10 ways you can prevent asthma

The following was originally published at myasthmacentral.com/asthma on July 22, 2011.  Keep in mind that these are theories, and once you have asthma you can no longer prevent it.  

How can you prevent asthma?

A common concern of moms and dads - especially when asthma runs in the family - is how they can prevent their children from getting asthma.  New evidence suggests there are things you can do - or not do - to at least reduce the risk your child will develop asthma.

I think the surest way to prevent your child from acquiring asthma is to not give your child the asthma gene.  Yet there seems to be quite a bit of evidence that even folks with no history of asthma can develop asthma.  Good examples of this are premature births (immature lungs) and occupational asthma.

To get a better understanding of why the following may lead to asthma you should read up on the hygiene hypothesis that surmises asthma may be caused by lack of exposure to bacteria, and the microflora hypothesis that surmises asthma is caused by an imbalance of microbes in the intestines.

Likewise, click on the links provided in this post for further reading.

So you want to prevent your child from developing asthma.  The following are some things believed to prevent one from developing asthma:

1. Breastfeeding:  The child will be exposed to microbes in the mother's milk that the child's immune system needs to develop properly. I wrote morehere.  The U.S. Department of Health and Human Services notes here that infants where eczema and asthma runs in the family who were breastfed at least three months were 42 percent less likely to develop asthma than infants not breastfed for three months. The American Accademy of Allergies Asthma and Immunology (AAAAorg) reports that breast milk also strengthens the immune system.  Exposure to cow milk and soy proteins may cause an allergic response that may lead to asthma.
2. Vaginal birth:  The child will be exposed to bacteria for the immune system to develop properly.  In fact, studies show c-sections increase the asthma risk by 80 percent as I wrote here.
3. Attendance at daycare:  The immune system will be exposed to plenty of bacteria to develop properly and remain strong throughout childhood.
4. Large family:  The immune system will be exposed to plenty of bacteria to develop properly as proven by this study reported by The American Accademy of Pediatrics.  Likewise, The New England Journal of Medicine reports families with more than two children has declined from 36 percent in 1970 to 21 percent in 1998. As family sizes get smaller, asthma rates have risen.
5. Large intake of fruits and vegetables:  Provides your body with vitamins and minerals to keep your immune system strong.
6. Omega 3 fatty acid found in fish: Several studies as you can readhere and here show that populations with adequete levels of fish oil in the diet have lower asthma rates.  The theory is that acids found in fish oil prevent the allergic response that causes inflammation of the respiratory tract.  
7. Cats and dogs:  Early exposure has been shown to prevent dog and cat allergies, and allergies can lead to asthma. I wrote about this here.
8. Farm life, primarily pig exposure:  Studies show asthma rates for kids who live on farms are lower, and the theory is due to bacteria from pigs and other animals the kids are exposed to.
9. Community resources:   Educational and financial opportunities greatly influence asthma rates because it proveds better exposure to diagnosis, treatment, and medicine.  You can read more here.
10. Normal respiratory rate:  Studies show people who have chronic respiratory rates greater than 20 have a greater risk of developing chronic inflammation of the air passages.
11. Vitamin D:  Lack of exposure to the sun may cause asthma. Studies show people with higher vitamin D levels have better lung function because it helps the immune system function better.
12. Exercise:  Overdoing exercise can actually cause asthma due to high respiratory rates, and this may be one reason olympians have high asthma rates (may be referred to as occupational asthma.  Yet fat tissue has also been proven to release chemicals that cause inflammation in the air passages that can lead to asthma, and exercise can prevent obesity along with strengthening the heart, lungs, and immune system and mental status.
13. A healthy diet:  High fat foods may cause inflammation in the lungs. Obesity has been linked to increased asthma rates. I wrote about this here, and you can read more here.
14. Treating nasal congestion:  Sinusitis and rhinitis (hay fever) may lead to airway inflammation and cause asthma if the nasal congestion is not diagnosed and treated swiftly.
15. Treating eczema:  Studies show eczema may lead to asthma, yet if diagnosed and treated swiftly the risk may be reduced.  I wrote about thishere.

