord because he made us and has the final say in everything. When we fear Him we show respect for Him. When you respect history might repeat itself, it shows you have respect for history. And that's why we MUST never forget history.

We must educate. We must teach about depression. We must teach our kids how to spend their money frugally instead of creating a big debt. We must teach our politicians the same. We must teach them to read the Bible and to learn the lessons of it. Even if you don't believe in God you can still learn the lessons of the Bible, because it's all history (it may be allegorical, yet it's still history).

Then again, if you're a Bible follower as I am, you get a totally different view of fear. In the book of Isaiah (8: 11-15) a prophet warns: "Do not join in the schemes of the people and do not be afraid of the things that they fear. Remember that I, the Lord Almighty, am holy; I am the one you must fear... Many will stumble; they will fall and be crushed. They will be caught in a trap."

We must heed the warnings. We must be prepared.

So in the end we learn that FDR was wrong. He was wrong because in reality, fear is not the only thing to fear. In reality the only thing to fear is not being prepared.  Thoughts.

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Smoking linked to increased mucus production

It's common wisdom that if you smoke enough you'll eventually develop a smokers cough, and the chances are also pretty good you could end up with Chronic Bronchitis. A new study purports to prove that smoking itself causes excess sputum production.

A new study published online ahead of the print edition of American Journal of Respiratory and Critical Care Medicine reports that chemicals in cigarette smoke suppress a protein called Bik in your lungs that prevents the natural death of mucus producing cells.

It has been known for years that smoking destroys cilia in the lungs that are the main mechanism for bringing up excess secretions to the upper airway to be swallowed, why the increased sputum production was unknown until this recent study.

Previous such studies found that overproduction of mucus cells is in the large and small airways of people who smoke, and this chronic mucus production is responsible for airway obstruction, reduced lung function, and increased pathogens in the lungs that cause things like pneumonia.

The researchers, who studies samples from human and mouse lung tissue exposed to cigarette smoke, also showed that bik protein levels remained low even after the person (or mouse in some cases) was no longer exposed to cigarette smoke.

So permanent damage to the lungs exposed to cigarette smoke is highly likely. This might also explain why asthmatics exposed to cigarette smoke have worse asthma, because I'm sure second hand cigarette smoke decreases the bik protein in anyone exposed to cigarette smoke.

Further studies will be needed to further this research.

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Smoking linked to increased mucus production

It's common wisdom that if you smoke enough you'll eventually develop a smokers cough, and the chances are also pretty good you could end up with Chronic Bronchitis. A new study purports to prove that smoking itself causes excess sputum production.

A new study published online ahead of the print edition of American Journal of Respiratory and Critical Care Medicine reports that chemicals in cigarette smoke suppress a protein called Bik in your lungs that prevents the natural death of mucus producing cells.

It has been known for years that smoking destroys cilia in the lungs that are the main mechanism for bringing up excess secretions to the upper airway to be swallowed, why the increased sputum production was unknown until this recent study.

Previous such studies found that overproduction of mucus cells is in the large and small airways of people who smoke, and this chronic mucus production is responsible for airway obstruction, reduced lung function, and increased pathogens in the lungs that cause things like pneumonia.

The researchers, who studies samples from human and mouse lung tissue exposed to cigarette smoke, also showed that bik protein levels remained low even after the person (or mouse in some cases) was no longer exposed to cigarette smoke.

So permanent damage to the lungs exposed to cigarette smoke is highly likely. This might also explain why asthmatics exposed to cigarette smoke have worse asthma, because I'm sure second hand cigarette smoke decreases the bik protein in anyone exposed to cigarette smoke.

Further studies will be needed to further this research.

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The walk of the RT

A nurse today was watching me closely as I walked off the elevator, and then I moseyed by her with my hands casually behind my back. I said, "Why are you watching me so closely."

She said, "Because I can tell if you're busy or not by how you walk." She smiled. Right now you're not busy.

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The walk of the RT

A nurse today was watching me closely as I walked off the elevator, and then I moseyed by her with my hands casually behind my back. I said, "Why are you watching me so closely."

She said, "Because I can tell if you're busy or not by how you walk." She smiled. Right now you're not busy.

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What are order sets?

Due to the Keystone Collaborative of Michigan, Michigan hospitals are now the envy of the nation, and have even caught the eye of President Obama. One of the key features of the commission is to encourage hospitals to install order sets for each particular diagnosis (DRG).

In the past order sets were rejected by doctors mainly because they viewed order sets as cook book medicine. So, what is cook book medicine?

Cook Book Medicine: Treating all patients with a given DRG the same way.

Obviously this wasn't thought to be a good idea. While the main goal of the commission is to help hospitals improve patient outcomes and reduce costs, I believe the main goal is to make sure a patient meets the criteria for receiving a reimbursement check from the Centers for Medicare and Medicaid Services (CMS).

As you know, CMS has set standards for minimal care they will reimburse for. It doesn't come down to the personal opinion of the doctor treating each patient according to what is best for the patient. What it comes down to is the fact CMS decided in order to reduce it's cost (not the hospital's cost), it will only reimburse if it's own reimbursement criteria is met (see this post).

Thus, if order sets were to the benefit of the patient, they would have been enacted many moons ago. The truth is, order sets were never enacted until CMS increased it's standards on what patients will meet criteria for reimbursement.

So based on Keystone Recommendations, many hospitals in Michigan have adopted Order sets. So what is an order set?

Order sets: This is a sheet of paper a nurse pulls from a drawer that has on it all the procedures that are recommended for that particular diagnosis. It pretty much lists anything a doctor might want to order, plus anything CMS might recommend for that patient to meet criteria for reimbursement (this is key). This type of order set would be ideal because it simply acts as a reminder of what the doctor might want to order to help the patient.

Pre-checked order sets: Many of the boxes on order sets at many hospitals are pre-checked. This means they are ordered automatically and are mandatory whether the doctor thinks they are needed or not. Due to government criteria, many hospitals have had no choice but to resort to doing this.

Advantages of order sets:

• Puts the doctor, nurses and all other staff (including RT) on the same page
• Assures best practice medicine is met for this patient
• Makes sure doctors don't forget to order what is recommended or needed
• Allows hospital to modify care based on evidence based practice
• Increases organization so you know what will be ordered for a patient
• Everyone knows their role in regards to that patient

Disadvantages of order sets (unintended consequences):

• Treating all patients the same
• Decreases doctor autonomy
• Decreases incentive to think outside the box (critical thinking)
• Many unnecessary orders
• Causes burnout due to too many procedures
• Causes apathy due to burnout and lack of ability (or lack of time) to do critical thinking

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What are order sets?

Due to the Keystone Collaborative of Michigan, Michigan hospitals are now the envy of the nation, and have even caught the eye of President Obama. One of the key features of the commission is to encourage hospitals to install order sets for each particular diagnosis (DRG).

