New Treatment Ways: August 2011

August is peek ragweed -- HAYFEVER -- season

So you woke up in the middle of the night due to sneezy, stuffy, head, and a downright miserable feeling in your nose. Your breathing feels tight, chest aching, itchy eyes, and you feel congested. Perhaps you have a headache that won't go away. You may feel like you have a cold, but chances are you're suffering from Hay Fever.

You were hot and put the fan in the window, with it blowing right on you. So your first inclination was to blame the fan for your misery. Yet it wasn't the fan per se: it was what the fan was blowing your way -- ragweed pollen. It's also referred to as ambrosia, and you can see some picures here.

The sumer of 2012 was an excessively dry summer, and this is prime weather for weeds to grow. Plus shorter days and cooler nights "stimulate pollination in the ragweed plant," according to a report by Dayton Daily News.

These weeds hit their prime in August, with August 15 being the peek of ragweed pollen season. The pollen start to fall from the weeds and the wind blows them where they are used for pollenation.

With all this pollen in the air, much of it blows into your open window. The fan helps it reach your airway, and you inhale it without thinking. Your immune system recognizes it as an enemy, and generates an all out attack. Your blood vessels dilate and your airway tissues become inflammed. If you have asthma this means increased inflammation, and possibly worse asthma.

Either way, you feel miserable. To get relief you'll have to get out of bed and walk to the bathroom or kitchen where you keep your benadryl. Yet this makes you tired, so you might be better off with Claratin or Zyrtec. In some cases, your allergies may be so bad you might want to try both. You'll also want to make sure you take your Singulair if you have it.

It'll take 30- mintues to an hour for this medicine to start taking effect, if it takes effect at all. So it's 2 a.m. and you have to sit on the couch watching reruns of Everybody Loves Raymond until you finally feel enough relief to go back to bed.

One study (as you can read here) shows that of people sensitive or allergic to pollen, 75 percent are allergic to ragweed pollen. One expert notes that more people are allergic to ragween than any other pollen.

The pollen count generally starts to settle down around labor day, with September and October bringing relief to allergy sufferers.

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August is peek ragweed -- HAYFEVER -- season

So you woke up in the middle of the night due to sneezy, stuffy, head, and a downright miserable feeling in your nose. Your breathing feels tight, chest aching, itchy eyes, and you feel congested. Perhaps you have a headache that won't go away. You may feel like you have a cold, but chances are you're suffering from Hay Fever.

You were hot and put the fan in the window, with it blowing right on you. So your first inclination was to blame the fan for your misery. Yet it wasn't the fan per se: it was what the fan was blowing your way -- ragweed pollen. It's also referred to as ambrosia, and you can see some picures here.

The sumer of 2012 was an excessively dry summer, and this is prime weather for weeds to grow. Plus shorter days and cooler nights "stimulate pollination in the ragweed plant," according to a report by Dayton Daily News.

These weeds hit their prime in August, with August 15 being the peek of ragweed pollen season. The pollen start to fall from the weeds and the wind blows them where they are used for pollenation.

With all this pollen in the air, much of it blows into your open window. The fan helps it reach your airway, and you inhale it without thinking. Your immune system recognizes it as an enemy, and generates an all out attack. Your blood vessels dilate and your airway tissues become inflammed. If you have asthma this means increased inflammation, and possibly worse asthma.

Either way, you feel miserable. To get relief you'll have to get out of bed and walk to the bathroom or kitchen where you keep your benadryl. Yet this makes you tired, so you might be better off with Claratin or Zyrtec. In some cases, your allergies may be so bad you might want to try both. You'll also want to make sure you take your Singulair if you have it.

It'll take 30- mintues to an hour for this medicine to start taking effect, if it takes effect at all. So it's 2 a.m. and you have to sit on the couch watching reruns of Everybody Loves Raymond until you finally feel enough relief to go back to bed.

One study (as you can read here) shows that of people sensitive or allergic to pollen, 75 percent are allergic to ragweed pollen. One expert notes that more people are allergic to ragween than any other pollen.

The pollen count generally starts to settle down around labor day, with September and October bringing relief to allergy sufferers.

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Everyday Life through a Trauma Lens

Jenna’s mentor just called and her therapist, Eileen, is talking to the mentor before transferring the call to Jenna. But she can hardly hear what the mentor is saying because Jenna is banging on her door. “That’s my call!!” Jenna yells. “Stop talking with her!” This feels like the last straw to Eileen. Can’t Jenna just give her a minute? Jenna is always so demanding. Whatever she wants, she wants it now. She asks for the same thing over and over. If there is a delay, she becomes angry and starts calling Eileen belittling names. This makes Eileen less interested in doing whatever Jenna is asking for. Whenever Eileen is involved with one of the other girls, Jenna interferes. She doesn’t have any friends because she is just as demanding and bossy with her peers. Really, Eileen has taken Risking Connection© training and has been inspired to understand her client’s behavior as trauma related. This has helped her respond to Marcelis’s cutting, and Tenisha’s running away. But this constant obnoxious behavior from Jenna is something else.

Eileen has explained to Jenna that her insistence gets in the way of getting her needs met. She has reminded Jenna that she always keeps her promises whenever she can. But Jenna keeps being loud, demanding and rude. She is so self centered, thinks the world revolves around her and she should have everything her way. Maybe they should institute some kind of reward… Jenna could get a prize for polite behavior?

Stop! Just like when we consider the big symptoms (like self harm) let’s try the trauma lens on the everyday behavior that drives us crazy. So, as usual, we start by trying to understand WHY Jenna acts this way.

Every adult in Jenna’s life has let her down. Her mother has been in and out of her life, and in and out of drug involvement and treatment. When she stops using she and Jenna have some wonderful times. But when Jenna least expects it her mother disappears again into the drug world. This has left Jenna caring for her two twin younger brothers, although they are both in foster homes now. Earlier in her life Jenna fed, changed and played with them when her mother was not there. Jenna did her best not to share with anyone at school how bad things were at home, but despite her best efforts DCF became involved after a report from the twins’ doctor. Jenna didn’t fare much better in the four foster homes she has lived in. She experienced one episode of abuse and repeated interpersonal conflict leading to disruption. Jenna’s aunt Mary has been an important person in her life throughout all this. However, Mary too has vacillated about whether Jenna can live with her. Recently after a difficult visit she told Jenna that she cannot live there, and she has started proceedings to get custody of the twins.

Does Jenna act demanding because she thinks she deserves and should get everything she wants? No, she acts demanding because in her life she has never gotten anything she wanted, needed or deserved. Adults have not cared for her the way they should have. She has had to rely entirely on herself. The only way she has survived is through relentless demanding and grasping whenever she could. She does not trust adults, and there is no reason she should. Furthermore, underneath her bluster Jenna is sure that everything that has happened to her is her own fault. It is her fault that her mother went back to drugs, it is her fault that the twins were placed, it is her fault that her aunt doesn’t want her. So she is sure that if adults are talking about her, they are saying something bad. She knows that no one would want to spend time with her, or be nice to her, or take care of her. She will only get what she wrestles from the world.

