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In My Opinion

Here Come the Pollen Vortex
April 14, 2014 9:44 AM by Jimmy Thacker

Well, here it comes. Are you ready? This winter we heard the term "polar vortex" a lot, but now get ready for the "pollen vortex." Grab the tissues because the worst winter in years may give birth to the worst allergy season in years, too. 

Imagine you are a tree. All winter long, you sat there patiently, waiting to release all that pollen. But snow after snow after snow has come. All that moisture is just being stored inside you. Temperatures so cold we do not even want to imagine them just keep hanging around. It's OK; you can be very patient. Once the first signs of spring come, you release all the pent-up pollen into the air, giving those with allergies a good reason to hate you and life as we know it. Though some of your neighbors have released their pollen, maybe you are a birch, oak, or maple, and just have not gotten around to it yet. But you will.

Most years, allergy-sufferers catch a break. After the initial shock, the runny noses and puffy eyes level off a bit, making allergy season marginally sufferable. That may not be the case this year. With such an extended winter, allergy season may be short and dramatic. And not only for pollen. All that moisture that looks so pretty on your lawn before the footprints means that molds will also be creating havoc. 

So a few tips. First, start medicating early. Whether you are an "over-the-counter" person who tries to relieve his or her symptoms with non-prescription stuff, a "do-it-doctor" person who relies on those trained angels that give us the stuff we need to be able to breathe, or somewhere in between, you are going to have to start early this year. Like waiting to drink water until you are thirsty, if you wait to medicate until you have symptoms, you have waited too long. There are a host of meds out there, both OTC and prescription.

Ask your doctor for advice and be careful of interactions with your other medications. Second, know what you are allergic to. If this is your first rodeo with allergies, note the symptoms and discuss them with your doctor. If you are a seasoned veteran, you know what to expect, so you can prepare early and defend yourself. Third, be careful with the spring workouts. We all like working out more if we can do it outside. But if you are an allergy sufferer, you have to be careful. Plan ahead for what "may" happen. Finally, keep pollen out of your home. Remove your shoes before going in. Do not lay your jackets or clothes on your bed or favorite chair where the pollen can rest and wait for your return. Take a shower if you have been outside for a while and wash the pollen off your body. On bad days, try to plan an inside day, close the windows, and turn that air conditioner on. 

In my opinion, the pollen vortex will never receive all the attention of the polar vortex, but people suffering with allergies will remember it for a long time. Plan ahead for it; it is coming whether you are ready or not. Seek out advice from your local doctor, respiratory therapist, asthma educator, or pharmacist. As respiratory therapists, we need to control our allergies so that we can be on the job where we can help everyone else. We also need to be prepared to offer advice to those showing up in emergency rooms and asthma clinics, so they can manage the season well.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

0 comments »     
Obamacare Is Here
April 7, 2014 8:04 AM by Jimmy Thacker

President Obama's health plan, Affordable Care Act (ACA), also know an "Obamacare," reached an important milestone this week. The reports are that 7.1 million people have signed up, barely reaching the goal of 7 million that needed to be reached by March 31. Still, despite being a law for some time, despite a late-round charge by the Republican Party to repeal it, and despite the Democratic Party hiring possibly the most inept and incompetent baffoons to administer the site to sign up on, the law reached its goal. While Democrats celebrate, Republicans will argue for the next several months if the numbers are true. Welcome to American politics!

Whether you are a Democrat, Republican, Independent, Libertarian, Tea Party, or something else, if it works, Obamacare would be the most important social experiment since Medicare and Medicaid. Unfortunately, rather than abolishing our current insurance industry, Obamacare tried to include the insurance industry into its plan. That was dumb. Insurance of any kind is a scam. We pay hoping we don't have a wreck in our cars. We pay hoping that our houses do not flood. We pay planning on dying. And we pay hoping we never get sick.

The bottom line is that the insurance industry specializes in one thing; making sure that all that money you paid in is never received by you when you need it most. Health care is no different. Insurance is not insurance when those who need it most are not included.

A child with spina bifida cannot be insured by some companies, because they have a "pre-existing condition" that our government and insurance regulators have not made mandatory to cover. Parents go broke trying to provide for their children. What "insurance" do they have, though they pay thousands of dollars into insurance? For Obamacare to be effective, the first thing that must be done is to fix insurance itself. Until that is done, this is not socialized medicine; it is simply capitalistic medicine like we have had since private insurers were allowed to do business in this fear mongering country. 

