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In My Opinion

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.

Resolve to Grow as an RT and as a Person
January 19, 2015 12:38 PM by Jimmy Thacker
This time of year, many are working on New Year's resolutions. As a respiratory therapist, one of your resolutions should be to improve yourself somehow, personally or professionally, and preferably both. It can be hard. For many, work takes up so much time. Not only do you work your regular shifts, but maybe you cover for someone else, or take overtime from time to time get a little extra cash. There is nothing wrong with that, but remember that you have a license, and maintaining that license requires getting your CEUs. Last year, I met so many therapists struggling at the last minute to get their CEUs before the cutoff. Rather than picking and choosing which meetings they wanted to go to, they ended up taking whatever they could find. This might them get through their CEU crisis for the year, but did not help them grow into the therapists they could be.

Be smarter. Make time for growth. Not only is it important to your patients and your employer, but it is equally important to you. You may discover some other need for your talents in a different sector of respiratory therapy, like home care, DME work, or moving from the floors to the ICU. Professional growth should be mapped out by you and your department director. If he or she is not involved in your professional growth, you do not have a good director.

Personally, you need to grow, too. Find outside interests to blow off some steam, help you relax, and just enjoy life. Working 24 hours a day seven days a week is fine if you need the money, but at some point, you will want to enjoy the fruits of your labor. A vacation that involves work is not a vacation. Read a book, take a dance class, do some woodworking, travel, or maybe even turn a passion of yours into a new business. This will take your mind off of work and give you some rest, improving your focus when you go back to work. Otherwise, what is the point of doing all that work if you cannot enjoy it?

In my opinion, one of your resolutions should be growth. Personal and professional growth are both important, and I think they compliment each other. I do not know of many who can grow professionally without growing personally, and vice versa. It is easy to get wrapped up in work and forget to take care of ourselves, just as it is easy to do the bare minimum at work and focus too much on our personal time, even while we are at work. Either way, you are not giving your employer or yourself all you can, and eventually, that will catch up to you. Enjoy life. Work hard and play hard. You will be much happier.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO


Modern Healthcare Is All About Money
January 12, 2015 9:27 AM by Jimmy Thacker

The television show 60 Minutes is not a comedy, but I had to laugh when it aired last night. Part of the show was dedicated to the Affordable Care Act and what it has and has not accomplished. One of the subjects was that it has not reigned in rising hospital costs. In part, this is due to some chief executive officers of non-profit hospitals and their pay. One short interview was with Jeffrey Romoff, CEO of the University of Pittsburgh Medical Center, who admitted that last year his salary was $6 million. He looked out over the city of Pittsburgh from his lofty office with a 360 degree view, and it made me wonder why I wonder that healthcare costs are going up, particularly when it comes to hospitals.

You cannot blame just one source. The short answer is that healthcare costs have always gone up. Yes, but why in the hospital? I mean, most money is made in outpatient services, not overnight hospital stays. Insurance companies make millions off of us, but it is not solely their fault. Pharmaceutical companies make billions off of one of the most pill-dependent societies ever known to mankind, but you cannot blame them solely, either. Doctors, who used to be thought of as the culprits, often have their own struggles just to make ends meet between paying for their hospital work and their office time, not to mention the costs to their personal lives. But $6 million worth of administration is, in my book at least, a lot of administration, particularly for a hospital that does not make the ranks of the top 100 hospitals in the country. The problem is that our healthcare system does not work together. We sell out to the lowest bidder, then pay top price and pass those costs to the consumer. It's called making money, and in healthcare, that's really all we worry about.

The United States spends $2.6 trillion on its healthcare. That is 18% of our gross domestic product, or 18% of everything we make as a nation. That amount is expected to rise to 20% by the year 2020. For that kind of investment, you would expect our health care to be pretty good, right? Well, the World Health Organization recently ranked the U.S. #37, not #1. So how do we spend all this money and get such poor results. Because making money is more important than anything else in our healthcare system.

Other factors that lead to high health care costs include paying for doing more, not doing better. We do tests that are not needed, repeated, or even dangerous, "just in case" because our society will sue if you do not. We are also getting older, more sick, and fatter. This places stress on an already broken system. We think that new is better, so we continually update our old equipment with newer stuff that may not have even been approved except for safety.

Patients are just as bad as providers here; everyone wants only the newest stuff. We overuse our expensive healthcare plans. This trend is changing some, so there is some hope, but those with insurance have been shown to actually drive the costs of healthcare up, where most people felt it was those without insurance.