So now that we understand Jenna’s behavior does that mean we just accept it? No. Jenna will not have a life worth living if she keeps alienating people by being demanding and insulting. So how do we proceed?

One idea would be for Eileen to begin exploring with Jenna how her ability to speak up for what she needs has been and is a strength. But I do not mean saying this perfunctorily and moving on to how she needs to learn to communicate better. I mean discovering times when Jenna saved herself and her twin brothers from death. Were there times when Jenna successfully helped her mother and brothers? Were there times when she got herself what she needed? Stay with exploring the strength Jenna has developed for a LONG time with no hint of wanting her to change. Communicate a genuine appreciation for a little girl who had to find a way to protect herself and her brothers because absolutely no one else was doing it.

Meanwhile, Eileen and all the staff can constantly validate the need beneath Jenna’s demands. Validate without adding “but you shouldn’t talk to me that way ” or “you can’t have everything, you have to think of others.” Instead say, “Jenna it’s hard when you know adults are talking about you, you are sure they are saying something bad. Jenna, you wish Marci could spend all her time with you. Jenna you want Shayna’s book so much you couldn’t wait and you took it.” A constant stream of validating the feelings beneath the words.

And we all should be as completely reliable and trustworthy as we can possibly be. If we have to change something, we should acknowledge it directly. And we should point out when we fulfill our promises, NOT with any implication that Jenna should have known to trust us. Just say: “Jenna, I said I would call your worker today. I did, and here is what she said.”

Is there any possibility that Jenna could use her ability to advocate for the good of others? When she is ready could she call (after rehearsing) a bowling alley and negotiate a discount for the program? Could she collect all the girls’ preferences for activities and present them to staff?

It would be great if Jenna could participate in a social skills training group, such as a DBT skills group. There she will learn interactive skills along with others, without reference to her particular issues.

And most of all, as Jenna feels safer, more appreciated, happier, more included, more trusting and more able to meet her needs she will be able to let her guard down and become more gentle. Then we may reach that miraculous day when Jenna says: “ I tried to talk to my DCF worker about a clothes voucher but it didn’t go too well. Could you help me figure out how to do it better?”

Why is asthma sputum white?

Your humble question: Why is asthma sputum white?

My humble answer: Asthma is a condition that often results in an increase in the number of goblet cells that line your lungs. Goblet cells are cells that produce sputum. During an exacerbation of asthma these cells increase production of sputum.

It's important to know your lungs are normally sterile. It's normal for your body uses sputum to trap particles that you inhale to prevent them from getting to your lungs and to keep the lungs germ free. This sputum makes it's way to your oral airway for you to swallow or spit up. Usually this sputum is so scant you won't even notice it, and if you do notice it it's clear or white.

If you are sick with a lung infection your sputum produciton may increase as a natural mechanism to rid your otherwise sterile lungs of the infecting microbes. Depending on the infecting agent, this sputum will come in a variety of colors. To learn what colors represent what condition check out the sputum lexicon.

Asthma sputum is unique in that it is not produced to fight off an infection. Actually, the ironic thing about asthma is it's a disease whereby your immune system works too well. It's your body thinking something you inhaled that is normally considered safe (like dust mites for example) is an enemy bacteria. Or it's your immune system attacking your own body.

For this reason, the increased sputum will not contain bacteria, and it will not contain viruses. It will be sterile. In other words, it was not produced to kill off an infection (that is, unless an infecting agent triggered the attack). For this reason, asthma sputum is sterile. It is white.

Why is asthma sputum white?

Your humble question: Why is asthma sputum white?

My humble answer: Asthma is a condition that often results in an increase in the number of goblet cells that line your lungs. Goblet cells are cells that produce sputum. During an exacerbation of asthma these cells increase production of sputum.

It's important to know your lungs are normally sterile. It's normal for your body uses sputum to trap particles that you inhale to prevent them from getting to your lungs and to keep the lungs germ free. This sputum makes it's way to your oral airway for you to swallow or spit up. Usually this sputum is so scant you won't even notice it, and if you do notice it it's clear or white.

If you are sick with a lung infection your sputum produciton may increase as a natural mechanism to rid your otherwise sterile lungs of the infecting microbes. Depending on the infecting agent, this sputum will come in a variety of colors. To learn what colors represent what condition check out the sputum lexicon.

Asthma sputum is unique in that it is not produced to fight off an infection. Actually, the ironic thing about asthma is it's a disease whereby your immune system works too well. It's your body thinking something you inhaled that is normally considered safe (like dust mites for example) is an enemy bacteria. Or it's your immune system attacking your own body.

For this reason, the increased sputum will not contain bacteria, and it will not contain viruses. It will be sterile. In other words, it was not produced to kill off an infection (that is, unless an infecting agent triggered the attack). For this reason, asthma sputum is sterile. It is white.

How to prepare your asthmatic child for school

So you have an asthmatic child. Are you doing everything you can to prepare your child for the challenge of having asthma in school? What follows are some tips created in a recent post at MyAsthmaCentral.com

It's Time To Create An Asthma Action Plan For School

I'd like to take this opportunity to introduce you to Jane Gallant. She's the asthma mom who does everything right when it comes to her 5-year-old daughter Jessie's asthma. She's likes to be proactive and prevent.

Jane remembers her grandma saying something like, "It's important to be proactive. If you're proactive you prevent something bad from happening. If you wait until something happens before you respond, you're being reactive. If you're reacting, it means something bad already happened. It's too late to stop it. So it's better to be proactive."

So when it came to Jessie's asthma Jane was definitely proactive. She spends a lot of time right here on this site, and she reads books, and she makes sure to take Jessie to her pediatrician at least once a year.

She also makes sure to assist her daughter in taking her medications, and makes sure she takes them every day, especially when Jessie is feeling well. Jane has also worked with Jessie's pediatrician in creating a good asthma action plan.

Her doctor mentioned something about working with Jessie's teacher and principal on creating an asthma action plan for school. So, reminded by the daily onslaught of back-to-school ads, she's decided there's no better time than right now. She set up a meeting with the principal, and asked that Jessie's teacher and gym teacher are all present.

Jane knows Jessie's early warning signs of asthma, and what to do when she observes them. And she wants to make sure Jessie's gets the same good care at school that she would get at home. So she plans on creating a list of Jessie's early warning signs and making sure anyone who cares for Jessie (like her teachers) knows what they are, and also what to do.

She especially wants to make sure her child is able to participate in gym class, as it's important for everyone, especially asthmatics, to stay physically active. Exercise has many advantages, including making your heart and lungs stronger.

