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The times have changed. Independent blogging isn't as huge as it once was. Most of us are now writing for other health communities, is the reason. But, I've managed to keep this blog going. It's still here for anyone to enjoy. Something I struggled with is who to make as my general audience here. Initially I wrote to respiratory therapists and patients. So, it was a unique situation to be in. It would have been easier just to focus on the  respiratory therapy profession. Here I share wisdom, but also poke fun at some of the unique situations we find ourselves in. But, I started out also telling my story about asthma. So, this sort of spawned my asthma writing career. And I also wrote about COPDers. There are the types of patients we RTs take care of nearly every day. So, it's kind of hard to have an RT blog and not focus on the patients we get to know on a daily basis. So, here we are going into our going into our 12th year. So many things have happened in that time. So...

You see them in isolation rooms. They are usually referred to as Fake Stethoscopes. They are made by Fake Incorporated. Sometimes they are referred to as "Dim Stethoscopes." It's because you can't hear lung sounds for crap. So, you find yourself just writing or clicking, "Diminished." And sometimes you don't even bother using it. I mean, it's been in the same room as a MRSA patient for a week now. And the lung sounds have been the same since the patient arrived. And so you just scan the patient. You start the treatment. And you just (if no one is looking, that is) go right to charting. And, without even touching the Dim stethoscope, you click: "Diminished." There is one exception. If the patient is wet. That's the exception. Because, if that's why the doctor ordered it, it's mainly because of that audible cardiac wheeze . You don't need a stethoscope to here it. So, you can then click on "Wheeze" So, that's you...

You cannot vote on science. Science either is or is not. So a consensus is not science. In 2010, The CDC's Advisory Committee On Immunization Practice voted. They voted that everyone over the age of 6 months should be vaccinated against the flu. (1) Personally, I'm in favor of the flu vaccination. But, I will admit this is my opinion and not science. It is not science that the flu vaccine will prevent you from getting the flu. In fact, the flu vaccine, in the years researchers are the most accurate at guessing what viruses will be in the air in a given season, is only 40-60% accurate. (2) This is because there are many, many, many different flu viruses. It's also because the flu virus can mutate. So, even if you are vaccinated against the H1N1 influenza A virus, you can still get the H1N1 virus. This happened in 2009. The H1N1 flu virus is one of the most popular flu viruses. You are vaccinated against it every time you get a flu vaccine. But, in 2009, the virus mutated as ...

Those dog gone suckers just won't leave me alone. My health insurance company, that is. They called me for the 4th time to talk to me about talking to a pharmacist to review my medicine. I actually tried to be nice this time. So, I just said, "Why do I need it?" To be honest, I think me asking this threw the person off her script. She didn't know what to say. After a long pause, I said, "I already talk to my doctor about my medicine. Why do I need to talk to a pharmacist." "Well," she said, "It's nice just to have your medicine reviewed by a second person." I said, "Why would I need that. Like I have said every other time someone has told me I need to review my medicine. I already review my medicine with my doctor. I'm also a respiratory therapist. What more is there for me to gain?" Once again I threw her off script. And, allow me to add again that I tried to be very pleasant with my tone. I was a nice boy. I was hoping...

I usually stay pretty cool about things. But, I'm getting rather annoyed that insurance companies have more control now than doctor's do. I'm just beside myself at how annoyed I am about this. For starters, my pharmacist insists he needs to sit down with me and review my medicine. The past two years I have adamantly resisted this. I don't need to review my medicine. It's something I do with my doctor when needed. Why would I need to sit down with my pharmacist so he can tell me what I already know. Besides the fact I'm a respiratory therapist who is a writer who specializes in asthma. Like, I read up on asthma every day. Asthma is my specialty. Not saying I know it all, but I certainly don't need to be lectured by my pharmacist. So, today I get a call from my insurance company. It's a call I have not taken until today. But, considering they are persistent and keep calling frequently, I finally took the call today. And, lo and behold, a nice lady is on th...

RT Boss displaying new goggles. You heard it here first. The Federal Agency for Efficiency (FAKE) has created a new regulation requiring goggles. They must be worn by employers who are on the clock when reading magazines. I was kind of confused when I learned of this policy. It came down to me via the respiratory care manager at Shoreline Medical Center. He said he was required to write a hospital policy for Goggle Management. I inquired as to why this policy was created. He said it passed the FAKE board by a vote of 8-1. The policy is expected to prevent wisdom from magazines from splattering off the pages of said magazines and offering wisdom to readers. The goal here is to prevent workers from getting smarter. If they remain dumb, it's easier for said individuals to become brainwashed by top management officials. Ditto for government officials. I called Mike Wisdom, the chair of the Fake Committee. He said "This is just the beginning. You can basically call this the test ph...

