The link between asthma and intelligence

The following was published at myasthmacentral.com/asthma on June 13, 2011.

Does asthma make you smarter?

So does asthma really make you smarter?  I'm not being facecious either by asking this. In fact, the idea that asthma makes you smarter is one of the aformentioned "Seven Benefits of Asthma."

Asthma certainly can make you smarter!  Right?

I think so.  I surmise asthma forces us to become philosphers of sorts, and philosophers must be perspicacious to see questions others haven't thought to ask such as, "Does Asthma Make You Smarter?"

I'm pondering this idea today because I had a patient recently who was admittedly a hardluck asthmatic.  In fact, she's so hardluck she's become a good friend of mine.

She's admitted for asthma a lot, yet she's quite convivial, and she usually has to set down a book when I enter her room.  It's often our love of stories that sparks a discussion, and usually we become so rapt in some intelligent idea -- often philosophical -- time gets lost, sometimes hours.

She and I also have the asthma link to discuss.

We both love to learn. Her bedside stand usually has a stack of books, and magazines, and newspapers.  She might even have her laptop open to an interesting article, or her Kindle on.

Interestingly enough, one of our recent discussions was about my post about the benefits of having asthma, particularly about how I wrote that asthma can make you smarter.

She liked that idea, and noted asthma has obviously made both of us more astute.  Perhaps near death experiences force one to appreciate and to think uniquely.

Seneca wrote about this 2,000 years ago, back when the most effective asthma medicine was patience.  He wrote how having asthma forced him to find something useful to do with his mind, and he ultimately became a Senator and philosopher.

He wrote, "It is your body, not your mind as well, that is in the grip of ill health.  Hence it may slow the feet of a runner and make the hands of a smith or cobbler less efficient, but if your mind is by habit of an active turn you may still give instruction and advice, listen and learn, inquire and remember, Besides, if you meet sickness in a sensible manner, do you really think you are achieving nothing?"

Now it's not scientifically proven that if you have asthma your brain will somehow magically become bigger and you will somehow develop a higher IQ. Yet it is a proven fact that if you read and think you WILL get smarter.  It happens by default.

In fact, I read once that you have a memory muscle in your brain.  Lack of thinking causes it to atrophy, yet excessive thinking causes this muscle to increase in scope and size, such as when an athlete pumps iron.

Another interesting fact about asthma is it forces you to take a time out.  Often breathing exercises and relaxation exercises are needed to help you ease your mind and catch your breath.

New evidence, as you can see from this study, even shows that mindfulness meditation can help "relieve pain and improve memory by regulating a brain wave known as the alpha rhythm, which 'turns down the volume' on distractions."

While most asthmatics -- including myself -- may not be trained in mindless meditation, I think sometimes we're forced to do something similar to ease our minds and help us cope with our dyspnea.  

Even if my perspicacity is on the wrong track and I'm spurious with the brain wave conception, many asthmatics do tend to read more.  It beats sitting around feeling sorry for yourself when you're brothers are out in the allergy ridden woods chopping down trees.

Regarding this, Seneca wrote, "Leet me tell you, the things that provided me consolidation in those days, telling you to begin with that the thought which brought me this peace of mind had all the effects of medical treatment.  Comforthing thoughts contribute to a person's cure; anything which raises his spirit benefits him physically as well.  It was my Stoic studies that rally saved me.  For the fact I was able to leave my bed and was restored to health I give the credit to philosophy."

Many asthmatics before and since have experienced a similar epiphany.

To delve into a good book is so much more productive, and fun, than to sit around and say, "Oh, woah is me!"

Sure you can ask, "Why me?" Yet those of us with good character take advantage or our down time and we make the best of it.

If you're like me and my good friend -- and Seneca, you'll find something fun to read, or an idea to mull over, or at least some productive hobby to keep you busy. And by default you'll make yourself smarter.

Thoughts?

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My Book is Available!

Order from www.nearipress.org. Choose bookstore and then put my name, Wilcox, in the search engine.

I am so delighted to report that my book came out this week. It is entitled: Trauma-Informed Care: The Restorative Approach. This book is a practical guide to implementing trauma-informed care in all sorts of settings. The focus is on making our every day actions in treatment settings match what we know from brain science helps children heal.

Chapter One introduces the trauma framework, a useful road map to understanding both the effects of trauma and how people can heal. Although we have considerable new information about what helps people heal from trauma, many programs serving the children who have experienced the most trauma have not yet incorporated this information into their treatment or their programs’ milieus.

In the following chapters I provide a specific treatment design using this new brain science as the blueprint for treatment programs for children. Chapter Two is an overview of the method, including its theoretical underpinnings, day-to-day operations, how it addresses shame, and answers to common questions and concerns.