The gym teacher will need to be taught how to pre-treat Jessie before exercise, and to be especially vigilant regarding Jessie's early warning signs. Jessie needs to exercise, yet there may be days when she may need to take it easy. It's important for the gym teacher to know when to encourage Jessie to exercise, and when to encourage her to take it easy, or when to stop.

Jessie learned through her many readings it's very important for those responsible for her daughter at school need to be on the same page as Jane and Jill's doctor. This will allow for Jessie to get the best asthma care.

That's why she's created an asthma action plan for school. She also purchased from her pharmacy an extra Ventolin inhaler and plans on giving it to the principal to keep in his office just in case Jessie forgets her own inhaler and needs it.

Likewise, Jessie will have to make sure she tells the teacher when Jessie is using her inhaler a lot, because sometimes hyperactivity can be a side effect of using lots of this medicine. Likewise, the principal will have to call Jane when Jessie needs her inhaler at school. Good communication is essential.

National Jewish Health's "Back to school health tips, notes that if your child misses school, or assignments, the teacher will have to be helpful and patient in helping and encouraging Jessie to get caught up so she doesn't get behind. A plan needs to be in place just in case.

Likewise, if Jessie has been having trouble breathing, and perhaps up late, she "may be tired and have difficulty concentrating the next day at school," National Jewish notes. So this is yet another instance where good communication is a must.

Although some hospitals don't allow kids to carry their own medicine, so she needs to make sure she knows what the policy at Jessie's school is. That's part of the goal for this meeting.

She also bought an extra peak flow meter that she will keep with the inhaler. In fact, she's decided to buy a small box and put the list of early warning signs, the asthma action plan, the Ventolin inhaler, and the peak flow meter in it. This will be Jessie's asthma emergency box for school.

It's important she's being proactive, because asthma is a very treatable disease. With good care, asthma attacks can be prevented, or at least nipped in the bud.
So if you're responsible for a little asthmatic, be it as a mom, a parent, guardian, teacher, or even a grandparent, are you proactive like Jane Gallant? Are you a gallant asthma mom or dad?

If so, right now's the time to start thinking about creating an asthma action plan for school.

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Do Antibiotics Cause Asthma?

We're learning as we progress through out "things that cause asthma" series that asthma may be caused by more than just genetics. Our own use of antibiotics may be one of the other culprits.

Parents Beware! Antibiotics Might Cause Asthma
From MyAsthmacentral March 21, 2011

Parents and doctors beware! Antibiotic use during the first year of life probably does cause asthma!

There is enough research now that we can definitely say probably. General thinking for years has been that if a child has an infection it should be treated with antibiotics. Yet newer evidence is leaning in the direction that while antibiotics cure an acute infection, it may cause asthma later on.

The most recent study was completed by Yale University researchers, and they interviewed women during pregnancy and when the child was 6-years-old. Of the 1,401 studied:

40 percent of infants given just one dose of antibiotics developed childhood asthma and allergies.

70 percent of infants given two rounds of antibiotics developed asthma

These are pretty significant statistics, and they correlate well with past studies like this one completed in 2007 at the University of Manitoba and McGill University in Montreal.

Back then 13,116 infants were followed to age 7, and the conclusion was that infants who received antibiotics were at a much greater risk of developing asthma. Likewise, the more rounds of antibiotics the greater the risk.

At present there are two educated guesses that scientists are keeping an eye on to help explain this phenomenon:

Hygiene Hypothesis: Lack of exposure to bacteria causes your immune system to get bored and attack things that aren't supposed to be bad. Thus, newborns must be exposed to certain bacteria in order to develop properly. Since antibiotics kill the bacteria it needs to develop, such infants develop asthma.

Micro Flora Hypothesis: Lack of normal bacteria in the intestinal tract causes a response that leads to an increase in inflammatory markers, which then leads to asthma and allergies. Thus, certain antibiotics may wipe out the good bacteria along with the bad.

If we go by the Hygiene Hypothesis, all antibiotics should be avoided. However, if we go by the Micro Flora Hypothesis, it appears the main culprit is broad spectrum antibiotics such as erythromycin, azithromycin and clarithromycin.

Again, broad spectrum antibiotics wipe out the good bacteria with the bad. However, narrow spectrum antibiotics will target only the bacteria causing an infection.

So, in the past, a mom brings in an infant that is sick with nasal congestion, runny nose and an ear infection, the doctor would instantly thinks, "I have to do something. Since it takes 48 hours for cultures to get back, let's prescribe a broad spectrum antibiotic! When cultures come back and we determine what specific bug is causing the problem, then we can switch to a narrow spectrum antibiotic."

Yet that thinking might have to change in lieu of modern wisdom. In the absence of a life threatening situation, it might be better to forgo the antibiotics and let kids under the age of one tough it out.

As a matter of fact, I presently have a child under a year in my house with eczema, and he developed an infection on his face. Yet knowing I have the asthma gene, we simply toughed it out -- just like they did in the olden days. And guess what? We all survived.

Rest assured, though, because there was already a plethora of evidence that antibiotics are over-prescribed. Consider the following:

Quite often antibiotics don't do any good anyway

Many infections are viral and not bacterial (antibiotics do nothing for viral infections). Many times doctors have no clue what's causing the infection, yet antibiotics are ordered anyway (broad spectrum).

Many times antibiotics are only prescribed so mom's think something is being done. Or sometimes they're ordered just so the doctor can make sure he covers all his bases.

Likewise, abuse of antibiotics has lead to antibiotic resistant bacteria.

So the bottom line here is antibiotics may not even be necessary for your infant anyway. If they're in need then they should be used. But just beware! Antibiotics may, cause asthma.

Here's what I believe...

For one thing, I believe any of us could be wrong.

I believe facts are facts and cannot be disputed (like 2+2=4). I believe a theory is a theory, yet sometimes we treat theories as facts. No opinion is wrong.

I believe it doesn't matter what religion you are, so long as you believe.

I think that even those who murder can get to Heaven if they truly change inside.

I believe (and studies confirm) true believers are more likely to handle adversity. For example, a religious patient recently diagnosed with cancer is more likely to be a happy and pleasant patients than one who doesn't believe.

I believe there is a place like purgatory where our souls can remain on earth. I believe these souls are the Angels of Heaven. While I'm a Catholic the church can and is wrong on some issues.

I believe that Western Society was the result of Christianity. I believe this because this was the first religion that encouraged people to be good to one another and do your best to make the world better as a means of getting to Heaven. This philosophy resulted in the Magna Carta and then the U.S. Constitution and, hence, freedom.

I believe that you can be wrong and still be my best friend. Ah, but that is the Christian way.

I believe you can be wrong and still get to Heaven.

I believe you can be other religions too and get to Heaven.

I believe you can disagree with everything I write and still enjoy my philosophy, and vice versal.

I believe their is a doctor somewhere and someplace who reads my blog and agrees with my view that bronchodilators are the most abused medicines in the hospital (Maybe second next to Tylenol, yet that's open to debate).