In the past order sets were rejected by doctors mainly because they viewed order sets as cook book medicine. So, what is cook book medicine?

Cook Book Medicine: Treating all patients with a given DRG the same way.

Obviously this wasn't thought to be a good idea. While the main goal of the commission is to help hospitals improve patient outcomes and reduce costs, I believe the main goal is to make sure a patient meets the criteria for receiving a reimbursement check from the Centers for Medicare and Medicaid Services (CMS).

As you know, CMS has set standards for minimal care they will reimburse for. It doesn't come down to the personal opinion of the doctor treating each patient according to what is best for the patient. What it comes down to is the fact CMS decided in order to reduce it's cost (not the hospital's cost), it will only reimburse if it's own reimbursement criteria is met (see this post).

Thus, if order sets were to the benefit of the patient, they would have been enacted many moons ago. The truth is, order sets were never enacted until CMS increased it's standards on what patients will meet criteria for reimbursement.

So based on Keystone Recommendations, many hospitals in Michigan have adopted Order sets. So what is an order set?

Order sets: This is a sheet of paper a nurse pulls from a drawer that has on it all the procedures that are recommended for that particular diagnosis. It pretty much lists anything a doctor might want to order, plus anything CMS might recommend for that patient to meet criteria for reimbursement (this is key). This type of order set would be ideal because it simply acts as a reminder of what the doctor might want to order to help the patient.

Pre-checked order sets: Many of the boxes on order sets at many hospitals are pre-checked. This means they are ordered automatically and are mandatory whether the doctor thinks they are needed or not. Due to government criteria, many hospitals have had no choice but to resort to doing this.

Advantages of order sets:

• Puts the doctor, nurses and all other staff (including RT) on the same page
• Assures best practice medicine is met for this patient
• Makes sure doctors don't forget to order what is recommended or needed
• Allows hospital to modify care based on evidence based practice
• Increases organization so you know what will be ordered for a patient
• Everyone knows their role in regards to that patient

Disadvantages of order sets (unintended consequences):

• Treating all patients the same
• Decreases doctor autonomy
• Decreases incentive to think outside the box (critical thinking)
• Many unnecessary orders
• Causes burnout due to too many procedures
• Causes apathy due to burnout and lack of ability (or lack of time) to do critical thinking

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Rapid breathing may cause CF lung symptoms

While science is aware that in order to get Cystic Fibrosis (CF) one has to have the CFTR gene, scientists now suspect that rapid breathing that is associated with the disease is what ultimately leads to most of the lung damage due to CF.

In his most recent blog entry (click here), Dr. Artour Rakhimov writes that as the disease progresses, one of the biggest complaints is the feeling of dyspnea. And the reason might be due to the fact the disease causes hyperventilation that washes out CO2 from the alveoli.

With a less than normal alveolar CO2 tension, the following may result:

• Average minute ventilation in CF patients ranged, according to these 7 publications from 10 to 18 l/min, while healthy subjects have between 6 and 7 l/min at rest.
• Alveolar hypocapnia (low CO2) immediately causes bronchoconstriction or constrictions of bronchi and bronchioles due to irritation or an excited state of the cholinergic nerve.
• Alveolar hypocapnia destroys lungs tissue. In their study, Canadian doctors observed that "Deliberate elevation of PaCO2 (therapeutic hypercapnia) protects against lung injury induced by lung reperfusion and severe lung stretch. Conversely, hypocapnic alkalosis causes lung injury and worsens lung reperfusion injury" (Laffey et al, 2003)
• Chronic hyperventilation reduces cell oxygen content in all vital organs due to disturbances in oxygen transport.
• Cell hypoxia leads to anaerobic energy production mechanism, elevated lactic acid level in the blood, generation of reactive oxygen species, suppression of the immune system, and cellular damage.
• Thus, if heavy breathing is the problem, there are natural therapies available to address chronic hyperventilation and restore normal breathing parameters 24/7

Basically, he believes that having the CF gene alone does not guarantee eventual dyspnea, yet if the patient develops chronic hyperventilation, then the risk is raised. "Hence," he notes, "Hence, if chronic hyperventilation is present, the gene can enhance these pathological effects."

Likewise, in a study done in 1990, respiratory frequency was associated with being a good predictor of respiratory dysfunction.

Perhaps until a cure is found, another method of preventing worsening CF might be attempts to restore normal breathing.

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Rapid breathing may cause CF lung symptoms

While science is aware that in order to get Cystic Fibrosis (CF) one has to have the CFTR gene, scientists now suspect that rapid breathing that is associated with the disease is what ultimately leads to most of the lung damage due to CF.

In his most recent blog entry (click here), Dr. Artour Rakhimov writes that as the disease progresses, one of the biggest complaints is the feeling of dyspnea. And the reason might be due to the fact the disease causes hyperventilation that washes out CO2 from the alveoli.

With a less than normal alveolar CO2 tension, the following may result:

• Average minute ventilation in CF patients ranged, according to these 7 publications from 10 to 18 l/min, while healthy subjects have between 6 and 7 l/min at rest.
• Alveolar hypocapnia (low CO2) immediately causes bronchoconstriction or constrictions of bronchi and bronchioles due to irritation or an excited state of the cholinergic nerve.
• Alveolar hypocapnia destroys lungs tissue. In their study, Canadian doctors observed that "Deliberate elevation of PaCO2 (therapeutic hypercapnia) protects against lung injury induced by lung reperfusion and severe lung stretch. Conversely, hypocapnic alkalosis causes lung injury and worsens lung reperfusion injury" (Laffey et al, 2003)
• Chronic hyperventilation reduces cell oxygen content in all vital organs due to disturbances in oxygen transport.
• Cell hypoxia leads to anaerobic energy production mechanism, elevated lactic acid level in the blood, generation of reactive oxygen species, suppression of the immune system, and cellular damage.
• Thus, if heavy breathing is the problem, there are natural therapies available to address chronic hyperventilation and restore normal breathing parameters 24/7

Basically, he believes that having the CF gene alone does not guarantee eventual dyspnea, yet if the patient develops chronic hyperventilation, then the risk is raised. "Hence," he notes, "Hence, if chronic hyperventilation is present, the gene can enhance these pathological effects."

Likewise, in a study done in 1990, respiratory frequency was associated with being a good predictor of respiratory dysfunction.

Perhaps until a cure is found, another method of preventing worsening CF might be attempts to restore normal breathing.

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Treatment for sleep apnea

So if you are diagnosed with sleep apnea, or are an RT or RN taking care of such a patient, you should be aware of the treatment for this condition.

1. Weight reduction: This often decreases the severity of the condition because it reduces fat tissue in the throat area.