Chapters Three, Four, and Five use case examples to convey the specifics of the approach. Chapter Three focuses on demonstrating the daily workings of a trauma-informed treatment program. Chapter Four illustrates the power of how staff define and talk about the children and their behaviors. Chapter Five contains examples of the challenges of caring for traumatized children, and how the method works during hard times.

Chapter Six examines one of the most difficult decisions in implementing trauma-informed care: how to respond when the children hurt others. This chapter asks providers to consider their theory of change, and to operate from a theory of what will actually help the child be less likely to repeat this behavior. It introduces the restorative task, a response that incorporates opportunities for healing and for making amends, and gives examples of such tasks. Suggestions for improving tasks and how to respond if the child refuses the task are included.

Chapter Seven focuses on the role of the clinician in trauma-informed care, the characteristics of a clinician who will succeed in this system, and necessary training. In the Restorative Approach, the clinician and the child-care team work closely together providing individual, group and family therapy as essential parts of the treatment program. Treatment planning reflects the therapist’s theories of what steps help a child heal. As in all best-practice programs, the therapist will need support and supervision in order to lead the team in a clinical approach to behavior.

Chapter Eight covers the importance of providing trauma-informed care for the families. Most of the parents of children in treatment are themselves trauma survivors, which presents unique challenges in parenting. The program helps them by being attentive to their need to feel safe and to build trust. A key component is to recognize and honor their strengths, and to provide opportunities for the family to have fun and joy together. The families can be educated in the restorative approach and experiment with using it themselves when the client is at home.

Chapter Nine extends the restorative approach to foster care, describing how training in understanding trauma can help foster parents not to take behaviors personally and to keep the child despite behavioral problems. Formal training is important, and the support workers use of the theory to understand actual events will solidify the family’s understanding.

Chapter Ten looks at characteristics of the agency-as-a-whole that support trauma-informed care. The role of agency leadership is crucial in implementing this approach. The agency structure makes a big difference in the success of the Restorative Approach. Developing the necessary culture of connection takes time, but enables the approach to endure. The physical plant affects the experiences of both the clients and the staff.

Chapter Eleven, “Cultivating a Trauma-Sensitive Staff,” describes the processes that are essential to develop and maintain a good staff. Many agencies find that staff turnover decreases after the implementation of trauma-informed care. Hiring, training, supervision and promotion are all crucial tools. Certain skills that support a trauma-informed approach can be deliberately taught. Most crucial is attention to vicarious traumatization, the way the work affects staff and how they can take care of themselves and each other to stay alive and hopeful in the work.

Chapter Twelve covers the actual change process, and what steps an agency can take to facilitate the change. A transformation committee is a good mechanism to lead the change. Later steps include changing policies and procedures to solidify the changes. John Kotter’s Stages of Change (1996) form a helpful guide to examine the process.

Chapter Thirteen concentrates on sustaining the change. Unfortunately there are many forces pushing the system back towards a punitive approach. Certain challenges can be predicted and addressed.

Chapter Fourteen emphasizes measuring and celebrating progress. The chapter presents various factors to measure and scales to utilize in measuring them. Results garnered from these data can be shared with funders, the Board of Directors, consumers and other stakeholders. Celebrating success will help sustain the transformation.

The Appendices contain useful tools for agencies to employ.

The books can be ordered from www.nearipress.org. Choose bookstore and then put my name, Wilcox, in the search engine.

If you do read the book, PLEASE email me (patw@klingberg.org ) and let me know what you think of it. I hope you will find it to be a valuable resource to you in implementing and sustaining trauma-informed care.

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What is an order set doctor?

Order set doctor:  A doctor who orders everything he can possibly think of.  He fills out every order set possible with the hope that something -- anything -- will work.  He covers all his bases by ordering as many procedures as possible.  Yes there will be duplicate orders and even triplicate orders.  Yes the unit secretary will go bonkers trying to sort it all out, and the nurses and respiratory therapists will snivel about doing all the "useless" stuff.  But that doesn't matter because the theory is that if you throw everything at the patient, something is bound to work. 

Medicine is no longer about tailoring therapy to the needs of the individual, it's about treating every patient the same (see cookbook medicine) and hoping something works. It's making sure you did everything so you can avert a potential lawsuit. Common sense and individual thought seem to have taken a back seat to cookbook medicine.  What do you think?

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The kindness rule

The kindness rule involves stocking.  It's being considerate of your coworkers, and if you use the last of something, you replace it.  Or, if you're too busy to replace something, you tell your coworker during report so he can restock it.