I believe decisions should be made based on facts as opposed to feelings, and that most of the wrongs in the world are the result of decisions made on feelings and ignorance as opposed to fact.

I know the U.S. Founding fathers -- people like Thomas Jefferson, Alexander Hamilton, George Washington, John Adams, James Madison, Benjamin Franklin, Samuel Adams and Thomas Paine -- knew democracies always ended in tyrany and that's why they chose to make America a republic. If you don't believe me you should study Ancient Rome and Ancient Greece.

Considering this fact, I think it's funny most people think the U.S. is a democracy.

I believe some ignorance is a product of laziness, yet most ignorance is a product of other responsibilities (like the need raise a family and spend time with your kids).

So if the U.S. were a democracy every voter would be expected to show up and be informed. The founders knew this type of system never works, that more and more people quit showing up to discuss policies and vote, and one tyranical dictator -- See Augustus as one example --of one political affiliation is the result.

The founders didn't want the U.S. to fall to dictatorship. They knew most of us don't have time to be truly informed, so they created a republic. In this way, politicians are expected to stay informed. If they don't, we -- the voters -- hold them accountable.

I believe if you are a politician you ought to read and make yourself wise. Well, I believe we all ought to do that, but especially politicians. I believe politicians should not be allowed to buy votes, and that includes signing bills that only benefit their constituents at the expense of the rest of us. By golly, why should I have to pay for a bridge in Alaska? Why would I care about the sexual behaviors of shrimp? I don't, and therefore -- I believe -- my tax dollars shouldn't go there.

I believe all Americans ought to learn as much as possible about American history, lest we are doomed to return to the old ways the founders sought to get away from.

I believe schools ought to teach all points of views, especially those of which the teachers might disagree with, and let the kids decide. I believe -- strongly so -- that teachers ought not teach theory as fact.

I believe we ought to lead by example as opposed to other methods.

I believe if we force our kids to do things our way we will stifle creativity. I believe we ought not convince young impressionable kids their parents are wrong.

I believe if Washington forces hospitals to run their business the same way, that we will stifle creativity, and we will stifle imaginations, and we will prevent progress. I believe if we force every hospital to do it the same way we prevent competition that results in innovations that would make our health care system better than it is right now.

I believe freedom breeds innovation, as we can see by the 1920s and 1980s.

I believe in God.

I believe people ought to prioritize: God, wife, kids, other people, other things.

I believe those adults who speak the most know the least.

I believe those who are silent appear to be the wisest, although they may not be.

I believe we ought to read and think before we speak.

I believe we ought to read and think before we make laws.

I believe every law results in one freedom taken away, so we ought to have few laws and enforce them with a heavy stick.

I believe it is better to do nothing than to do something stupid.

I believe the Internet should remain free.

I believe that freedom is fragile.

I believe that every tax dollar given to the government is one more job lost that we will not even see because what we do see is that dollar being spent by the government.

I believe people ought to be open minded as opposed to dogmatic in their views.

I believe people should be open to change.

I believe stupidity is the result of pride, ignorance or dishonesty.

I believe if our health care system gets worse it's because of pride, ignorance or dishonesty.

If you believe you have the solution, and you force your solution on everyone else, they you better -- by God -- hope you are right. I say this because once a new government program is enacted -- i.e. social security, Medicare -- it becomes a Holy grail of politics that no politician will want to touch.

I believe in Natural rights, such as we are all born with the right to speak, the right to breathe air, the right to eat, the right to sleep, the right to defend ourselves, the right to enter into a contract, the right to life, the right to liberty, the right to pursue happiness, and more. I believe -- as did our founders -- that these rights cannot be taken away except for by government policy.

I believe if America faces another revolution, no matter how small, it's because of pride, ignorance or dishonesty.

I believe that Ventolin does not treat anything but bronchospasm, and that most people have no clue how to diagnose bronchospasm due to pride, ignorance or dishonesty.

I believe stupidity breeds stupidity.

I believe kids ought to look around the table tonight at dinner and see what they will be when they grow up, because most of us will end up just like our parents unless we choose not to. I believe it takes an intelligent and strong willed child to see the flaws of his or her parents and step up and become better.

I believe a wise person will read material he does not agree with, and listen to people he does not agree with. I believe all ideas should be debated in the arena of ideas, and this should be done in a sensible fashion with level heads (and that this is easier said than done, because most people don't like to hear opposing viewpoints and would rather shut other people up than listen to them).

I believe everyone should have one vote, yet I think the way to euphoria is for everyone to do their homework before they cast that vote.

I believe we should reach for euphoria yet have the wisdom to know that we cannot reach it or ever achieve it. We must know there will always be bad guys to defend ourselves against. We must know there will always be stupid people. We must know there will always -- either by choice or chance -- be impoverished folks. We must know we cannot give everyone a job even in the most ideal society -- although we can strive to end poverty.

I believe every American will have at least one opportunity to improve his or her lot in life, if he or she chooses to take the effort to make that choice.

I believe everyone should take responsibility for their own actions that have either good or bad results.

I believe people should get their news from more than one source, lest they risk getting brainwashed.

I believe no two people have the same opinions on any subject.

I believe everyone should learn the truth, even when the truth hurts.

I believe even two people who agree disagree.

I believe opinions are just that, opinions.

I believe the secret to life is to follow each expiration with an inspiration.

Hypoxic Drive: Here's a new theory

Here's something interesting to think about. Now, for simplicity purposes, let us assume that the hypoxic drive is real, that if a COPD retainer is given too much oxygen he will stop breathing.

So, that in mind, many doctors do not want to give a COPD patient oxygen even when his sats are low, and even at the risk that his heart and brain won't get enough oxygen.

Yet, think of this. The hypoxic drive is based on arterial PO2. If you give a COPD patient 100% oxygen, and his sat is still in the 80s, that means that oxygen isn't getting to the arterioles anyway. Hence, it shouldn't effect the hypoxic drive.

Thus, if you have a CO2 retainer, and assuming the hypoxic drive is real, you should be able to give as much oxygen as is needed to maintain an appropriate PO2, like say something around 88% would even be nice.

And even while the oxygen is not making it to the arterioles, and not sitting on hemoglobin, excess oxygen will disolve in the plasma. Oxygen bound to hemoglobin isn't of much use immediately because it's being stored, and it must be chemically separated from the hemoglobin.

Oxygen is not just transported in the body by hemoglobin, it's transferred in the plasma as well. This "disolved" oxygen is available right away because it doesn't have to be separated from hemoglobin. It is of use to the body, although it will not register on a pulse oximeter, and it will not register on an ABG PO2 either.

Medical schools teach that the amount of blood transported by plasma is so insignificant it's not worth even mentioning. Yet this is not true. Science has proven it.

This is just something one of my coworkers brought to my attention. Thoughts?