When I look at a building, whether it is a church, an insurance company, a bank, or anything else, I equate the size of it with the amount of people they are ripping off. Some of the biggest buildings I see are the insurers. I have never seen a small building with an insurance company logo on it. I have seen small churches. I have seen small banks. I have even seen small law offices and government buildings. Never have I cast my eyes on a small insurance building. 

Rather than arguing over a law that no Republican can possibly repeal until at least 2017, let's focus on other issues we have now, like education, immigration, feeding the hungry people in the United States, crumbling infrastructure, and unemployment. All over the country, hospital workers are having to deal with Obamacare. Doctors will or will not accept it, depending on how much they truly want to help people or if they are just in it for the money. Hospital boards will meet and figure out how to best capitalize on the new rules and regulations. Life will go on, but how health care, hospitals, and hospital workers like us respond to it will determine whether the plan is successful or not, and will determine whether the law is valid or if it needs to be repealed, not by Democrats and Republicans arguing over something that has not even had a chance to be implemented yet. A majority of people do not like Obamacare, but do not want anything else simply because they are tired of hearing all the arguments. So let's go with the people and try it out. Though a million people are losing their insurance policies, 10 million are now insured that were not before. Is that an acceptable tradeoff, or should we try for our typical "no tolerance" status that all incompetent leaders rely on to make their case. 

In my opinion, leave me out of it. If I am treating you in the emergency department, I do not care if you are covered by Obamacare, Medicare, Medicaid, or another insurance company. With a masters in health administration and a masters in business administration, I know who the people are that need to be fighting these fights, and it is not the therapist called to the ED in the middle of the night. I encourage those in the position to determine which laws are good and bad for us to do so, and let me do my job and continue to care for every person who comes to my facility for help.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

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Measles Make a Return
March 31, 2014 10:23 AM by Jimmy Thacker

Now there is something "old" to look out for. A resurgence of measles is underway in California. Orange County officials are saying it is the worst outbreak in decades. The measles are very contagious, and usually start with a fever, cough, runny nose, and pink eye. It progresses to a rash and can lead to pneumonia, encephalitis, and brain damage, all of which can be fatal. Measles are spread though airborne exposure from a person's mouth, nose, or throat.

Now, San Francisco and New York are both reporting cases of the measles, too. In today's world where travel is so easy and frequent, outbreaks like this can be hard to contain. Once infected, you may not even have symptoms for seven years. You just carry it with you everywhere you go. 

Particularly at risk are the usual suspects: children, especially under 6 months of age, and those with compromised immune systems. It is a good time for respiratory therapists to not only familiarize themselves with signs and symptoms, but to also review how to protect themselves by regular hand washing, sanitizing equipment, and wearing masks around those who have coughs or other expulsions that could cross contaminate the room.

In my opinion, we need to stay on top of news like this. It affects us because we do not necessarily know everything that is wrong with the person in the emergency room or hospital bed, and they may not know, either! Following breaking news like this should be a habit with respiratory therapists. So many things eventually lead to respiratory complications. Unfortunately, in many cases, by the time they get to us, things have usually turned bad, and it is up to the respiratory therapist to keep them alive and buy time so that other modalities can get to work. Knowing the background of what you are facing will help you take better care of your patient.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

2 comments »     
Burning Wood
March 24, 2014 7:56 AM by Jimmy Thacker

Well, old man winter just keeps hanging on here in Missouri. Like many Missourians, particularly the ones out where I live, I continue to cut wood almost daily to heat the house. Now the government wants to stop me from burning wood because of the health risks it brings. The Obama administration wants the 2.4 million homes that rely on wood heat to suddenly stop. Good advice and better for everyone, but highly impractical and unenforceable for many. 

Wood stoves produce noxious gases. We all know that. All you have to do is enter my house and you will smell the wood smoke in any room. Like second-hand and third-hand smoke, wood smoke produces some of the same toxins as cigarette smoke or gas exhaust from my car. Making it even more dangerous is that many of the particulate matter is smaller in size, from 2.5 microns and up, enabling the matter to go deep into the lungs. At particular risk are infants, the elderly, and those whose breathing or circulatory systems are already compromised.

Wood stoves have been improved. Most built after 1992 are cleaner and more efficient than those in previous years. Still, scientists continue to find more ear infections, along with adults suffering increased respiratory symptoms, decreased lung function, aggravated asthma, development of chronic bronchitis, irregular heartbeat, nonfatal heart attacks, and premature death in those already bothered with heart or lung diseases. 

