My daughter is in the fourth grade. She brings home homework that requires me to sit down with her for two hours, either to help her understand it, or to_ motivate her to do it_. Many nights shes up until 10 p.m. doing homework, when her bedtime is 8:30. Im wondering: is she getting too much homework? _I try to discuss this topic with my teacher friends, and I start out with this: if Im going to be spending two hours a day helping my child with homework, I might as well home school her. _ On every occasion I get the e-e-e-e-e-evil stare!!!! Then my wife says, "shes a teacher, you better not go there. Well I want to go there with someone. The teacher of my student wont go there either. She is relentless, and so too was the fourth grade teacher of my older son. Its like discussing "homework" is not allowed; that if they mention the words "reducing homework" Zeus will strike down upon them with a bolt of lightning. Its really not that big of a deal. I just want to have a friendly discussion as to why I think fourth graders get so much homework. I believe its because NoChildLeftBehind Act requires a test in the fourth grade, and the results of that test determine the schools rating, and how much money they will get. So, they punish fourth graders with too much homework. Well, there really not just punishing the kids, but the parents too. My kids are lucky they have a loving, caring and patient mother Note: I do believe responsible parents will spend time helping their kids with homework, and that doing so when the child is younger will result in good study habits later in life. However, how much homework is too much? Thoughts? Facebook Twitter

I will say one good thing and one bad thing about my job.

Surely it makes sense that if a perosn is scared to death, or if he is depressed, his immune system will be negatively effected. We see this many times in the hospital setting, where an elderly person who is infested with disease is silent, which is a sign of depression. In such a case, hopefully the physician is also trying to relieve the persons depression in order to facilitate healing. Another option would be faith healing, where a priest comes in to see the patient to provide spiritual healing, which has been proven to promote happiness. And this goes along with my theory that hope and faith in and of itself can facilitate healing. On the other hand, as noted, fear and depression may make a person worse. This was a topic that historian Fielding Hudson Garrison discussed in his 1922 history of medicine:

In surveying these different superstitions, one point becomes of especial moment. It is highly improbable that any of the remedies mentioned actually cured disease, but there is abundant evidence of the most trustworthy kind that there have been sick people who got well with the aid of nothing else. How did they get well? Short of accepting the existence of supernatural forces, we can only fall back upon such vague explanations as "the healing power of nature," the tendency of nature to throw off the materies morbi or to bring unstable chemical states to equilibrium, the latter being the most plausible. But, in many cases of a nervous nature or in neurotic individuals, there is indubitable evidence of the effect of the mind upon the body, and in such cases it is possible that a sensory impression may so influence the vasomotor centers or the internal secretions of the ductless glands as to bring about definite chemical changes in the blood, glands, or other tissues, which, in some cases, might constitute a "cure." We know that the reverse is possible, for example, in such occurrences as the whitening of the hair from intense grief or fear, or the production of convulsions in a suckling infant whose mother has been exposed to anger, fright, or other violent emotions before nursing it. As Loeb strongly puts it, "Since Pawlow and his pupils have succeeded in causing the secretion of saliva in the dog by means of optic and acoustic signals, it no longer seems strange to us that what the philosopher terms an idea is a process which can cause chemical changes in the body."1 Billings compares the sensation obtained by placing the hand on a cold object in a dark room with the way in which the blood "runs cold" when one realizes that this object is a corpse.2 Criles important studies of surgical shock show the strong analogy existing between the phenomena produced by shock, the extreme passion of fear, and the symptom-complex of Graves disease, particularly in regard to the pouring out of the thyroid secretions and the destruction of the Purkinje cells in the brain. W. B. Cannon shows that in fear, rage, or anger, the emotions which prepare the animal for fight or flight, the digestive and sexual functions are immediately inhibited, the adrenal secretion is rapidly poured into the blood, mobilizing sugar from the hepatic glycogen up to the point of glycosuria, counteracting the effects of muscular fatigue, and hastening the coagulation time of the blood, thus giving the organism wonderful capacity for offence, defence, flight, and repair of injured tissues. A man in a fighting or frightened mood is a ductless gland phenomenon. The pathological effect of ideas upon the sacral autonomic is seen in the

A little knowledge from our past.

I write on this blog often how ignorance impedes progress. I came upon an excellent discussion of this by the greate historian Fielding Hudson Garrison. Sorry this passage is long, but its worth the read:

Buckle* maintained that ignorance and low-grade minds are the cause of fanaticism and superstition, and, since his equation is reversible, we may consider this proposition true if we apply it to certain fanatical leaders of mankind, savage or civilized, who, as "moulders of public opinion," have retarded human progress. Chamfort said that there are centuries in which public opinion is the most imbecile of all opinions, but this reproach cannot be entirely saddled upon "the complaining millions of men." History teaches everywhere that permanent ignorance and superstition are the results of the oppression of mankind by fanatical overmen. In medicine, this is sometimes ludicrously true. "There is nothing men will not do," says Holmes, "there is nothing they have not done to recover their health and save their lives. They have submitted to be half-drowned in water, and half-choked with gases, to be buried up to their chins in earth, to be seared with hot irons like galley-slaves, to be crimped with knives like codfish, to have needles thrust into their flesh, and bonfires kindled on their skin, to swallow all sorts of abominations, and to pay for all this, as if to be singed and scalded were a costly privilege, as if blisters were a blessing, and leeches a luxury. What more can be asked to prove their honesty and sincerity?"1 Yet while the lack of public enlightenment in certain periods produced the stationary or discontinuous mind, there are signs that the modern organized advancement of science may bring forth rich fruit for the medicine of the future through the social cooperation of the mass of mankind with the medical profession. As the ancient Greeks hung upon the teachings of Empedocles and Hippocrates, as modern humanity responded beautifully to the ideas of Jenner, Pasteur, and Lister, so there has been at no time a greater interest in the advancement of medicine and public health, as manifested in periodicals and newspapers, than in our own. The awakening of the people to looking after their own interests in regard to the organization and administration of public hygiene is, no doubt, the hope of the preventive medicine of the distant future. Yet, even under the best conditions, it is still possible and probable that many highly intelligent and highly educated persons will continue to hug their whims and superstitions, consult quacks, and be otherwise amenable to psychotherapy, absent treatment and "action at a distance." "To folk-medicine," says Allbutt, "doubt is unknown; it brings the peace of security."

Its interesting that this observation was made in 1922 and it still holds true today, 91 years later. We still have doctors who believe in myths, and as we know, a myth is something that is based on superstitions and feelings as opposed to fact. A myth is something that has never been proven, such that ventolin treats pneumonia, CHF and pulmonary fibrosis, or that oxygen will knock out a COPD retainers hypoxic drive. Surely you know such are myths, as they have never bee proven, although they are treated as facts by God knows how many people -- way too many people. A few good examples can be found in my post: The 15 biggest myths of respiratory therapy. *I have no idea who this is. In many older history books the author generally uses last names without any further knowledge on who the person was. Although I imagine he was a smart man

So the patient was sitting on the edge of the bed, leaning on a pillow to breathe. She was diaphoretic and extremely dyspneic. She was rhales all the way to the tip of her voice box, and she was moaning in agony, "Please just shoot me! Please, just put me out of my misery!" The RT said, "I cannot do that." The QA analysts said, "Such therapy is not covered by CMS, nor is it covered under Obamacare. Although Obama would probably like it because it would reduce the cost of healthcare." Hence is the state of medicine. Forty-five minutes after the page the doctor responded to the call. In the meantime, the patient suffered. The RT stood by the patients side wishing he had the power to treat the patient. Thankfully, however, some things get better. The market has forced many hospitals to hire hospitalists, who respond to patients in need, as opposed to treating patients over the phone. Those in Washington will, however, continue to treat patients from the comfort of their leather chairs, sometimes thousands of miles, and sometimes thousands of hours prior to the time the patient even gets sick. Facebook Twitter

The following is a report from Will Lessons When our local Walmart chooses to under staff check out clerks, customers get grumpy due to long lines, but no lives are lost. When hospitals under staff doctors, nurses and respiratory therapists, lives are put at risk.

The patient was in a raging fight with the nurses. She was cursing and calling for her mother. She was 97, so you know that her mother probably (quite certainly more like it) is not around other than spirit. And so you think: somehow, some way, the nurses will think of a reason to call respiratory. And, lo and behold, your beeper goes off. You are called to assist this patient. And its not your muscles they want, and its not your Ventolin they want, and its not your oxygen they want: its you. Its your personality. This is what happened to me tonight. I entered the room and found it to be a patient I knew quite well. She was a regular. And she was one who was very bossy, picky, and quite cantankerous. Many (most) of the nurses and doctors do not like her. But, for whavever reason, she has always like me. When I work she makes sure I wake her for her treatments just so she can visit with me. So today I was called because of my communication skills. I was called because I was the one person this patient liked. And I was called so I would sit next to her, on the bed (that they just wrestled her into), and touch her hand. I said, "Hey, Mrs. Smith (fake name no doubt), whats going on tonight? "The nurses are treating me like shit," She said angrily, "and you can go away too." "What can we do to make things better for you?" I said. So I talked to her like this for about a half hour, yet it didnt take that long to talk her down. She told me about her mother, of whom she wanted to visit her. She told me stories about her mom and dad and her sister. Surely, she was hypoxic for so many years, and this was the person she had become. She was living in the past. And the nurses werent able to reach her. But they forget, as its easy to do when youre wrestling with a patient, that people never forget who they are. People dont forget their past. Thats where you make contact. It certainly beats wresting. And while I was talking with her the nurses were able to put the medicine in her system that was truly going to help her. Facebook Twitter