Reference: My anonymous source will be referenced here when his book is published. I hope it's soon because I can't wait to purchase a copy and set it where the physicians sit every day.

Hypoxic Drive: Here's a new theory

Here's something interesting to think about. Now, for simplicity purposes, let us assume that the hypoxic drive is real, that if a COPD retainer is given too much oxygen he will stop breathing.

So, that in mind, many doctors do not want to give a COPD patient oxygen even when his sats are low, and even at the risk that his heart and brain won't get enough oxygen.

Yet, think of this. The hypoxic drive is based on arterial PO2. If you give a COPD patient 100% oxygen, and his sat is still in the 80s, that means that oxygen isn't getting to the arterioles anyway. Hence, it shouldn't effect the hypoxic drive.

Thus, if you have a CO2 retainer, and assuming the hypoxic drive is real, you should be able to give as much oxygen as is needed to maintain an appropriate PO2, like say something around 88% would even be nice.

And even while the oxygen is not making it to the arterioles, and not sitting on hemoglobin, excess oxygen will disolve in the plasma. Oxygen bound to hemoglobin isn't of much use immediately because it's being stored, and it must be chemically separated from the hemoglobin.

Oxygen is not just transported in the body by hemoglobin, it's transferred in the plasma as well. This "disolved" oxygen is available right away because it doesn't have to be separated from hemoglobin. It is of use to the body, although it will not register on a pulse oximeter, and it will not register on an ABG PO2 either.

Medical schools teach that the amount of blood transported by plasma is so insignificant it's not worth even mentioning. Yet this is not true. Science has proven it.

This is just something one of my coworkers brought to my attention. Thoughts?

Reference: My anonymous source will be referenced here when his book is published. I hope it's soon because I can't wait to purchase a copy and set it where the physicians sit every day.

How to suction a patient with thinning blood

Your RT question: Can you or have you done nasotracheal suctioning on a patient on blood thinner like coumadin, or is it contraindicated? Can you suction a patient in DIC?

My humble answer: You are right to suction with reservation and to question any suction order. Yet if a patient absolutely needs to be suctioned, then you have no choice in the matter. I was taught a method that should always be followed when NT suctioning that makes the process easier for you and for the patient, and prevents trauma to tissues.

Follow the following technique and you shouldn't have to worry if the patient is a bleeder or not:

1. Always insert a nasal airway prior to NT suctioning. Nasal airways are soft and easy to insert. They actually make it easier to insert the suction catheter, and also prevent the catheter from nicking the nasal passages (you'll have to lubricate the suction catheter before inserting it).

2. Never go all the way down to the corina. Hitting the corina with the suction tubing can cause trauma, bleeding, and if done often enough it can cause necrotizing tissue.

I hope this helps

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How to suction a patient with thinning blood

Your RT question: Can you or have you done nasotracheal suctioning on a patient on blood thinner like coumadin, or is it contraindicated? Can you suction a patient in DIC?

My humble answer: You are right to suction with reservation and to question any suction order. Yet if a patient absolutely needs to be suctioned, then you have no choice in the matter. I was taught a method that should always be followed when NT suctioning that makes the process easier for you and for the patient, and prevents trauma to tissues.

Follow the following technique and you shouldn't have to worry if the patient is a bleeder or not:

1. Always insert a nasal airway prior to NT suctioning. Nasal airways are soft and easy to insert. They actually make it easier to insert the suction catheter, and also prevent the catheter from nicking the nasal passages (you'll have to lubricate the suction catheter before inserting it).

2. Never go all the way down to the corina. Hitting the corina with the suction tubing can cause trauma, bleeding, and if done often enough it can cause necrotizing tissue.

I hope this helps

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Stem cells may lead to new wisdom about lung disease

New evidence that scientists are working overtime to find better treatment for lung disorders comes from a recent study that concludes scientists have found a stem cell "that plays a part in the repair mechanisms in the large airways of the lungs," Daily News and Analysis reports.

Mucus glands are important because they produce mucus that traps particles and brings them to the oral cavity to be swallowed. This is one of our bodies natural defense mechanisms to keep our lungs sterile and free of infection.

Diseases like COPD, Asthma and cystic fibrosis often result in increased mucus production that further complicates their breathing. In the case of COPD and cystic fibrosis, this increased mucus can become trapped in the lungs and increase the risk for lung infections like pneumonia.

So far most of the studies have been completed on lab animals, so it's not yet sure how this will translate to humans.

And while it's not likely this will lead to any new treatments or a cure for any lung diseases in the near future, it does provide scientists with an opportunity to further study mucus glands and the "mechanisms" for diseases of the upper airway.

Just another post to show there is hope for the future for all those folks suffering with lung illness.

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Stem cells may lead to new wisdom about lung disease

New evidence that scientists are working overtime to find better treatment for lung disorders comes from a recent study that concludes scientists have found a stem cell "that plays a part in the repair mechanisms in the large airways of the lungs," Daily News and Analysis reports.

Mucus glands are important because they produce mucus that traps particles and brings them to the oral cavity to be swallowed. This is one of our bodies natural defense mechanisms to keep our lungs sterile and free of infection.

Diseases like COPD, Asthma and cystic fibrosis often result in increased mucus production that further complicates their breathing. In the case of COPD and cystic fibrosis, this increased mucus can become trapped in the lungs and increase the risk for lung infections like pneumonia.

So far most of the studies have been completed on lab animals, so it's not yet sure how this will translate to humans.

And while it's not likely this will lead to any new treatments or a cure for any lung diseases in the near future, it does provide scientists with an opportunity to further study mucus glands and the "mechanisms" for diseases of the upper airway.

Just another post to show there is hope for the future for all those folks suffering with lung illness.

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Michigan VAP rates on steep decline

I wrote earlier how the Keystone Collaborative in Michigan has been so successful at improving patient outcomes and reducing costs that the Fed is recommending other states come up with a similar program. New evidence shows that the Keystone Collaborative has helped to significantly lower the rates of ventilator acquired pneumonia (VAP) in Michigan Intensive Care Units.

The new study on at the U.S. Department of Health and Human Services, "Rates of Pneumonia Dramatically Reduced in Patients on Ventilators in Michigan Intensive Care Units," In fact, rates of VAP in Michigan hospitals has declined by 70 percent since the Keystone Collaborative was started. The study included data from 112 ICUs in Michigan.

This is interesting considering I wrote this post about a presentation I gave about how Keystone Policies helped shoreline significantly reduce the rate of readmission rates for pneumonia patients.

The Keystone Collaborative is significant because it pools resources and wisdom from leaders from hospitals in Michigan and some surrounding states to decide what methodologies are needed to implement best practice medicine to improve outcome and reduce costs. The Keystone Collaborative then recommends certain core measures for each hospital to try to achieve.

The Core Measures include measures that are proven to work for a specific diagnosis to speed the time from admission to discharge, reduce readmission rates, best practice medicine, and to make sure intensity of service is met in order to make sure the patient meets reimbursement criteria.