2. Sleep posture: Sleep on sides instead of on back.

3. Quit smoking: Smoking is believed to increase inflammation in the lungs and also increase fluid retention in your throat and upper airway*

4. Avoid alcohol: Alcohol relaxes muscles of the throat and may interfere with breathing. This explains why people are more likely to snore after drinking*.

5. Avoid sleeping pills: These also relax throat muscles*.

6. Avoid sedatives: These too relax throat muscles*.

7. Avoid Caffeine: Within 2 hours of going to bed*.

8. Avoid Heavy Meals: Within 2 hours of going to bed*.

9. Maintain regular sleep hours: This will help you relax and sleep better. This keeps your circadian rhythm in sync.

10. Elevate head of bed 4-6 inches:

11. Keep nasal passages open: Use a dilator, airway sprays, decongestants, breathing strips. See a doctor if you have chronic nasal congestion.

12. Don't be stubborn: I find many sleep apnea patients don't get the treatment they need for no other reason that they are martyrs. Be willing to seek help, and be willing to accept help options when they are presented to you.

13. Supplemental oxygen: To help offset hypoxia that might occur and prevent hypoxia induced arrhythmias and pulmonary hypertension

14. Decreasing REM sleep: Decreasing REM may decrease apnea episodes. One medicine that does this is protriptylinee, which is a tricyclic antidepressant tht markedly reduces REM sleep.

15. Reduce daytime somnolence: Central nervous system stimulants such as methylphenidate may help in this area for obstructive or central sleep apnea.

16. Surgical interventions:

• Tracheostomy: Emergency management of severe onset
• Palatopharyngoplasty: Posterior section of palate and the uvula are resected (taken out), as well as tonsils and lateral posterior wall of the pharynx to remove soft tissue that might obstruct the airway.
• Mandibular advancement: If mandibular abnormalities are believed to be the cause, this can be corrected with surgery
• CPAP: Continuous Positive Airway Pressure helps keep the airways open from the tiniest alveoli to the soft upper airway tissue. It's effective only in obstructive sleep apnea. Other names for CPAP are EPAP (End Positive Airway Pressure) and PEEP (Positive End Expiratory Pressure).
• BiPAP: Bilevel Positive Airway Pressure. This is CPAP plus air that helps the patient take in a deep breath, more commonly referred to as pressure support (PS). The CPAP helps keep the airways open, and the PS helps the patient take in an effective breath. This is more commonly used when obstructive sleep apnea is more advanced, or when it is combined with COPD (particularly end stage COPD).
• Mechanical Ventilation: This is a short term solution for when the obstructive or central sleep apnea causes respiratory failure.
• Chest cuirass: May help a patient with central sleep apnea breathe.

References:

Egans Fundamentals of Respiratory Care (6th Edition, 1995)
*helpguide.org/life/sleepapnea

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Treatment for sleep apnea

So if you are diagnosed with sleep apnea, or are an RT or RN taking care of such a patient, you should be aware of the treatment for this condition.

1. Weight reduction: This often decreases the severity of the condition because it reduces fat tissue in the throat area.

2. Sleep posture: Sleep on sides instead of on back.

3. Quit smoking: Smoking is believed to increase inflammation in the lungs and also increase fluid retention in your throat and upper airway*

4. Avoid alcohol: Alcohol relaxes muscles of the throat and may interfere with breathing. This explains why people are more likely to snore after drinking*.

5. Avoid sleeping pills: These also relax throat muscles*.

6. Avoid sedatives: These too relax throat muscles*.

7. Avoid Caffeine: Within 2 hours of going to bed*.

8. Avoid Heavy Meals: Within 2 hours of going to bed*.

9. Maintain regular sleep hours: This will help you relax and sleep better. This keeps your circadian rhythm in sync.

10. Elevate head of bed 4-6 inches:

11. Keep nasal passages open: Use a dilator, airway sprays, decongestants, breathing strips. See a doctor if you have chronic nasal congestion.

12. Don't be stubborn: I find many sleep apnea patients don't get the treatment they need for no other reason that they are martyrs. Be willing to seek help, and be willing to accept help options when they are presented to you.

13. Supplemental oxygen: To help offset hypoxia that might occur and prevent hypoxia induced arrhythmias and pulmonary hypertension

14. Decreasing REM sleep: Decreasing REM may decrease apnea episodes. One medicine that does this is protriptylinee, which is a tricyclic antidepressant tht markedly reduces REM sleep.

15. Reduce daytime somnolence: Central nervous system stimulants such as methylphenidate may help in this area for obstructive or central sleep apnea.

16. Surgical interventions:

• Tracheostomy: Emergency management of severe onset
• Palatopharyngoplasty: Posterior section of palate and the uvula are resected (taken out), as well as tonsils and lateral posterior wall of the pharynx to remove soft tissue that might obstruct the airway.
• Mandibular advancement: If mandibular abnormalities are believed to be the cause, this can be corrected with surgery
• CPAP: Continuous Positive Airway Pressure helps keep the airways open from the tiniest alveoli to the soft upper airway tissue. It's effective only in obstructive sleep apnea. Other names for CPAP are EPAP (End Positive Airway Pressure) and PEEP (Positive End Expiratory Pressure).
• BiPAP: Bilevel Positive Airway Pressure. This is CPAP plus air that helps the patient take in a deep breath, more commonly referred to as pressure support (PS). The CPAP helps keep the airways open, and the PS helps the patient take in an effective breath. This is more commonly used when obstructive sleep apnea is more advanced, or when it is combined with COPD (particularly end stage COPD).
• Mechanical Ventilation: This is a short term solution for when the obstructive or central sleep apnea causes respiratory failure.
• Chest cuirass: May help a patient with central sleep apnea breathe.

References:

Egans Fundamentals of Respiratory Care (6th Edition, 1995)
*helpguide.org/life/sleepapnea

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Bronchial thermoplasty new option for severe asthma

If you have hardluck or severe asthma, now there's a new option available for you.  This was the topic of a recent post by me at Myasthmacentral.com

So you have hardluck asthma. That is, you're asthma isn't responding to conventional asthma medicines on the market. If so, there is a relatively new option available to you, and it's called bronchial thermoplasty.

It may or may not be something you'd be interested in, yet at least it's another option for you to discuss with your asthma doctor. After a study of 297 patients, the Food and Drug Administration (FDA) approved the Alair Bronchial Thermoplasty System in April of 2010.

Actually, Pat Bass wrote in his asthma blog the following results of the study:

• Improved quality of life
• 32 percent reduction in asthma attacks
• 84 percent reduction in emergency room visits
• 73 percent reduction in hospitalizations
• 66 percent reduction in loss days from school and work

So, what is this procedure and how does it work?

