New Treatment Ways: April 2012

The link between high fat foods and asthma

The following originally appeared at Healthcentral.com/asthma on May 16, 2011.

Can Eating High-Fat Foods Trigger Asthma?

American's love Big Macs, Whoppers, French fries, onion rings and deep fried chicken. These are convenient foods that are simply delicious. Yet the old saying goes, "If it tastes good, it's probably not good for you."

Now we already knew such high-fat foods are bad for your heart. Yet new evidence suggests they may also be bad for your lungs.

A study completed by Australian researchers in 2010 tested asthmatics before and after eating a meal, and determined that lung function was worse after eating a high-fat meal.

If that wasn't bad enough, the study also concluded that high-fat foods also made it so asthma rescue medicine (like Albuterol) worked less well.

Scientists aren't sure why this is, yet there are theories. One theory suggests that your asthmatic immune system might recognize saturated fat as an enemy and promptly acts to rid it from your system.

This response results in an increase in markers of inflammation such as leukotrienes and hystamine, and these increase inflammation in your respiratory tract. This causes muscles lining your air passages to constrict, and thus an asthma attack is the result.

Perhaps due to the increased inflammation, asthmatics who used their rescue medicine after eating a high-fat meal did not get as much relief as those who ate low-fat meals. Likewise, lung function improved less in subjects who used their rescue medicine after eating high-fat meals.

Obviously asthma rates have increased incrementally in the U.S. and other western nations over the past 20 years. This new theory suggests one of the factors might be the high-fat foods we put into our bodies.

I've also read other studies that suggest that if you're exposed to something that triggers inflammation in your lungs, and exposed to it often enough, the inflammation may become permanent. Thus, asthma is developed.

It's studies like this that remind us that the way we eat may determine the lives we live. If you want to prevent asthma, or prevent an asthma flare, it may be a good idea to eat a healthy diet.

Does that mean we asthmatics should never eat great tasting, convenient and high-fat foods? Absolutely not. Yet it's good to know the facts, and it's good to know what foods might not be good for us.

Delayed gratification

I am one of many who will contend that one of the problems with our society, and why the economy is doing so poorly lately, is that so few Americans believe -- or even comprehend -- the idea of delayed gratification.

We live in a society where we want everything, and we want everything now. We want the best house and the best car and the best toys for our kids and the best toys for ourselves. Many of us are even willing to mortgage everything we have in order get all this stuff.

Delayed gratification, defined, means that you do just the opposite: you wait. You wait to buy something until you can pay cash for it. In this way, you can get twice as much and enjoy it twice as much.

Yet many of us can't wait. We think we need things right now. This was the topic of a research project completed in the 1960s and 1970s (and discussed here at science daily) where pre-school kids were given a marshmallow and told if they wait five minutes before they ate it they could have another marshmallow. "Some of the children resisted, others didn't."

A new study followed up with the kids tested in the original study and the results showed that the same kids who resisted eating the marshmallow when they were kids showed that they were still skilled at delayed gratification as adults.

Kids who couldn't resist the temptation to eat that marshmallow (or cookie, or candy bar) as kid were equally as likely to be unable to resist the temptation of immediate gratification as an adult. Which almost makes one wonder if the skills of gratification are inert and genetic as opposed to environmental.

Of equal interest, the study showed this:

Brain imaging showed key differences between the two groups in two areas: the prefrontal cortex and the ventral striatum.

Researchers say this is the first time they've found "specific" brain differences associated with gratification. This might help them, they contend, to learn more about and how to treat people with addiction -- like addiction to stuff.

I learned about the above study from this article in the Blaze.

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STAT: A word that is often abused

The word "STAT" comes from the Latin word staim which means immediately. So stat is essentially an abbreviation of the old word. It's common for the English to be lazy with speech, and thus is how the word stat was formed.

Proper use of the word is either capitalized or not capitalized.

Essentially, when someone is called STAT it means that person is needed immediately. Unfortunately, however, the word "immediately" does not denote what the person is needed for. So you can be called STAT because your services are desired to save a life, or you could be called so the doctor can get his EKG results quick so he can see it before he goes home for dinner.

Ideally you'd think the word STAT would be used for life and death situations, such as the following. :

RT STAT to ER..... we have a patient in respiratory distress
RT STAT to 244.... we have a patient in V-tach
RT STAT to ICU... we have a patient with a heart rate of 27
RT STAT to ER... we have a patient who can't breathe

Realistically, the above plus the following are more likely to occur in tandem:

RT STAT to ER.... EMTs are 20 minutes out with a cardiac arrest
RT STAT to 244.... Dr. Jones wants an EKG done before he goes home, pt is fine
RT STAT to ambulatory surgery... Dr. wants pre-op EKG done
RT STAT to CCU... RN wants EKG to see what rythm patient is in

Actually, I have recent pages such as the following:

STAT EKG in 2234 in two hours
STAT ABG in an hour on the vent patient

With such a vague definition, and with such frivolous use of the word statim or STAT, the word has lost much of it's luster and RTs have become deconditioned to the word. When an RT may be needed immediately, he may be inclined to finish his last bite of steak before sauntering to where he's needed.

He may also be written up for responding to a code overly relaxed and in a non-urgent manner.

What is intubation?

Intubation is where we insert an endotracheal tube into the airway of a patient to the lungs in order so that we can breathe for that patient. (to watch a video click here)

Indications for intubation may include:

1. During surgery. Your breathing may be stopped with anesthetic medicine and your breathing will be assisted with a ventilator.

2. Drug overdose: The patient took medicine that made him so relaxed that he is in danger of vomiting and inhaling that vomit (aspiration). In this way, intubation may be indicated to protect the patient's airway.

3. Neuromuscular paralysis: Some diseases cause the patient to be unable to breathe, and in these cases the patient will require intubation. If the disease is permanant or long term, a tracheostomy may be inserted.

4. Trauma: The patient has been in an accident and is unable to breathe on his own. In these cases intubation may be indicated.

5. Labored breathing: The patient has a disease like asthma, COPD, lung cancer, pneumonia, heart failure, etc. and is having severe trouble breathing. We can intubate these patients so we can breathe for them while we work our magic to fix the underlying cause.

6. Heart attack or head trauma: In these instances, we may need to assist the patient with their breathing so that we can rest their bodies in order to allow our medicines to work their magic.