One of the dumbest and least successful ways of committing suicide is by taking pills. Surely it works sometimes, but more often than not someone will come around and find your butt and call an ambulance. Youll end up in an emergency room. The same is true for alcohol abuse. You end up in the emergency room, and you will be poked, prodded, puked, and maybe even tubed. Doctors and nurses like to make you as miserable as possible so you dont do such a dunderhead thing again. Then when you are better you will end up in the psych unit at some hospital, and you will have to see a psychiatrist or psychologist. You will be required to sit through counseling sessions. Yes, you will be forfeiting some of your freedoms. Whether this is right or not can be debated later. You will, hopefully, benefit as a result and hopefully not try to kill yourself again. Hopefully you will realize that depression is a disease that can be treated. Its normal to be depressed. Its okay. So dont take your life. Its not worth it. Its special. Your life is special. Your life is a gift. You are a gift. You are special. You are loved by someone, and that person will miss you. That person may blame himself. But in your depression you probably fail to think how others think. You may not care. And you might take the misery the nurse and doctor put you through and make sure you do it right the next time. But if you dont do it right, chances are that your doctors and nurses will simply think you are seeking attention. And you will get attention in the psyche unit. Or, perhaps you ARE seeking attention. And I dont think the psych unit is a bad thing. Honestly, depression is a disease that can be treated. And, while many people make fun of psych units, they are good. They do good things. Depression might simply be the most under diagnosed disease in the world. It is because most often it goes unrecognized, and on the other hand the patient who is depressed is too embarrassed to say anything. So the cycle continues. Surely there are those people who abuse the system. But for the other 80 percent, I think we need to take you more seriously. I think we need to not throw everything at you. I think we ought to have a little more empathy, and treat you with respect and dignity (the way wed treat you if you were one of us in trouble). I think one of the roles of respiratory therapists, nurses, and physicians should be to watch for the markers of depression, and a common one is silence. We ought to do our part in trying to address this however we can, and perhaps the best remedy is kindness on our part. Note: There was no research into this article. This is merely an opinion. Facebook Twitter

The following are wit and wisdom previously featured on RT Cave: * Silence * Its easier to criticize a doctor than to be one. * If youre ignorant then you are not telling a lie, you are just ignorant. * Wisdom that is not expressed is like an Albuterol treatment for pneumonia -- both are useless. But a person who hides behind ignorance is better than one who keep his wisdom to himself. * Brevity is the soul of wisdom. Albuterol is the soul of doctors. * Albuterol is Gods medicine. Everybody ought to bathe in it. Grim care, moroseness, anxiety, - all this rust of life, ought to be scoured off by the mist of Ventolin. It is better than mirth and even better than emery. Every man ought to rub himself with it. * If 80% of what we did wasnt useless wed probably care more * An RTs best friend is a patient who refuses whats not needed * If it werent for ignorance most of what we RTs did wouldnt be a waste of time. Yet if we got rid of all ignorant people thered be no one left on earth. * The best of all gifts around any Christmas tree: the presence of a happy family all wrapped up in each other. ~Burton Hillis * When you talk you only hear things you already know. When you listen you learn new things. Chinese proverb * I thought I was wrong once but I was mistaken." nurse * Live as if you were to die tomorrow. Learn as if you were to live forever. Indian philosopher * No matter what you say is the wrong thing, and thats why its better just to stay silent. me * Words are open to interpretation, and therefore its wiser to not use words at all. * If words offend you then you will never learn. * If you are afraid to make mistakes you will never learn-- friend * I thought I was wrong once, but I was mistaken -- friend * Epictetus: The key is to keep company only with people who uplift you, whose presence calls forth your best. * Epictetus: The essence of philosophy is that a man should so live that his happiness shall depend as little as possible on external things. * What is smart? Education doesnt make you smart, in fact education can corrupt you. You can have a Harvard degree and still make stupid decisions. You have people with little education running successful businesses. So education doesnt make you smart. What makes you smart is common sense. What makes you smart is knowing how to apply the wisdom you learn. * Silence shows you care * Give your kids enough to do something, but not enough to do nothing * * The nature of medical causation is such that it takes as much time and trouble to rectify an error as to establish the truth. Thus it may require the experience of one mans life to arrive at some plausible theory, and the counter-experience of another mans life to show that it is false." Late 19th century writer * "The purpose of education, of thought -- of life, even -- is to clarify our ideas so we can develop knowledge instead of opinion." Norman Cantor * Epictetus: There is only one way to happiness and that is to cease worrying about things which are beyond the power of our will. * Epictetus: To accuse others for ones own misfortunes is a sign of want of education. To accuse oneself shows that ones education has begun. To accuse neither oneself nor others shows that ones education is complete. * "The purpose of education, of thought -- of life, even -- is to clarify our ideas so we can develop knowledge instead of opinion." Norman Cantor * Ignorance and low-grade minds are the cause of fanaticism and superstition. When such people become leaders of mankind, they become the molders of public opinion. * Take time to think, and think for yourself. * He who would serve the cause of truth in science must be, above all, a free thinker." Ptolemy * Kind words are more effective than the best of gifts, and if you are really concerned, you will give both. (Sirach 18:17) * Youre going to spend more mornings getting up to go to work than to school, so choose a career youll enjoy doing -- Career Counselor * "You can take all the money in the world and distribute it equally. 5 years latter the poor will be poor again and the rich will be rich again." Grandpa Frea * Ventilitize: The process of loading up a patient with so much ventolin there will be no further need for hospitalization. * Kind words are more effective than the best of gifts, and if you are really concerned, you will give both. (Sirach 18:17) * A hero only comes around when one is desperately needed * The elderly are the seat of wisdom in any society. They are the sages who help us get through life by making wise decisions, and by sticking to principles that hold any society together. *