The procedure is minimally invasive, and is therefore an outpatient procedure. The patient is sedated, and a bronchoscope with the Bronchothermoplasty System is inserted into the airway.

The physician then burns away extra smooth muscle from the air passages of the lungs by using radio frequency waves (a type of electromagnetic radiation). This procedure will need to be repeated three times approximately three weeks apart.

The idea here is that with less smooth muscle the airways have less ability to constrict, and this -- ideally -- reduces the frequency of asthma attacks, and improves quality of life. With less bronchial smooth muscle, the lungs stay open and are therefore less reactive to asthma triggers.

It should be noted here that this procedure does not cure asthma, it simply reduces symptoms. Yet studies show that it has reduced severity of asthma, reduced emergency room visits, improved quality of life, and reduced days lost from school or work.

What are the side effects?

As far as side effects of the procedure, Bass notes that, "While there were some increases in respiratory symptoms immediately following the procedure, they were similar to what one would expect following bronchoscopy in an asthma patient."

Of course as with any medical treatment you must weigh the risks with the advantages.

Who qualifies for this procedure?

To even be considered the asthmatics must be at least 18 years of age. The patient must also have severe and persistent asthma that does not respond to inhaled corticosteroids and long-acting bronchodilators (like Advair and Symbicort).

One question I had about the procedure was regarding the burning away of bronchial smooth muscle. Won't this cause other complications? Yet after extensive research about bronchial smooth muscle, I learned it serves no useful purpose other than to cause asthma (I wrote about this here).

Therefore, you should't have to worry about the loss of bronchial smooth muscle. 

Why does burning away bronchial smooth muscle make asthma better?

Asthma is a disease of chronic inflammation of the bronchioles causing the smooth muscles surrounding bronchioles to contract and tighten, and this ultimately narrows the air passages. This makes it so air cannot escape the lungs. This, in essence, is an asthma attack.

Inhaled corticosteroids and long acting bronchodilators usually work well to control this inflammation. Yet for a few, these medicines don't work. these are your Hardluck Asthmatics.  Bronchothermoplasty is now an option for them.

With less smooth muscle the air passages won't be able to contract and narrow, and this ultimately reduces (hopefully) your lungs ability to react to your asthma triggers.

So if your asthma is getting in the way of your life, and you are compliant with your asthma controller medicines, and your asthma is still out of control, perhaps this relatively new procedure is an option you can discuss with your physician.

My friend Breathin Stephen attended a focus group regarding this procedure and wrote some very good blog posts on it. So if you're interested in some further reading you can either check out the links above or the ones below.

• Bronchial thermoplasty promising?
• No Thermoplasty for Steve
• Considering Bronchial Thermoplasty
• New Treatment Reduces Asthma Symptoms

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Treating Lung Cancer with Papua Ant Nest

Treating Lung Cancer with Ant Nest - If you choose the medical treatment of cancer, the measures that can be done is with surgery to remove cancer cells, radiation therapy, chemotherapy, and photodynamic injection (PTD). In addition, you also can choose an alternative cancer treatment using herbs which will certainly help you save money and avoid the various side effects of cancer treatment is medically.

One herb that is now being ogled by people as lung cancer drug is a natural ant nests originating from the forests of Papua. What is the secret behind his success in destroying cancer?

Ants Nest (Myrmecodia pendans) is a plant that was traditionally used by indigenous Papuans to treat a variety of hereditary diseases. Now, modern research shows that these plants contain active compounds is important as flavonoids, tannins, polyphenols and is rich in various minerals that are useful as antioxidants and anticancer, so appropriate to be used as a cure for cancer and tumors, said Dr.. M. Ahkam Subroto (Expert Researcher of the Center for Biotechnology LIPI).

Basically any type of cancer including colon cancer occur due to cellular changes due to outside influences, as already described above. So influential in the process of oxidation in the body, which increases the number of non-stable oxygen molecules called free radicals. If not controlled, these free radicals can attack DNA and damage the structure and function of cell membranes. Thereby is formed cancer.

The fight against free radicals that is the task of antioxidants. Antioxidants obtained through dietary intake or supplement called exogenous antioxidants. Included in eksogena antioxidants are carotenoids, flavonoids, alkaloids, vitamin A, vitamin C and vitamin E in the form of tocopherol. Believe it or not, Ants Nest is rich in it all!

Research shows that alpha-tocopherol at a concentration of 12 ppm have been able to reduce free radicals up to 96%, while the ant nest of Papua is rich in antioxidants tocopherol, to about 313 ppm.

Then, in an in vitro, proved that the ant nest as a potent cancer drug. Which proves the efficacy of it is "Qui Kim Tran" of the University National of Hochiminch City and his colleagues "Yasuhiro Tezuka, Yuko Harimaya, and Arjun Hari Banskota. Third person Qui colleagues worked in Toyama Medical and Pharmaceutical University. In his research, Qui Kim Tran uses Ants Nest weighing 2-3 kg, then extracted with various solvents such as water, methanol, and methanol-water mixture.

They then grow three highly metastatic cancer cells are easily spread to other body parts such as cervical cancer, lung cancer, and colon cancer. Each extraction was then given to each cancer cell. The results are truly amazing, Ants Nest has antiproliferasi activity, meaning it can inhibit cell growth is very fast and abnormal.

Information on the top line with a positive response from the users of ant nests. For example Hendro Saputro ant nests that have been introduced as a medicinal plant since 2001 revealed that those who consume this herb is getting a lot of healing that is really thorough, such as brain cancer, uterine cancer, and prostate cancer. He commented as published in Nature magazine that "The average who drank boiled Ants Nest and get results after a week some have 3 days have seen the results".

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Lung Cancer Drug | Lung Treatments

Lung Cancer Drug | Lung Cancer Treatments - This article will explain to you about how to avoid lung cancer, knowing the symptoms of lung cancer, medical treatment options available, and why herbal "Ants Nest Papua" is the perfect solution as a lung cancer drug.

Lung cancer is a malignant tumor that attacks the tissue in the lungs. Most lung cancer caused by abnormalities of cells in the lungs, but lung cancer can also be derived from cancer in other body parts that spread to the lungs.

These cancers are more common in men and generally strikes people over the age of 40 years, but did not rule if it occurs in a relatively younger age.

Risk Factors Esophageal Lung Cancer

1. Smoking is the main cause of about 90% of cases of lung cancer in men and about 70% in women. The more cigarettes smoked, the greater the risk for lung cancer.
2. Pollution of air and industrial pollutants.
3. A history of lung cancer in the family.

Symptoms of Lung Cancer

1. Persistent cough or become great.
2. Bloody sputum, change colors and more.
3. Shortness of breath and shallow.
4. Headache, sore or cracked bone with no apparent cause.
5. Chronic fatigue.
6. Losing selara eating or weight loss for no apparent reason.
7. Hoarseness/husky.
8. Swelling of the face or neck.

