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In My Opinion

Justifiable Crime?
July 28, 2015 9:53 AM by Jimmy Thacker

Well, it was bound to happen. Respiratory therapists, often characters themselves, have to put up with all kinds of characters in the hospitals and clinics where they work. And while it seems as though nurses get all the glory and physical therapists get all the funding, respiratory therapists get to see the whole spectrum of humanity. Some of the most difficult people to put up with are our co-workers; including other hospital staff. Just ask Donald Samson, a respiratory therapist in Glendale, Ariz., who was arrested for kidnapping recently.

It seems Samson believed that Chad Rogers, MD, violated too many rules as a resident physician, ordered unnecessary tests, and was generally seen as arrogant. The straw that broke the camel's proverbial back was when Rogers changed the settings on a ventilator without informing the RT. Now, any of us who have been around a day or two has had this happen, and none of us worth anything would fail to say something. I mean, in court, when they are asking about particulars about ventilator settings and who was the last person to sign his or her name on the ventilator check sheet, it isn't the doctor. It's the respiratory therapist. Still, there may be a case to be made that RT Samson went a bit too far. 

Enraged, Samson took Rogers and stuffed him into his trunk. By his own admission, he drove him around in the desert for a couple of days. A man hunt ensued after Rogers' wife noted he had not been home in a week. Police put two and two together, and found the good doctor in the trunk of Samson's car. The kidnapper's only comment: "I'd say we're even." 

The story was taken off the internet in November 2013, but it is true. I'm going to hazard a guess that Rogers has not changed another ventilator setting because he likely feels respiratory therapists are a little nuts. True or not, it is certain that a doctor should not just go messing with the vent, just like a respiratory therapist should not just go messing with the IV or changing the prescription on medications ordered by the doctor. Everyone has a role in the hospital. Those roles get confused sometimes by people on power trips who believe they are smarter and more indispensable than they really are. Good staff from all disciplines learn quickly that the biggest force multiplier in the hospital is when everyone respects everyone else and everyone works together for a common goal; quality patient care.

While none of us would approve of Samson's handling of the situation, you do have to admire his passion for his work and his very definite statement on what he considers his specialty in the hospital. I do not know if he still works; surely kidnapping is a reason to lose a license in any state. Hero or villain, Donald Samson has made his mark in respiratory therapy and on the career of a young physician, along with all the other hospital staff who know one of them. I always encourage people to speak out for the amazing things a respiratory therapist can do; most hospitals barely scratch the surface. This is probably not the best example of how to do that, but it sure was a fun read.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, Wellington, MO

Value of CPAP Goes Beyond OSA
June 22, 2015 9:03 AM by Jimmy Thacker
Even though the use of CPAP has been around for a while, we are still discovering the varied applications for which the devices can be used. One long-term effect of obstructive sleep apnea (OSA) can be an increased risk for cardiac disease and stroke. A cardiac program by the World Health Organization says that OSA can increase the risk associated with cardiac disease and stroke by two times, and should be considered among risk factors when physicians and clinicians interview patients. Estimates are that 50 to 70 million people in the United States are affected by some sort of sleep disturbance. The WHO team published their results in EuroHeartCare 2015. The conclusion it pointed to is "compared with men who did not have a sleeping disorder, those who did were found to be at 2 to 2.6 times greater risk of heart attack and 1.5 to 4 times higher risk of stroke."

CPAP machines have changed over the years, too. Big, burdensome, loud machines have given way to devices no larger than clock radios. They are quiet and easily maneuvered in the patients' bedroom or in their travel baggage. In a mobile society that is chronically tired, these machines may treat more than we have previously given them credit for.

Patients need to be encouraged to bring their home CPAP machines into the hospital whenever possible. The cost of a hospital putting a person on a machine temporarily for even a single night is way too high. Physicians, when talking to the patient about possible admission, should remind the patient that no hospital machine will be as comfortable or as inexpensive as the machine they already pay for. In smaller facilities, this also keeps the CPAP/BiPAP machine available for acute cases. For those not already on the machines, new uses may also tax the resources a hospital has available, particularly in smaller facilities with fewer machines. CPAP could be used more extensively to treat not only OSA, but also in cases where indicated for patients with chronic heart, circulation or sleep conditions.

In my opinion, the indications for CPAP are probably more far-reaching than just OSA. We should continue to investigate the effects of obstructive sleep apnea on the whole body, and come up with progressive ways to treat these effects. The machines are easy to use, have user-friendly interfaces, and can be transferred to home use with little training. Partnerships between hospitals and DME's could make the transition from hospital to home easier still. Respiratory therapists can serve as advisers to patients, physicians and hospital staff if we all work together for the good of the patient.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, Wellington, MO


New Hope for Those with Asthma
May 4, 2015 9:50 AM by Jimmy Thacker

 A new study by scientists at Cardiff University in Wales say they have isolated the root cause of asthma. If true, this could lead to relief for the millions suffering with the condition. Using mice and human airway tissue, the scientists proved that calcium sensing receptors (CaSR) are the problem. The CaSR is overactive in asthmatics, causing the person to experience coughing, wheezing, tightness in the chest and loss of breath. If that is not exciting enough, consider this: medications already exist to keep the CaSR in check. Calcilytics, presently used to treat bone deficiency, could become the drug of choice in the fight against asthma. 