I have to note here that I'm not particularly happy that many redundant and unnecessary procedures are the result when hospitals resort to cook book medicine (which is what I think order sets are), in that it basically treats all patients the same. Yet while this may be a side effect, the overall result for the hospital IS improved outcomes and reduced costs.

This recent study is proof again that that Michigan hospitals like Shoreline are taking steps in the right direction. This is good for the patients, and it's good for RTs like you and me in that it helps to keep our hospitals financially sound so we can continue to get our paychecks.

The Keystone Committee at Shoreline has created order sets and some protocols that are aimed at accomplishing the core measures designed to implement best practice medicine, evidenced based therapies, prevent complications (like infections due to catheters being inserted too long and ventilators and central lines), and reduce the risk of patient's dying in the ICU.

When it comes to core measures, the study shows an increase from 32 percent to 84 percent in Michigan hospitals that have successfully implemented the core measures. The study also showed a sharp decline in blood stream infections from central lines and has reduced the number of patients who die in the ICU (see sepsis protocol and extubation protocol).

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Why is dose of Albuterol same for all ages?

Your RT question: Why is the adult dose for bronchodilator solutions the same as the pediatric dose?

My humble answer: The main reason is because most of the medicine is wasted, as you can read here. When you give nebulized medicine to an adult 12 percent will get to the bronchial tubes where it relaxes them (if there is bronchospasm present). The smaller the airway the greater the degree of impaction in the upper airway, and the less medicine gets to the air passages. So while 12 percent looks bad, it might look more like 5 percent in a pediatric airway. Now that's assuming you give the medicine via a mask or mouthpiece. If you give the medicine by blowby you can decrease that 5 percent by another 75 percent. So you can safely assume most of the medicine is wasted in any patient.

Another reason is because Albuterol is safe and effective at the given recommended dose of 0.5cc or 2.5mg. Even higher doses are effective and safe. While no clinical studies were ever done as far as I've ever seen, best practice evidence suggests (as most RTs have witnessed) several back to back Albuterol breathing treatments tends to be very effective at relaxing airways with minimal side effects. For this reason, epinephrine has pretty much been phased out as a top line medicine for asthma in the emergency room. Albuterol is as effective and safer even while giving the same dose to adults and pediatrics.

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Why is dose of Albuterol same for all ages?

Your RT question: Why is the adult dose for bronchodilator solutions the same as the pediatric dose?

My humble answer: The main reason is because most of the medicine is wasted, as you can read here. When you give nebulized medicine to an adult 12 percent will get to the bronchial tubes where it relaxes them (if there is bronchospasm present). The smaller the airway the greater the degree of impaction in the upper airway, and the less medicine gets to the air passages. So while 12 percent looks bad, it might look more like 5 percent in a pediatric airway. Now that's assuming you give the medicine via a mask or mouthpiece. If you give the medicine by blowby you can decrease that 5 percent by another 75 percent. So you can safely assume most of the medicine is wasted in any patient.

Another reason is because Albuterol is safe and effective at the given recommended dose of 0.5cc or 2.5mg. Even higher doses are effective and safe. While no clinical studies were ever done as far as I've ever seen, best practice evidence suggests (as most RTs have witnessed) several back to back Albuterol breathing treatments tends to be very effective at relaxing airways with minimal side effects. For this reason, epinephrine has pretty much been phased out as a top line medicine for asthma in the emergency room. Albuterol is as effective and safer even while giving the same dose to adults and pediatrics.

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How to prepare your asthmatic for College

Parents. If you have a kid with asthma you'll want to take that slight extra effort to help them make the transition. Here are some tips from a recent post from MyAsthmaCentral.com

Tips For Parents of College Bound Students

So you are the parent of an asthmatic who is soon heading off to college, or perhaps is already off on that journey. Yes it's true you have to let your child go at some point, and hope he uses the wisdom you provided wisely.

Yet it's also important to know that your role as a parent has not ended. Even if he or she won't admit it, he will still rely on mom and dad for help. If your child has relied on you for help controlling his asthma, he will be especially vulnerable, and in continued need of your help.

Even if you and your child's doctor have managed to get his asthma under control, it's a proven fact that changing environments, plus the added stress of a new school, can result in worsening asthma control.

Thus, poor asthma control may result in:

Days of school missed
Poor grades
Less exercise
Increased obesity
Increased sluggishness
Loss in confidence
Loss in self esteem
Dependence on rescue inhalers
Excuses for poor grades
Increased drop out rate

To prevent worsening asthma control, it's important you keep in touch with your college-bound asthmatic. However, you'll want to be reasonable.

When I was younger, and when my dad wanted to give me his advice, he would almost always start this way: "You do whatever you want, but if I were you I would....( fill in blank).

Of course he would also limit his advice to 30 seconds and move on. Of course I didn't always listen to dad, but more often than not I did.

So, here are the tips:

1. Allergy Free Room: Help him find an allergy free place to live. Most college dorms are fine, if an apartment house smells musty, it's not a good choice. Be picky.

2. Vaccines: Make sure to remind him to get his flu and pneumonia vaccines. If he doesn't do it, at least it will be off your chest.

3. Reminders: Occasionally ask him, "Are you taking your asthma controller medicine?" He may shun you, but this simple reminder will still be taken to heart and heeded.

4. Alcohol: College is about learning, but it's also about discovering yourself. I did it, and you know your child will too. Just make sure to remind your son that alcohol is an asthma trigger (and to drink responsibly if he chooses to take that course).

5. Dr. Visits: Occasionally remind him he still needs to see his doctor at least once a year.

6. Technique: Watch him when he uses his inhaler. Is he using his spacer? Is he still using proper technique? He may need a humble reminder.

7. Money: All college kids need money. It may be a good idea to buy your son's prescriptions for him, or at least offer than if he needs you to you are available. That way he won't feel uncomfortable if he has to ask. And you can be sure if he isn't taking his medicine, it's not because of money.

8. Asthma Action Plan: Again, a simple reminder from time to time might be nice. Is he using his peak flow meter. He may feel awkward using it in front of his friends. Yet he should at least know his early warning signs of asthma and what to do.

9. Asthma wisdom: He's going to be too busy getting good grades to keep up on his asthma wisdom. At least for a while, it will be your job to do that for him.

10. Friends: Many asthmatics like to keep their asthma a secret. They like to puff in private. Yet make sure your son tells at least one friend about his asthma. He should also have access to a ride to the hospital if he needs one. Did you buy him a car? Or does he have a friend with a car? Or does the dorm RA have the ability to help in this regard?

Going to college should be an education and a fun time in your son's life. With the latest asthma wisdom and modern medicine, most asthmatics should be able to live a normal active life college life.

With some discreet help from you, he should be able to maintain control of his asthma, and prosper.