Prevention of Lung Cancer

1. Stop smoking.
2. Avoid cigarette smoke for nonsmokers.
3. Be careful for those who work in industries that produce carcinogenic pollutants.
4. Do not drink alcohol to excess.
5. Eating nutritious foods such as vegetables and fruit.

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We used to overcome hardship on our own

I remember as a kid my mom wanted to ride her bike three miles to her sister's house, and I was excited to go with her. I think I was about 8 at the time, and this was the first time I was ever allowed to ride my bike on the road.

About half way there I started to get bored, "How far now, mom?" I asked. She probably said it was just a little further, yet to a mom a mile and a half is not far. To an 8 year old it is a long way. To make the ride a little more interesting, I decided to experiment.

I started moving my front tire left and right real fast. This was fun for a while, until all of a sudden the front tire went a little too far to the left and the bike came to a sudden stop. I somersaulted over the front of the bike and skidded on the ground.

I ended up with a scrape on my hand. I cried to mom who had stopped and was now waiting for me to catch up. "Come on! Rick! Quit goofing around."

"Mom, I'm hurt!" I said. She never even got off her bike. She basically told me to be a man about it and go on. So I did. And that was the point I wanted to make. Back in the 1980s parents encouraged their kids to be tough.

When I was a kid I remember getting colds a lot. I also got the flu a lot. Yet every time this happened mom would let me lie in her bed all day and drink Brandy every four hours and gargle with salt water. The medicine tasted like crap, but we were supposed to drink it because that's what was to get us better.

I lost a job once, and instead of telling me to seek unemployment for 99 days my parents encouraged me to get another job. They wanted me to get a job so I could support myself and I didn't have to suck off them. They wanted me to have my own health insurance. They wanted me to be proud.

That's right. My parents new that people who get things for free, who have someone else making decisions for them, lack confidence. They give up. They become the bums of society. And people knew that. And now it's the opposite. We keep paying people to stay unemployed. We keep adding to unemployment thinking somehow that's going to help them.

We think them spending that money is going to put more money into the market. It's not. It's just taking money that's already been spent by you and me (our taxes) and giving it to someone else. While you and me might have bought computers or cars with that money, those unemployed are going to buy food and staples. Or so one would hope. How's that going to end a recession.

It used to be we'd say suck it up and get back on your feet.  In fact, one of our natural rights is the unalienable duty to support ourselves and not mooch off other people.

This doesn't happen any more. Now people are encouraged to treat every little cut and scrape and cold like it were the end of the world, and ERs are filled with a bunch of people who don't even need to be in there.

We don't give our kids medicine that tastes like medicine. The taste was supposed to discourage us from abusing it. Now we give kids medicine that taste like candy, and they come begging us for more every time they are sick, or are faking sick.  And then we wonder why so many people come to our ERs as medicine abusers.

Back in the good old days people didn't fake sick. If you did that you were the laughing stock of society. When I faked sick as a kid, my dad put me in my place. He called me on it every time. Now when someone is faking sick to get drugs or sympathy or whatever, we have to at least pretend to take them seriously because otherwise the liars will sue the honest folks.

It's a twist it is. To really help some of these people we should be honest with them. It's kind of like Simon Cowell on American Idol telling these people who can't sing that they can't sing, and then watching these people who can't sing wha wha about how their feelings were hurt. "Everyone tells me I'm a great singer," they say.

The truth is what Cowell would tell them. He'd basically tell them what their mommy and daddy should have told them a long time ago: that they suck at singing. Not anymore. Now we are encouraged to make our kids feel good. We are encouraged to lie to our kids. We can't keep score at T-ball games because we might hurt their feelings. We can't play dodge ball (one of my favorite games) because someone might get hurt either physically or mentally.

Yet in a capitalistic world people succeed and people fail. In order for newer and better and more productive companies who make more useful products to enter the market, those companies that are antiquated and have less popular products have to close their doors. It's a process called creative destruction.

Today we don't let people fail. We have banks giving stupid loans to people who never could afford them in the first place in order to give them a piece of the American dream, and then we are "stunned and surprised" when we learn what we should have realized all along: that the people who can't afford a home can't afford a home.

That's why we have all these foreclosures. That's why we had the housing bubble burst and the economy tank. Yet instead of allowing for creative destruction to take place we bail all these banks out. So instead of newer and better banks moving in, instead of better products, we now have the same old same old failed banks screwing more people.

I remember playing t-ball with my brother David who was a year younger than me, and the coach was hitting baseballs on the ground for us to field. The only ball the coach could find that day was a rubber ball, and when he hit it to my brother it bounced off the pitchers mound and hit David right in the mouth.

My brother was rushed to the Dentist by mom, and that was the end of it. My brother's tooth died, he now has to have it dyed white or whatever for looks, but he lives with it. It's not the end of the world. Yet today that coach would have been sued. That's right. What we used to suck up and live with we are now encouraged to sue.

I talked to a doctor friend of mine who worked in the 1980s, and he said back then the ER didn't even have 24 hour coverage. Basically if there was an emergency someone was on call to come in, yet otherwise there was no coverage.

And the ERs back then weren't packed either. Back then if there was an emergency, a true emergency, you went to the ER. Otherwise you stayed home. The reason was because there was no such thing as free health care. When something is free, people abuse it.

For some reason, when something is free, people lose all ability to think. When health care is free, instead of thinking people go to the ER even for things they should stay home with and suck up.

People don't question stupid orders either.  The other day I gave a breathing treatment to someone who came into the ER with a runny nose, and I gave him a treatment.  He was not short of breath, and never was.  Yet he never even once asked me, "Why are you giving me a breathing treatment?"

So here we are in 2010 with the Federal Government wanting to give even more people free health care, and you know what's going to happen. Swamped ERs are going to be even more swamped. And it's not going to be with more sick people either.  And there's going to be more order sets so every patient with a given diagnosis is treated the same, regardless of need.

And you can't tell me there are more sick people today than there were in 1980 or ever. The number of sick people hasn't changed. Yet our ability to suck it up has changed. We have become a nation of wimps. We have become a nanny state. "Oh, poor baby," is more commonly heard now instead of, "Be a man! Suck it up!"

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The solution to RT Apathy

Advertiser: Neurological society of Shoreline Medical Center
Target audience: Respiratory Therapists, male and female
Media: RT magazines, direct mail
Target age: 30-55
Trial run: RT Cave

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Apathetic?