People around me burn wood not because it is romantic, but because fossils fuels are expensive and wood is plentiful. The people are not the villans. That award goes to polycyclic aromatic hydrocarbons, some of which are found in tobacco smoke, along with nitrogen oxides, benzene, formaldehyde and dioxins. These elements not only aggravate airways, but can also change DNA within the body to make otherwise healthy individuals trigger responses that lead to cancers and other conditions.

I have been interested to know why we know so much about the gases emitted by our cars and by our factories, and so little about those produced by our wood stoves and fireplaces. Any asthma educator can tell you that we always advise asthmatics be keep away from wood heat sources. Still, other than knowing "it is bad for you" we really do not know much.

Many cities have enacted "clean air days" where burning wood is limited or illegal. Though I think Mr. Obama's intention is good in limiting exposure to the hazards of wood smoke, his implementation by the EPA is completely off base. Though he may not burn wood in the White House, many people, particularly in rural communities, need to burn wood to stay warm. For some, like me, it is a choice. Rather than rely on the electric grid which is, at best, spotty in my community and expensive in every community I know, I choose the exercise and self-sustainability of burning wood. I have electric heat, but am often able to use it sparingly because of the two wood stoves in my cabin. 

In my opinion, we need to do more studies on how wood heat affects us. In particular, we need to study who is and is not at risk. I do not know how old my wood stoves are, or even if they are pre- or post-1992 vintage. I only they know they keep me warm during the winter. I know I am exposing myself to harmful gases and accept that risk during the winter months in Missouri. I also know when the electricity goes off, I will still be warm while you, using expensive fossil fuels that are non-renewable, will not.

An open discussion needs to be held about the effects of wood heating not only on those doing it, but those around the burners who are also exposed when those same chemicals come out of my chimney. In my case, my nearest neighbor is a mile away, so they are probably OK. In some cities or areas prone to "thick" air that does not move, however, this, too, could be a problem. 2.4 million homes use wood as a heat source. The EPA's policy of banning wood stoves altogether and allowing people to sue for permission to stay warm is stupid, irresponsible, and typical political garbage. It does, however, raise an important point that all respiratory therapists should be aware of when examining a patient. It may be that person with shortness of breath in the ED is not smoking at all as you may suspect. He or she may just be trying to stay warm.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

1 comments »     
Stroke and the Need for Speed
March 17, 2014 9:20 AM by Jimmy Thacker
Stroke is the number four killer in the United States. Faster treatment helps save lives, but faster treatment may also be quantified, thanks to a study at the University of Melbourne, Australia. Dr. Atte Meretoia discovered that for every 15 minutes quicker that treatment is received, a month can be added to the patient's life. The faster tissue plasminogin activator (tPA) is delivered, the better the outcomes. The standard 4 or 4.5 hours may not be the standard much longer, giving way to as soon as possible.
    The secret seems to be that the faster the drug is delivered, the more tissue and blood flow is restored to a nearly normal state. This means that not only elderly folks who we typically think of as stroke patients, but younger people, too, can benefit from quicker administration of tPA.
    In my opinion, we need to get on board with Australia and get tPA to our patients as quickly as possible. This is another reason why every hospital should have quick reaction teams specifically designed for the treatment of stroke and other deadly events we see in our emergency rooms. The teams can react quickly with protocols designed to improve efficiency and reaction times, giving our patients better outcomes and prognoses. The United States needs to do studies and get this standard into every emergency room in the country as soon as possible.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, MO
1 comments »     
Is Your Stethoscope Contaminated?
March 10, 2014 9:25 AM by Jimmy Thacker

 A recent study reminds us of the importance of cleaning our equipment. While healthcare has made a big push on cleaning hands, offering hand sanitizing gels in our hallways for workers and guests, insisting on routine hand washing between patients, and other preventative measures to reduce the transmission of germs, we often forget about the tools we use routinely, like our stethoscopes. We have standards that dictate our hand washing, but not our "ears" and we may be helping bacteria and viruses move around our hospitals.

Workers' clothes, jewelry, shoes and stethoscopes can be a safe harbor for everything that makes us sick. We have known this for some time, but have not really addressed it. We decided long ago that if you want to be in healthcare, your fingernails, for example, should not be too long when you are dealing with patients, because they harbor germs. We pull our hair back (those of you who have it) so our hair is not in the way and the germs in it does not contaminate our working field. Still, the thing that hangs around our neck, the thing we use more than any other piece of equipment in the hospital, has no standard for cleanliness, nor does it get much attention, by many who place it on one patient, then a second, then a third, and so on, pressing against our patients' chests without so much as a wiping off.