Man is born with the tendency to sin. As a Catholic I was taught that man is born with the seven deadly sins already wrapped up under his belt, and this is the purpose of Baptism. The seven deadly sins are: * WRATH: Anger. People have a natural tendency to feel defensive, and mad when things dont go their way, or they feel threatened. * GREED: The desire for material wealth or gain. You are unsatisfied with what you have. You are unhumbled. * SLOTH: Lazy. You avoid physical work. You are dependent on others. You avoid spiritual work. * PRIDE: Excesive belief in your abilites to the point it interveres with your recognition of the grace of God. Many people say that all other sins arise from pride, also known as vanity. * Lust: You have an inordinate crazing for the pleasures of the body. You are a drug addict, or you are a sex addict. You put personal pleasure before God. * ENVY: Instead of being satisfied, or humbled, you want what other people have. You want their status, their stuff, their situation, their money, their house. You are jealous of them. * GLUTTONY: Inate desire to eat and drink to fullness.

One of the most frustrating things for a respiratory therapist is trying to explain to "some" nurses why a breathing treatment isnt needed. Nurse: The patients wheezing Me: Thats not a wheeze Nurse: Yes it is. I can hear it audibly and throughout Me: If you hear it audibly its not a wheeze. What youre hearing is stridor or rhonchi radiating. Nurse: Have you seen that patients x-ray? It looks really bad. Me: Bad x-rays are not indications for beta adrenergic therapy Nurse. Youre just lazy and trying to get out of work Me: No, Im using science to justify indication for giving a medicine. Nurse: Stomps off angry. Me. Humbly give the treatment with a smile while having fun with the patient. I think we could probably make a cartoon out of this. Facebook Twitter

For years now the science has shown that blowby treatments are useless. Yet I find that they are very useful. Allow me to explain. When I was a new RT a 1 YO patient was admitted with a stuffy nose, audible congestion, and retractions. I did a blowby treatment to no effect because there was no other way to do the treatment. Theres no way the child would have tolerated the mask, and the mouthpiece was out of the questions. So I did a blowby to no effect. And then I told the doctor blowby treatments only get 1 percent of the medicine to the patient, and so he ordered continuous blowby nebulizer. You see my predicament here. I have learned that its better to just do the blowby and be done. Its better to just blow the medicine past the patients nose, watch it waft away in the breeze, and just be done with it. Then I can return to the RT cave and blog. Yes, this is great. Ignorance of the nurses and doctors in this way has made me a lazy RT. Facebook Twitter

Ive had many people email me over the years saying that they wish more people would leave comments on my blog posts. They say things like, "I just want you to know that even though no one leaves comments on your blog posts, we love your blog." Perhaps you are one of these folks. I thank you. I also often remind folks that I see no reason for anyone to leave comments on my posts, because I pretty much say it all. Once I finish a thought, theres not much else to say on it. Im not saying this to be arrogant, but more or less to show that most of what I write on this blog is what other respiratory therapists think but cannot say for fear of losing their jobs. I dont fear losing my job, so I just say what I think. How many times in the course of doing your rounds have you ever said to a doctor, "That person doesnt need a breathing treatment because Ventolin does nothing for pneumonia, ha ha ha." You dont. You dont because you have to maintain a professional relationship with that doctor, who, as a matter of fact, probably believes ventolin cures rickets. For crying out loud you know its true. Yet every once in a while a doctor comes around who agrees with what I write. I have one doctor who uses my terms as he discusses patients, saying things like, "That patient doesnt need scrubbin bubbllin therapy, but in order to get reimbursed... da da da." I love that doctor. He knows, and he admits. I love all our doctors. I love and respect them all, but there are many who are clueless about respiratory therapy. I mean no disrespect when I say it, its just true. And the same is true of some nurses, and Lord knows its also true even of some respiratory therapists (and if youre reading this you probably dont know who you are, so Im not worried about offending you). Look! I would love to have more comments on my posts, but I also understand you guys have to keep your jobs, and that means you have to be careful. Its also for this reason that I always keep the option open for you to make comments anonymously or by using a fake name. The problem with this is I have to deal with those ignorant bastard spammers. So if you want to leave comments on my post, but are afraid to, feel free to hide your real self. Trust me, you would not be the first. In the meantime, feel free to email me, as many of you already do. Oh, and please note that the contact me icon to the right is not working for some reason, so you can contact me by my email: freadom1776@yahoo.com. I know I invite spammers by putting my email on here, but so be it.