If the kindness rule were followed at all times everything would always be in stock, and when you need something it will be where it's supposed to be.  This would work great because when you need something you won't have to search all over for it and look like a goofus RT in the process.

The kindness rule also entails cleaning and redressing ventilators and other such equipment as soon as it's done being used by a patient.  You should also do the function checks as necessary.  Or, if you are unable to do it, tell your replacement.

The kindness rule also entails getting all your work done.  If an incentive spirometer is ordered one hour before your shift ends, you should go out of your way to do it.  However, if you are extremely busy, the kindness rule allows you to notify your relief the work needs to be completed.

The kindness rule involves consideration for the other people you work with.  It involves a common sense approach to getting your work done and not leaving work for other people.

So we'll make this RT Cave rule # 58: The kindness rule entails that you get all your work done so you don't create work for your coworkers.

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Things that affect distribution of aerosolized meds

What are some things that effect distribution of aerosolized medicine to the air passages of the lungs?

1. Tidal volume or depth of breath
2. Rate (ideally you'll want a normal rate)
3. Speed of inhalation (ideally you'll want a smooth laminar flow)
4. Crying (results in prolonged expiration and too fast inspiration (turbulent flow)
5. Breath hold (can increase deposition)
6. Narrow air passages (asthma) can cause increased deposition into central air passages instead of lung periphery
7. Mucus plugging (excess mucus)
8. Nose breathing as compared with mouth breathing
9. Atelectasis

Source: Source:  Elliot, Deborah, Patrick Dunne, "A Guide to Aerosolized Drug Delivery," American Association of Respiratory Care, page 9

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The link between thunderstorms and asthma

The following was published at myasthmacentral.com/asthma on June 8, 2011.

Do thunderstorms trigger asthma?

A cool refreshing breeze redolent of rain is wafting over me as I write this.  The sky is overcast, and dark clouds are moving in; a distant rumble heard.  As I inhale I can feel a slight tightness deep within.

This reminds me of an article I read a few years ago that said most asthmatics have fewer symptoms during the summer months, yet this isn't so true during or after a thunderstorm.

The evidence showed there were an increased number of emergency room visits on days when there was a thunderstorm.

So many asthmatics complained of asthma symptoms after thunderstorms this prompted the powers that be to pay lots of money to study this matter.

I read it first at COPD News of the Day in her post, "Weather and COPD -- thunderstorms linked to asthma attacks."  She wrote about a study completed in the southern states by researchers at the University of Georgia and Emory University.

The study, which you can read more about here at Science Daily, examined 10 million emergency room visits for asthma in hospitals around Atlanta from 1993 to 2004, and concluded there was a three percent increase in asthma visits on the day after a thunderstorm.

Experts surmise this may be because rain causes pollen grains to rupture causing minute particles that can be inhaled.  If it's windy (I can still feel the breeze) these particles can waft right up your nares and into your lungs.

And of course we know what happens from there.  If you're allergic to pollen, inflammation in your sensitized lungs increases, and you feel tight -- like I do now.

Another study reported here at Medescapes.com was done in 2003 in the United Kingdom and showed emergency rooms visits for asthma exacerbations increased 8.6-10 percent the day after a thunderstorm.

This study showed an increase in fungal spores by 50 percent, and determined this might be a possible cause of increased thunderstorm related asthma.

I observed rain as an asthma trigger years ago, yet I figured it was due to a change in barometric pressure or increased humidity.  Yet the theories noted above make sense too.

The experts may continue to debate the cause for some time, yet it does appear that thunderstorms can indeed trigger asthma.

Of course we could shut our windows and hide in a bubble somewhere like my 2-year-old daughter would like done.  She's now grasping my leg and saying, "Daddy, I'm scared!".

Yet then we'd miss out on a good thunderstorm, and the cool, refreshing breeze it provides.

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The first testament came from testicles?

Yes you read that question right.  The ancient world had no concept of anatomy, disease and bacteria.  They reasoned that bad health and bad days were the work of all the spirits that are ubiquitous.

We don't live in fear of bacteria.  We wash our hands, clean wounds, and do common sense stuff like that.  In the same way primitive and ancient men and women didn't live in fear of demons, spirits, mad gods.  They learned to live among them.

They had incantations, prayers and amulets to fend off the spirits, to keep them happy, to maintain a good balance between the living and dead.  In Ancient Mediterranean countries one such amulet was the genitalia.  Consider the following:

"In Latin, the word testis (hence testiculus, little testis) means both 'witness' and 'testicle,' while the Greek word for 'testament,' diatheke, literally means 'by the bag,' which is equivalent to 'by the scrotum' as suggested by the Latin testamentum (that is, 'testiculation').  All this is related to the fact that it was universal custom in the ancient East to pledge faith or swear testimony by touching or grasping one's own and/or another's genitals."