Studies by Didier Pittet, director of the Infection Control Program at University of Geneva Hospital, showed that after examining 83 patients, the only "tool" used by a physician that was more contaminated than the stethoscope was the doctor's fingertips. Stethoscope diaphrams were robust with bacteria, including MRSA, in 71 of the after examination samplings. 

I have long been an advocate of cleaning my stethoscope after each patient, just like washing hands. It made sense to me, though colleagues would occasionally make fun of my "germophobic" nature. To me, it was not about being a germophobe, but about being clean. We wash hands; we keep our uniforms clean. Why do we spend so little time cleaning the one thing we are putting in contact with every single patient we meet?

In my opinion, the push for a medical standard to clean stethoscopes is a bit much. I just do not think people will follow it, and enforcing it would be a nightmare. I think it is up to each individual therapist "to do no harm" by taking responsibility themselves. If you think of all the germs your "ears" have been exposed to in just one shift, that should convince you to clean your equipment well. Remember that often, that same stethoscope that has been used in the emergency department, ICU, or on the floor, is often the same one you will use on your daughter when she has a chest cold or your father when he is not feeling well. Bringing your work home is admirable, unless that work involves hospital germs. Do not give them a ride to your house, and do not let them leave one hospital bed and travel to another with your assistance. A quick swipe with an alcohol pad can probably take care of most germs, takes less than 10 seconds, and can help you improve your care. 

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

Windsor, MO

4 comments »     
New Source of Transplantable Lungs?
March 3, 2014 9:31 AM by Jimmy Thacker

Researchers in the U. K. have presented findings that lung transplants, even from heavy smokers, can be beneficial to those in need. A "heavy" smoker is someone who has more than a 20 pack-year history of smoking. The Annals of Thoracic Surgery report that the study used 237 participants between 2007 and 2012, and concluded that though the lungs of heavy smokers were older, there were no apparent differences in the acceptance by the body or benefits when compared to those of non-smokers. 

I think this is big news. For years, the exclusion to lung donation was that if you were a heavy smoker, your lungs were no good. This research suggests otherwise. On the other end, if you are needing a new set of lungs, more opportunity may have just opened up because the exclusion appears to be unnecessary. Further study is needed, but it is exciting to think that more patients will spend less time on the waiting list for a new set of lungs and a new lease on life. According to Dr. Anton Sabashnikov, one of the researchers involved with the study, "donor lungs from heavy smokers should be considered for patients needing lung transplantation as they may provide a valuable avenue for expanding donor organ availability."

In my opinion, we should continue to explore this. Lives are depending on it, and respiratory therapists need to stay updated on the subject and answer questions potential lung transplant patients may have about the safety and viability of lungs that have been subjected to heavy smoking. It is exciting to think that more lives can be improved and even saved based on this research. The U.S. must follow up with our own studies now, and see if we reach the same conclusions.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

3 comments »     
Good Reasons to Dim Lights
February 24, 2014 8:43 AM by Jimmy Thacker

It's late, the lights are low so the patients can sleep.You are walking the hallways ready to save lives. Have you ever considered the effects of the lighting on your job?

Researchers at the University of Toronto Scarborough in Canada and the University of Illinois recently published findings in the Journal of Consumer Psychology suggesting that lighting has a dramatic effect on how you perceive the world around you. In six separate studies they found, in general, that the more light there is, the more optimistic we are. Is this why "night-shifters" all seem to have that low-key, factual, and almost depressing attitude? 

Emotions appear to be more intense with light. The stock market looks better, spicier foods are more welcome, and even fictional characters on television seem more aggressive than when viewed through low levels of light.

The bad part is that for those living in depression, and particularly those of our patients either ill or injured and stuck in a hospital, high levels of light can lead to increased emotions and eventually suicide. Suicide rates always rise in the bright sunlight of the spring and summer. These studies may suggest a reason why. The brighter lights bring on more emotions, and if your emotions are already troubling, you may dive even deeper into depression. 

The studies suggest that turning down the lights may actually result in better decisions. Office managers, human resource folks, and stores have thought for years that the brighter the lights, the better the work environment. Not true, according to the new research. Lower lights have a calming effect that takes emotion out of the picture so decision-making is not affected. The result? Better decisions based on facts rather than feelings. This is why you will never see Wal Mart or your HR folks turn the lights down when you are buying stuff or negotiating your salary.