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Burnout!
The rest of your shift you feel, well, Apathetic!You find yourself complaining to your co-workers.Am I dong a good job of describing you?If so, we have the perfect remedy.
The Remedy!
You're one of those respiratory therapists who says to yourself, "So, why am I doing this?" You often find the answer is, "there is no reason!"Thus, you find you are running around ragged for no frickin reason.It's completely understandable,and you definitely are not alonethe solution is a... FRONTAL LOBOTAMY That's righta complete disiction of the respiratory thinkum
So I was running around ragged all day doing breathing treatments that were only ordered so the hospital could get reimbursed. I did EKGs and ABGs ordered not because a doctor wanted them but because... hmmmmmmmmmmmmmmmmmi DON'T KNOWI know longer careMy lobotomy cured everythingI now love my job Get your lobotomy scheduled todayThe waiting list is longso call now1-800-lobotom

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Guidelines for home BiPAP and oxygen

We in the medical profession do as we are told. That's the general logic we need to maintain our jobs and to help the hospitals we work for to get reimbursed by the Centers for Medicad and Medicair Services (CMS).

When it comes to qualifying someone for home oxygen, we are told we need to walk the patient and to monitor saturation (SpO2). If the saturation gets to 88% or less, the patient qualifies for home oxygen.

Even if you think the patient should have home oxygen, and the SpO2 does not drop to 88% during a walk, then the patient does not lie...

...which sets the ground for a little white lie. If I think someone needs home oxygen, and they only drop to 89%, I might fudge a little on my charting. Sorry, that's just the way life is. And, quite frankly, I'm sure I've saved the lives of more than one patient in this way.

I guess you can say that rules encourage lies.

Another thing we often qualify patients for is home BiPAP. Aside from doping a sleep study, sometimes we have patients that could benefit from home oxygen now, and don't have time to wait for a sleep study.

So, to qualify these patients for BiPAP we are told to chart the following:

Patients requiring BiPAP at home will need the following pulse oximetry test completed @ night prior to their discharge. During the test, the patient is to be on 2 liters of oxygen or their usual FiO2 whichever is greater.

A full five minute pulse ox test as needed, while patient is sleeping. There must be documented proof of 88% or below oxygenation for a full five minutes during the test.

Documentation example: Patient removed from BiPAP at 23:00, sleeping soundly. The patient is currently on 2 lpm oxygen. By 2304 patient pulse ox dropped to 87%. Patient remained @ or below 88% throughout next 5 minutes of test as evidenced by the following findings:

2305: 87%
2306: 86%
2307: 88%
2308: 85%
2309: 85%
2310: Patient placed back on BiPAP @ this time with 30% flow of oxygen. Pulse ox rebounded to 92%

So you can see, this is pretty dimwitted, yet it's how it is. You know in reality this situation will never happen. Nobody is going to be taken off BiPAP and fall asleep that fast. No SpO2 is going to drop and rise that fast. I've never seen it.

So I lie. I make the charting look like they want it to look, and so will you. This is a perfect example of how the people who make the policies, the rules, have no idea how things really work in the medical field.

The people who make the rules should be you and me, the people who know how it works. In reality, it works like this:

Person taken off BiPAP @ 2300. Patient does not fall asleep, yet the SpO2 drops stays at 98% until three hours later when patient falls asleep, yet I'm not around to document. SpO2 now 80%, and I come into room. I put patient back on BiPAP and SpO2 rises to 98%. I document as CMS instructs, although I'm not in room for six minutes watching the SpO2 which does change when I'm in room.

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Guidelines for home BiPAP and oxygen

We in the medical profession do as we are told. That's the general logic we need to maintain our jobs and to help the hospitals we work for to get reimbursed by the Centers for Medicad and Medicair Services (CMS).

When it comes to qualifying someone for home oxygen, we are told we need to walk the patient and to monitor saturation (SpO2). If the saturation gets to 88% or less, the patient qualifies for home oxygen.

Even if you think the patient should have home oxygen, and the SpO2 does not drop to 88% during a walk, then the patient does not lie...

...which sets the ground for a little white lie. If I think someone needs home oxygen, and they only drop to 89%, I might fudge a little on my charting. Sorry, that's just the way life is. And, quite frankly, I'm sure I've saved the lives of more than one patient in this way.

I guess you can say that rules encourage lies.

Another thing we often qualify patients for is home BiPAP. Aside from doping a sleep study, sometimes we have patients that could benefit from home oxygen now, and don't have time to wait for a sleep study.

So, to qualify these patients for BiPAP we are told to chart the following:

Patients requiring BiPAP at home will need the following pulse oximetry test completed @ night prior to their discharge. During the test, the patient is to be on 2 liters of oxygen or their usual FiO2 whichever is greater.

A full five minute pulse ox test as needed, while patient is sleeping. There must be documented proof of 88% or below oxygenation for a full five minutes during the test.

Documentation example: Patient removed from BiPAP at 23:00, sleeping soundly. The patient is currently on 2 lpm oxygen. By 2304 patient pulse ox dropped to 87%. Patient remained @ or below 88% throughout next 5 minutes of test as evidenced by the following findings:

2305: 87%
2306: 86%
2307: 88%
2308: 85%
2309: 85%
2310: Patient placed back on BiPAP @ this time with 30% flow of oxygen. Pulse ox rebounded to 92%

So you can see, this is pretty dimwitted, yet it's how it is. You know in reality this situation will never happen. Nobody is going to be taken off BiPAP and fall asleep that fast. No SpO2 is going to drop and rise that fast. I've never seen it.

So I lie. I make the charting look like they want it to look, and so will you. This is a perfect example of how the people who make the policies, the rules, have no idea how things really work in the medical field.

The people who make the rules should be you and me, the people who know how it works. In reality, it works like this:

Person taken off BiPAP @ 2300. Patient does not fall asleep, yet the SpO2 drops stays at 98% until three hours later when patient falls asleep, yet I'm not around to document. SpO2 now 80%, and I come into room. I put patient back on BiPAP and SpO2 rises to 98%. I document as CMS instructs, although I'm not in room for six minutes watching the SpO2 which does change when I'm in room.

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Sleep Apnea

The Greek term "apnea" literally means "without breath." So when someone stops breathing, even for a short period of time while supposedly sleeping, this is what we refer to as sleep apnea. This "apnea" results in the patient not getting enough air to the lungs.

People with sleep apnea quit breathing repeatedly during the hours of sleep, often hundreds of times, according to the American Sleep Apnea Association. It's a disease that is more common than most people think, and many who have it are unaware they have it.

According to Egans Fundamentals of Respiratory Care, the scientific definition, and the one most medical professionals go by, is cessation of breathing for 10 seconds or longer. Likewise, it's diagnosed as 30 or more episodes of apnea in a six hour period

Symptoms of sleep apnea usually include:

• Excessive daytime sleepiness
• Fatigue
• Loud snoring
• Restless sleep
• Morning headaches
• Irritability
• Mood swings
• Depression
• Learnign difficulties
• Memory difficulties (Continued drops in oxygen cause loss of brain tissue)
• Sexual dysfunction

These symptoms are secondary to the patient constantly waking up during the night. Usually the patient doesn't even know he (or she) is waking up. And this results in "unexplainable" exhaution during the day.