The following are things you should avoid exposure to:

1. Broad spectrum antibiotics:  They wipe our your normal bacteria your immune system needs to develop and function properly.  I wrote about thishere.
2. Inhaled chemicals and fumes:  Long term exposure to chemicals (such as at your work) can cause chronic inflammation of the air passages.  This is a common cause of adult onset or occupational asthma.
3. Air Pollution:  Long term exposure to high pollution levels (like from car exhaust and ozone) may lead to chronic inflammation of the air passages.  I wrote about this here.
4. Premature birth: If the lungs don't have a chance to develop properly this can increase the asthma risk.  Sometimes this can't be prevented, yet being a wise mom and listening to the advice of your doctor is a good place to start.
5. Mold:  It has substances in it that increase airway inflammation.  Don't leave water sitting around, clean up and prevent standing water in basements, paint moldy or repair moldy walls or floors, etc.
6. Viruses:  Keep young kids -- especially infants -- away from people with colds.  Lung infections, especially when the lungs are developing, may cause asthma (such as RSV, bronchiolitis).  Of course, accomplishing this may be easier said than done.  I wrote more here.
7. Exposure to cigarette smoke:  Studies show exposure may cause asthma as I wrote here.  Moms should also avoid 1st, 2nd or 3rd hand smoke during pregnancy.
8. Unhealthy foods during pregnancy:  AAAAI.org reports, a proper diet during pregnancy
9. Delay exposure to allergens:  The AAAAI.org reports this may also help prevent asthma.
10. Stomach acid in lungs:  Gastrointestinal reflux (GERD) should be properly diagnosed and treated. 

To this point in history better knowledge, technology and medicine has not stopped asthma rates from rising, especially in western nations. 

American Accademy of Allergy Asthma and Immunology statistics show asthma rates climbed 160 percent from 1980 to 1994, and The U.S. Centers for Disease Control reported reported 4.3 more people were diagnosed with asthma between 2001 and 2009.

Yet as technology, knowledge, and medicine continues to improve, perhaps we can prevent premature birth, provide kids at high risk for developing asthma with some sort of bacterial vaccine, reduce pollution I imagine despite our greatest efforts some cases of asthma may not be preventable, such as asthma caused by exercise, premature birth, and viral infections.

As we learn more, we certainly can make a gallant effort to do better.  Doctors might want to make an effort to reduce c-section rates, allow pregnancies to go to term, and encourage breast feeding. 

Better technology and regulations may reduce pollution rates.  Elilminating uneccessary use of broad spectrum antibiotics may help. 

There are things you can do to, such as educate yourself, keep your homes free from mold, wear masks when exposed to chemicals and fumes at work, encourage your kids to exercise and eat healthy, and make sure stuffy noses and colds are treated promptly and efficiently.

Asthma experts are working hard to learn about the causes of asthma.  Perhaps with all of us working together we may see asthma rates start falling sometime soon, and hopefully someday asthma may be a rare malady.

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Have people forgotten how to think?

I just had an in depth and very intelligent discussion with a patient.  The theme was:  have people forgotten how to think?  Have people become so complacent with their machines that they've lost the ability to do their own thinking?   Are kids these days too eager to accept what their teachers say without questioning them or challenging them? 

"Many people accept global warming as a fact.  Yet it's only a theory," my patient said.

I explained that when my kid came home from school the other day my son said I shouldn't squirt that spray because I might be adding to global warming.  I told him he should be careful because global warming is a theory, and while it should be respected, one must still understand it's not a fact. And people still need to use sprays.

One of my friend's kids told me that he was upset when he learned the founding fathers were racist.  They created a flawed Constitution.  I asked him what he meant.  He said that the founders created a document where blacks were only considered 3/5 of a resident of this country. 

That's what he was taught in school.  I asked him, "What do you think of the U.S. Constitution?  What do you think of your freedom?  What do you think of America?"

The boy said, "I love it all."