The following is a guest article by Sarah Cummings. By Sarah Cummings Guest Writer to RT Cave Unless you have to live with asthma, it probably won’t really occur to you that the condition which has a profound effect on the respiratory system of the body can result in difficulty finding sound slumber on a regular basis. It’s not until you think about it that this actually makes sense and becomes clear. Wheezing , coughing, and feeling breathless, are all symptoms that can create a hostile environment for mind and body to relax and settle in for a good night’s sleep. What’s more, there are also people who can be diagnosed with a condition known as night-time (nocturnal) asthma . This has the potential to make asthmatic symptoms even more severe in the night-time. What happens to our breathing at night? When you head into the night, particularly as bedtime approaches, changes occur in conjunction with your ‘body clock’ or natural circadian rhythm. For those who are healthy, these nig...

Your Question . My best friend's doctor told her that she has:j45.9 unspecified asthma. She's never heard of that type before and could not find useful information about it. I remembered this blog and the useful answer you gave me in the past, so I thought I would ask you. What does this type of asthma mean? My Answer.   What is this unusual asthma type ? J45 is the official billing code for asthma. J45.9 basically means it's unspecified. That basically means your doctor is billing for asthma but didn't list anything specific about it. It's what's officially called an ICD-10 Code. This is not a subgroup or anything like that. It's just for billing purposes. It's a code your doctor enters into the system so the office gets paid by the insurance company or Medicare.  Here is a link if you're interested. 

Heart failure, if untreated, can lead to death because other organs of the body will not be receiving enough oxygen. Usually, one of the first organs to be affected are the kidneys. The kidneys will fail and lose their ability to excrete salts and water, and actually, cause your body to retain more fluid. Actually, kidney failure alone can lead to pulmonary edema, or exacerbate it. Likewise, fluid will back up in the liver, which in turn will fail in its job of removing toxins from the body. Lacking oxygen, the large and small intestines will lose their ability to absorb nutrients, and thus one organ after another will fail, ultimately leading to death. Of course, our job as healthcare workers is to prevent this. Well, it's the doctor's job actually. We as RTs usually only treat heart failure after symptoms arise.

Bronchodilators are a top-line treatment for heart failure. Just kidding! However, some studies do show that some bronchospasm may result from heart failure. But, this bronchospasm is secondary to fluid overload. A bronchodilator will not treat heart failure. It may relieve some of the shortness of breath if it is caused by bronchospasm. So, you can only treat heart failure with heart failure medicine. Here's what the Mayo Clinic says: " You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure." Treatment for heart failure includes. Medicine . Medicines used to treat heart failure are those that strengthen the strength and contractility of the heart, such as Digoxin. They also include medicines to lower the blood pressure or to make patients pee, such as Lasix or Bumex. These are medicines that are often taken every day to prevent heart failur...

Heart failure is when the heart is too weak to pump blood through the body. It poops out. The patient becomes winded on exertion as the person's heart cannot keep up with demands on the body. So, what causes heart failure? Here's what to know. 1.  Hypertension : Coronary artery disease is one ailment that causes blood vessels to become narrow. Years of working hard to pump blood through narrowed vessels can cause the heart to become hypertrophied (enlarged). A large bicep is good, and it's a sign of good health. A large heart is a sign of a weak pump. It is bad. Eventually, it will tire and become an ineffective pump. In fact, 60% of heart failure cases are the result of high systemic blood pressure and coronary artery disease. 2.  Coronary Artery Disease (CAD) : According to the National Heart, Lung and Blood Institute ( NHLBI ) ,  CAD is a disease whereby plaque builds up inside the coronary arteries (arteries that supply oxygenated blood to the heart)....

It's asthma even if it's heart failure. So, it was so long ago. It was in 1998. I was called to a room. The patient was extremely short of breath. The patient was winded. She was sitting in the recliner all frogged up. She was blue. Her saturation was 77%. The nurse said, "She just went to the commode and she got like this."  I was a new RT. I was stressed. What do I do? Thankfully, a senior RT came to the rescue. She smoothly investigated the situation. She said, "What are the patients i's and o's." It was the first time I heard that question asked. The  nurse said, "I don't know?" The RT bluntly said, "I think we should check." Later she said to me, "Sadly, RTs are the only people who ever check the i's and o's." Twenty years later, when I found myself the seasoned RT, I found myself saying the same thing to a new RT. Go figure! Twenty years on this job and not much has changed. So, anyway, this seasoned RT...

So often respiratory therapists are required to give breathing treatments to patients presenting with dyspnea and wheezing. This is fine and dandy if it's asthma. But, when it's heart failure (a.ka. cardiac asthma), a bronchodilator isn't going to work. The treatment is something else, totally. But, because we are good RTs, we do the treatment anyway. And, while the treatment is going, we investigate the patient's chart. We often begin and end with the i's and o's (ins and outs). It ends if we determine the patients I's are way more than the O's. This means the patient is probably wet. And it means that it's probably not bronchospasm and shouldn't be treated as such. As we just proved once again, among the most common reasons for this failure is a misdiagnosis of asthma when the primary cause of symptoms is actually heart failure. So, that said, the RT Cave participated in an unofficial poll of 2,000 respiratory therapists. Nearly 80% of them sai...