Now that we know who is really responsible, we can move (and are moving) to fix it. But we have no information. When is the last time you checked on your doctor bill to see if what he or she charged you was consistent in today's market? You haven't. You are not that smart, and no one else in America is, either. Corporate hospitals are getting increased market shares, which drives up prices because they do not have competition. When a corporation (like our aforementioned University of Pittsburgh) takes over a market, costs automatically go up 20% because of a lack of competition. Corporate takeovers rose 33% between 2000-2010, including in small towns where big corporate hospital chains make health care as easy to access as the local McDonald's, with about the same results. Last, we are still practicing defensive medicine. I have insurance in case someone sues me. You do, too, if you are smart. Nurses should, and doctors all do. Rather than treat what they know, we have to treat what could be. That is the reason for useless orders for incentive spirometry and oxygen that never gets used, but gets charged for. It's all defensive, because when money is involved, it really is "us versus them" and it always will be.

In my opinion, as I have stated before, the healthcare system is broken. Good people are leaving the hospitals for other options because responsible people with high morals and ethics simply cannot stand to watch the hospital system of yesterday implode upon itself. The only thing that matters to that CEO with his office overlooking his or her kingdom, rather than being somewhere accessible to the community, is money. That's it. You are fooling yourself if you think different. There are, of course, exceptions. CEOs involved with their staff often get much more out their employees than the typical boss does. But these types of leaders are not getting into hospitals, either, because they know what is coming. What is left is the type of leader who, though not actively involved in saving any life, not having any skills to affect customer service at the bedside, and not having any idea what you do for a living, is making decisions based on how much money can be made rather than what is best for the community, the employee, the doctor or nurse, and the patient.

Sure, they build new, shiny hospitals with spiral staircases as a testament to the power of the dollar, but if you move the same people that was in the old, crummy hospital to a new building, have you really improved anything? But hey, in the United States health care system, "that's how we roll."

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

School Nurses Need Support from RTs
January 5, 2015 10:18 AM by Jimmy Thacker
Our children spend 28% of their daytime in school during the academic year, and 14% of their total time between the ages of five and 18 will be sitting at the desk learning the three R's (yes, I know they are no longer taught). Behind the scenes, someone is responding to the 18 million children estimated by the Department of Health and Human Services who have health care needs or a chronic illness. The school nurse may be the unsung hero of the nursing profession. Quietly, they sit at sports events they are not interested in, they respond like the school's version of 9-1-1 any time a child goes down on the playground, in the classroom, or in the halls, and they are responsible for making sure children get the medicines they need to succeed in class through 12 grades. That's no easy task. Yet, talking to school nurses, they feel underappreciated, misunderstood in their role, and unsupported for the herculean task they must do for every child in the school district.

School nurses have a lot to be frustrated about. Few schools have oxygen available, let alone artificial airways. AEDs are spread out to the point of being useless in an emergency. Few people other than the nurse may even know CPR or what to do if a child has an asthma attack. School nurses seldom get practice either. Though 86% of surveyed schools have an emergency medical plan, less than 35% of them have ever tested it. EMS tries to help; the average EMS response time to a school with a medical emergency is about 10 minutes. School boards tend to cut expenses through the school nurse's budget; there is little money to send a school nurse to a conference or training where he or she could improve his or her skills; skills that may save the life of a child.

Given all the hazards that exist at a school, from playground equipment to foods with allergens, to the germs of the other kids, one might think that schools would lead the way in providing clean and safe environments, but you would be wrong. Walk through your local school. Schools where I live and a couple of towns surrounding me have mold in their walls, dust everywhere, broken glass in the parking lots, and paint chips falling off the walls. It is up to the school nurse to point these things out, too, as safety hazards.

School boards are not always cooperative. Often board members do not have children in the school, or worse, they do and rely on the child to bring up potential problem areas. Non-emergent injuries or illnesses can completely bypass the school nurse, with other staff making decisions to send the sick or injured straight to the doctor without involving the one person who will be expected to know the most, the school nurse. Parents can also be a problem. Parents assume the school's job is to provide every need their child has during that eight or so hours day and are upset when there is a lack of communication, but no school nurse I know of can do that for every child. If the parent does not bring up the latest visit to the doctor, the change in medicines, or the new allergy discovered, how would the nurse know? Parental involvement would add greatly to the safety of their children and the effectiveness of the school nurse.