Most intubations are short term, just in long enough until the surgery is complete, or until the disease process is resolved. When a patient is intubated the patient will either be ventilated (breathed for) by an Ambu bag or a ventilator.

When this tube is removed it is called extubation.

What is an ambubag? (coming soon)

What is a ventilator? (coming soon)
History of respiratory therapy (coming soon)

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Do Rapid Response Teams work?

Hypothesis: I personally believe that the more people caring for a patient, and the more people assessing the patient, the better off the patient will be. It is for this reason I think Rapid Response Teams are a good method of preventing patients from going into respiratory and/or cardiopulmonary arrest, and thereby improving patient outcomes by preventing the need to transport patients to the Critical Care Unit (CCU).

Question: Do Rapid Response Teams really work? This was a question recently taken up by RTmagazine.com, "Are Rapid Response Teams the Answer?" The article, written by Michael V. Frey, RRT/ NPS, creates several good arguments that the answer to the question may be no.

What is a Rapid Response Team (RRT)? It's a team of experts who respond to the patients bedside when the patient doesn't look quite right to the attending nurse or physician. The team consists of CCU nurse, Nursing Supervisor, Respiratory Therapist, Physician (if one is available) and the patient's nurse. The goal is to be proactive and do what is necessary to prevent the patient from getting worse.

Why were RRTs believed to be a good thing? According to Frey

1. Most floor nurses lack critical care experience

2. Some nurses were hesitant to do proactive therapies without a physician's order. This is important because sometimes it takes a while for the physician to call back, and the patient needs something done right now. For our small town hospital, I think this was the key to forming an RRT. There were many times a nurse wouldn't treat the patient that needed immediate attention just because she didn't want to do something without an order. RRTs eliminated this, and the end result has prevented such patients from needlessly ending up in the CCU. This I would consider the most valid reason for an RRT.

The following studies seem to show RRTs work, as mentioned by Frey:

50% reduction in the occurrence of cardiac arrest outside the ICU
17% decrease in the incidence of cardiopulmonary arrests (6.5 versus 5.4 per 1,000 admissions)⁴;
Severe postoperative adverse events (ie, respiratory failure, stroke, severe sepsis, acute renal failure) reduced by 58%⁵;
Emergency ICU admissions reduced by 44%⁵;
Postoperative deaths reduced by 37%, and mean duration of hospital stay decreased from 23.8 to 19.8 days in surgical patients⁵; and
There has been a decrease in the number of unnecessary transfers to a higher level of care by a mean of 30%.⁶

The argument against RRTs: (According to Frey)

1. RRTs are a band aid solution to a bigger problem of nurses not understanding the needs of their patients.

2. Some patients are on the medical/ surgical floor, or step down unit, only because there are no beds available in the CCU. It's these patients who are at greatest risk for deterioration.

3. Due to cost cutting, some patients are moved our of CCUs and to step down units. These patients are also at high risk for deterioration.

Conclusion; I think the general conclusion is that RRTs work. My experience with them is they work, and I noted one very good reason above: At a small hospital, we don't have physician coverage 24 hours a day, and therefore RRTs sort of fill the gap between observation of a deteriorating patient and communication with the physician.

Surely, however, there are methods that could be improved. For example, if the CCU nurse already has several critical patients, it's difficult for that person to be pulled away from his already critical patients to care for a patient of another nurse. However, all in all, I think the teams are working, and the statistics show they are working.

What do you think?

What is a blood gas?

A blood gas is a test we use to determine how much oxygen and CO2 are in the patient's blood. It's a blood draw where you insert a needle into the patient's radial artery in the wrist area, bracheal artery in the antecubital area (the backside of the elbow) or the femoral artery in the groin (thankfully we don't use this area too often).

About 90 percent of the time we draw this blood from the wrist. We draw arterial blood because this blood is freshly oxygenated blood from the lungs on its way to tissues. We want to know how much oxygen is in this blood. If oxygen is low then we may choose to supply the patient with supplemental oxygen. We can do this with a nasal cannula or a variety of masks.

If the CO2 is high we may need to assist the patient with his ventilations in order to help the patient blow off this CO2. The reason CO2 gets high is because the patient is not taking good enough breaths. He may be pooping out because his lungs are diseases. In this case, we use his CO2 level to help us determine what we can do to help him.

Another thing an ABG does is help us determine the acidity (pH) of the blood. If a patient is in severe respiratory distress his blood may become very acidotic. If this happens, we may need to help the patient breath so that we can get his pH back to normal.

This blood test can also help a doctor diagnose some diseases. For example, if the CO2 is chronically elevated this can be a classic sign of chronic bronchitis or emphysema. Too see a video of an ABG being drawn you can click here.

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Have you ever switched from Advair to Symbicort

Your Question: Have you ever switched from Adair Symbicort ? If so were the results the same, or is one better than the other?

My humble answer: As of right now there are no FDA approved generics for Advair or Symbicort. I did switch from Advair to Symbicort once. As far as control of my asthma it was the same either way. The Symbicort was nice in that it acts like a quick relief inhaler opening my airways immediately, as opposed to 15 mintutes for Advair. This was nice. However, Symbicort made my heart pound while Advair never did that. So in my case I switched back to Advair. The medicine in both are "relatively" the same, so from the expert standpoint I think which one works best is a matter of personal or professional preference. In my case, I prefer Advair. I do know quite a few asthmatics who prefer Advair and also quite a few who prefer Symbicort. There' salso another option available along this line of medicine called Dulera. I tried that once too and it was basically the same as Symbicort. So that's my own personal experience with Advair and Symbicort.

Seven tips to help get rid of acne

Whatever your age is, you have probably had some kind of acne. Although everyone gets it, not everyone knows how to treat it. The following article is going to provide you with tips to help you get rid of your acne and get healthy skin once again.

Speak with your doctor about your acne's cause. While some cases of acne is caused from improper hygiene, other cases may be caused by a hormonal condition or other medical problem. Your doctor can run tests to determine its cause, and once the cause is determined, treatment becomes much easier.

Do your research about which acne treatments will work best and before using any medication, speak with a pharmacist. Simply put, some treatments are more effective than others and you do not want to spend your time or money on one that is not going to work for you. A pharmacist can help you determine which one is best for your specific case.

Wash your face everyday. In fact, try to wash it once in the morning and once before bed. Believe it or not, when you are sleeping, your face may acquire sweat and bacteria, both of which can cause acne breakouts. Also, during the day, your face is exposed to dirt, sweat, and bacteria, meaning it needs to be washed at the end of the day as well.