A common sign of sleep apnea is snoring at night, periods were it looks like the person isn't breathing (apnea), and the feeling you need to smack the person in order to wake him up. This "poor quality" sleep results in tiredess during the daytime.

These patients have a hard time staying awake in school, at meetings, or while simply sitting around the house or office. In this way, it can effect your day to day living.

A greater concern is that it can effect your health in other ways too, such that when a person stops breathing, or takes inadequate breaths, oxygen levels (PO2) may drop to critical levels, and this places a strain on the heart.

As hypoxia occurs, the heart starts to beat faster in an effort to pick up more oxygen. The only time this wouldn't occur is if the heart is already weakened due to other conditions, or due to
In this sense, those with sleep apnea are at high risk for:

• Cardiovascular disease (due to constant drops in oxygen)
• Stroke
• High blood pressure (does not drop while sleeping)
• Arrhythmias
• Diabetes
• Sleep deprived driving accidents (due to lack of adequate sleep)

Likewise, if apnea periods are long enough, this can result in chronic hypoxia and chronic carbon dioxide retention (high CO2).

The diagnosis is usually made based on an evaluation and history of the patient and anyone who might be present with the patient while he is sleeping, such as a spouse. Diagnosis is generally made based on symptoms noted by the patient and family members.

Once it's believed the patient has sleep apnea, a sleep study is required to confirm the diagnosis, and to determine appropriate treatment. (see sleep study and treatment below).

There are three types of sleep apnea:

1. Obstructive (OSA): This is the most common. The soft tissue of the upper airway (throat) collapses and when the brain signals the body to take in a breath, it doesn't go in. Instead an effort is made, and perhaps a loud snore or gasp. This prevents oxygen from getting to the lungs, and results in hypoxemia (low oxygen to the blood) and hypoxia (low oxygen to the tissues).

This most commonly effects males ages 40-65, and may effect as much as 8% of the population, particularly obese males with large necks with little muscle tone. It's also more common in the elderly as opposed to young people.

Also of significance, about 20% of people diagnosed with OSA also have COPD. Hypoxia that occurs with COPD coupled with OSA may speed up the development of right heart failure.

Those at high risk for this include:

• Smokers
• Obese (the risk rises as weight rises)
• Age
• Diabetes (3 times the risk)
• Enlarged tonsils
• Enlarged adenoid
• Excessive pharyngeal tissue
• Goiter
• Large tongue
• Micrognathia
• Myotonic Dystrophy
• Shy-Drager Syndrome
• Hypothyroidism
• Accromegally
• Males (8 times the risk as females)

Usually these patients go to sleep lying on their backs and fall into a light sleep, and this is eventually followed by a deeper sleep.  In the deeper sleep the muscles and tissues of your body relax, and this is when the tissues in the throats of OSA patients collapse and thus block the airway.  The patient then reverts back into a light sleep and is easily awakened.

This can happen hundreds of times during the night.  When these patients wake in the morning they know they have been lying down for 8 hours, yet they don't remember waking up a bunch of times in the night.  The result is feeling tired all day.

2. Central: The airway is not blocked, but the does not send the usual signal to take in a breath. This is also called Cheyne-Stokes Respiration. Breathing has the following pattern: none... fastter... faster... faster... very fast... slower... slower... slower... slower... none...
Genrally, breathing cycles between periods of hyperpnea (rapid breathing), apnea and hypopnea (slow breathing). If the period of apnea (pause) is long enough, the patient's oxygen level can drop significantly.

3. Mixed: A combination of obstructive and central sleep apnea.  Symptoms of this disease have been recorded in the annuls of history for thousands of years.

There are two other types of sleep apnea that are often used:

4. Pickwickian Syndrome*: This is used to describe patients who are very obese and excess fat tissue on the chest wall and below the diaphragm prevents the lungs from becoming fully expanded. This results in shallow and ineffective breathing. This is often accompanied with obstructive sleep apnea. The term was coined in 1957 to describe the cardiorespiratory effects of ineffective breathing due to obesity.

It was about 1970 when it was determined by scientists that there was more to this condition than just obesity. They determined that these patients presented with daytime sleepiness, flaccid upper airway tissue, and respiratory abnormalities during sleep. It was from here that sleep apnea was defined as a diagnosis and divided into OSA and CSA.

Another reason Pickwickian Syndrome doesn't always apply to sleep apnea is because in some cases sleep apnea is present is patients who are not obese.

However, from time to time, you'll still see Pickwickian as a diagnosis. Yet, thechnically speaking, Pickwickian is not a form of sleep apnea, just a condition that usually presents with it.

5. Ondine's Syndrome**: According to German folklore, the nymph Ondine falls in love with a mortal who becomes unfaithful to her. When this happens, the king of the nymphs places a curse on the mortal. The curse is such that instead of breathing automatically without thinking about it, the mortal will have to think about it. If he doesn't make a conscious effort to breath -- as if he falls asleep -- he will stop breathing. If he forgets to breathe he will die.

This is the earliest description of Central Sleep Apnea and should not be used. Instead...

6. Congenital Central Hypoventilation Syndrom (CCHS)**: This is used to describe people (particularly newborns) who have periods of hypoventilation and hypoxemia without any cardiac or neuromuscular disease. They breathe normal while awake, and hypoventilate while sleeping. While hypoxemia and hypercapnia progress during hours of sleep, there is no natural inclination to wake up when CO2 gets high enough as in OSA.

However, CCHS is still often called Ondine's Curse, and still it's just another way of describing CSA.

Cardiac and pulmonary effects***:  While apnea is occuring the patient is not drawing in oxygen (O2) and not exhaling carbon dioxide (CO2), so oxygen in the blood drops (hypoxemia) and CO2 in the blood rises (hypercarbia).

Secondary to hypoxemia, the heart slows down (bradycardia).  This is the body's natural response to decrease the body's oxygen consumption when there is less oxygen available.  Once breathing resumes, the heart increases (tachycardia), and this is the body's natural tendency to find oxygen.

Systemic and pulmonary blood pressure rises during periods of apnea, probably due to hypoxemia.  This is where most cardiac dysrhymias occur, and it is also believed that it is probably a life threatening cardiac arrythmia caused by hypoxemia that causes OSA and CSA patients to die in their sleep.

Likewise, about 10% of sleep apnea patients have high blood pressure.