In my opinion, as respiratory therapists you should know that your local school needs you. If not, you either live under a rock or you simply do not care. A class on asthma, a partnership between the hospital and school where school nurses are supported keeping the CPR and even advanced training current, advising school boards on policy and procedure, and many other ways. I walked 110 miles across my county a few years back to raise money for asthma, and bought spacers for all kids in my county schools that had asthma. The appreciation I received from school nurses was wonderful. We had a county where every asthmatic child in the public school system had two spacers; one for school and one for home. A little creativity and care go a long way. Get involved with your local school. Check up on your school nurses and see if you can help them. If you are an asthma educator, get your school aged asthmatics a treatment plan on file with the school nurse and the parents. Jan. 25 is School Nurses Day. I challenge you all to support your local school nurse any way you can, make contact with him or her, acknowledge the difficult job they have with a gift or visit, and improve the lives of the children in your communities.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

Circle Conference Day on Your 2015 Calendar
December 29, 2014 9:21 AM by Jimmy Thacker

As the New Year quickly approaches, I just want to let you know about some conferences coming up so you can plan your calendar:

  • The AARC Summer Forum takes place in Phoenix this year and goes from July 13-15. The AARC Congress is in Tampa, FL and runs from November 7-10.
  • The Pulmonary Disease Education Course, which may be an extension of the COPD Educator Course, is being presented in Arlington, VA on March 16 and 17.
  • The Adult Critical Care Specialist Course will be in Winfield, IL on March 20, and Marco Island, FL on July 13-14, but is only for registered therapists.
  • The Association of Asthma Educator annual conference will be held in Anaheim, CA from July 31-August 2.

In my opinion, it's important to plan an educational event this year. Renew friendships, meet others, get out of the hospital and see others in a more relaxed mode. Hit your department manager up for it now, before the budget gets blown on the next "doo-dad" that he or she forgot to figure in, and you can lock in the best rates for rooms, flights, and fun packages that may be offered.

That's just my opinion,

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

Patience for Patients
December 22, 2014 9:56 AM by Jimmy Thacker

Christmas is upon us, and the New Year is not far away. After all the presents are unwrapped and travel to "grandmother's house" is done, we settle in for the rest of winter. Interrupted by New Year's Day celebrations, often, this can be a tough time of year for many. Depression seems to run rampant this time of year. Some, shut in by conditions they have acquired over the years and life experiences, can feel gloomy and even give up on life.

It's a good time of year to check in with people. Christmas cards are great, but an email, a phone call, or even a short text message to check in on family and neighbors goes a long way. We get to see people at their worst; stuck in a hospital over the holidays. Encourage visitors to stop by if possible. Give your patients a little "me" time to enjoy, as you see practical. You may even make some new friends and be able to show how important respiratory care is to the community.

With the New Year come resolutions.Some will resolve to get their lives in order. Some will resolve to make life-changing decisions like quitting smoking or getting more exercise. Sadly, by this time next year, many resolutions will still be that, promises to oneself that never quite happened for one reason or another. Soon, in early 2015, the shock of what the season costs will set in, as credit card bills come in and about the time you get used to writing 2015 instead of 2014, income tax season looms on the horizon. The first six months of any new year can be all uphill for those unprepared. Patients, now looking at increased expenses from their visit to you, can get down, even angry, at their situations. Even workers can feel the pinch, trying to balance their checkbooks and their time to have a good holiday season.

In my opinion, this time of year requires more patience than most. I get anxious for football season. Once it is here, I often wonder why I watch since my team seldom does well. Some anticipate birthdays or anniversaries. Others are looking forward to that raise they have been promised and hope this is the year it actually happens. Patience is a virtue, it is said, and frustration can be its byproduct. I often do not have much patience. I admit it, I am flawed. I am just not geared to be patient, but I am learning and you can, too. So many things going on this time of year wears a person's patience thin. Take a deep breath. Squeeze that stress ball you got at the hospital Christmas party harder than you ever have, and show some patience with your patients and each other. It may be hard and require you to bite your tongue a time or two, but in the end, you will be a better person for it. The dark, gloomy winter days that haunt us now are here for a while, so let's make the best of them.

It's a good time to get some education. Nothing passes time like writing papers or doing math equations into the wee hours of the morning. It's a good time make a list of your priorities for the coming year. It's a good time to catch up with old friends. It's a good time to rekindle old relationships that have slipped away over the years with a card or message from the heart. It's a good time to look at what happened last year and what you want to make happen next year. It's a good time to relax, give yourself a "chill pill" and enjoy the success you have had in 2014 and plan for the challenges you will face in 2015.

Merry Christmas and Happy New Year to all of you. I wish you fun times, safe travels, and a wonderful season. Remember those who are serving in our military at home and abroad, as well as their families, and those who serve our communities every day. Thank all of you for your contribution to our nation's health, to the services you provide your communities, and to your organizations. May the New Year keep you healthy, happy, and enjoying your professional and personal lives in 2015.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT

Wellington, MO

What's Your 'State' of Health?
December 15, 2014 11:58 AM by Jimmy Thacker

I love this time of year. Not because of the holidays, and not because of the crispness in the air. I don't care for either of those. I love it because at this time of year, every year for the past 25 years, a new report from America's Health Rankings comes out. The report, broken down state-by-state, is available online and is hot off the press now, after it was released Dec. 10. The rankings are actually published as a cooperative by the United Health Foundation and partners at the American Public Health Association and Partnership for Prevention. Since it was first launched in 1990, we now have 25 years of progress (or not) to look at, which makes me all tingly inside.