The time table is clear; five years. Five years from now, if testing in humans is successful, asthmatics could finally get some relief. While not a cure for asthma, it could lead to a vast improvement in the treatment and exacerbation of asthma symptoms. Scientists have started formulating a testing paradigm, which could lead to studies using a treatment group and a placebo group, to see if calcilytics can live up to the expectations these scientists seem to believe. 

In my opinion, pursuing this is a no-brainer. Asthma affects 25 million people in the United States. About five percent do not respond adequately to their current treatment regimen. If even the chance of relief exists for that many people, many of whom are children, then why not? Will it put an end to asthma as we know it? No, probably not. But for the masses who suffer daily with asthma symptoms, it could offer a choice when typical asthma treatments are not working well. It could give doctors, nurses, respiratory therapists and asthma educators another tool in the toolbox to help their clientele. Everything is still being worked out, but what better time than asthma month to make a major find like this and explore the possibilities? I am sure asthmatics will be waiting with anticipation to learn if they can start to lead normal lives thanks to the wonders of science.

That's just my opinion, Jim Thacker, MBA, MHA, CRT Wellington, MO

Support Community Hospitals
April 13, 2015 9:05 AM by Jimmy Thacker
I never meant to switch. The gas station I always went to in the small town closed down for a while because of a fire, and I just started going to the only other station in town. Many times, people switch for better and much more common reasons than that. In healthcare, today's climate is all about offering a wide range of services. Well-funded corporate hospitals can afford to do it, and normally leave smaller, city-run or county hospitals in the dust. People get a taste of the "big-city" hospital and just like that, they are gone for good.

My switch was forced. Hospitals are similar. Patients simply cannot get specialized tests in rural facilities. Rural facilities cannot afford the equipment or the doctors, or special care that may be required after a test or procedure has been completed. Still, it is important that smaller hospitals, if they want to stay relevant and open, become as diversified as possible. Some do this by contracting doctors periodically for clinics, which works well. CEOs must, however, think ahead. Long-term planning must include growth, and growth means catering to a new population every decade or so. Any business that cannot change with the times gets left behind. It really is that simple.

In my opinion more focus needs to be put on smaller facilities. What can we do to help them? Do we really want all of them swallowed up by corporations with multi-million dollar budgets? Anyone who has been to one or worked in one can tell you the feel of the place is just different. The equipment is better, the care may be better and more broad, but the small county hospital is still important. Especially if it is a critical access hospital, it may be the only care available in a life and death situation. I would enjoy hearing your opinions on rural versus city and metro facilities you have worked in, and if you agree the "feel" just is not the same. I think rural facilities often do amazing work; the epitome of doing more with less. They pull this off all the time, yet few outside the hospital CEO and CFO realize it. They work with small budgets and small staffs, yet save countless lives every year. I believe in shopping local, and I believe in keeping rural facilities out there as lighthouses for those soles who do not want or have time to go into a metro area for their care, especially routine care. My opinion is that abandoning them now, after so many years of faithful service, would be disrespectful and would negatively impact countless lives.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT
Wellington, MO

Are Unions Needed in Healthcare?
April 7, 2015 7:48 AM by Jimmy Thacker

I have been reading over the weekend about negotiations between some 1,600 nurses and Penn State Milton S. Hershey Medical Center. The hospital reached an agreement with the nurses extending contracts three years. My question for readers are: 1) have you ever worked under a labor agreement forged through a union and 2) do you believe unions have a place in healthcare?

Healthcare is hard work. In the last 20 years, it seems to me that healthcare has become more about paperwork and preventatives against litigation than taking care of patients. The advent of electronic charting was supposed to provide relief from this, though I do not believe it has. I have been in places where "mandatory overtime" was the general rule, places that paid more per hour if you signed up to help on a short shift, places where overtime was forbidden, and places where therapists and other healthcare workers were just taken for granted. 

I am not really "pro-union" per se in healthcare. Still, there are benefits to having a union representative do your negotiating for you that cannot be denied, in any job. I have never worked for a union, but have also never been offered the opportunity. For the sake of discussion, I would like to hear from you, the reader, about your thoughts on unions in healthcare, if you have ever worked for one or are working for one now, and your experiences, both good and bad, with them. 

In my opinion, the taking over of healthcare by corporate hospitals has led to a dramatic upswing in satisfaction and resources for patient care, while leaving out the important human elements of those who do the caring. The one corporate hospital I worked in made me feel like an employee number, not a therapist. Have you had similar thoughts, or do I have it all wrong?

I am inviting all my readers to express their opinions, tactfully, whether you are for or against, whether you think this is a necessity in today's global and corporate climate, and how you think healthcare is affected. I hope you will participate. My views, shaped only by a narrow band of nurses, therapists, doctors, and others in hospitals and clinics locally, are that people are either very strongly for or very strongly against unions, but that nearly all agree that something has to be done to protect the workers, curb impending shortages throughout the country in nearly every discipline, and to keep the "care" in healthcare.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Online Medical Advice Can't Replace Face-to-Face Care
March 30, 2015 1:24 PM by Jimmy Thacker

There is a new wave in diagnosing your patient coming, and you need to be aware of it. It is "self-diagnosis," specifically the kind done based on internet research. With the advent of computers, smart phones and "an app" for nearly everything, sites like the Mayo Clinic's Symptom Checker, WebMD, and MedicineNet have become even more popular. People simply put in their symptoms on the site, and a diagnosis can be found. Once the patient decides it is time to consult with a physician, he or she is so convinced the diagnosis is already known that the visit is merely a formality. This can put your doctor off, making him feel anxious, or making her feel legally at risk if you happen to get the diagnosis wrong. It is a growing trend, however, because the information highway gives us so much information that there is literally no way it can all be true. 