As far as treatment goes, try to have an open mind. Many people consistently suffer from acne because they are not willing to try some of the treatments. There are many natural remedies for treating acne, such as tea tree oil, and people think it is too odd to try. Just keep an open mind and try many different treatments until you find one that works for you.

Once you have found the treatment that is best for you, pick out a specific time to use it everyday. Many people will try a treatment once or twice and forget to use it after that. Your acne is not going to get better if you do not use it when you are supposed to. This is why it is best to set aside a certain time each day, such as right before bed, to use it.

If you have tried numerous over-the-counter treatments and none of them seem to work, you may want to visit a dermatologist. While some cases of acne are easily treatable, other aren't. In these cases, prescription treatments may need to be prescribed. Your dermatologist can determine what is going to work the best for your specific case.

It is important that you never give up, no matter how frustrating treating acne may be. Many people give up trying to treat their acne when nothing works right away. You must remember that acne does not clear up overnight and you must give treatments time to be effective. Until then, keep a positive mindset!

As mentioned in the beginning of the article, you have probably had acne at one point in your life, but you probably did not know how to treat it. However, if you use the advice in this article, you will never again have to wonder about what you can do to treat it.

Are expired asthma medicines safe to use?

The following was originally published at HealthCentral.com/Asthma on May 23, 2011:

Is it OK to Use Expired Asthma Medicines?

You found your asthma medicine sitting at the bottom of your sock drawer and now you're wondering: Can I still use it? Is it safe? Will it still work? Is it okay to use expired asthma medicines?

Asthma medicine has a tendency to be expensive. One Advair Discus costs over $100 just for one month. Even with good health insurance, I pay about $1 for each Singulair pill. The cost of other asthma medicines can add up to.

If you're normal like me, you lose your inhalers. I just opened three brand new Ventolin inhalers in the past week, and I already can't find two of them. I did find one when I cleaned under the bed, yet it was dated January 2009.

While it's recommended every asthmatic have a rescue inhaler like Ventolin on hand at all times, and that we replace it every year, I know of many of you guys who have one yet it's done nothing but sit at the bottom of your sock drawer. Now you're short of breathe and wondering, can I still use it?

More recently I received a question about how long Advair is good for. This person had no insurance and wanted to know if it was safe to use an Advair that was opened but expired four months ago. She also had one Advair that was expired but was never opened.

Are these medicines safe? Would they still be effective if used?

When I was a kid I'd lose inhalers all the time. If the one I was using ran out, and I for some reason didn't tell my mom I needed a new one, and I was having a raging asthma attack in the middle of the night, I'd rummage my room hoping to find a lost one.

Then I'd find one and take a puff. If you've ever taking a hit off an expired Ventolin inhaler you'd know it, because it tastes like rotten mints. Yet you wouldn't mind so much, because it still helped you get your breath back.

More recently I did some research to find out what the scientific evidence was regarding old and expired medicine. I asked the pharmacist where I work, and he gave the old stand-by and political response, "It's good for up to a year."

Yet that didn't satisfy me. So I continued my search for answers. What I learned is that science has pretty much proven that no asthma medicine will harm you if you use it beyond its expiration date.

So in that sense you can feel okay about using expired medicines. I mean, I'm proof expired asthma medicines don't kill. If nothing else, I've proved that many times.

As far as potency, over time asthma medicines do become less potent, although they will still work better than using nothing. In fact, most new medicines are good for two to three years from the day they are produced so long as they remain in the original packaging.

And considering a medicine may sit on the shelf of storerooms, trucks and then pharmacies, the expiration date is generally listed as one year as of your purchase date.

So you can see there really is no scientific reasoning for that expiration date. The medicine might still be potent for some time. So if your package is not opened, you should be able to use older medicine (within reason of course).

However, once the original container is opened for use or dispensing, the expiration date on the container no longer applies. In fact, according to, this ABC News post, the expiration date of a medicine is actually just the predicted date at which the drug will lose 10 percent of its potency.

Once a medicine loses more than 10 percent of its potency it's no longer considered effective. From that point on, it continues to lose more and more of it's potency. Plus, if it's an an inhaler, it starts to taste nasty.

The expiration date also assumes you are storing the medicine at the recommended temperature and humidity. Most medicine should be somewhere between 59 and 86 degrees F (15-30 degrees C) and away from light and moisture. You'll have to check the package of your medicines to see the exact recommendations.

This means that asthma medicines should not be stored in the bathroom where

it will be exposed to high humidifiers during and after showers. So I suppose the bathroom medicine cabinet’s not such a wise place to store your meds after all.

While most asthma drugs are not hazardous if used after their expiration dates, the efficacy of the medicine after that date can no longer be guaranteed. Thus, if you are using an expired medicine you may not be getting the expected results.

So, should you use those expired asthma medicines? At least now you can make an educated decision.

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Say Goodbye To Your Blackheads!

Blackheads are a very common issue. If you have them, you are probably having a hard time getting rid of them. This article is filled with useful tips you need to try!

Wash your face gently every morning and every evening without going to bed. Use a soap with a neutral PH. This is the best way to keep your face clean and to get rid of bacteria. Be very gentle and do not rub your face with a towel; this will only lead to an excessive production of oil and more breakouts. Keep this towel as clean as possible and make sure your hands are clean too before you wash your face. Make this a routine so your skin stays clean all the time.

You can clean the inside of your pores with an exfoliating scrub. Compare different products and look for something specially designed for blackheads. Exfoliate your skin once or twice a week. Wash your face with hot water to open your pores and apply the exfoliating cream. Gently rub in circular motions and focus on the areas where you tend to have blackheads. Rinse with hot water and splash cold water afterward to tighten your clean pores.

Facial peels are very efficient against acne. These products will clean your pores and erase any mark or scar left by blackheads. Compare different products, read reviews and try getting samples so you can try different facial peels before you decide which one you want to use. Use your facial peel two or three times a week, for instance when you are not exfoliating your skin. Wash your face, apply the facial peel and wait a few minutes before removing it.

You can remove blackheads with special strips. This should be used only if you have prominent blackhead that slightly protrude from your skin. Wash your face, apply the blackhead strip, wait a few seconds and pull it off slowly. All the oil in your skin will stick to the strip. Make sure you clean your face right away in case any oil remains at the surface of your skin. Read instructions before you use these products.