First, life expectancy is up. At 78.8 years, you will likely live longer, but not necessarily better. Along with expectancy, also up are conditions that will plague you later in life. There are some clear cut successes: smoking prevalence is down from 2013 by 3%. Immunization coverage is up 5% in adolescents, and a 4% decrease in infant mortality has quietly slipped under the radar of your local news show. Of course, we do have challenges. Pertussis is making a comeback, increasing 154% since 2013. Obesity, which has been well covered by the media, is up 7%. Drug deaths are up 7% also, but the report does not specify if it is talking about illicit, prescription, or over-the-counter drugs. Finally, physical inactivity is up 3% when people were asked to rate their exercise programs over the last 30 days.

The report also allows us to compare today with 1990, which I find particularly useful and fun. Since the first report in 1990, smoking has decreased 36%. High school graduation rates have increased nearly 10%. Violent crimes are down 37%. Air pollution has dropped 25% and preventable hospitalizations have decreased roughly the same amount. Occupational fatalities, infant mortality, premature deaths, cancer deaths, and cardiovascular deaths have all decreased. Still, there is some work to do. Obesity, physical inactivity, the number of children living in poverty, public health funding, child (19-35 months) immunization coverage, adolescent (13-17 years) immunization coverage, low birth weights, and diabetes are all areas that have become worse since the original report in 1990.

So, who is the best and worst? The top five healthiest states are (#1) Hawaii, (#2) Vermont, (#3) Massachusetts, (#4) Connecticut, and (#5) Utah. All five states have very active programs focusing on prevention, improving air quality, and community education. The bottom five states are (#50) Mississippi, (#49) Arkansas, (#48) Louisiana, (#47) Kentucky, and (#46) Oklahoma. Biggest improvements from 2013 to 2014 were seen in Maryland, which went up eight places, while Texas and Virginia moved up five. Alabama, Rhode Island, and South Dakota all moved up four places in the reporting year.

The report is full of "fun facts" and is one you should look up to be an educated therapist, especially if your state is one of those bottom five. "U.S. health outcomes are much worse than most other developed countries despite spending a greater percentage of our resources [on] health care than all other countries. We have an opportunity to make dramatic improvements [in] health if we focus on prevention..." according to Anna Schenck, PhD, MSPH, Chair, America's Rankings Scientific Advisory Committee, Director, Public Health Leadership Program, UNC Gillings School of Global Public Health.

In my opinion, as I have stated in the past, it is hard to focus on prevention when you have to focus on pleasing your stockholders, which is what America's hospitals put their priorities on. Though some numbers have improved, you may notice that the improvements are in individual statistics and choices, and are not things influenced by the hospital or clinic. You may note that "challenges" are all community issues that require a massive education effort by communities and community-based hospitals that fail to utilize the resources they have and do not place education as a priority.

Are hospitals and clinics failing us? Maybe, but a more plausible answer is that our health system is failing us. A doctor or clinician has eight minutes to spend with you on average. After eight minutes, he or she will chart on you for 15 minutes to cover him or herself legally. And you will wait 30 minutes on your new prescription to be filled if there is no line; longer if you are not the next number on the ticker. Then you go back and repeat the process in a month or two because there is no talk of prevention, only treatment.

Seriously, who is the person that believes that system will work? I cannot tell you when the last smoking cessation class was in my community, but I can tell you it was hosted by a lady who has never smoked, so you can guess how horribly that went. I failed to get an asthma clinic going at a corporate-run hospital simply because the corporation saw that I could attract patients and wanted to bump the prices up to a point no one (who needed the clinic) could afford. My local health department and health care collaborative here in Missouri are not smart enough to use an asthma educator in their community education programs. Sadly, this is the norm. Friends in Wyoming, North Dakota, Oklahoma, Tennessee, and Florida who are respiratory therapists and asthma educators tell me the same thing happens in their communities.

Prevention does not make money, and does not please stockholders. Treatment, especially repeat treatment, does. And now, after 25 years, the proof is out in a report that this type of medicine has done very little for us. 18% of our nation's gross domestic product is spent on a healthcare system that that does not keep us healthy. If you were that ineffective at your job, you would be jobless. But it seems to be OK for the healthcare industry. Money is made hand over foot, and your hospital CEO likely has a much bigger bank account, investment portfolio, and car than you do. Do you really think he or she has your best interests in mind, or the interests of your community? Look at the report. Educate yourself. Be a change agent, because in my mind, the best thing respiratory therapists and other healthcare professionals can do according to this report is work tirelessly to change our healthcare system.

That's just my opinion,

Jim Thacker, MBA, MHA, CRT, AE-C

Wellington, MO



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