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What are good breathing exercises for asthmatics

Back in 1982 my doctor recommended I spend an hour each day blowing up balloons to build up lung strength. I'm not sure there were any studies to show this did any good, yet it didn't matter because I didn't spend much time doing it anyway. I was a kid sheeese -- I had better things to do.

Of course I was also educated about the infamous diaphragmatic breathing. So what is that? Well, read on and you'll learn about "diaphragmatic breathing" and other exercises proven to benefit asthmatics.

Breathing Exercises to Control Asthma
From MyAsthmaCentral.com, March 14, 2011

I remember the first time a respiratory therapist talked to me about the importance of breathing exercises to control my breathing. I was 11, and the year was 1981. Several years later, 2006 to be exact, a study was completed to confirm that breathing exercises really do help us asthmatics.

In fact, the study was completed in Australia and first reported inThorax, and showed that asthmatics who used their rescue inhalers regularly for mild asthma, and who performed breathing exercises on a regular basis, reduced their need for rescue inhaler use by 86 percent. Also, inhaled corticosteroid use dropped by 50 percent.

Likewise, the study confirmed that it does not matter what breathing exercises you do, all that matters is you do one or the other. Other evidence already confirmed, as the RT back in 1981 already knew, that breathing exercises during asthma episodes can help make breathing better.

How does the way we breath affect our asthma?

Experts now believe that asthmatics tend to breath faster than people with normal lungs, and many also have a tendency to be mouth breathers. This exposes the lung to cooler and drier air which is an asthma trigger. This results in increased need for rescue medicine.

So it only makes sence that breathing exercises that encourage shallow breathing at a controlled rate may actually reduce asthma symptoms and the need for rescue and preventative medicine.

What are good breathing exercises for asthmatics?

1. Diaphragmatic breathing (belly breathing): (Click here for video) This is what I was taught back in 1981, and what I was encouraged to teach in RT school. It's a basic and simple breathing technique that maximizes air distribution in your lungs.

You can lie down or sit.
Concentrate on your breathing
Preferably you should breathe in slowly through your nose
When you inhale your abdomen should go out (not your chest)
Exhale slowly with your abdomen going inward
Ideally exhalation should be twice as long as inhalation

2. Reduced breathing exercises: (Click here for video)

Sit upright, relax, focus on posture feet on floor with legs uncrossed
Relax chest and belly muscles while breathing
Focus, close your eyes and look up
Breath through your nose gently (keep mouth closed)
Breath slowly and shallow
After exhaling slowly until you feel their is no air left in your lungs
Hold your breath as long as you can and then return to gentle breathing (do not hold breath so long that you feel urge to inhale through mouth)

3. Physical movement exercises: (Click here for video)

Focus on good posture (sitting in firm chair with feet on floor, legs uncrossed with your back straight)
Relax (Tense all muscles, and then relax, paying particular attention to muscles in shoulders and belly. This should release all tension) This makes breathing easier. This is rest position
Concentrate on breathing (close eyes)
Focus on breathing while relaxed in rest position
Focus on breathing with shoulder rotation
Focus on breathing with Forward curl
Focus on breathing with arm raises
Rest position with focus breathing can be done anywhere

4. Yoga: One study showed that regular yoga participation reduced asthma symptoms and rescue inhaler use by 43 percent. In doing yoga you hold poses and concentrate on your breathing. Click here to learn more and to see if Yoga classes are held in your area.

5. Buteyko: According to the Mayo clinic this is a a breathing technique that teaches asthmatics to "habitually breathe less." Click here for the Buteyko website.

6. Papworth method: Similar to diaphragmatic breathing and Buteyko method. You can read more about it here.

These breathing exercises are believed to be beneficial to patients with mild asthma that is caused by rapid breathing and mouth breathing, and may not necessarily benefit those with more severe asthma, or those asthma episodes caused by other asthma triggers, such as colds and allergies.

There are other methods of controlling your asthma:

7. Pursed lip breathing: This can be used when you are having an asthma attack. Since asthma causes air to become trapped in your lungs, this may help you get more air out and may make breathing easier. This is where you inhale slowly through your nose and then exhale through pursed lips, or exhale slowly as though you were going to whistle. You should exhale twice as long as you inhale. This should be done while using diaphragmatic breathing as described above.

8. Progressive Relaxation Technique: This is a technique I was taught while I was a patient at National Jewish in 1985, and it works great. In fact, I think this works so great that I might dedicate an entire post to it some day.

Lie down and close your eyes
Concentrate on breathing through your nose
Use Diaphragmatic breathing
Tighten muscles of right foot and hold for 20-30 seconds, relax, feel tension release
Do same for right upper leg, left foot, left upper leg, right hand and forearm, right shoulder, left hand and forearm, left shoulder, jaw area, mouth chin, and forehead.
Continue to concentrate on your breathing this entire time.
When done your body should feel "heavy and warm... weightless."
Stay in relaxed state for as long as you want or need

9. Other: Work with your doctor and use whatever method that works for you.

The recommendation of the researchers is that asthmatics incorporate breathing exercises to go along with asthma preventative medicine. The recommendation is first thing in morning, and last thing at night (the same as most asthma controller meds are taken).

Likewise breathing exercises should be incorporated into your asthma action plan. If you're feeling mild asthma symptoms slow down and concentrate on your breathing. Do this and you may find you won't need your rescue medicine.

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What are good breathing exercises for asthmatics

Back in 1982 my doctor recommended I spend an hour each day blowing up balloons to build up lung strength. I'm not sure there were any studies to show this did any good, yet it didn't matter because I didn't spend much time doing it anyway. I was a kid sheeese -- I had better things to do.

Of course I was also educated about the infamous diaphragmatic breathing. So what is that? Well, read on and you'll learn about "diaphragmatic breathing" and other exercises proven to benefit asthmatics.

Breathing Exercises to Control Asthma
From MyAsthmaCentral.com, March 14, 2011

I remember the first time a respiratory therapist talked to me about the importance of breathing exercises to control my breathing. I was 11, and the year was 1981. Several years later, 2006 to be exact, a study was completed to confirm that breathing exercises really do help us asthmatics.

In fact, the study was completed in Australia and first reported inThorax, and showed that asthmatics who used their rescue inhalers regularly for mild asthma, and who performed breathing exercises on a regular basis, reduced their need for rescue inhaler use by 86 percent. Also, inhaled corticosteroid use dropped by 50 percent.

Likewise, the study confirmed that it does not matter what breathing exercises you do, all that matters is you do one or the other. Other evidence already confirmed, as the RT back in 1981 already knew, that breathing exercises during asthma episodes can help make breathing better.

How does the way we breath affect our asthma?

Experts now believe that asthmatics tend to breath faster than people with normal lungs, and many also have a tendency to be mouth breathers. This exposes the lung to cooler and drier air which is an asthma trigger. This results in increased need for rescue medicine.