You can easily find blackhead extractor in most beauty stores. These tools look like a pen with a small loop at the end. Press the end of the tool on your skin firmly and the blackheads should be extracted from your pores. It is very important that you clean your tool and your skin before and after you extract blackheads, or you might spread oil and bacterias all over your face.

Your diet can greatly influence your skin. Vitamin A and fiber will give you a healthy skin and help you balance the levels of oil in your skin. You can find Vitamin A and fibers in a lot of different fruits and vegetables or in multivitamin supplements. Make a few changes to your diet or start taking supplements: you should see a different within weeks.

Try these different methods to get rid of your blackheads. Test different products and remember to keep your skin as clean as possible while you treat your blackheads.

How to deal with criticism and faults

Giving criticism is something we all must do with from time to time. The problem is, most people hate to criticize -- except behind your back -- and most people hate to be criticized. Yet an appropriate level of criticism is essential, and can even be good if done appropriately.

Believe it or not even the ancients dealt with this topic. If you read the Bible you'll see that it was dealt with in Matthew 18: 15-17. Matthew writes: "If your brother or sister sins, go and point out their fault, just between the two of you. If they listen to you, you have won them over. But if they will not listen, take one or two others along, so that 'every matter may be established by the testimony of two or three witnesses' If they still refuse to listen, tell it to the church; and if they refuse to listen even to the church, treat them as you would a pagan or tax collector."

To give a good example, I had a doctor write me up recently because I was, in her words, "too relaxed in my approach to an emergency." My initial response was anger, and that's a normal response. My second response was to laugh it off with my boss. Neither of us took it seriously (as you can note for yourself in this facetious post).

This doctor did not follow the rule of talking to me first. She was tactless.

I have to be honest and tell you that when my boss comes to me and tells me I did something wrong, or a doctor didn't agree with something I did or said, I get angry. That's almost always my first reaction. Then I shut my mouth and listen. Then I listen to my boss as she tells me how to do it right.

Chances are I'll leave her office upset and angry. I might even be in a mood. Yet there's also another thing that almost always happens as a result of this criticidsm: it gets me to thinking. Somehow and someway I will make some change that will make me better. As a return, this will make the department better.

So a good manager who follows the appropriate steps can use criticism to make her workers better, and make her department better. Yet for the sake of God and the sake of morale, she better not come complaining to us about trivial things, and she better not go to her boss to complain about me before she talks to me.

That was the mistake my doctor friend made. She failed to take the appropriate steps. Her soft skills in this regard were severely lacking. This is a problem I face with her -- and so do my fellow workers -- on a regular basis. Yet we bite our tongues and deal with it. Sometimes we get angry, yet mostly we laugh it off.

I can guarantee that something will change after just about every criticism. If I don't make myself a better therapist, I'll use that energy to make myself better at avoiding the critical person. I will avoid that person like the plague. I will become quite adept at it.

If I cannot avoid the annoying criticizer, then I will find a way of only speaking to that person on a professional basis. Thus, if you me how I like that doctor, I will say: We have a good professional relationship". If I say that about you, then you know I don't like you. Although I've said it only three or four times in my 15 years as an RT.

My point here is that sometimes you must approach someone with criticism. If you do it appropriately, good things can result. Yet if you do it inappropriately, you become the fool.

RT Creed: Fear and Stress are necessary

Date: 7/11/62

To: Sim body, Director of IT Services

From: Dr. Na buddy, ER physician, medical director

Re: Relaxed ITs

Memo: It has been observed that many of our fine Inhalation Therapists (ITs) have been reporting to codes and over head pages in a relaxed mode of behavior. Just yesterday I witnessed two ITs enter the ER in a lackadaisical manner, relaxed and acting as though nothing was going on. The truth was that the patient needed a STAT Bronchosol breathing treatment or he was going to die. It was essential we got the bronchodilator into the patient's system before we inserted the chest tube to make sure the air got out of the patient's chest faster.

For the future, we recommend all ITs reporting to the ER be all stressed, sweaty, and have their tongues lagging from their mouths out of pure exhaustion when reporting to emergency calls. We want to make sure the IT is on the same mental footing as the nurses and doctors so they can make the essential decisions out of panic and fear rather than from a relaxed state of mind. Please consider this an unwritten policy at this institution.

Also, I have been alerted that many of your fine ITs have still been talking to patients during breathing treatments. We find this affects the deposition of the medicine and is causing the patient to feel too much at home and relaxed. Again, we find that stress and anxiety help with the lung healing process. Again, please consider this an unwritten policy at this institution.

Thank you for your attention in this regard

What is a crash cart

A crash cart ready for action

A crash cart is a cart that has all the emergency equipment and medicine emergency medical professionals need to attempt to save the life of a person who's not breathing or is in a life threatening cardiac rhythm.

Usually the cart is compiled of a tool cart.

The cart is on wheels so it can be transported to different areas where an emergency will be. It's generally available in case a patient goes into respiratory or cardiopulmonary arrest (heart and breathing stop), or for emergencies often referred to as codes or code blues.

Yet the cart is also used to treat impending or active symptoms that could lead to more serious complications if not treated immediately, such as new onset symptomatic supraventricular tachycardia.

It's also carted to the bedside of patients who don't look quite right, and in this case a rapid response team is called. The goal here is to avert an impending emergency situation by treating early signs and symptoms of failure, such as mental changes, vital sign changes, and erratic heart rhythms. (Learn when to call a doctor by clicking here).

On top the cart is usually a heart monitor with defibrillators to monitor the heart and to shock the patient if required.

Next to the heart monitor is a box or bag with respiratory therapy equipment needed to intubate and manage the airway of a patient should the patient stop breathing, or should the breathing become inadequate. Also up on top is a clipboard one nurse will use to record. This nurse if often referred to as the recorder.

Sometimes the respiratory equipment is locked inside one of the drawers, although I think it's best on top the cart for easy access in an emergency.

In the drawers are suction equipment and an assortment of emergency medicines for all sorts of situations that might arise in an emergency situation. It will have Advanced Cardiac Life Support medicine like epinepherine, atropine, amioderone, cardizem, dopamine, etc. It may also have Albuterol in case the patient is having trouble breathing and nebulizer equipment.