I had a father of a cystic fibrosis child email me a few years back because he noted his child did not benefit from bronchodilator therapy, yet his doctor insisted, saying, "Your child has cystic fibrosis, and all cystic fibrosis patients benefit from bronchodilators such as ventolin." I have had many chronic bronchitis and emphysema patients note the same. And there are many of such patients that I have observed medicines such as Ventolin to have no effect, yet physicians continue to order them for all their COPD patients, and all their CF patients. Yet all the evidence in the world suggests Ventolin and other B2 agonists benefit one disorder and one disorder only, and that is hyperactive airways or asthma. It only benefits those other diseases when asthma is present. If asthma is not present, Ventolin should not be ordered (although it should always be on hand). Science shows that many, but not all, cases of CF are associated with hyperactive airways (and this is asthma). The same is true of all COPD patients (not all have asthma). These conditions often present with comorbidities, and one of these is sometimes asthma. Note the following facts * Ventolin will not treat CF, it will only treat the underlying asthma * Ventolin will not allow emphysema patients to grow more lung tissue * Ventolin will not allow chronic bronchitis patients to stay infection free * Ventolin will not help pneumonia patients cough up pneumonis.

We must first remember that white magic was considered magic that made people feel better, and black magic was magic that made people feel worse. Now we must consider that chemistry was originally referred to as the black art. Chemistry comes from the term "chemi" which comes from Ancient Greek and refers to the Black Land, which was the term for Egypt due to black soot left after the annual flooding of the Nile River (this black soot fertilized the land). Although some speculate the term "chemistry" came from the term _al-kimia_ which means to cast together. The Greeks learned of the Black Land and of the Black art through people who traveled as traders between the two lands. The Egyptians are considered by many to be the first to mix various chemicals to come up with substances, many of which we still use today (such as make up, perfumes, soaps, dyes, distillation, leather, glass, alloys and amalgams, and more). Physicians would eventually learn of various herbs that would be mixed in such a way by apothecaries who would provide remedies to the physician. In this way, the chemists, the pharmacist, was a middle man who worked between those who discovered and found the various herbs and the physician. It wouldnt be until the 5th century A.D. that the Arabs would form the first apothecaries who worked between the physician and the patient. And thus we had the birth of the pharmacy profession.

Medicine to the primitive mind was what we might now call folk medicine. In our minds we think of it as mythical, even irrational, although thats not a fair way of viewing it. Primitive man had no way of knowing what we know today, and to rationalize medicine they came up with "theories" as to what might cause disease. We refer to it now as folk medicine. Folklore are essentially easy to remember and recite tunes. We think of them as fun for kids, although for most of human existence they were simple truths. For most of human existence people were ignorant of real truths, and therefore had no way to explain what happens when people die, and what happened before we were born. So they rationalized the only way they could: through folklore. They shared these at night, perhaps by the flicker of the fire. The Epic of Galgamesh was one of the first stories ever put to writing, and was probably told for centuries before it was written down sometime around 3200 B.C by the Sumerians. It was the story that pretty much highlighted the gloomy view held by the Sumerians about life and death. Galgamesh made a good friend, and his friend was taken from him by the gods, and he sought the stone of eternal life, only to have it taken from him by the serpent. While folklore provided entertainment, folk medicine provided hope. To the primitive mind, hope was medicine. The primitive mind had primitive knowledge; he was ignorant of what we might refer to as basic facts. Even the primitive doctor had scanty knowledge of anatomy, and therefore had no real concept of disease. For this reason, the symptoms was the disease. You _had chest pain_. You _had leg pain. _You had _a runny nose. _You had _shortness of breath. _You had _a broken leg. _ External injuries may have been classified accurately because they could be seen. A broken leg was a broken leg, and a cut finger was a cut finger. But what is going on when a person suddenly becomes confused? The primitive mind, having no knowledge of internal anatomy nor disease, begins to speculate. These speculations, then, work their way in to easy to recite little tunes, and are recited from one generation to the next by the flickering light of the fire. Folklore provided entertainment, while folk medicine provided hope. To the primitive mind, which was ignorant by our standards (but not theirs) accepted this way of living. In fact, it was essential to their survival in an otherwise arduous, dark and vicious world. There were evil spirits, dark demons, and angry gods lurking amid the dark trees, in the sky, and in dark corners (like the closet and under the bed) of homes.

Garrison, Fielding Hudson, "An Introduction to the History of Medicine," 1921, pages 31-41