Imagine, instead of setting one's palms on a Bible and swearing an oath, placing your hand on your crotch.  Some customs change for the better.

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What is work?

Many times in passing people in the hall I ask, "So, are you working hard?"  I think this makes for a better comment than, "So, how are you doing today?"  I don't wait for an answer, yet I often get chuckles.

So today I was asked my own question in passing, "So, are you working hard tonight, Rick."  I surprised her with this response:  "It depends on your definition of work?"

"Um, work is when you are being productive?"

"Well, I am being productive, yet is productivity actually work?  I can be productive doing something I'm being paid to do, or I can be productive doing something I want to do, like blogging."

"I see," she said, smiling.  "So what is the definition of work?"

"So I guess work, by our bosses definition, is being productive doing something you're getting paid to do, like respiratory therapy stuff.  If that's your definition, then no.  Yet I am being productive one way or another."

"Or..."

"Or is work laboring and sweating and stressing..."

Yes, we have a little fun here at work (the place where we get paid).

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Have guidelines replaced critical thinking?

I think guidelines and order sets are good in a way, yet more often than not I think they are used as a crutch, or as an excuse to be lazy.  I honestly and truly believe guidelines and order sets have replaced critical thinking.

Guidelines are good in that they help "guide" our thought decision process.  They help us with the critical thinking process given an individual set of circumstances.

A good example here is Basic Life Support (BLS) and Advanced Cardiovasular Life Support (ACLS).  Given a specific emergency situation, and given specific medical training, these programs help people decide what to do in various emergency situations.

That sounds good, yet it's not always good.  For instance, most BLS programs say you should give breaths after so many chest compressions for people in presumed cardiac arrest.  Yet some people get so  intent on making sure they give breaths that they become overwhelmed and do everything wrong.

In this way, the layman's attempt to do BLS right replaces common sense, which would dictate that if you do chest compressions correct you shouldn't have to give breaths.  Common sense also dictates that if you give mouth to mouth breaths you are giving that person less oxygen than is in room air, which is not enough to sustain life.

Common sense would say you treat the patient not the order set, guideline or "ALGORITHM."  Yet there are a ton of nurses, respiratory therapists and DOCTORS who's main focus is on order sets, guidelines and algorithms, and they focus so hard on following these things they don't think.

Those who suffer are the patients, who get less than adequate care.  I can give example of up the ying yang, starting with doctors who order Albuterol on every patient because they were taught in medical school that this drug cures all annoying lung sounds and lung diseases.  Yet an accurate assessment of the patient, with a dose of critical thinking, would reveal that the patient actually needed lasix.

The best example I can think of was once a patient was inadequately breathing yet was still awake.  ACLS guidelines say if you have to put a mask over a patients face so you can give breaths with an AMBU bag you should have a second person hold the mask firmly over the patient's face and have a second person give the breaths.

Yet I was doing both on my own, and the patients sat was 99 percent.  The patient was getting adequate breaths.  Yet the doctor insisted I take my hands off the mask and she held it so tight that air was squeaking out the edges of the mask.  The patient was fighting.  Then all of a sudden the patient's sats were in the 70s and the doctor panicked.  She said it was my fault because I didn't follow the ACLS guidelines.

Yet I disagreed.  I told her it was her reluctance to do critical thinking that caused that patient's sats to suddenly drop, and it was for that reason this patient needlessly died of asphyxia.  She died because she was so intent on following the ACLS guidelines that she failed to think.  She killed the patient not because she had bad intentions, but because she was taught to follow the guidelines.

What we must realize is that guidelines, order sets and algorithms are good, yet they are just that -- guides. Guidelines must not replace the critical thought process.

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Tips for reading chest x-rays

To get a good idea of what's going on with our respiratory patients it's a good idea to look at chest x-rays.  We RTs aren't expected, nor do we need to, be as proficient at reading them as a doctor, yet it's still a good idea to be able to see basic abnormalities.

This post is intended to simplify chest x-rays interpretation from an RT perspective.  For the purpose of this post we will be looking at posterioranterior (AP) films.  You should look at these as though the patient were standing right in front of you and facing you.  Ideally you should have an older chest x-ray for comparison, although often this is not possible.

You can see the landmarks in a normal chest film below:

(a) A normal chest film with landmarks

(b) A normal chest film with lobes marked.