Respiratory therapists have dealt with this for years. Who among us has not had the COPDers who treat themselves, despite what the doctor or "best practices" say? If you have been in the field for longer than a week, you have had those people. The "frequent fliers" are usually the most staunch. They believe they know what is wrong, know how to fix it, and do not hesitate to change their medical routines to accomplish what the doctors and hospitals could not -- control over their condition. I would imagine that other conditions have their fair share of this, too, such as diabetics, cancer patients, or patients on long-term care. Now, it would seem that the internet superhighway will make this a common genre in diagnosing patients, too. 

I want to be clear; I am not knocking sites like the Mayo, WebMD or MedicineNet. I think they all provide a reasonable service to people sitting anxiously at home trying to figure out what is wrong with them. Still, the information has to be gauged with some amount of criticism, if for no other reason, for safety. Nothing can or will ever replace meeting face to face with a healthcare provider, nor should it. I recently started seeing what I thought may be skin tags around my neck. With a long history of cancer, including skin cancer, in my family, I asked my doctor. Before I went, I used some sites to check, and all the indications were cancerous tags that needed immediate attention. I was ready to start planning my funeral. When the doctor looked at them, he almost laughed. I told him I had looked them up and already had diagnosed them, and that he would not be mentioned in my will. He announced that there was nothing to worry about, explained I was getting older and could expect even more, and that they were, in fact, pockets of fatty tissue that were harmless to me. I told him I may reconsider the will thing. 

In my opinion, the internet is an awesome thing, probably the most important invention since fire. Still, using the internet comes with an imperative that not everything you see and read on it is necessarily true. I, for instance, had no idea fat pockets would form as I got old, so I never thought of that. As I answered questions about my medical history, which was extremely short for a site diagnosing with a terminal disease, I was leaning toward answering with responses that I already knew would doom me because I feared the worst, so I answered based on assuming the worst. It was when I sat in front of a doctor, when he felt them with his own hands, when he looked at them with his own eyes, that a diagnosis turned out to be nothing.

We can often change the minds of our patients by showing that we care enough to spend time listening to them and attending to their needs, even if those needs are not spoken. Many people are alarmists, believing that every new thing is an end to life. Others ignore everything until the completely mundane condition they had has become a force to be reckoned with because it has been allowed to fester and grow in severity. Add to that a source on the internet saying you are going to die, and we have a society that is scared of its own shadow.

By all means, use the internet to make yourself smarter. Encourage patients to look up things they may not understand. Just remember that the skilled healthcare provider; the doctor, the respiratory therapist, the nurse, also needs to be consulted. Experience and first-hand knowledge after an in-person inspection always trumps a web site, and always will.

That's just my opinion, Jim Thacker, MBA, MHA, CRT

Wellington, MO

RTs Need Exercise, Too
March 23, 2015 11:00 AM by Jimmy Thacker
Here in Missouri, the spring weather is trying to break through the winter frost. People are kicking their exercise routines into high gear, excited to be outside and enjoying the sunshine. For many, it is hard to get started while winter is still looming outside the window. Well-meaning New Year's resolutions to drop a few pounds and inches give way to cabin fever, and the workout and diet both get pushed to the side while life goes on, and then suddenly the temperatures are in the 60s and 70s. At that point, most realize there is no excuse. It is also the time of year to get hurt. Injuries from over-zealous exercise routines are a common detractor, waiting to railroad your journey to an awesome body even longer. Many injuries require nothing more than some rest, maybe some pain management, and possibly a revision of your routine, but at least you can still persist and accomplish your goals. A few, however, may put you on crutches, in a sling, or even in a hospital or clinic. So here are a few reminders to keep you on the right path.

Exercise is great. It is necessary. We all know that. People who work often do not "have enough hours in the day" but somehow they manage it and feel better because of it. Exercise can help us stay focused at work. It can help us lose some unwanted winter pounds, and can affect our bodies in even more important ways, like lowering blood pressure and cholesterol levels and improving our mood. Like anything with a positive outcome, exercise can also hurt if not done properly. Just going out and buying that fancy new treadmill and deciding to walk five miles while watching your favorite television show probably is not a sustainable goal. First, it's hard. Second, do you have any idea how far five miles is when you are on a treadmill? It takes forever! Last, many of us will try it, but forget the importance of warming up and cooling down. This can lead to injury.

So first, if there is any question about your health at all, see a physician before you start your exercise routine. Seriously, go to the doctor and let him or her check you out. Nothing is going to ruin your summer more than recovering from your first heart attack because you wanted to get a "beach body" before your class reunion. Next, consult with someone smarter than you. Now, I know as respiratory therapists, it is hard to admit that some people are smarter than us. But try, look around. Find someone with some exercise and diet knowledge, like a nutritionist or dietitian, an exercise physiologist, or even a local lifter or competitor at the local gym. Learn from them. Ask specific questions about your specific situation. A pre and post workout diet are dramatically different from everyone else's if you are diabetic, for instance. Decide what your goals are. Are you just trying to fit back into that dress for the reunion? Do you want to build a routine you can sustain through next winter so you do not have to go through this again? Are you preparing for a competition of some sort? Decide your goals and break them down into smaller, more manageable goals. If you want to lose 50 pounds, that's great, but let's make our first goal the first five pounds. 