WHAT FOLLOWS IS WHAT WILL BE ADDED TO THE NEW ADDITION TO THE REAL PHYSICIANS CREED: HOW TO TAKE CARE OF PESKY RTS. AGAIN, THIS IS TOP SECRET INFORMATION FOR PHYSICIAN USE ONLY, AND WAS NEVER INTENDED TO BE RELEASED AMONG THE RT COMMUNITY. MY SOURCE FOR THIS TOP SECRET INFORMATION WILL BE KEPT ANONYMOUS, BECAUSE IF HIS PEERS FIND OUT HE IS THE LEAK, HE WILL BE BANNED FROM THE MEDICAL COMMUNITY AT BEST, OR RIDICULED AT WORSE. ------------------------- Date: April 9, 2012 From: Dr. Al Buterol, M.D., President of physiciansrock.com To: Dr. Ven Tolin, president of the Dr. Creed Association Basically the hypoxic drive theory was created as an excuse to get physicians off the hook for when a patient dies of hypoxia. It was originally intended to cover COPD patients, although we have extended it to include patients with severe asthma, lung cancer, cystic fibrosis, etc. It also includes every person who ever smoked, whether they are a CO2 retainer or not. Since most people smoked in 1962 when Mr. Campbell gave his great presentation to the physicians of the American Medical Association, this theory seemed like a very good idea -- it made us all feel good. And just think about it, if our own fake theories make us feel good, thats a bonus. This new hoax pretty much got us physicians off the hook in most cases where we were sued for a patient dying of anoxia (for those who barely graduated medical school, that means lack of oxygen to the brain). This new hoax pretty much got physicians off the hook in most cases. However, the bimbo heads in Washington continue their quest to get people to quit smoking, and this has put a damper on our profession. Since fewer people smoke today, this has resulted in increased litigation, and there be your reason for all the increased medical costs and all the warnings on medicine that most people ignore. We owe it all to evil lawyers who now have an open door to suing us because our hoax is no longer valid as often as wed like due to people no longer being ignorant. Now it also appears that some incompetent physicians and nosy respiratory therapists are on to our hoax, and are out to expose our efforts. This would be terrible because it would make us out to be wrong, and you know the medical profession is always right. So my effort by sending out this memo to all my fellow physicians is to remind you of the importance of the hypoxic drive hoax, and the importance of the efforts to ignore RT efforts to inculcate the idea the Hypoxic Drive Theory is really a hoax. We know it is, but we dont want lawyers catching on to this, because that would result in lawsuits when when we intentionally keep COPD patients hypoxic. Keep up the good work fellow Dr. Creed members. We must continue our quest to keep anyone outside the medical profession ignorant.

143. SUPERTROPIUM BROMIDE Symptom: any general ailment outside the pleural spaces of the lungs Diagnosis: general Frequency: Varies Effect: Has a high affinity of Ventolin type particles in the lungs. This is important, because Ventolin is a great medicine, but at a size of 0.5 microns will only cause bronchodilation unless helped along by Supertropium Bromide. This medicine in effect works like a GPS system and litterally guides the Ventolin to wherever in the body the physician has directed it to go. Also, Supertropium has a certain metalic property so that it allows the newly patented GPS-GLAS system track the progress of the patients air passages, including the level of fluid. Note: In order for this product to work physician must have the newly patented GPSoscope. Physician doesnt have to be present for medicine to work, all he has to do is dial in designation from the comfort of his own home. Recommended use with all above Ventolin Types. Comes individually packaged as Ipatromium Bromide or in combination with the Ventolin Type of your choice in the form of Duoneb.

The GLOBAL LUNG ASSESSMENT SYSTEM (GLAS) is a space-based satellite navigation system that provides location and time information in all diseased patients, anywhere on or near the Earth, where there is an unobstructed line of sight to four or more Global Positioning System (GPS) satellites. It is maintained by the United States government and is freely accessible to anyone with a GPS receiver and a teleskinoscope. All you do is hook the telekinscope to a patented GLAS converter on the GPS and you can hear any lungsounds from the comfort of your own home. You can control the settings so that its extra sensitive, or you can set the sensitivity to stubborn.

EXTRA SENSITIVE: Will let you know right away the lung sounds of any patient anywhere in your client base. Most doctors dont like this because it creates too much work for them.

STUBBORN: Will only let you know lungsounds of patients admitted to a hospital you are qualified to treat patients at. Most doctor prefer this one because it allows them to immediately hear significant changes in patients already being monitored.

The GPS-GLAS program provides critical capabilities to military, civil and commercial physicians around the world. In addition, GPS-GLAS is the backbone for modernizing the global air traffic system and the for monitoring astronauts by NASA. To make the system work the patient is required to inhale Supertropium Bromide every four hours to maintain a steady base of the Ipatropium qualities in the lung passages. Supertropium is picked up by a GPS system and litterally guides the Ventolin to wherever in the body the physician has directed it to go. It also allows the physicians to minitor (from home mind you) the level of fluid in the lungs, and the level of constriction in the airways. Note: In order for this product to work physician must have the newly patented GPSoscope. Physician doesnt have to be present for medicine to work, all he has to do is dial in designation from the comfort of his own home. Recommended use with all above Ventolin Types. Comes individually packaged as Ipatromium Bromide or in combination with the Ventolin Type of your choice in the form of Duoneb.