In my opinion, there are several good reasons to limit lighting in many cases. Brighter lights obviously burn more energy and make it difficult to sleep. Now there is evidence that suggests that lower levels of lighting may make a workplace more productive, calm, and a better environment to do the serious work we do, whether at night or on the day shift. I think this is worth looking into. There must be a reason why every ICU is dimly lit; is it to help hospital staff make better decisions? Even at home, I must agree that I do some of my best work when my office is dimly lit. I focus better. I am not distracted as much. I am not suggesting we put the whole hospital in the dark. I do, however, believe that if this is something that can help us work and help our patients heal, it is certainly worth looking in to.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, MO

1 comments »     
Human Lung Created in Lab
February 17, 2014 9:14 AM by Jimmy Thacker

Using a scaffolding of collagen and elastin from two children who died in an accident, researchers in Galveston, Texas, have created human lungs in the lab. Though the advance is not likely to impact patients for several years, the promise of being able to "grow" lungs in the lab could have a tremendous effect on the over 1,600 people waiting for lung transplants. Immersing one lung into a liquid that provided nutrients, the second lung was used to harvest cell tissue to be planted into the lung being fed. Four weeks later researchers had a lung. To prove it was not a fluke, two other children's lungs were used to repeat the process with complete success. 

Joan Nichols, one of the researchers, says that the manufactured lungs are almost like normal lungs, only "pinker, softer, and less dense" than normal lungs. The plan will be to first try the manufactured lungs on pigs to see if they function normally. Nichols believes that using manufactured lungs for transplants into humans could be up to 12 years away. The first synthetic trachea was implanted in 2011, so this would seem to be a natural step in regenerative technology.

In my opinion, this is great news for us as a human race. Though many fear that regenerative technologies and "cloning" could spell the end of the world, I believe anything we can do to support a higher quality of life for those who need this technology is a good thing. It will be interesting to see how cost, development, cottage industries and insurances all factor into more synthetic technology in the coming years. I am certain the issue will also raise ethical questions for many, but for now it is exciting to see that science has taken us to a point where we may be on the threshold of finding new cures and replacing parts in our bodies to improve so many people's quality of life.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

0 comments »     
Know the Facts About Smoking
February 10, 2014 9:40 AM by Jimmy Thacker

New studies are proving that banning smoking in areas such as public places, bars and industries can help people quit. Even those who ban smoking in their own homes can have a positive impact on helping people stop. While many bans have met with controversy, they do seem to work. Of course, the first ingredient for stopping smoking successfully is a person who wants to give it up. But studies may suggest that though not convenient for smokers, the bans do seem to serve a purpose.

Many hospitals joined the bandwagon. Many facilities have become "tobacco free campuses" for both employees and patients. The days of giving a breathing treatment to a COPDer just before or after their outdoor breathing treatment (cigarette) seems to be coming to an end. Other industries are following the lead. It is not uncommon at all to go to a business that is in no way related to healthcare and find that it is smoke-free, too. This is a huge advance not only for those who are disgusted by smokers, for those who need a little extra "oomph" to encourage their quitting efforts.

One issue we are now dealing with is the popularity of electronic cigarettes. I have written about this before. Electronic cigarettes may be less hazardous than a regular smoke, but some employers are also banning those. I still think we will one day have to have a conversation about breathing in vapor over a hot lithium battery, but for those who use the E-cigs as a way to quit, the bans may do more harm than good. I think we need to look at that closely, along with the attractiveness of "vaping" to children and the lack of regulation in electronic cigarettes.

In my opinion, we are moving in the right direction, but we really need some direction to go. Respiratory therapists should be well educated to talk to people about regular cigarettes and E-cigs. We need to study the issues, look at the effects, and monitor studies being done now and in the future. This singular issue may allow the respiratory therapist the opportunity to be the subject matter expert on something that affects so many in this country and around the world. Arm yourself with facts, unless you state it is an opinion, and be the ambassador that healthcare needs you to be. This will increase your value to your respiratory team, your facility, and your community.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

0 comments »     
Raising the Minimum Wage
February 3, 2014 8:10 AM by Jimmy Thacker

In last Tuesday's State of the Union Address, President Obama made it clear he intends to raise the minimum wage for governmental employees to $10.10 and hour. While few would argue that everyone, including low-skilled workers, deserve a wage they can live on, the analytical side of me wonders what effects such a move might have on skilled workers, like respiratory therapists and others in the healthcare industry.