Conclusion:  Sleep apnea is a serious condition that may result in day time sleepiness that may effect the every day life of the patient, and may even result in premature death.  It may be up to family members and/ or the physician to recognize the symptoms, and knowing that obese men with thick necks are most at risk

More References:

*Guilleminault C, Eldridge FL, Simmon FB, et al: "Sleep apnea syndrome-Can it induce hemodynamic changes," West J. Med, 123: 7-16, July 1975

**http://emedicine.medscape.com/article/1002927-overview


***Wilkins, Robert L, Dexter, James R, "Respiratory Disease:  Principles of Patient Care," page 313, 1993

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could a fever lead up to my sons asthma attack coming on?

Your question: Could a fever lead up to my sons asthma attack coming on?

My humble answer: Asthma itself does not cause a fever. A virus may cause a low grade fever. A virus may trigger asthma symptoms. As long as you use your bronchodilator inhaler as instructed by your doctor, it is very safe. If you sense that your child is having early signs of asthma, it is a good idea to have him use his bronchodilator inhaler. At eight, he should be old enough to tell you if he feels better after using it. However, if you continue to have concerns, it's always a good idea to contact your doctor.







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could a fever lead up to my sons asthma attack coming on?

Your question: Could a fever lead up to my sons asthma attack coming on?

My humble answer: Asthma itself does not cause a fever. A virus may cause a low grade fever. A virus may trigger asthma symptoms. As long as you use your bronchodilator inhaler as instructed by your doctor, it is very safe. If you sense that your child is having early signs of asthma, it is a good idea to have him use his bronchodilator inhaler. At eight, he should be old enough to tell you if he feels better after using it. However, if you continue to have concerns, it's always a good idea to contact your doctor.







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Here's how to be a better asthma mom

So you have a baby with asthma. Parenting is hard enough, yet when you have an asthmatic child it's that much tougher. Actually it isn't if you are a wise and vigilant parent. Learn more by reading my latest Sharepost from MyAsthmaCentral.com

Have A Baby With Asthma: Here's Ten Signs To Watch Out For

If you're like me and have a baby at home, and also have a family history of asthma, it's important you know the baby signs and symptoms of asthma -- just in case.

Likewise, if you know your baby has asthma, or if you are a daycare provider, teacher, grandparent, or anyone else who cares for children, you also should know the baby signs and symptoms of asthma -- just in case.

This is important because a baby cannot speak for herself and tell you she is having trouble breathing. In this way, YOU are responsible for knowing when asthma is present, and YOU need to know what to do to treat it.

Actually, Asthma is very difficult to diagnose in children less than 2, and many times doctors won't diagnose asthma until the child is older. However, if there is an extensive family history of asthma, sometimes the diagnosis is made based onthat fact alone. (To learn more about diagnosing asthma, click here).

Still, many of the symptoms of asthma in small children are similar to the symptoms of other illnesses that mimic asthma, such as cough variant asthma, upper airway viral infection (like croup), foreign body obstruction (like a hotdog stuck in the airway), or other disorders such as cystic fibrosis.

In essence, asthma is sometimes diagnosed after other possible causes are ruled out.

Many of the symptoms of asthma are the same as those of older kids and adults (as you can see here), yet since she cannot speak for herself, it's your job to know she's short of breath.

Thankfully there are some classic signs specific to babies and small children that indicate they are in respiratory distress. If you are vigilant, you should be able to pick up on these signs.

Now with that said, here are some signs of pediatric asthma. If you notice any of these signs you should call your child's doctor to get proper diagnosis and treatment:

• 1.Coughing, especially at night: This is actually a classic sign of asthma


• 2. Nighttime wakenings:May be due to coughing and/or chest tightness


• 3. Wheezing: May be audible or silent

The following are signs asthma might be getting worse, and immediate attention is necessary:

• 4.Rapid respiratory rate: Breathing is faster than normal


• 5.Trouble feeding:Or lack of desire to eat


• 6. Agitation/ crying: When babies can't eat they get restless


• 7. Retractions: One great way to tell babies are having trouble breathing is if her chest isbeing sucked in with each inspiration.This is also a good sign for small children. See a video of this here.


• 8. Nasal flaring: This is theflaring out of the nares upon inspiration.It is done in an attempt to suck in extra air. A classic sign of air hunger in babies.


• 9. Grunting on expiration: This is the baby's natural attempt to keepher lungs open. Another classic sign of air hunger.


• 10. Cyanosis: This is the blue discoloration of skin caused by lack of oxygen to that area. Usually it's aroundthe mouth, nose and fingertips. This isa sign the baby not getting enough oxygen.

If you notice the last four on this list you should call your doctor right away, or go to the emergency room to have your baby checked out. Regardless, all these signs should result in a call to a pediatrician.

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What We Say Matters

I was recently participating in a training at which we were discussing the function of cutting. One participant said:

“We had a girl named Megan who was cutting to be manipulative. She was doing it to get discharged and go to a place like detention where she wouldn’t have to work on her issues.”

What are the assumptions behind this statement? How does it differ from this statement?

“Megan has been working on some difficult issues recently. This has brought up some painful feelings and she has begun cutting for relief. Sometimes she doesn’t even want to work on her issues and wishes she were in a place like detention where she wouldn’t be in treatment.”

Same facts, different assumptions, leading us to different responses.

Another place I visited I noticed how often staff made statements about how bad the children were. Examples are:

“You’d better watch out putting that in your pocket. These kids will steal it from you in a minute.”

“These kids don’t care what we say as long as they get what they want.”

“You always have to watch your back around these kids.”

The staff tended to bond with each other around how awful the kids were.

Or, consider a staff member talking about a child who says mean things: "There is nothing you can do about Jesse. We have tried everything. Jesse just likes making other people feels bad. He admits it. It makes him happy to hurt others.”

Someone describing the cutting of a foster daughter: "she just wants the foster mother to feel sorry for her."

Do you agree that the phrase "feel sorry for her" connotes an illegitimate need, something that she shouldn’t want or need? Doesn’t it imply that she is trying to get some kind of unwarranted or excessive response? Also, this phrase implies that we should resist feeling sorry for her- and by extension resist coddling her, fussing over her, or being sympathetic. Yet some cuddling and caring may be just what she needs.

We make these casual comments constantly in our many discussions about the kids. Yet by each comment we are expressing a theory, an understanding of why they are doing these things. And at times it is a theory that blames the child and implicitly accuses him or her of doing the behavior deliberately to annoy us.

When we make these comments we forget that the child is doing the best she can, that her fears and needs are legitimate to her, and that she is using the only means she has to meet them. She will only be able to change when she feels safety within committed relationships, and when she gradually learns new skills.

Try monitoring the conversation where you work, and see what assumptions are expressed in the casual comments about the children. Click on “comment” to let me know what you discover.

it is important to stop and challenge ourselves. One comment can lead to an entire attitude that will infect our response to the child and interfere with the child’s healing.

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