 When you go to a gym, it is easy to be a little humiliated at first. Overwhelmed maybe. That guy over there looks great and has the body you want, but does not seem approachable. He probably is. He is just a few years ahead of you. Talk to him. Ask him about his routine. Find out how he got started. The lady over there killing the yoga class is probably not at her first session. Talk to her. Ask her about what she is doing. Do not interrupt her while she is doing the downward dog, but when appropriate, talk to her and get her opinions. Do not let these folks discourage you. They have been at it a while, and once you have, too, then you will be the one others are hesitant to approach. 

Also, do not forget that exercise comes in many forms. Sure, there is the gym. There is running. Remember, too, that swimming, walking the dog, dancing, and even doing some housework can also count as exercise if you plan it out and do it at a pace that burns some calories. Just like any other exercises, do not forget to warm up. Twisting a knee while doing the "cha-cha-cha" is every bit as painful as it is when you twist it stepping into a pothole while running. Wrenching your back while planting roses is just as debilitating as spraining it when weightlifting. Be smart. Warm up, and after exercise, cool down. Keep a diet that gives you energy, but that is not loaded in unhealthy fats and remember that water; plain old see-through water, over ice, is a necessity for many reasons and still the best thirst-crusher out there. 

 In my opinion, we all need some exercise. It is hard to get started, but many people report they love it once it gets to be a part of their daily routine. Like any habit, it has to be reinforced over and over until it is second nature. You cannot do that from the sidelines. If you go out there and decide a marathon is your first event for the year, your exercise routine is probably going to end that same day. Just like you did in school, take it slow, learn a little and build on it. Make goals and focus on achieving the smaller goals first, leading to whatever bigger goal you have in mind. In the end, you will be healthier, happier, more focused, a better employee, and a better you. Isn't that what we all want?

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

RTs on High Alert during Motorcycle Season
March 16, 2015 10:30 AM by Jimmy Thacker

I was finally able to get the motorcycle out of the garage yesterday and put some miles on it. About 350 or so. Nice weather, light winds; it was great. I saw many other motorcycle enthusiasts out yesterday, too, after a long hiatus for the winter. Depending on where you are, the weather is just now getting motorcycle-friendly. Here in Missouri, cold temperatures are finally starting to give way to the sunshine, and the last few weekends have been great.

So now it is once again the time to look out for bikers. They are out there. They are hard to see sometimes. Some do stupid things on their bikes. If you have ever worked a motorcycle accident in your emergency room, you know what this blog is about. I wrote a similar blog a couple of years ago, and got comments like, "What does this have to do with RT?" Spend some time working with what is left of a motorcycle accident, and you willknow the answer. The good news, you will likely get to intubate. You will draw blood gasses. You will probably set up the ventilator. Bikes are not like cars. Bikers have no such protective shell. Only a few bikes have air bags, and their worth is still up for debate. A bike wreck is not like a car wreck. With no protection, bikers normally die, albeit very painfully.

Motorcycle deaths were going down, according to the Institute for Highway Safety, for some time through the 80's and 90's. Then, a culture shift occurred. First, older men like me, in our 50's or older, started riding. It was no long James Dean on a Harley, but doctors, accountants, bankers, lawyers and respiratory therapists on Harleys, Hondas, Yamahas, Suzukis, Kawasakis and Indians.

The other thing that occurred just a few years later was the popularity of the "crotch rocket." Younger people went with the fast, powerful crotch rocket, while old folks like me went with big heavy cruisers. The number of crashes started going up. So did the number of deaths. For the young crowd, it always seemed to involve speed and stupidity. For the older crowd, it was getting hit by people who never saw them riding or even while sitting at a stoplight. And the older crowd liked taking passengers along. Passenger death was a new statistic to track, and while there is less of a chance of accident with a passenger on board, there often is an extra death to report when there is a crash.

So why is motorcycling so dangerous? Well, we talked about the lack of protection. Trust me, leather is great for warmth if you happen to lay the bike down on the road, but when you are hit by a car, it is useless. Same with a helmet; great for head protection at low speeds, but honestly if you are counting on a helmet to save your life in a 70 mph crash with another vehicle moving at 70 mph, you have very unrealistic hopes. I still wear mine, though. I figure it cannot hurt to have it on, and it just may mean the difference between life and death. Many states now do not require helmets, allowing some to be stupid legally.

And then there are cars and trucks -- normally not a problem. In a pack of good drivers, a motorcyclist has every reason to feel safe and secure. However, get one person texting while driving, another jamming out to the tunes on his radio, and yet another trying to find that last french fry that fell out of the bag, all while moving 70 mph down the highway, and the motorcyclist has little to protect him or herself from these idiots driving too fast, not paying attention, changing lanes, or tailgaiting.