You should also note that the right diaphragm is 2/3 higher than the left.  When these landmarks are not in their correct anatomical position this can indicate an abnormality. You should also observe that light bounces off solid objects causing these to appear white on the film.  With this in mind, the following are true:

• Gray is usually indicative of fat
• Black is air
• White is a solid object (bone, metal, mass, fluid, fibrotic tissue)

Most lung diseases are associated with an increased density within the interstitium, the air spaces or both. Increased density is generally seen as white, or increased whiteness of the lung fields, or more whiteness than what is normally present on a chest x-ray**.

Now that you have the basics down, you will want to have a "systemic approach" in looking at these films. Each radiologist may have his own system, yet a common one is as noted below:  Note that this post is from an RT perspective, so I may have left one or two steps out.

 1.  Check the Airway:  Is the trachea mid line?  If it is shifted this could indicate an abnormality as you can see in this post. You'll want to observe the Carina, which is where the trachea bifurcates.  It should normally be midway between the clavicles or over the spine at the 6th posterior rib or T4.  The ETT should be 2 cm above the carina.  The spine should go down the middle of the air column, and shifts may indicated scoliosis, kyphoscoliosis or other spinal disease that may cause a lung restriction.

2.  Check bones:  I'm not going to go into detail what to look for here.  Bones should typically appear white.  A break should be seen as a darker mark.  If the bone appears darker or whiter it may be an indication of a disease process, such as a sclerotic bone may appear whiter.  The ribs should be of equal distance apart.  A narrow spacing between ribs may indicate paralysis on that side.  Severe coughing can cause rib fractures, and this may be see on the 6th through the 9th ribs***

3.  Check the heart:  A normal heart size should occupy half of the left lung.  If it's greater than this you have some degree of cardiomegally. If the heart looks like a water bottle this could be indicative of a pericardial effusion. The right heart should show up as two bulges in the right middle lobe.  If they are not present this could indicate a pneumothorax of the right middle lobe***.

4.  Check the diaphragm:  A flat diaphragm may indicate hyper inflated lung, which may be indicative of emphysema or severe asthma attack.  A flat diaphragm can easily be spotted if you see that the left and right diaphragm are at the same level. 

(c) Note blunted costrophrenic angle

5.  Check the costrophrenic Angles:  These are the angles of the lower left and lower right of the lungs.  The angle is normally sharp.  If it is blunted or rounded, this is indicative of a pleural effusion.  It may also be blunted with heart failure.  This angle is blunted because gravity pulls fluid down**. 

6.  Check the lung fields:  You should be able to see the air passages as they branch from the trachea, bronchi, bronchioles. The smaller air passages and alveoli should not be visible.  However, certain conditions will make them visible, such as pneumonia, atelectasis, pulmonary edema, pulmonary fibrosis, etc. 

Fluid in lung tissue may cause a thickening of tissues of the air passages, and this may cause the passages to show up more clearly (they will be whiter).  Depending on where they are in the lung will help determine the cause (although it's mostly a guess based on the patient's presentation and history).  If it's isolated to one area of the lung it may be a lobar pneumonia.  If it's in both lungs, like in both lung bases, it may be indicative of heart failure (pulmonary edema). 

Things to look for in the lung fields:

(d) White arrows point at atelectic regions

• A.  Atelectasis: Usually looks like a white linear (straight) line. It's the most common finding, and is often caused by mucus plug or tumor.  You can see a good example in picture c.
• B.  Consolidate:  Solid white that you cannot see through.  You cannot see landmarks.  If it is isolated to one region of the lung, or is circular, it may be indicative of a lung mass.  It could also be a really bad pneumonia.  
• C.  Infiltrates: When fluid builds up in the interstitial walls of the bronchioles and alveoli, these make these air passages appear whiter than usual.  Since only the air passages are white, you should still be able to see the landmarks behind them.  Thus, infiltrates are patches of  whiteness that you can see through.  It's generally described as patchy, or patchy infiltrates.  It's indicative pneumonia if it's isolated to one region of the lung.  If it's in both regions (such as both bases) it could be indicative of fluid build-up due to heart failure.