So, I was called stat to the emergency room. I was told to give a breathing treatment to the lady in room 221. She was in severe respiratory distress. I opened the door to her room. She was sitting there blue and puffing. But, I watched as the nurse disconnected her from her home concentrator and hooked her nasal cannula up to the wall She continued to be blue and winded. She was a happy little lady, though. She never stopped chatting, despite the fact she was pretty winded. And she started talking about her cats. Oh, how she loved her cats. And so I checked her nasal cannula. It had holes in it. She said, "My cats got into my oxygen tubing. And I didn't have any replacement tubing." From the cabinet, in the room, I grabbed a new nasal cannula. I took her off of her cannula. I put the new cannula on her. And, lo and behold, her pulse oximeter reading perked right up to 92%. She was also no longer blue. Of course, I still have to give her that breathing treatment. But, by ...

So, this is not respiratory therapy related. But, we all have families. And we all enjoy kids. So, here's a little conversation I had with my 7 YO a few days ago. Son: "Dad, what does the F-word mean?" Oh, keep in mind I have a teenage daughter. And my son will not say these words. He will only refer to them. I said, "Ummmmm" While I scratched my head in search of a good answer, he spared me. He said, "Does it have something to do with the S-word?" "What S-Word?" I asked. He sad, "You know: S-E-X." I did not answer. After a short pause, he said. "Say it day. Say the s-word." "I said, "The s-word." "No, say the actual s-word." "The actual s-word." "No. Say S-E-X." "S-E-X." "Dad, just say the word," he continued on, calmly, cooly. "Fine," I said, "Sex." Pause for effect. Then I bravely added a question. I asked, "What does sex mean, any...

"Hi, John! "How's it going?" The person says. I'm at Walmart. My mind races to find the gray matter where in my mind that brings forth a memory of this person. Nothing! "Hi," I say, "How are you doing?" "Great!" The person says."  Then she starts talking to me as though I know who she is and what she's talking about. I am so guilty of this. My favorite part of my job is having conversations with patients. I've discussed many of these discussions on this blog. I am so willing to talk about God and politics even. I mean, you do so appropriately. But I have had such deep conversations with people. So, this person is probably one of them. But there's so many of them. There's no way I can remember them all. My wife remembers all her patients. She knows them all when she sees them. If she wanted to, if it weren't for HIPPA, she could entertain me with stories about people she meets. But not me. I don't remember...

A week before Christmas every year we walked across the street to the nursing home. This would have been in the 1970s. I would have been seven, eight, and nine. This would have been on Monday nights. That’s when we had Catechism classes at Manistee Catholic Central. So, here it was December 1976. We were all to bring in some gift. My mom bought me a handkerchief. So, that was my gift. It seemed like a stupid gift. But I wrapped it as awkwardly as a seven-year-old might do this. I walked my gift with my class across the street. My teacher opened the door to the nursing home. The redolent smell of bleach and urine. It was an old building, so there was also that old musty smell old buildings have. Back in 19th century, up until 1970, it was a hospital. It was Mercy Hospital. My grandma said it was one of the most beautiful hospitals. It had a huge Church cathedral in the middle. They tore the Church down left the rest to become this nursing home. Immediately we saw old people. There was a...

So, they wanted to talk to us about VPAP. Their goal was to sell VPAP units. They kept talking over each other so you could see their excitement. VPAP units work. Studies show they prevent readmissions for COPD, so they said. They said it's easy to qualify patients for VPAP. All they have to do is have one blood gas with a PaCO2 greater than 50. It doesn't matter when that ABG was done. It could have even been done in the ER when the patient was having a flare-up.  One of the reps said that it's easy setting patients up on VPAP. All we had to do was notify them that a patient qualifies. Then they take over from there. They said that they talk to the doctor. They said that they talk to the patient. And then they set the patient us.  One of the reps is the one who works with the patients. He said that he has been doing this for two years, and only had one patient reject the machine. He said they are tolerated that much.  They made VPAP sound so good. They made it sound way ...

“Am I going to die?” It’s a question I’ve heard many times over my 20 years as a respiratory therapist. Yeah! Like, how do I answer that? Here I was, fresh out of RT school, and I was posed with this question my very first day on the job. I said nothing. I just stood there at the edge of the bed feeling guilty that I did not know. I wanted so bad to give an answer. I wanted so bad just to get out of the room. I felt so guilty. I was posed with the same question a few weeks later. She was 62-years old. She was recently retired. She was looking forward to enjoying her retirement. She had worked so hard to enjoy this benefit of life. She was recently diagnosed with end-stage COPD. She was also diagnosed with pulmonary fibrosis. It was a big double-whammy! We had become friends, of sorts. We spent lots of time together due to her disease. I was with her in the emergency room. I was there when she was first put on a BiPAP machine. I gave her numerous Duoneb treatments before she was adm...