My mom hated farting. My mom wouldnt let us use the word fart. If we laughed when dad farted, mom would say, "then you can sit in the bathroom next time your dad is taking a crap." Yes, that was my mom. She never farted. Well, she did, we just never heard it. Dad farted. Thats how you knew dad was up in the morning: youd hear that loud fart. And wed try to fart like that too, but our little bodies couldnt produce such a loud noise. Maybe thats why it was so funny to us. I remember staying up late at night when Id sleep with my brothers in their rooms, and wed be giggling so hard because we were all farting. Wed be up half the night because our tummies would hurt so bad from farting. Now that Im an adult my kids think the same about my farts as I did about my dads. The first thing in the morning I fart, mainly because dad did it and it was cool then. Like my mom, my wife frowns on this, although shes not as hard up against it as my mom. Yes, believe it or not, my wife farts too, and its okay when she does it. Oh, and did I tell you my mom hated the word fart. We had to call it "passing gas." That seems so dull, but its how it was. Dad did not fart, he passed gas. Now its okay to say fart. My kids say fart all the time. Fart was one of the first words my two year old son learned. Even he laughs. And, yes, we fart in the hospital too. Many times I walk into a patients room and toot, so many times I cant remember them all (whod want to). Ive heard nurses and patients fart too. But nurses want patients to fart, so its okay. Nurses love farting more than anyone in the world. Only to nurses farting isnt so funny. Its not funny because its part of the job. Nurses are perhaps the people in the world who become apathetic to farts, and the smell. Well, I supposed nurses aides also get used to that smell. They smell it so often they dont even notice it; or at least they dont acknowledge noticing it. Many times Ive walked down a stinky hall, and I wince and plug my nose, but the nurses and aides are just sitting there going about their business. Its like they dont even notice the stink It has to be because they are apathetic to it; they smell it so often they dont even notice it. Or, better yet, they develop a tolerance to it; nurses are fart tolerant. So you toot and then you squeeze your cheeks to prevent any more gas from escaping, and you continue along as though no one heard you. But you know they did. Sometimes if you figure you were obvious enough, you might apologize and excuse yourself from the room. But mostly you just keep going as though nothing happened, hoping no one noticed -- but you know they did. Yeah, and everyone else does the same thing. And sometimes I fart silently in a room with a ventilator, and then I snicker at the nurses station as I watch the nurses turning the patient to change his britches. And then I snicker louder as the nurses find nothing. They never catch on. They never catch on unless I think they can take a joke and then I tell them. Then we all laugh until our tummies ache. Yes, farting is normal. Its nothing to be embarrassed about. Its not something to pretend doesnt exist. So its something to be laughed at. Farting is funny. (The Happy Hospitalist thinks farting is funny too).

Surely this isnt respiratory therapy related, although interesting nonetheless -- and medical, or sort of. Yet ancient societies recognized dental carries and many believed it to be caused by worms, perhaps because they noticed the canals in rotten teeth. The following Babylonian tests shows how the Babylonians believed diseases were caused by gods or evil spirits, although they were aware of the naturalistic process: After Anu (had created heaven), Heaven had created (the earth) The earth had created the rivers, The rivers had created the canals, The canals had created teh marsh, (And) the marsh had created the worm - The worm went, weeping, before Shamash, His tears flowing before Ea: "Wht will thou give for my food? What will thou give to me for my sucking?" "I shal give thee the ripe fig (and) the apricot." "Of wht use are they to me, the ripe fig and the apricot? Lift me up and among the teeth And the gums cause me to dwell! The blood of the tooth I will suck, And the gum I will gnaw Its roots! Source: _Ancient Near Eastern Texts, _edited by james B. Pritchard, Princeton, Princeton University Press, 1969, pages 100-1 Facebook Twitter

If you guys thought tracheostomy tubes were a modern tool for physicians, think again. The following is an advertisement from the a physicians catalog of S. May and Son from 1866: Reference: * S. Maw and Son, Manufacturer of respiratory equipment, "A catalogue of surgeons instruments, air and water beds, pillows, and cushions, bandages, trusses, elastic stockings, inhalers, galvanic apparatus, and other appliances used by the medical profession," 1866, London, 11 Aldersgate St., Buttler and Tanner, The Selwood Printing Works, page 85

There is an old Hebrew saying that "what has been is what again will be, and what has been done is the same as what will be done; theres nothing new under the sun." The idea here is that while societies change, wisdom matures, and technologies improve, mankind stays the same. Or, as historian Fielding Hudson Garrison wrote in his 1921 history of medicine: "Human races and racial customs have changed as they became more highly specialized. the heart of man remains the same." We are born pure, and we error, and we become impure. Then we find ways to purify ourselves once again, and we often succeed in doing this. Then mankind forgets the past, and the same errors are repeated. This cycle has been repeated ad nauseum throughout history, and we need look no further than the Bible or any history book. We need look no further than healthcare for one great example. Many of my friends say there has never been a healthcare crisis like we are seeing in America today, although they are wrong. Yes, my friends, humans had a great healthcare systems many times in our past, only to screw it up.