Motorcycles are also hard to see sometimes. Harleys have "loud pipes" so that they can be heard. I understand the idea, although I would personally rather be seen than heard. My bike, a Honda Goldwing, has chrome for daytime visibility and is lit up like a Christmas tree at night, all in the hopes that when you are out on the road with me, you can see me. It really isn't that I think chrome is all that cool, it just reflects sunlight nicely and gets your attention. That may be my only chance of surviving my ride. Same with lights; my lights are startegically placed to be spread out so that you know I am on a bike and you know how big my bike is.

In my opinion, the biggest things other vehicles can do for a biker is to slow down and look. Look once, twice, three times; I don't really care -- just look! Bikers still have a stigma to overcome; bad, dirty people who cannot afford a car, out on the road causing trouble. Yet bikers raise millions every year, particularly for children and veterans. I dare you to slap your child in front of a biker. 

We bikers just like the wind. We like the freedom of riding. Like any other freedom, there is a cost to pay. As with any freedom, people die and people get hurt. For us, it is people who abuse their freedom, either on their bikes doing something stupid or in another type of vehicle doing something that leads to a crash. Motorcyclists are no longer the highway roughnecks you see in the movies, no matter what kind of bike they ride, how loud their pipes are, or how many stickers or patches are on their vests or helmets. Often, they are doctors, lawyers, cops, EMTs, fire fighters, nurses, accountants, preachers, and even an occasional respiratory therapist. Watch out for bikers. The number of fatal crashes rise every month on average between now and August because more and more will be out there. If you have ever worked a motorcycle crash in an emergency room, you know what this blog is about. If not, well, I hope you never have to.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO 


Addictions Come in Many Forms
March 9, 2015 11:03 AM by Jimmy Thacker

I want all of my readers to know I consider you friends. That is why I am going to tell you what I am going to tell you. You are my friends, and I count on your support. I have an addiction. It started innocently enough; just here and there really. I had the mindset so popular with people dealing with addiction of "I can quit any time I want." That simply was not true. Denial is usually the first stage.

Soon, my addiction was taking up more and more of my time. It has evolved now to a huge portion of my day, and I cannot keep it concealed any longer. I love Solitaire. There, I said it. I mean I love it. So much so, in fact, that I started taking notes about a year ago on how I play, strategies I used, and what my expected outcomes were. In my head I know there are things that need to get done. Work, laundry, fixing the car, and a host of other stuff that comes with life in the country. Solitaire takes precedence. I do what has to be done right before it must be done for me to earn a living, and the rest of the time, I put it off for a quick game.

I admit to being a nerd. I always have been. I have been an amateur astronomer for over 40 years. I like to read math books. I overthink everything. I make predictions on everything from people's behavior in airports and the local store to how the Dow Jones industrial market will react to something going on in the world, all based on hours of research watching news shows over and over and scanning the Internet. To say I am a nerd is actually being kind to me; I am not sure there is a description for someone who is so preoccupied with things others would consider so mundane. Though my Solitaire addiction is under control for now, I just needed to come clean.

Many of you have addictions, whether you realize it or not. I am also addicted to coffee; it determines my mood. One of my fondest memories was when the VA doctor told me I could still drink coffee (black only) when fasting for blood work. Ah, good times! Addictions are not necessarily all bad. I know people addicted to going to the gym. I know people addicted to reading fiction. I know people addicted to taking cruises on their vacations. Not all addictions are bad, unless they interfere with your daily life like mine sometimes does. You have seen the people with addictions. The therapist at work who has to check his text messages 50 times per shift. The one who posts "selfies" on her Facebook page when she is supposed to be in the ICU checking ventilators. The person who seems OK losing a tooth or having a car broken down on the side of the road, as long as he or she has the Kindle or tablet with them when it happens.

Addiction is caused by the dopamine crossing the blood-brain barrier, and giving us that feeling of euphoria or satisfaction. It eventually restructures the brain. This is why smoking is hard to quit, why some get addicted to food, and why addictions take such a precedence in our lives. Despite negative physical, personal or social consequences, we need to satisfy our craving. We are addicted.

I have often wondered, as I watch people, what life was life before cellular phones. I am old enough to remember, but I wonder how we survived. Even people who cannot afford food seem to have cell phones these days. We have become addicted. Some, in a quest to satisfy their addiction, even wait in line when the newest version comes out, hoping to grab the first "newest and best" cell phone. I do not have this addiction. I hate my phone. I leave it in the window sill often just to get away from it. My theory is that the more important you are, the less use you have for a cell phone. Of course, this does not apply if it is your only phone, a growing trend, or if you are using it because you are on call at your hospital. Then a cell phone is a necessity. But if you cannot live without your cell phone, if you have a panic attack when you misplace it, or if you mourn its loss like a the loss of a friend or a good dog, then you may have a problem. If you spend more time texting friends than actually talking to them, you could have issues. If your life is consumed playing games on social media or on apps you have downloaded, you could have some dopamine receptors crying out for help.

In my opinion, some addictions are good. Addictions to exercise, healthy eating habits, good lifestyle choices, washing hands, and buckling your seat belt are all great addictions to have. Some call these healthy habits, but "let's call a spade a spade" and recognize our addictive behavior here. Other addictions; cell phones, tablets, and preoccupation with what all your "friends" are doing every moment of the day, what they are eating (including pictures), where they are, and who they are with (insert  "selfie" here) is not a normal brain. I have few friends on Facebook these days. I simply do not care what everyone is up to. I outgrew that. The few I keep are those who interest me for one reason or another.