"Okay," I said, "If it weren't for the 3/5 rule you wouldn't have any of that." 

He looked at me cockeyed and confused, "What do you mean?"

"What I mean is that the 3/5 rule was needed to get Southern states to ratify the Constitution.  Most of the founders were not racists.  Yet they knew the only way to get the Constitution passed was the way they did.  This was why it's still called the great compromise. The flaws, they knew, would be ironed out later.  The signers knew once the Constitution was signed it could be amended, and amended it was.

When I was in school we were taught the first Thanksgiving was the Pilgrims thanking the Indians.  Yet after reading about it further on my own I learned that this wasn't true at all.  The Pilgrims threw the first Thanksgiving to thank God for teaching them about capitalism. 

The first few years they ran their little society based on socialism, and then they decided to try capitalism and let each man keep what he makes.  This worked so well crops flourished.  The Indians were there and they helped, but they weren't the only ones being thanked:  the main purpose for the party was to thank God for teaching them about capitalism, a technique that gave pilgrims an incentive to work harder. 

My patient said the following:

"How many people today just get their news from one source and accept it as fact?  If they don't do their own research there's no way of them knowing what they are reading is BS.  The same can be said of students at school.

"Do kids know how to add in their head?  Would they know if the teller made a mistake and screwed them out of $10.  Or do they simply just assume the machine was correct.  If the machines stopped working, would people be able to take care of themselves?  To feed themselves and their families?  

"Our parents grew up on farms.  They raised their own meet, cooked the meet, prepared the meet.  They killed the animals and ate the meat and used every single part of that animal.  They wasted nothing.  Then they sold the meet, and counted money, which came in bills and coins, and they had to figure the correct change." 

"They built their own houses.  Now we are so used to our modern way of living, our machines, that most of us wouldn't know what to do if the electricity went out.  We've forgotten how to think.  We've forgotten how to challenge each other.  We've forgotten how to listen to opposing opinions. Not all of us, but a good many. 

"Can you imagine how lopsided the presidential polling would be if people payed attention to politics instead of having their heads in their fantasy worlds.  In 1980 when hostages were held by Iran people cared and it influenced the election.  Today we have strife in Egypt and Libya and people sniff their noses and place their faces back in their dream world: their Facebook, their X-Box, their Wii, their Kindle, their Zuma Blitz game.  That's why Obama and Romney are tied in the polls, because people today are tuned out."

So have people forgotten how to think?

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Things my patients like about me

The following are things I often get complimented on by my patients:

1. Remove glasses before putting mask over face
2. Keep women covered during EKG
3. Remove cup prior to shaking mask (so their whole face doesn't shake)
4. Friendly
5. Sociable
6. Good conversation
7. Love to discuss the Bible
8. Love to discuss Politics (even with people I don't necessarily agree with)
9. Positive demeanor
10. Relaxed
11. Pull up a chair next to the bed and put it away when I'm done
12. Great at explaining things
13. Make patient feel good about themselves
14. Go out of my way to make sure patients has everything he needs (blankets, ice water, etc.)
15. Get things right away for patients instead of making them wait
16. Check up on patients between treatments, sometimes just for a chat
17. I make them breathe better
18. I make ABGs a gentle explerience

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Study: Exercise can help you live longer

COPD News of the Day provided a link to an interesting article about how important it is for the aging to stay active.  She blogged that:

Individuals older than 75 who were physically active and participated in social activities lived a median 5.4 years (95% CI 3 to 7.8) longer than those with a less healthy lifestyle and more limited social life, according to Laura Fratiglioni, MD, PhD, and colleagues from the Karolinska Institute in Stockholm.

And even those who were 85 and older lived an extra 4 years (95% CI 0.8 to 7.2) if they remained active, the researchers reported online in BMJ.

read this article from MedPage Today - click here

 This is just another example of useful information we can obtain by following fellow bloggers.

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Social Space Rule: How to use space properly

Every person who works with people should be aware of how to appropriately use space surrounding another person.  If you get to close to the person you're talking to things get kind of awkward.  If you're too far away a shouting match occurs.  So a quick refresher is in order on how to use up space.