One of the things I try not to do much of on this blog is write about life at Shoreline Medical. Of course you guys know thats a fake name right. Im not stupid enough to write the real name of where I work. I started out this blog thinking Id write about my experiences as Shoreline Medical (fake name), although I quickly got scared out of writing about things, fearing even if I change names, dates, etc. someone might see through my story. In fact, one of my early stories was read by one of my coworkers before he even knew I had a blog, and he said, "Are you writing a blog?" Fortunately hes a good friend. My point is I learned to be careful. I have read many other RT bloggers over the years who have been forced to shut their blogs down because they got a little bit too personal. And Im not saying I havent crossed the line a time or two. Sometimes I get out of work so irritated that I sit down at my blog and write pretty detailed posts, only to never publish them out of fear. However, I usually use this energy to come up with humor. I use the words of actual doctors, twist them into RT humor. I think this is safe. So far its been safe. Im basically showing absurdity with absurdity. And occasionally I write an actual educational post, blend in some philosophy, in order to not make my blog look like its one made to blast the respiratory therapy profession. I hope it doesnt appear on this blog like Im blasting the profession, as thats not my intent at all (well, yeah I guess it is to a point). But what Im trying to say (write) is that this blog is meant to shed light on what is good and bad about the profession, and to have a little fun along the way. The ultimate goal is to be honest, and to hopefully make this profession better. If yourre just riding the wave, well, thats not how we get better. The way to get better is to actually look at yourself, and to see what is good and bad, and to make changes that make you better. The same is true of a profession. Just so you know, I love being a respiratory therapist. I love taking care of people. I love having chats with my coworker and patients. And, just so you know, I do think its fine to talk about religion and politics. Its a fallacy that you shouldnt talk about these things. Im pretty good at reading people, and I often know as soon as I walk into a room what I can and cannot say. If the patient isnt a talker, I sit there and I come up with blog ideas. And I take notes. And when I see something, or a doctor says something stupid, I write it down. If something new happens, I research it and I come up with a blog post idea. When its slow I read books, magazines, Internet articles, and anything I can get my hands on. All this gives me ideas. I take notes. I usually dont blog when Im working. I think there are too many risks at that. My son recently came to me and said he didnt want to be a dentist or psychiatrist because he learned theres a high suicide rate among those professions. I think there are a lot of people who dont want to be doctors because of Obamacare. I hear there are a lot of people who dont want to be RTs due to lack of respect for the profession. I hear there are people who dont want to be teachers because of high burnout. Yes, it was a teacher who told me not to be a teacher. I regret not becoming a teacher. You guys benefit, because I went to journalism school instead, and thats why I can do this. Yet I told my son that you do what you think youd like to do, and dont let other people, or studies, sway you one way or another. You need to set your goals high and, if you decide you want to stop, then you can settle with wherever youre at. But you start out reaching high. So thats why, despite the flaws of this profession, I never tell people not to pursue it. If you have asthma, if you love people, then this profession is right for you. Dont let the pessimism stop you. Why? Because no profession is ideal. There are flaws with every one of them. Your job as a high school student (or wherever you are in life) is to find the flawed job that is best for you. My son said once he wanted to be a professional baseball player. I encouraged that goal too. If he becomes a Tiger for a day (and he expects to replace Verlander), then Im sure hell take care of me when Im old (financially that is). What I did not tell him is that even baseball players get burned out. Its a long grueling season you know. Life can be whatever you make of it, and a job can be whatever you make of it. So dont be discouraged by what you hear, or what you read. Do what you want. And thats my rant. Thanks for hanging around here, and thanks for all the kind emails and comments. And make your own decision, heed what people say or write, but dont let them sway you. Or, think for yourself. Thats what my grandma used to say. Rick.

The road down the path to drug abuse usually begins with something simple like alcohol, and then to marijuana and then to something stronger to "take the edge off." Thats what a former patient who was a former drug addict told me once. And she probably knows more than anyone the road to drug abuse, considering she took that route. Its also true that more than 50 percent of crimes in this country are associated with drug and alcohol abuse. So this is why progressives earlier in the decade championed for laws banning the sale and production of marijuana. They tried to ban alcohol too, but they succeeded before they failed on that one. I never smoked marijuana before, and I never intend to do it. I also hope to God my kids decide better than to do it. However, I was in a room once at a fraternity party where a fag was passed from one person to another. I held it, and passed it to the person next to me. Yet considering I was in the smoke filled room, I can say I didnt put it up to my lips, but I did inhale. And then I was sick for the next two weeks with asthma. If sitting in a room with cigarette smoke is bad, sitting in a room with marijuana smoke is 100 times worse. So Id highly recommend if you have breathing trouble that you never touch the stuff. Marijuana is one thing that Ive changed my mind on over the years. My friends used to smoke it, obviously. They said it made you happy and gave you no hangover. And they also claimed it to be safe. And it is, relatively, except that there are some side effects: * 6-7% of car accidents are related to marijuana smoking * Increased risk for lung cancer * Breathing difficulties * Speed up heart rate * Speeds up breathing * Increases blood pressure * Thus, increased risk for heart attacks and strokes Now, keep in mind theres risks to alcohol too. I understand people who are opponents to the legalization of marijuana, but I also understand the supporters of overturning those laws. It is a free country, and you cant get rid of all risks by making laws. If someone wants it, they can get it without much difficulty. And in Michigan, the people who used to make it illegally now do so under the guise of medical marijuana. So Ill stop there and open the door to discussion.