When there is an emergency situation most hospitals are now universal in calling overhead "Code Blue!" When this is called all members of the code team are to report to the specific location, with one member bringing the crash cart.

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42 undeniable truths about healthcare

Surely some of these may be controversial, as the truth often is. Yet the following are the 42 undeniable truths of the healthcare industry:

All medical professionals have an inert yearning to be self reliant and use the education and experience they've obtained
The way to improve the healthcare system is to get the government out of it.
The RT (doctor, RN) at the bedside knows what's best for the patient more so than an order set
Order sets are are socialistic and are an excuse for doctors and nurses to be lazy
Protocols are capitalistic and encourage thought
I am not arrogant
Supervisors quickly forget what it was like to work on the patient floors
The way to reduce healthcare costs is to make everyone pay for each service
DRGs increase medical waste and lying about a diagnosis just to assure reimbursement
Keystone Committees are an attempt to enforced socialized medicine
Evidence Based Medicine is a nice way of saying everyone must do it the same
Intensity of Service is an excuse for doctors and nurses to lie
Quality Assurance Analyzers are only needed because the government is involved in healthcare
Tylenol is not a default cure for all that ails a patient
Throwing everything at a patient in the hopes something works is not common sense
Regulating hospitals does not make for better healthcare, it makes for fewer hospitals
We need more humor in healthcare
Bronchodilators treat shortness of breath due to bronchospasm and nothing more
They hypoxic drive theory was a hoax created to make respiratory therapists relevant in the 1960s
Xopenex is the same as Albuterol with the same effect and same side effects.
IPPB does not work better than patient coaching with an incentive spirometer to treat and prevent atelectasis, and studies prove this.
Too many patients are put on a ventilator out of panic rather than logic
Much of what respiratory therapists do is either a waste of time or delays time
Dyspnea with exertion is not asthma and should not be treated with a bronchodilator
If it's audible it's not bronchospasm
If it's coarse it's rhonchi.
The best way to hear lung sounds is to use a stethoscope on the patient's chest
The best way to assess a patient is by touching the patient (not by talking over the phone)
It's immoral to NT suction an awake, alert and orientated patient
Respiratory therapists are not ancillary staff (they are professionals knowledgeable in an area beyond the scope of most physicians)
Doctors and nurses who are stupid about respiratory therapy don't know they are stupid about respiratory therapy and most will never admit it
If you refuse to do a breathing treatment that isn't indicated you are not being lazy
BIPAP does not help fulmonating edema by forcing fluid out of the lungs, it reduces fulmonating edema by reducing venous return and therefore reducing cardiac output so the heart can catch up
Supplemental oxygen will not treat anemia, and is not indicated just because someone has chest pain because if all the seats on a bus are full, the extra passengers won't get a seat
The truth hurts before it makes you better
Scientific evidence disproves that albuterol will treat pneumonia, CHF, rickets, cystic fibrosis, lung cancer, pulmonary embolism, pneumothorax, pleural effusion, detox, dehydration, and even emphysema and chronic bronchitis. It only benefits these patients if asthma (hyperactive airways) is a component of said ailment.
All that wheezes is not asthma
All dyspnea is not asthma
If a patient is obnoxious, annoying, belligerent, rancid, or has maggots, respiratory services are not automatically indicated
Order sets and physician convenience are not indications for using the word stat.
The clinical picture doesn't always match the science (i.e., hypoxic drive hoax, hoaxenex, and studies showing inhalers work the same as nebulizers)
Some studies are conveniently ignored by the medical community (such as beta adrenergic receptors don't exist in lung parynchema and renal tibules.)

How to Fight Acne and Win

Many people have to deal with acne at some point in there lives, but others have to deal with it for much longer than others. Usually people are in their teens when they have to deal with acne, but the truth of the matter is that acne can affect adults as well. While this may all be a natural part of growing up, there are a few things that can be done to make the situation better. Continue reading if you would like some information on how to deal with acne.

One of the main ways to prevent acne is to make sure that you keep your face clean at all times. There are several brands of beauty bars that were formulated to combat acne, and you should consider using one of them. Do not use soap made for the body because it is much too harsh and it may irritate the skin on your face. Keep your hands off your face as much as possible, since you can transfer dirt and oil to your face and make things worse than they already are.

It is much easier to say you want to eat healthy than it is to actually do it. While this is true, you will have to eat better if you want to see your symptoms get any better. Eliminate all processed foods, oily foods and sweets from your diet and you should see improvement. Substitute those things with fresh fruits and vegetables if you want it to have much more of an impact.

Avoid going out into the sun too much if you have acne, particularly if you have oily skin. A rise in temperature sometimes creates excess oils in the face and this can cause acne. If you must go out into the sun, make sure that you use a product on the face before you go out that will stop the oils from forming.

There are several over the counter remedies for acne, but you should be careful about using any of them. While they are generally safe to use, you should stop using them if you notice that your acne is getting worse instead of getting better. If you find a product that works, stick with it since switching brands too often can cause skin issues.

If you have acne that looks unsightly, you can buy an acne treatment cream that also acts as a concealer. That way you will be able to have confidence when you walk out of the door, but at the same time you are treating your acne.

If you have tried several methods and none of them have worked, you should go and see a dermatologist. After examining you he should be able to tell you what the next course of action should be. There are prescription strength creams and oral medications available, and one of them may be the solution to your problem.

While it is not likely you will be able to avoid acne altogether, following the advice given here will help you keep your breakout to a minimum. You should be able to walk outside with confidence after your acne troubles are a thing of the past.

Up with IPPB

As my regular readers know, I am not a fan of the IPPB as I wrote in my post "Down with IPPB." Yet if you are ordered to use it you might as well do it right.

For this reason I approached one of my fellow RTs -- Jane Sage --who's been working in the field since the mid-1980s. She provides us with the following IPPB wisdom:

Many of our newer respiratory therapists don't know this, but that little green IPPB (Intermittent Positive Pressure Breathing) machine that sits in the corner of storage rooms collecting dust used to be ordered for admitted patients like Ventolin is ordered today.

Those little machines first hit the market in the 1950s and were your first positive pressure ventilators. I bet you didn't know that. The problem with using this pneumatic device as a ventilator is that you were forcing a set pressure into a patient and there were no alarms. Likewise, you had no idea actual pressure you were using, and you had no idea what volumes you were pushing into the patient.