I do not "tweet" because I think it is stupid. I do not even know where to find Instagram. When I work, my cell phone rests in my book bag I always have with me, on vibrate, so that I can dedicate my time to my patients and clients. My Kindle stays home, although I will admit to running through some algorithms I have built for Solitaire between the people I see.

Determine if you have an addiction, and decide if it is a good one or a bad one. Keep the good, but do not be like the lab guy I worked with once. He drew blood on a patient in the emergency department while talking on his cell phone through one of those "ear things" that hook up to your phone. The patient was distraught, thinking the whole time he was talking to her, adding to the problems that brought her to the ER to begin with. Your "friends" will still be there waiting for you when your shift is over. If not, they were never meant for you in the first place, so don't text or message them on social media when you should be cleaning equipment or running controls on the blood gas machine. If you cannot do these simple steps to help yourself, seek help. As your friend, I am here for you, because I have been there.

That's just my opinion,

Jim Thacker, CRT, MBA, MHA

Wellington, MO


Even 'Mr. Spock' Couldn't Beat COPD
March 2, 2015 12:59 PM by Jimmy Thacker

"It is not logical, Jim." Those word were so memorably uttered to Star Trek's Capt.James Kirk by his colleague Mr. Spock, played by actor Leonard Nimoy. Nimoy passed away last week at the age of 83. A talented actor, director, poet, photographer and all around good guy known mostly for his role in the original Star Trek series, Nimoy made the show with his stoic, ultra-logical character. His cool demeanor, his "live long and prosper" sign, and his calm way of analyzing and troubleshooting everything that happened aboard the USS Enterprise saved Capt. Kirk's hide more than once. But even Spock couldn't save Nimoy, who died of COPD even though he had given up smoking 30 years ago. It is a lesson on how life choices can affect us long after we make them.

If there is anything we can learn, it is that bad decisions, even ones made decades ago, can come back to haunt us. Though Nimoy faced his nicotine demons years earlier, in the end, they won. It is a lesson for young people in particular. Nimoy smoked when smoking was popular, long before Chantix or e-cigarettes were even thought of. Though he fought and won his battle with the addiction, he ultimately lost the war because of ill-advised actions he undertook early on.

This is a lesson for all smokers, but especially for the young ones. Even if you promise yourself you will quit, and even if you do, the affects of smoking last a lifetime. That lifetime is shorter when you use tobacco, as Nimoy's death illustrates so poignantly. Those of us in the healthcare field must preach to everyone we meet about the hazards of smoking. We must learn from Nimoy's mistakes and lovingly tell colleagues, friends, neighbors and patients the hazards of the burning gift that keeps on giving -- smoking

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO


Marijuana Seems to Be Making In-Roads
February 23, 2015 9:28 AM by Jimmy Thacker

We are at a crossroads in this country. In one direction, we move to what we think the people want. The other road moves to what is safe for the people.The question over the next several years is which road we should take.The players are marijuana and electronic cigarettes. It seemingly became more tolerable to have legal pot and less tolerable to let people "vape" in 2014, making for an interesting 2015.     

The FDA says that "vaping," the use of electronic cigarettes, brought in $1.7billion in 2013. You have no doubt driven around and seen what us old people would call "head shops" built for vapers to go into and vape with others and buy their gear so they can vape anywhere they want. That was, after all, the biggest selling point up to now; you can "vape" where ever you want. Not so any more.

Though cigarette manufacturers project the use of electronic cigarettes to increase steadily over the next 10 years, it will get harder to make that little light on the end of the stick in your mouth glow in some areas. Los Angeles, New York City, and Chicago are already banning vaping in public areas. And 172 other cities and counties across the U.S. are doing the same, making vaping unwelcome. North Dakota, New Jersey, and Utah do not allow vaping as an alternative in zones where smoking is prohibited. If you cannot smoke somewhere, you also cannot vape there. Many states are dabbling their feet in it, like Arkansas, where vaping on a school property by anyone, student, parent, or staff, is illegal.     

That other road is strange, too. Alaska, Oregon, Washington, and Colorado have legal marijuana. A legal marijuana store in Colorado, for example, generates over a million dollars in taxes for the state each year. Unlike vaping, marijuana is regulated. Some 23 other states are looking at legalization of cannibis, too, after recent elections show the majority of people in those states want to at least have the option to vote for or against it. Even in Washington, D. C., where I personally would at least like to see the do-nothing politicians mellow out with a doobie and do even less, marijuana is up for consideration as a legal recreational substance. Although I think D.C. making marijuana legal might take the edge off of some folks on Capitol Hill, it means that Cheetos and pizza parlors will become booming businesses. You do not have that situation with vaping. 

Marijuana can bring in some serious cash if it is regulated, taxed, and overseen by someone who knows Mary Jane on a personal basis, as opposed to some stuffed shirt who has been in Washington for 100 years. I'm just saying, if you want to legalize it, then let's not have Senator So-and-So regulate it, let's hire an experienced professional, somebody who admits he uses it and really does not care what you or I think about it. Drug dealers always know how much pot they have left. Let one of them run the pot regulating and I guarantee you there will be nothing to worry about.