As a general rule of thumb, the following rules should be followed:

1.  Social Space:  4-12 feet  (this is good for the initial introduction to the patient)
2.  Personal Space:  18 inches to 4 feet  (This is good for the interview)
3.  Intimate Space:  0-18 inches (This is good for the patient assessment)

A majority of conversations should involve the use of social space. As a general rule, as you approach someone to talk, you should be about 4-5 feet away. I think 4-5 feet is a good distance.  If you get to close take a step back.  It's actually better to be too far away than too close.  I call this the "Social Space Rule."

In my experiences through life I've found most people follow this rule.  However, once in a while you get a space hogger. A "Space hogger" a person who feels the need to get right up close to you during even the most social of conversations.  So you take a step back and they feel the need to re-occupy your personal space.  Those conversations rarely flow smoothly because you feel uncomfortable, and are concentrating on the space rather than what that person is saying.  It's not good.

This rule was taught to me by my parents when I was a kid, and re-introduced when I was in college in sales class.  My sales teacher taught that proper use of space was 50% of the sale.  So he hashed this onto us on a daily basis. His policy was if during a fake sale I invaded his space, he'd hash my grade by 50%.  So you learned quickly of the importance of using space properly.

Don't be a space hog:  follow the social space rule.

RT Cave Rule #59:  Don't be a space hog:  Follow the Social Space Rule.  During a social conversation you should stay 4-5 feet from the person you're talking with.

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It Ain't Easy Being RICH- Hope

Anyone who has taken the Risking Connections â training knows that a key element is that the path to healing is through a RICH relationship- one that includes Respect, Information, Connection and Hope. This is such a central point that the publisher, Sidran, has copy write protected the concept independently. In our training we ask participants to share ways in which they are currently demonstrating RICH with the clients, and also with each other in their team. Because amazingly it turns out that what the clients need in a relationship is the same as what we need for ourselves.

For four weeks or so I am going to right about the dark side of RICH- by which I mean the difficult and complex aspects of creating RICH relationships. These are the areas where we struggle, stumble, and sometimes become less than helpful to our clients and each other. Let’s look at each part of RICH and discover what is hard about it and how we can overcome the challenges.

This fourth week I will focus on Hope.

Hope is the foundation on which all the other qualities rest. In the dictionary hope is defined as: “to cherish a desire with anticipation;” “to desire with expectation of obtainment;” and “the feeling that what is wanted can be had or that events will turn out for the best.”

I previously posted on Hope on 4/15/12. The focus of that post was the ways that a RICH relationship in itself creates hope, independently of the external reality.

Not surprisingly, the Risking Connection curriculum (Saakvitne, K., Pearlman, L., Gamble, S., & Lev, B. (2000). Risking connection: A training curriculum for working with survivors of childhood abuse. Lutherville, MD: Sidran) has quite a bit to say on hope. The authors maintain that holding hope is a key responsibility of the therapist. Our clients come to us hopeless, and they often experience setbacks that discourage them further. Meanwhile, we are doing this difficult work in the middle of an ineffective and inadequate child welfare system. So, it is possible for both the treater and the client to become hopeless. It is the treater’s responsibility to take care of him/herself and do whatever is needed to fight vicarious trauma in order to maintain hope. The treater’s job is to “Hold onto vision of the survivor’s potential future self,” and to “serve as trustees for the survivor’s future possibilities.” (RC pp.15-16) The treater is at her best when she can see clearly the client healed, living a productive life. The treater must maintain the tension between seeing that version of the client’s potential and also seeing the current reality of the client. The authors ask us to direct our attention to evidence of hope and resiliency in our client’s stories. When presenting or discussing a case, talk about strengths in a real rather than pro forma way. They also point out that hope is fueled by compassion for our clients. If we understand the adaptive nature of their symptoms, we feel less exasperated and less personally attacked. In other words, having a theory, a road map, that helps you understand the behavior and plan your next treatment intervention creates hope that counteracts the bewilderment and discouragement we usually feel in the face of extreme behaviors.