If you ever watch old episodes of that old movie called "Emergency" from back in the 1970s you can see the IPPB used as a ventilator. I don't know if you've ever heard of that old show, but I used to enjoy watching it, even if it was somewhat medically inaccurate. For instance, every time CPR was given the patient would instantly wake up and be fine and walk off. I've never seen that in real life, yet I digress.

So as better ventilators were invented, such as the Emerson and MA1 volume ventilators, the IPPB was released from it's duty as a ventilator. Yet much like the makers of baking powder tried to find other ways of re-marketing their product, so did the makers of the IPPB machine. Doctors were convinced that IPPB therapy would benefit every patient admitted with a respiratory disease. This was already going on in the 1950s, and it continued to the 1970s.

It was believed that the positive pressure breaths from this machine would re-open resistant alveoli and benefit post operative patients, and therefore prevent and treat atelectasis. It was also believed it would force bronchodilators deeper into the lungs, and enhance the effect of this therapy. So IPPBs were used for just about every patient.

When we had paralyzed patients ordered to take this therapy, or stroke patients, we used to use a special mouthpiece and we'd hold it over their mouths for the entire treatment.

In fact, it became such a common device that in some places there were clinics where several IPPB machines were bolted to tables and COPD patients lined up for their daily IPPB treatment. The patient would sit down and get his treatment. When he was finished the circuit was replaced with a new one and the next patient sat down.

Yet then studies were done to show that the IPPB could actually do more harm than good to some patients with lung disease. For example, if an emphysema patient had blebs, too high of a pressure could pop a bleb and cause an even greater problem, and even death. It was also learned that IS therapy was equally as effective as IPPB, that the pressures required to prevent atelectasis were rarely reached, and IPPB therapy actually made bronchodilators work less well, not more. So IPPBs slowly declined, so that they are rarely ever ordered today.

By the 1990s the IPPB machine was used for post operative patients to treat atelectasis. Yet by the late 1990s newer RTs weren't taught about this machine in RT school as most hospitals phased them out altogether. RT teachers didn't want to spend quality time teaching about a device that was seldom used.

So by the 2000s the device was still ordered on occasion, yet when it was ordered the therapy wasn't provided adequately by poorly trained clinicians. Yet I contest to this day that in certain conditions IPPB therapy can be very beneficial, and it's not above me to recommend it from time to time on the right patient.

Usually these patients will be post operative patients who aren't taking adequate breaths and are an impending respiratory distress waiting to happen. Using the IPPB for these patients can help to open those resistant alveoli and prevent the patient from buying a ventilator.

If you are ordered to use it you should know how to use it correctly. If you don't use it correctly it's nothing more than a glorified incentive spirometer. So, how do you use it correctly? How do you know if the patient is using it correctly?

First, you dial in the settings. A good place to start is a Peak Inspiratory Pressure (PIP) of 10 and a flow of 10. The sensitivity is usually set at about five. Then you adjust the settings to meet the demands of the patient. Ideally, PIP should never exceed 15. Rarely did I ever have to go higher.

You fill the cup on the circuit with whatever medicine is ordered, usually it's Ventolin or Xopenex. During the 1980s we usually used Alupent, yet that medicine has been since phased out because it has a greater cardiac effect than today's watered down bronchodilators. Back in teh 1950s ethyl alcohol was used for heart failure, Isuprel was a bronchodilator used for asthma and COPD, and mucomyst was used as a mucus thinner in COPD and CF patients. Yet now it's usually Ventolin or Xopenex.

Then you tell the patient to place the mouthpiece between his lips, close his mouth around it, and to start to inhale. Yet you will want to tell the patient to allow the machine to fill his lungs with air. When the set pressure is met, the expiratory cycle will be triggered and the patient can exhale.

To know the patient is using the device correctly you watch the pressure gauge. When the patient triggers the breath the pressure gauge should go negative for a second (like to -5 cwp) and then it should go positive. The pressure should gradually be increased until the expiratory cycle has begun.

Now, if the pressure goes way negative, such as to negative 10 or 20, then you know the patient is sucking in too hard. When this occurs the patient is using the device as a glorified incentive spirometer and you are wasting your time. You will want to coach the patient so he is using the device correctly.

A good IPPB therapy takes time and lots of coaching. It's okay to give the patient a break every few minutes, yet the therapy should be continued until the medicine in the medicine cup is gone. A full duration IPPB treatment should be about 10 to 15 minutes. And I must add, since you are using pressures that could be dangerous if improperly used, the therapist must stay in the room with the patient during the entire treatment. It's not like a neb treatment where you can leave the room if necessary. If you leave the room, if you must leave the room, please stop the treatment. I knew of an RT once who was fired because he left IPPB patients unattended. Not good.

So there you have it. IPPB therapy may not be as in demand as it once was, yet from time to time it can be a very effective therapy for the right patient. When used correctly, IPPB therapy can prevent further deterioration of a patient's medical condition.

Thanks, Jane Sage

Thank you, Jane. We always appreciate your wisdom. We hope you're enjoying your retirement.

Also read: The IPPB Revolution: The history of Intermittent Positive Pressure Breathing

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Does asthma effect your sex life?

Your question: My docter told me that my asthma will prevent me to have a proper sex life. He said that in 7 years i'll be like a 70 year old woman when I'll be of only 24years old. I'm still a virgin and I do not really know if this is true or not. I'm really scared and don't know what to do. Help?

My humble answer: I have never heard such folly in my life. If your doctor is telling you stuff like that then perhaps it's time to get a new doctor. It's not true. You should call your doctor and ask him or her to provide you with some evidence. If he does please share. So don't worry about it. If you need any proof, I've struggled with asthma for 42 years and have four kids.

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How to Keep Your Face Free of Acne

Nearly everyone experiences acne at some point their lives, but the severity of it varies from person to person. If you have serious acne or just an occasional outbreak, you can use some of the tips in the following article to help you deal with it.

The first thing that you should keep in mind when it comes to keeping your face free of acne is the fact that you have to keep your face clean. There are beauty bars that are specially formulated to be gentle on the face. Never use a regular bar of soap to wash your face because it is too harsh and it can dry your face out.

You should never touch your face with your hands. There is dirt and/or oil all over your hands and you will transfer that to your face if you touch it. If you have to touch your face for any reason, you need to make sure to wash your hands well beforehand.

Body lotion is great for keeping your skin nice and smooth, but you should never use it on the face. If your face is dry, you should try applying a moisturizing cream to it. That should keep it from drying out and cracking and/or peeling.