(e) White arrows point at consolidation

• D.  Air bronchograms: 
• E.  Pleural thickening:  Fibrosis of the pleura indicated by a white line around the pleural region.  It's almost always preceded by a pleural effusion, and causes a restirction *
• F.  Peribronchiolar thickening:  This is
• G.  Silhouette sign:  When you cannot see the "silhouette" of the lung markings due to whiteout (infiltrates or consolidation) due to fluid buildup or a mass in the normally air filled lungs.  See figure g.  In this figure the whiteout (opacity) is pneumonia.
• H.  Air bronchogram:  Usually the smaller airways and the alveoli are not visible on the chest-x-ray.  Certain disease conditions cause the tissues that surround the bronchi and the alveoli to become opacified (white).  This makes it so you can easily see the outlines of these parts of the lungs (you can clearly see the bronchial tree).  It can be due to consolidation (fluid) from pneumonia, pulmonary edema, ARDS, alveolar cell cancer, lymphoma or sarcoidosis.  See figure h.
• Nodule:  A circular opacity on the chest x-ray.  It may be dicative of calcification and be comletely benign (as in scarring from a past pneumonia), or it could be cancer. See figure e for a good example of a nodule.
• Kerey B lines:  These are lines that are usually seen in the right lower lobe near the costrophrenic angle.  They are perpendicular to the pleural space, are 2-3 cm long, and are horizontal in direction.  They are indicative of congestive heart failure or pulmonary fibrosis.
• Peribronchiolar cuffing:  This is caused by thickening of the bronchiolar wall due to congestive heart failure.  The bronchiolar walls become visible and appear as donut-like densities in the lung parynchema****
• Fluid in fissures:  Fluid may build up in the pleural between the lung lobes, and this will show up as a thickened fissure.  This is marked on the x-ray as a fissure line greater than the thickness of a line drawn by a pencil.  ****  This is indicative of congestive heart failure
• Pleural effusions:  This is where fluid builds up in the pleural space.  It's usually present when you see blunted costrophrenic angles. Large ones can be seen when you see a miniscus-like line on the x-ray.  This can be indicative of various conditions, including cancers and congested heart failure.

7.  Check the stomach:  You should see an air (black) bubble just below the heart, and this is from air in the stomach.  If it's absent or if you see more than usual air bubbles this may be indicative of certain processes.

8.  Check the Hila: Note the shadows of the right and left pulmonary arteries.  Since the left is higher than the right, the right hilum is higher than the right.  Note that the area around the hilum is often referred to as the perihilar region. 

9.  Check for instraments:  Any leads, IVs, central lines, pacers, etc. will show up on the x-ray. 

(f) Red arrows point to the hilar region

In making your interpretation of the chest x-ray you'll want to make comparisons to any previous chest x-rays you may have.  This will help you monitor the progression of the patient. 

Likewise, you'll also need to know the age, assessment, and medical history of the patient.  Plus you should consider other tests, such as laboratory tests, cat scans, etc. All of these together should help you paint a picture as to what might be wrong with your patient.

(g) Right heart border is silhouetted out***

Resources:

1. **Siela, Debrah, "Chest Radiograph Evaluation and Interpretation," AACN Advanced Critical Care, 2008, vol. 10, num. 4, pages 444-473
2. .  *  Pleural thickening: benighn, imaging.consult.com, http://imaging.consult.com/topic/Pleural%20Thickening,%20Benign/S1933-0332(07)70242-2
3. Introduction to Chest Imaging, http://www.med-ed.virginia.edu/courses/rad/cxr/
4. ***Egan's Fundamentals of Respiratory Care

(h) See the outline of the bronchi (air bronchogram)

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Is a bachelor's degree in respiratory therapy useful?

Your Humble Question:  I often receive in the mail letters from various universities to get a bachelor's degree.  I wonder if it would be useful to get a bachelors degree in respiratory therapy.  Yet then I think:  What's the point?  What do you think?

My humble answer:  Ironically, today I received in the mail an "Opportunity" to enter into a bachelor's degree program in respiratory therapy at Siena Heights University.  I'm going to do with it what most RTs do, and pitch it into file cabinet 13, which is the trash.  I'm doing this for two reasons:

1. I have no idea where Siena Heights University is
2. I already have a Bachelor's Degree

My degree isn't in respiratory therapy, it's in business and marketing.  Yet the same principle applies.  If you want to make a career advancement in the medical field you almost always need some form of an advanced degree.  If moving up the chair of command is something you're interested in, I most certainly would recommend furthering your degree.

Besides, it can never hurt to get better educated.  Furthering your career in this way will most certainly make you a better RT.  It will make you better aware of the ins and outs of hospital life, particularly how the administration runs.  

Now you don't have to get a bachelor's degree, it's just an option.  You can also further your career by chasing other degrees too, such as computer skills.  I know of n nurses who specialized  in IT services and now they are in charge of IT services (computers).  I also know of nurses who specialized in quality assurance and are now in that department, and getting paid better.  

So it never hurts to advance your education.  If you have the opportunity I'd recommend going for it.  

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Is your asthma severe? Is it under control?

The following post was originally published at healthcentral.com/asthma on June 6, 2011

Asthma control versus severity:  what you need to know

How severe is your asthma?  Is it under control?  Does it matter?  It seems the new recommendation is that asthma severity is out and asthma control is in.  So what does that me for me and you?