What is the meaning we ascribe to our client’s behaviors? When Aisha ran away and became involved in dangerous situations, Louis reacted: “How can she be so stupid! We have explained a thousand times that she is putting herself at risk. In fact, I just had a great talk with her last night about this! I told her how worried I was about her when she put herself in such danger. She told me she understood and would not run away again, and she thanked me for spending time with her. I guess she was just manipulating me to be able to stay up longer. She doesn’t care about me or anyone else. She doesn’t even want to get better. She’ll probably end up being kicked out of here just like our last two clients. Sometimes I wonder why we even bother.”

Mario was also affected by Aisha’s running away. He said: “I am so scared for Aisha. She still doesn’t value herself enough to keep herself safe. And we haven’t yet been able to teach her an alternative to running, or to make her safe enough to try it. I wonder if we set up a place on grounds where she could run and stay until she calmed down enough to come back if that would help her. And when I think of it, I realize that Aisha has been forming some close connections with both me and Louis. I wonder if that is scary to her, especially since we are guys? I’m going to talk to Tracy, her therapist, about that, and bring it to team. I don’t  know what we should do differently but maybe there is something. Aisha is so bright and has so much spunk. I know she has a great future if we can just find a way to get her there.”

The enemy of hope is vicarious traumatization (VT). Since it is the treater’s responsibility to maintain hope, it is essential that we combat this aspect of VT specifically. Some strategies, largely taken from the Ricking Connection curriculum, include:

·         Challenging negative thoughts and looking for evidence of resiliency

·         Celebrating all kinds of successes

·         Collaboration with others, within our agency, outside, and even outside our treatment community. For example, when a local business joins us and gives backpacks to all the students returning to school, it helps to know that there are others outside our world who care.

·         Noticing the advances in understanding trauma and in treatment that are being discovered through science and new technology.

·         Appreciating the gifts of the consumer movement.

·         Cultivating our spirituality, whatever that may be

·         Look for meaning and inspiration in everyday events and in natural beauty

·         Seeking and embracing the personal transformation that comes with this work. How has this job, and being involved with these clients, changed you for the better? What have you learned from them? In what ways have you grown?

There are also many ways the agency can help workers fight VT and remain hopeful- another time, another post.

Hope is an essential element of every moment of our work. In fact, our work defines hope- we embody a conviction that people can heal and change. We have seen it happen many times.  As we are presented with each new scared, snarly, obnoxious, difficult client it is our job to shine with the hope of all that they can become.

 

 

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If a patient needs a treatment he will get it...

Allow me to tell you two things about me.  If someone needs a treatment that patient will get a treatment whenever he needs it.  If the order is Q4 hours with a prn order, I won't make that patient wait until the four hour mark if the patient is short of breath. I know what it's like to be short of breath and I don't want my patients to have to suffer. 

I also know that when you're short of breath, even remotely dyspneic, you don't think straight; you second guess; you don't want to bother people.  Knowing that, I won't assume the patient's doing fine if I don't get a page.  I say this knowing some of my co-workers won't give a treatment any more often than the minimum requirement unless they get a page.  They simply assume the patient's fine, which isn't always such a good thing. 

I also say this knowing I'm lazy.  I'll do whatever I can to get out of doing work.  I'm a hard worker, yet I hate to do things that aren't needed.  So for this reason, if I'm busy in the emergency room I won't rush up to give a Q4 hour treatment I know isn't needed.  My coworkers often get all panicked when they are busy trying to rush to get every treatment done, yet not this RT. If I'm not busy surely I'll do it, yet I'm not gonna panic about getting a bronchodilator to a patient not exposed to bronchospasm.

Sorry, but it's the truth.  And I can tell you I got this way because I have asthma and I know I don't take a breathing treatment every time I'm short of breath, I use my inhaler which works just as well and costs 100% less money.  I also know I never use rescue medicine as palliative or prophylactic therapy, which is not what it was invented for.  Sorry, I'm just telling the truth.

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