There are a few foods that are said to help prevent you from getting acne. These food include walnuts, olive oil, apples and yogurt. You should limit the amount of fatty and/or fried food in your diet because they have the opposite effect, which means they will worsen your acne.

There are many people that have acne breakouts whenever they are under stress. This type of acne is hard to get under control, since the cause is not something that is easily controlled. The best thing you can do is to find ways to cut down on the amount of stress in your life if you notice that it is making your acne flare up.

There is no acne medication that can be called the best because different things work for different people. While a friend of yours can have great results with a product, you may not have any success with it at all. The best thing to do is to talk with a doctor to see what they recommend for you.

Wearing makeup is a great way to enhance your looks, but there is a downside to it. If you wear a lot of makeup, you run the risk of worsening your acne. This is because wearing too much makeup can clog your pores, and when your pores are not clear, that can lead to acne.

If you are experiencing problem with acne, there are times when it might seem like it will never go away. For some people this is true, but the majority of the time it just takes a certain type of care to alleviate the problem. By using the tips mentioned in this article, you can look forward to having a face that is free of unwanted acne.

What happens when asthma goes untreated?

The following was originally published at HealthCentral.com/asthma on May 3, 2011.

What Other Medical Problems Can Occur When Asthma is Untreated?

It's said a gallant asthmatics can live a normal, active life. Yet what happens to the goofus asthmatic who doesn't treat his asthma?

The truth is, many goofus asthmatics are lucky and are able to escape without asthma trouble, yet far too often they end up making frequent visits to their doctor, or to the local emergency room for asthma flares. Sometimes they simply stay home and tough it out like our Martyr Asthmatic.

While it's rare, untreated asthma can lead to serious medical problems that can make asthma even harder to control. Consider the following worse case scenario.

Joe Goofus refuses to see his doctor, and he is too dog-gone lazy to take his Advair discus, or maybe he simply forgets to take his medicine. He also refuses to avoid his asthma triggers. He's simply a bad asthmatic patient.

So after sifting through dusty boxes in his basement, he makes yet another rushed trip to the emergency room. His asthma is so bad this time that he needs to be admitted to the hospital. He's put on systemic corticosteroids.

Finally after a couple weeks in prison he's released on good behavior, and he once again quits taking his asthma medicine. He's short of breath for two weeks before he finally decides to seek help.

He's readmitted to the hospital and put back on inhaled corticosteroids. The cycle continues.

The following are the risks of untreated asthma:

1. Severe Asthma: Asthma that is not diagnosed and treated agressively with asthma controller medicines can increase the risk for lung scarring. This is permanent damage to your lungs that can make you always feel short of breath. It also makes it so your asthma might not be reversible when you use your rescue medicine (Ventolin or Xopenex). This type of asthma is called severe, persistent asthma, Chronic Obstructive Pulmonary Disease (COPD) or what I like to call hard luck asthma.

2. Steroid side effects: If Joe needs systemic corticosteroids long term to control his asthma, serious side effects can occur that can make it even harder to manage his asthma, such as:

Fluid retention: Swelling in your legs
Increased blood pressure
Mood swings: Can effect how you manage your asthma
Weight gain: Chemicals released from fat can trigger asthma, plus obesity makes it even harder for you to get the exercise you need to manage your asthma, and keep your heart and lungs strong
High blood sugar: You'll now have diabetes that needs to be controlled
Infections: Can you imagine if you also developed pneumonia?
Thin skin: It easily bruises and is slow to heal.

3. Anxiety/ stress/ depression: These can make it even more difficult for Joe to manage his disease, although treatable.

4. Muscle wasting: His lungs become so bad he's unable to get the exercise he needs. This can greatly complicate caring for Joe. It can lead to obesity, which complicates things even more.

5. Respiratory Failure: If Joe doesn't seek help, his asthma attack might get so bad he simply poops out. This is a serious complication that must be treated immediately. It can lead to death.

While what I describe here is the worse case scenario, I've seen it. It's basically self-induced hardluck asthma. It's not pretty. It can also be avoided.

It's much better to be a gallant asthmatic. It's much better to be properly diagnosed and stay on a treatment plan.

Asthma experts have long said asthma is easiest to control when it's diagnosed right away and treated aggressively. Now you know why.

Building Hope

Last week I attended and presented at the MASOC/ Massachusetts Association for the Treatment of Sexual Abusers 14th Annual Conference on The Assessment, Treatment and Safe Management of Sexually Abusing Children, Adolescents and Adults. I particularly enjoyed being part of a gathering of NEARI Press authors, and celebrating my soon-to-be-released book. It is in the NEARI press catalog and is expected to come out in June. Steve Brown also presented, his workshop was entitled: “I Can’t Get that Picture Out of My Head” – Vicarious Trauma in Work with Sexual Abusers – What It Is and What We (and Our Agencies) Can Do About It? My presentation was entitled: How to Use the New Brain Science to Provide More Effective Treatment- and to Have More Fun at Work. I guess you are doing okay as a presenter when the only improvement suggestions you get are to make the presentation longer. I was very moved when later in the day a woman I did not know came up to me and said: “that was the most helpful presentation I have ever been to”. If you are reading this in CT, I will be presenting on the same subject at the NASW Annual conference this Friday.

I attended a workshop entitled Parenting with Love and Limits (PLL): A Promising Practice for Sexually Aggressive Youth by Paul Castaldi, MSW. The presenter referred to a meta-analysis of the amount of improvement in treatment (I did not get the citation). He stated that the one variable that consistently correlates with improvement is the creation of hope.

So this made me start thinking: how do we actually create or enhance hope? Many of our clients have good reason to feel hopeless. We serve children who have no adult connections, children who have been hurt and betrayed repeatedly. We serve adults whose own early trauma histories have never been attended to and who feel despair about the ways in which their symptoms have interfered with their parenting. The system we work within is certainly not always responsive or able to give people what they need. Where then do we find the hope?

I think we often assume that we have to give clients concrete facts in order to create hope. We talk about pointing out their strengths, and remarking on instances of improvement. We try to create opportunities for clients to learn and grow, and to experience success. All this is of course extremely important.