To help us decide I think a few definitions from The National Heart, Blood and Lung Institute's Asthma Guidelines are in order here:

Asthma Severity: This is basically how bad your asthma is BEFORE you are on any asthma medicines, or how bad your asthma would be if you quit taking your asthma controller medicine.

The level of severity is best assessed when you are first diagnosed with asthma, and it helps your doctor determine the future course of therapy that will work best for you. This is generally measured to initiate asthma therapy.

The levels of severity are generally classified as: 

• Intermittent
• Mild persistent
• Moderate persistent
• Severe persistent

The problem most doctors have with diagnosing severity is most patients are already on asthma medicine before they are seen, so determining severity by the above definition is pretty much a guessing game. 

If you're like me you'd love to know how severe your asthma is, yet you won't want to quit taking your athma controller medicine to find out. 

Asthma Control:  This is basically a measure of how normal your life is compared to other people your age. It's measured once you are on asthma controller medicine and measures of how well your asthma therapy reduces asthma symptoms and impairments.

Control is generally measured to adjust your asthma regime. By measuring this at your doctor visits your doctor may tweak your medicine regime and/ or yourasthma action plan, or keep things as they are.

It's measured by: 

• The degree your symptoms are minimized (short of breath, wheezing, etc.)
• The degree your impairments are minimized (ability to exercise, walk, live a normal, active life)
• The degree to which your goals of therapy are met (I'm able to exercise without limitations.  No school or work days missed.)

According to the Global Initiative For Asthma (GINA) asthma guidelines, the classifications of asthma control are:

• Controlled
• Partly controlled
• Uncontrolled

To learn how to tell if your asthma is controlled click here, or you can click hereto download a neat pocket guide created by GINA that defines controlled, partly controlled and uncontrolled asthma.

So it's neat to know how severe your asthma is, yet experts have learned that monitoring level of control is a better way of monitoring your asthma status and adjusting your asthma meds as needed.

Still, regardless of how severe your asthma is, by being asthma smart most asthmatics can obtain good asthma control.

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We all need more competition

In 1930 and 31 my Great Uncle Tim Quinn was the fastest runner in the United States as you can see here and here and here . He was so fast, and so famous in his home town, that he was the first member elected to the Ludington, Michigan sports hall of fame at White Pine Village.  At least once every ten years the Ludington Daily News writes an article on him.

In one of the articles someone, perhaps his brother, was interviewed for the article.  He said that Tim ran so fast his brother Don couldn't keep up with him.  They'd practice a couple times a week running the 8 mile jaunt from Ludington to Scottville.  The person also said that Tim could have been even faster if he had competition.  

I think of my Uncle Tim every time I read about Tiger Woods.  Tiger woods was so good when he started playing golf that he won everything.  As an amateur and as a pro he was a winner.  Some tournaments, I remember one Green Jacket in particular, he won by such a large margin it wasn't even close.

The thing about Tiger is that he was so good he made everyone else around him better.  He was the pinnacle of a golf player, and other players knew they had to take more risks, practice more, and play better.  And I think that's what we are seeing in golf today.  That, I think, is one of the reasons he is just one of many great golfers in the PGA.

Tiger is what my Uncle Tim needed.  Other Tigers, of course, are the New York Yankees in baseball, the New England Patriots in football and the LA Lakers and Celtics in basketball.  I think these elite players/teams are great for sports and life in general.  It's forces the rest of us to work harder and do better.

Yet for the person at the top, Tim Quinn, Tiger Woods, Michael Jackson, and Elvis Presley, it's lonely.  It's difficult to learn to cope with this type of fame because so few have it.  Neither had a mentor who had similar fame to learn from.  While they provided the competition to make other people better, they themselves fell.

Ancient Egypt, Ancient Greece, Ancient Rome and the mighty British Empire were Tigers woods.  They had what everyone else wanted, and all other nations strove for such heights.  Yet while those nations rose to great heights, they all fell due to lack of competition above them.  They helped others rise, yet no one helped them stay at the top.

I think America is another Tiger Woods.  I think America, at it's pinnacle in the 1920s, 1950s, 1980, 1990s, and through most of the 2000s was so mighty, so great, it forced other nations to do better.  American has not fallen because there is competition at the top, and there are mentors in the name of books that tell of why great empires of the past fell.

Most of Europe now is democratic, and many nations in the Middle East are headed that way.  When people see greatness they want it for themselves.  They strive for more.  Hence we have rebellions in totalitarian states.  Yet few can handle such greatness and are henceforth destroyed by insidious means, or by their own actions.