So it only makes sence that breathing exercises that encourage shallow breathing at a controlled rate may actually reduce asthma symptoms and the need for rescue and preventative medicine.

What are good breathing exercises for asthmatics?

1. Diaphragmatic breathing (belly breathing): (Click here for video) This is what I was taught back in 1981, and what I was encouraged to teach in RT school. It's a basic and simple breathing technique that maximizes air distribution in your lungs.

You can lie down or sit.
Concentrate on your breathing
Preferably you should breathe in slowly through your nose
When you inhale your abdomen should go out (not your chest)
Exhale slowly with your abdomen going inward
Ideally exhalation should be twice as long as inhalation

2. Reduced breathing exercises: (Click here for video)

Sit upright, relax, focus on posture feet on floor with legs uncrossed
Relax chest and belly muscles while breathing
Focus, close your eyes and look up
Breath through your nose gently (keep mouth closed)
Breath slowly and shallow
After exhaling slowly until you feel their is no air left in your lungs
Hold your breath as long as you can and then return to gentle breathing (do not hold breath so long that you feel urge to inhale through mouth)

3. Physical movement exercises: (Click here for video)

Focus on good posture (sitting in firm chair with feet on floor, legs uncrossed with your back straight)
Relax (Tense all muscles, and then relax, paying particular attention to muscles in shoulders and belly. This should release all tension) This makes breathing easier. This is rest position
Concentrate on breathing (close eyes)
Focus on breathing while relaxed in rest position
Focus on breathing with shoulder rotation
Focus on breathing with Forward curl
Focus on breathing with arm raises
Rest position with focus breathing can be done anywhere

4. Yoga: One study showed that regular yoga participation reduced asthma symptoms and rescue inhaler use by 43 percent. In doing yoga you hold poses and concentrate on your breathing. Click here to learn more and to see if Yoga classes are held in your area.

5. Buteyko: According to the Mayo clinic this is a a breathing technique that teaches asthmatics to "habitually breathe less." Click here for the Buteyko website.

6. Papworth method: Similar to diaphragmatic breathing and Buteyko method. You can read more about it here.

These breathing exercises are believed to be beneficial to patients with mild asthma that is caused by rapid breathing and mouth breathing, and may not necessarily benefit those with more severe asthma, or those asthma episodes caused by other asthma triggers, such as colds and allergies.

There are other methods of controlling your asthma:

7. Pursed lip breathing: This can be used when you are having an asthma attack. Since asthma causes air to become trapped in your lungs, this may help you get more air out and may make breathing easier. This is where you inhale slowly through your nose and then exhale through pursed lips, or exhale slowly as though you were going to whistle. You should exhale twice as long as you inhale. This should be done while using diaphragmatic breathing as described above.

8. Progressive Relaxation Technique: This is a technique I was taught while I was a patient at National Jewish in 1985, and it works great. In fact, I think this works so great that I might dedicate an entire post to it some day.

Lie down and close your eyes
Concentrate on breathing through your nose
Use Diaphragmatic breathing
Tighten muscles of right foot and hold for 20-30 seconds, relax, feel tension release
Do same for right upper leg, left foot, left upper leg, right hand and forearm, right shoulder, left hand and forearm, left shoulder, jaw area, mouth chin, and forehead.
Continue to concentrate on your breathing this entire time.
When done your body should feel "heavy and warm... weightless."
Stay in relaxed state for as long as you want or need

9. Other: Work with your doctor and use whatever method that works for you.

The recommendation of the researchers is that asthmatics incorporate breathing exercises to go along with asthma preventative medicine. The recommendation is first thing in morning, and last thing at night (the same as most asthma controller meds are taken).

Likewise breathing exercises should be incorporated into your asthma action plan. If you're feeling mild asthma symptoms slow down and concentrate on your breathing. Do this and you may find you won't need your rescue medicine.

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Trauma Informed Foster Care

Foster parents are a precious resource in our child welfare system. They offer traumatized children what they need most: a loving family. The best thing that could happen to a child who has been wounded is to live with a family that loves him, accepts him, and sticks with him. Foster parents come into their role from all walks of life and for every possible reason. Every family constellation is represented. Some foster parents are relatives of the child, or have known him in some previous capacity. Many have experienced their own traumas and see providing foster care as their way to give back.

Being a foster parent to a trauma surviving child is quite different from being a staff in a treatment facility. You are in your own home, and there is no immediate backup. You may have other members of your immediate family present, such as your biological children. You are trying to integrate the child into your actual life, your extended family, your neighborhood, your favorite activities.

Child care staff in treatment programs are taught a method of interacting with children that is significantly counter intuitive, and is usually completely unlike the way they were raised. But they have a team, other workers, treatment professionals and policies to help them maintain these strange practices. Foster parents do not have any of these readily available. Instead, they have a chorus of extended family members and friends telling them they should be stricter and not let the child get away with so much. It is much harder to change one’s style of parenting in one’s own home where one has successfully raised one’s own children.

The most important gift that a foster family can give a child is permanency. The children are damaged by disrupting and moving over and over again. The education and support we give foster parents should be primarily aimed at giving them the stamina to stick with the child. Keeping these children is very difficult as they put the family through such extreme behaviors, all based on their own assumptions about relationships. Yet the foster parent has the most power to heal this child, but helping the child to experience pleasure and associate it with other people; and by building the child’s brain through rhythmic, repetitive, rewarding activities.

One of the most powerful determinants of how a family responds to behaviors is how they define them. For example, Natalie is a twelve year old girl who has severe difficulties at bedtimes. She was placed with the Bruce family, and they defined her bed time behaviors as defiance. They had told her to turn out her light and go to sleep, and she kept getting up. The Bruce’s case manager asked them to sit in her room, read her a story, and talk with her, and to give her a night light. Mrs. Bruce thought this was just being too indulgent; she would never let one of her own kids get away with this. Did Natalie have no respect for her? Besides, Mrs. Bruce said, she could tell that Natalie was enjoying her presence in her room. This was just rewarding bad behavior. The placement disrupted.

Then Natalie was placed with a single mother, Mrs. Harris. She immediately connected Natalie’s bed time behavior with her having been abused and left alone. She started using music to help Natalie fall asleep, and gave her a night light. They developed a bed time ritual that they both enjoyed which included reading a book and then singing a good night song to each other. These interventions did not make everything perfect and there were still many other behaviors to deal with. Buy Natalie gradually began going to sleep more easily.

When we train foster parents in understanding trauma, how it affects children, how it relates to their current behaviors and how they can heal, we offer them a new framework for understanding their child’s behavior. We help them not to take the behaviors so personally. We must stress that these behaviors are adaptive and reflect what has happened to the child. The child is doing the best he can, and will do better when he is happier, feels seen heard and connected, and when he feels safer. All our training efforts should be directed towards this end.

We are currently creating a training program for trauma informed foster care, and would love to hear from anyone who has any experience with this. Just click on the word “Comment”,

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