But I think we underestimate the hope that is created by forming an attuned, mutually respectful relationship. In such a relationship the client feels seen and heard. They feel a sense of belonging, of being part of something. Early templates about relationships always being associated with hurt and loss are challenged. The client gradually builds a secure base, a place he can return with triumphs or with pain. The client also builds an inner connection: he takes the treater into his mind, creating a caring voice that can soothe him in times of stress.

The very participation in a respectful relationship creates hope that there may be other relationships like this in the future. Maybe there are some people that can be trusted. Maybe love is a possibility after all. The opportunities in life expand.

As the relationship experiences difficulties (the child hits the staff member for example) and these are worked through and the relationship persists, new hopeful possibilities emerge. What if it is not true that whenever you do something wrong the other disappears? What if it is possible to get through hard times and reconnect?

One profound way that enduring relationships increase hope is through their effect on shame. Shame is the sense that deep within me I am no good, that I have a rotten center, and that anyone who gets to know me will turn from me in horror. But what if in fact this doesn’t happen? The antidote to shame is to be known, to share the secret self, and to have the other person not be repulsed. This is so hard to accomplish, because the person who experiences shame is so reluctant to share his true self, which he feels is so horrible. But if we are able to create a relationship that is strong and safe enough, and the client does share with us the parts they hide, we have a precious opportunity. By validating and not turning away, we begin to heal the shame. Consider how much hope flows into a person’s life as shame decreases, and the possibility of being a normal human emerges.

So, here are more reasons why we must emphasize the relationship as the vehicle of healing. This means providing time and space to build relationships, and creating policies and procedures that promote and honor them. It also means taking good care of our staff so that they have the stamina to stay open-hearted in these difficult relationships, and attending to the vicarious traumatization that is created by doing so.

And it also means paying attention to the personal transformation that can occur for us as treaters through increasing hope. Our own personal hope grows when we watch hope blossom in a child or a parent that has been wounded by life through no fault of their own, and who now is open to the possibility of love in their world.

Preventing break outs by staying clean

Break outs are caused by bacteria or an excess of oil in your skin. You can avoid most break outs by keeping your face as clean as possible. Here are a few tips to help you.

Your hands probably have a lot of bacteria on them, especially after a day at work, school or in any public places. If you touch your face with your hands, you are going to transmit these bacterias to your face. Even if your hands are clean, you might spread bacterias from one part of your face to the other. Avoid touching your face with your hands as much as possible and wash your hands regularly.

Items of clothing might not be clean or might contain acid laundry detergent residues. Clothing can even disturb the balance of your skin by simply rubbing against it and irritating it, which leads to an excessive production of oil and to break outs. Wear comfortable clothes that do not rub against your skin and avoid wearing scarves or hats. If you do, keep these items as clean as possible and wear them only when you really need to.

Your hair might help spread more bacteria on your face or might irritate your skin, especially if your hair is oily. Keep your hair away from your face: style it backward or up if you can. You should also keep your hair clean: wash it one day out of two with a quality shampoo. If you have oily hair, use a specific product to regulate the chemical balance of your hair. Avoid using hair styling products such as gels or sprays: there products will clog your pores if they get in contact with your skin.

Do not wear the same clothes all the time. Wash your clothes regularly and do not wear an item of clothing that covers your face more than two days in a row. In case an item of clothing is rubbing against your skin, wearing something different the next day allows your skin to regenerate instead of staying irritated. Keeping your clothes clean is also a good way to prevent bacterias from spreading and eventually getting in contact with your face.

Your bed linens, especially your pillow case, retain oil from your skin and hair. You need to keep these items as clean as possible. If you can, change your pillow case every day. Keeping an old pillow case means the oil it retains will clog your pores again the following night. You can also replace your cotton bed linen with silk: this fabric does not retain oil or bacterias like cotton does. And do not let anyone else use or touch your pillow.

A damp towel is ideal for bacterias to spread. Keep your towels dry and change them regularly. After you are done washing your face, you should dry it by gently patting: rubbing it will cause more oil to be produced. Your towel is going to retain oil or bacterias regardless of how careful you are: make sure you do not use the same towel more than two or three days in a row, and change it immediately if it has been damp for hours.

Following these simple tips should help you keep your face clean and avoid break outs. Changing towels or pillow cases so often means you will have a lot of laundry to do, but remember that this is the best way to prevent acne.

The Best Approach To Tackling Your Acne Problem

Acne can be a stubborn skin condition to control. It is frustrating to have it recur, especially at the most inconvenient times, like right before a party. You need to find the right approach to deal with it in order to get it under control. This article outlines some simple steps that you can take to manage those outbreaks.

Acne outbreaks can be caused by many factors. Basically, it is a reaction of your skin to certain things. Changes in your environment can trigger an outbreak if your skin is highly sensitive to the changes. Certain foods that you have eaten can also cause a reaction that triggers it. Stress levels in your life can result in an imbalance of your hormones; this, in turn, may lead to a skin reaction. Whatever the triggers are, you need to identify them in order to avoid or minimize contact with them. Start keeping a journal of the times when your face breaks out. Then, jot down anything different that has occurred around that time, like places that you had gone to or foods that you had eaten. See if you can identify a common thread among those outbreaks. If you keep a detailed record, you may be able to spot something. This would be a good start in getting those outbreaks under control.

It is always best to speak to a healthcare professional about your skin condition. An experienced dermatologist can help you identify any underlying medical reasons that may cause your acne. Based on his findings, he can recommend the best course of treatment. He may prescribe medication that you would not be able to get otherwise. If you kept a record of the times of your outbreaks, bring that with you to your doctor's appointment. The more information your doctor has, the better he is able to treat your condition.

Acne can be exacerbated by clogged pores. The clogging is caused by the mixture of oil and dirt that build up on your face. It is essential that you keep your face clean at all times. At least twice a day, cleanse your face with a mild cleanser, then apply a toner to remove any residual dirt that your cleanser could not pick up. A couple of times a week, use a mild exfoliant, but only if your face does not have an outbreak. This method deep cleans your face by removing dead skin cells from your face and opening up your pores. If you are experiencing an outbreak, wait until it clears up before exfoliating.

Use cleansers that are made from natural ingredients whenever possible. Artificial ingredients tend to be more harsh on your skin, which can irritate your acne problem even more.

Medicated cleansers can be effective if your face can tolerate it. Consult with your dermatologist about this, and only use it as directed.

Even if your acne problem is persistent, you can still take action to minimize the severity of the flare ups. Use this article as a guideline in finding the best solution for your condition.

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