My Uncle Tim was all alone at the top.  He was so high he was alone.  He was so high that when his running career ended he turned to alcohol.  He didn't know anything else besides running.  He died an untimely death in a Detroit alley in 1960 at the young age of 48.  You can see his records here.

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Two Conference Presentations Next Week

I am presenting at two national conferences next week. If you are attending either, please come up and introduce yourself. I would love to meet you!

The first is the annual NASW conference, Restoring Hope. The conference is in Washington, DC at the Wardman Park Marriott Hotel. My workshop is:

Using the New Brain Science to Create Hope and Healing for Child Survivors of Trauma
Date: Tuesday, July 24
Time: 3:15 pm - 4:15 pm
Room : Wilson B

The second presentation is at the Foster Family Treatment Association 26^th Annual Conference on Treatment Foster Care. The conference will be held July 22-25, in Atlanta, GA. at the Sheraton,Atlanta hotel.

My workshop there is:

Workshop D17 - Using a Trauma Framework to Strengthen Foster Placements.
Wednesday, July 25th
10:30 a.m. - 12:00 p.m.

Seriously I would love to meet you if you will be attending either of these conferences. Please say hello!

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"I feel like such a baby!"

Yes she was agitated, sweating profusely, and complaining of agonizing stomach, chest and back pain.  She was so uncomfortable she could barely sit still.  She was uncharacteristically complaining.  She said, "I feel like such a baby!"

Yet she wasn't being a baby at all.  In some cases I'd say, "Yes!  You are being a baby."  But in her case, she was being a hero to herself.  She was biting the bullet and seeking help. Even if she gets a clean bill of health, at least she'll know she's okay and the pain is just superficial.

Yet what if she stayed home and was having the big one?  What if she was having an aneurysm?  What if?  She couldn't take the chance.  In fact, chances are she already waited too long. She waited too long because she was a mom of five, a wife, and a tough woman. 

There are too many people in the world too modest to seek help when they should.  It's better to come in and be told you're fine than to stay home and risk dying.


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Beauty Review: Youth Infusion Serum Vaxin by Givenchy

I like serums! I just like how light, concentrated and quick to deliver the effect they are… I use a serum every 3 months... Vaxin serum caught my eye just as it was released. Probably it was the name :-) Vaxin – is like an injection against aging. Quite a strong message for a consumer, don’t you think?

So here is my review of Givenchy’s Vaxin

Product Tag Line:

Vaxin for youth

Product

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Why are Respiratory Therapists Frustrated?

Your RT Question:  Why is it that so many respiratory therapist are upset about their jobs?

My humble answer:  I think most people are upset about their jobs because the image portrayed of this profession by the AARC isn't necessarily how the job is.  While we went to school for two years, continue to study, and have learned much from our experiences, many times our opinions don't matter.  Likewise, many RT bosses don't want to make waves and want to maintain the status quo rather than make life better for the staff.  While RTs are trained to know who needs what therapies and when, they usually end up just being neb jockeys and button pushers.  They are frustrated by this.  They want to be more than just jockeys and pushers.  They want to be able to use the wisdom they studied hard to obtain.  It's a similar frustration a doctor might feel if he were called Mister instead of doctor.  They worked to earn their title just as we RTs worked hard to earn the ability to use our skills and knowledge base to the benefit of patients, doctors and the profession as a whole.  Plus when you go to school thinking one thing, only to end up being something else, it's frustrating.  Plus many doctors have no clue what a bronchodilator is and they keep ordering them for every patient who wheezes or huffs and puffs or has a low sat.  Still, while this is all true, you can make of this job anything you want.  I actually do pretty well where I work because I'm not afraid to go out of my way to make recommendations to the doctors and nurses, even if that comes with making waves and irritating some.  Yet those who benefit are the patients we serve.  What you must remember is this is a job.  No job comes without politics.  No job is ideal. 

Still, I can understand the frustration of many RTs.  Surely some say if you hate your job you should just go get another job, yet that's not always easy, especially when you have a family to raise.  Think of it this way:

• Contractors are hired knowing they will have to work hard
• Road construction workers know they will have to work in the elements
• Doctors know they will have to work with irritating patients
• Teachers know they will have to deal with snotty kids
• Baby sitters know they will have to deal with intractile kids
• School bus drivers know they will have to stay awake while driving

Yet, we RTs are told the following that is not always true:

• We will assess and recommend therapies
• Examine patients and decide what therapies are best for that patient
• Consult with physician to recommend a change in therapy based on your evaluation of that patient

This is a young profession.  Yet unless those three sentences in red above are adressed, many RTs will continue to be frustrated.  Sorry, yet that's just how it is when you're a respiratory therapist.

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