Vaping will need a czar, too, if we continue to allow it. Like teaching a class to stop smoking, hire a smoker or a vaping user to oversee everything. Nothing dumber than teaching a smoking cessation class with a person who has never smoked, and few things are dumber than regulating something and making decisions about it without including the people who have done it and whose lives it will likely affect the most. So marijuana looks like it is making progress, while vaping is headed out the door. Seriously, would you have imagined a scenario like this?

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

Sleep Deprivation in Teens
February 17, 2015 3:59 PM by Jimmy Thacker

New studies are showing that teenagers get less sleep than they may need. Many teens get less than seven hours of sleep a night. Some rate themselves as getting even less than that, and certainly less than the recommended eight to 10 hours. A lack of sleep can result in a loss of focus, pimples, mood swings, weight gain, substance abuse and trouble in school.

This opens up a field I have not heard of yet, dealing with the sleep problems specific to teenagers. Some of my sleep friends that read the blog can tell us if this is already being done, but the value of a sleep study on a teenager who cannot seem to get enough sleep seems high. Kids are under so much more pressure these days. The homework assignment of today makes the homework assignments I had in the 70s look like nothing.

Part of this, too, is the fragile nature of children and their need to be "social" 24 hours a day. This phenomenon takes even more time away. In my day, you went home and did chores, or played in a mysterious place we called "outside." These days, that doesn't happen for a lot of kids, and I bet those kids are the ones having trouble sleeping. We would wear ourselves out with work and play, and had no trouble sleeping at night. We also had little problem getting up in the morning and though we all dreaded school, once we got there, we generally enjoyed it and the task of learning. It would be interesting to have some detailed studies on why teenagers believe they are sleep-deprived and to discover what they are doing rather than sleeping.

In my opinion a big part of the problem is that we have forgotten what school is for, and that we are sending children to a building where they should be learning -- not to a factory. In preparation for this blog, I talked to some friends with school-aged children, and the schedules they are on are not conducive to achieving anything. Extra-curricular activities in the morning before school and after, groups, clubs, and functions that are school, church, and just plain social-related means that Johnnie and Jenna do not have time for sleep. Add to that some kids have an Xbox or PlayStation for a babysitter or a means to pass the time until dinner and even after, and I believe we would discover that we are turning our kids into the same robotic, work-way-too-much society that adults live in. We are merely starting them at an earlier age, not thinking about the long-term affects on the kids or our communities.

Turn the televisions and game stations off. Limit school and other activities during the school week, and pursue excellence in the classroom rather than on Facebook or Pinterest. I think if we did that, teens would sleep more and get more out of their education. The business part of me sees a great opportunity, because I know few parents will follow that advice, regardless of who it comes from. So let's exploit teenage sleep deprivation and further study the cause and effects. At least then we can earn a few new patients and possibly help some of them sleep.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO


A Win for Students with Asthma
February 9, 2015 7:18 AM by Jimmy Thacker
Finally! New York has joined the rest of the United States in approving a law that allows students to carry and self-administer epinephrine auto-injectors and asthma medication. With this, now all 50 states have some kind of right for students affected by asthma and allergies to protect themselves. The next issue is allowing schools to stock epinephrine. 40 states already have those laws, but the other 10 are lagging behind. 

This has been no easy task. Schools are slow to respond because of potential liability issues. Governmental agencies are slow because they fear the overuse and abuse of the "epi-pens" that students may be allowed to carry. For those of us who have worked with people with asthma, we know that asthmatic kids are usually light years ahead in maturity when it comes to their health, and are the least likely to let a life-saving pen be abused by anyone. But I understand the concerns. It's a drug, with potentially life-threatening or even deadly results if used improperly.

Still, one must wonder why it has taken so long for schools to get on board with some kind of program that protects the kids. To me, it seems plenty of money is invested in new football uniforms and computer labs, but not in keeping the kids alive if they have an allergic reaction. As I have stated many times in this blog, I think our priorities are a little messed up.

In my opinion, now that all 50 states have these laws, it is time to look at other ways we can improve the safety of our kids with respiratory issues in the schools. It isn't easy. Local health departments, hospitals, and other "health" agencies do not welcome outsiders, even with the best ideas, and are slow to support anything that involves money, liability, accountability, responsibility, or potential headaches, even if the idea could save lives or prevent suffering. School nurses, likely our strongest allies in helping kids, are overworked, underpaid, and have to fight school board members who have no idea of the depth or breadth of the problem. As respiratory therapists, so many of us are not working in our own communities that we do not feel the obligation to help out, which may be the biggest concern of all. Even if you work in a different community than where you live, get involved. We are always looking for ways to cement our future and show our worth; you have one now. Find out what your community needs. Quit talking about how valuable you are and let your works speak for themselves.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

Patient Dignity
February 3, 2015 9:40 AM by Jimmy Thacker

After talking to a former patient of mine, I started thinking about something to which we all get exposed. It is sometimes subtle, and sometimes very obvious, but at some point in health care, all of us will have some experience with it. It is dignity; specifically preserving the dignity of those for whom we care. I can remember several situations when what I was doing, the treatment or test, seemed less than dignified for the person I was doing it to. I know there have been times when I have been the patient, and felt I had given up some dignity in the name of tests run on me, too. 

Whether you work in a hospital or clinic, a patient's home, or some other setting, please keep in mind the person you are working on. Often, we see people when they are not at their best. Let's face it; people who feel perfectly well, who need no assistance, just have no need to come see us, or have us go see them. So whether you are a therapist or nurse involved in seeing people at their homes, a doctor or healthcare worker who sees them in the hospital, or anyone else who has one-on-one contact with people, particularly those of the opposite gender or those whose age is markedly different than our own, remember the person's dignity. 

Some tests are just that way. There are only so many ways a man, who could well be the only person able to do the ECG in the hospital at the time, can perform the test. Likely, it will result in some embarrassment, some uncomfortable feelings, and maybe even anger. When I did ECG's on females, whenever possible, I asked my patient if she was OK with me doing it, or if she would like me to have an escort of her gender in the room while I was testing her. On children, particularly those younger than the years of puberty, I would ask a parent or guardian to stand by within earshot and instruct the patient to call out to the parent if I did anything to make them uncomfortable. For older girls, I insisted on a person of the same gender in the room, for her protection and for mine. I spent a lot of time explaining what I was doing and why. Often, communication is all that is needed to go from the guy with cold hands to just another person doing a test. 

People at home may have limited mobility and financial means. They may not want you in their house or feel uncomfortable about their perception that you will judge them based on what you see. They may imagine you telling your co-workers. This puts them on defense and makes it hard for you to focus on the reason you are there. Again, communication and constantly striving to preserve another person's dignity can go a long way. We have all heard the stories and those of you from small towns know that in some cases if one person sees or hears something, the whole town knows about it very quickly. By the time it comes back to you, the story, your story, has changed significantly. Do not put yourself in that situation. "Loose lips sink ships" is another saying to remember; do not sink the ship that you and your patient need to ride to good health. 

Even in the hospital, clinic, or doctor's office, dignity can suffer. We put effort into not sacrificing a patient's health information, and many of us have to take classes on the subject yearly. Few of us, however, have ever had a class on preserving the dignity of the patient.  Everyone in healthcare, everyone who deals with patients, should be able to come up with plans aimed at preserving dignity; both our patient's and our own. The old saying "treat others as you would be treated" seems to be applicable here. Think about that the next time you see a patient. It is easy to hurry, to take shortcuts, particularly when you are busy, understaffed, overwhelmed or just plain tired. You have an opportunity to be the status quo, or be the example. It's your choice. 

In my opinion, very few of us allow a patient's dignity to suffer on purpose, but it does happen, and can be prevented or minimized. Plan ahead. Think about how you would want your healthcare worker to do that test, treatment, or procedure if you were the one in the bed. Think about how you would want him or her to treat your mother. That was always my trick; I pretended everything I did I was doing to my own mother. I think that is why patients often commented on not only my skill, but my consideration. Also, you can tell a lot about how you are perceived by the people you work with. If a co-worker of the opposite gender needs a test that is sensitive or could cause embarrassment, would they come to you, or would they go somewhere else? If they cannot come to you when they need you the most, you have an issue, as does your employer. Be the "go-to" person, no matter who needs your services. Treat others like you want to be treated in all aspects. Protect your patients information absolutely, but never forget that humans need to maintain a certain level of dignity, too, in order to fully recover and return to you the next time. 

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

'News' on E-Cigs Is Nothing New
January 26, 2015 9:21 AM by Jimmy Thacker
Can someone answer a question for me? What does our government do for a living? Seriously, someone needs to tell me. I consider myself reasonably intelligent, but when the government does "studies" and finds the same information, or non-information, over and over, I am baffled. I mean, just today, an article cites a study that shows that electronic cigarettes, when using a higher voltage battery, produces formaldehyde.

That's news? Really? Every asthma educator I know has known this for years. Every good respiratory therapist has known it. Every doctor and nurse has known or suspected it. So why is this news? It is sad that stuff like this is in the news, years after a trend like "vaping" catches on. I believe it is a part of our "treat symptoms" rather than "prevent disease" type of healthcare. The article had great timing; just the other day I was making fun of a woman puffing on her e-cig while driving through a small Missouri town. She puffed on it like I am sure she has never puffed on a real cigarette. It honestly made me laugh at how ridiculous she looked.

Now, under consideration is whether or not to regulate electronic cigarettes and treat them as tobacco products. Again, really? You are just now considering that? Whichever side you choose, the main benefit would be to help stem the tide of growing popularity with those too young to buy regular cigarettes, but old enough to buy the e-cigs. Other than that, I see little value in assigning rules to e-cigs because we have not yet learned how to enforce the rules for regular cigarettes. But that is what we do; we make rules without hope or a plan of enforcing them.

     My opinion is multifaceted. First, we know e-cigs contain nicotine, right? OK, then it is a drug and should be regulated, from controls over what the recipe is for the liquids used, to stopping commercials on television obviously aimed at young people. End of that discussion. Next, we do not know what effects e-cigs will have on users long term. So study that and stop rehashing information we have had for years. Give me new information. Get potential customers new information.

Do you really want to stop people from using this form of nicotine? Fund a real study and get real scientific information on the product and present it. Otherwise, we can all say it is bad for you, but as long as someone on television does not seem to have a problem with it, someone will think it is safer and buy it. I don't expect the government to pay my bills, and I don't expect them to be involved with every decision I make. But when they spend billions of dollars of our money to conduct studies, I do expect the studies to be worthwhile. I don't think that is too much to ask. Do the study. Make the determination. Tell me what you found out. Then maybe we could move on to the next problem.

 That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.



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