Common pricing theory suggests that as the costs of producing a product or service increases, so does the price. That shrinking Dollar Menu at McDonald's, for instance, which has already been converted to the "Dollar and More" menu, may do away with dollar priced items altogether, because the person flipping the burger for you has received a $3 per hour increase. McDonald's will have to make the extra costs up somehow, so guess where the price is going to go? My question is how will it affect those of us who make a comfortable living in respiratory care? The cost of our food will rise, but will our pay?

The Bureau of Labor Statistics says that a respiratory therapist made a median salary of $26.86 per hour in 2012. A shift from the current minimum wage of $7.25 to the President's $10.10 an hour represents an increase of almost 40%. By that logic, to keep up, the median pay of a respiratory therapist with an associate's degree would need to raise to over $37 per hour. Can your department afford that? I think many would struggle. Factor in the costs of nursing, occupational, physical, and other therapies, and other staff, and the costs could spiral to the point that only corporations with virtually unlimited budgets could afford to run hospitals, and those budgets could become limited very quickly. Corporate hospital groups are already common; my concern is for the rural county hospitals or the privately owned and nonprofit facilities. Are we really going to ask patients to pay even more for their health care to make up the difference? Standard procedure is for a general across-the-board 300% markup on products we use to care for others; are we going to charge another 40% to keep afloat?

There are many variables to consider. The oversimplification of my case does not include those, but you can see that such a move is a little troubling for those who are thinking into the future of healthcare. When a producer of goods or services experiences high costs, they naturally look for lower cost means to accomplish their goals. In automobile manufacturing it has resulted in robotics to produce cars rather than people. Now, I do not believe that robots will roam the hallways of our hospitals dispensing Albuterol, but producing a ventilator that makes changes to a patient's condition automatically based on feedback from a motherboard connected to the patient rather than requiring the skills and insights of a respiratory therapist would be much less expensive than a living person making those same changes. I feel scenarios like that are not all that far-fetched. We already have electronic charting to enhance our information flow and security of PHI, and use automatic pharmacy machines to replace real people, reducing the number of staff that have to be paid to hand out medicines. Will increased expenses make hospitals look further to reduce costs and increase their profit margins? It is not all bad. Pixis machines used in hospitals have decreased medical errors; electronic charting has helped us comply with HIPAA requirements, and even the automatic ventilator would likely be more responsive than many therapists, but the more machines we use, the less people we need. A lower-skilled worker can input information into an automatic ventilator, rendering the respiratory therapist an expense that is no longer considered vital to a hospital's staffing budget.

Obviously, these are worst-case scenarios. Years away, though someone has to think about them now. In my opinion, everyone certainly deserves a wage they can live on, though it is also up to each individual to strive to improve their situation and live within their means. Still, one has to consider the long-term effects of increasing the price of our workforce for companies, and the resulting ramifications 20 years from now, not just tomorrow. Though raising the minimum wage may be great for the fine folks at McDonald's and other industries where minimum wage is earned, I think more thought needs to be put into how it will affect those who do not work for minimum wage. Will our value be decreased as unskilled workers' values are increased, or will corporate America respond in kind by raising the price of everything to balance the books and maintain profits? I believe the long-term effects of this move have not been adequately considered, and should be studied now, rather than later, because of their potential to affect the costs we all have, as well as the wages we all earn.

That's just my opinion,

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

Windsor, MO

1 comments »     
Will Ultrasound Replace Stethoscopes?
January 27, 2014 8:47 AM by Jimmy Thacker

A pair of prominent New York City cardiologists are now touting the use of ultrasound technology for bedside patient evaluation. They claim it will soon replace the stethoscope, a staple of medicine since its invention in 1816. Ultrasound, which came about in the 1950s, allows a practitioner to "see" the problem rather than depending on hearing it. The cardiologists say that it is far superior to the stethoscope, and that its use should be expanded in every hospital in the country.

The problem with ultrasound technology is that it is expensive. Even in a couple of years, when its use is expected to be more mainstream, the cost of a single unit is projected to be around $1000-$2000. Compare that with the stethoscope you use now. Stethoscopes cost anywhere from $20 to whatever you want to spend, depending on the bells and whistles that come with it. This would make the ultrasound machine cost prohibitive for many facilities, and very cost prohibitive for medical, nursing, respiratory and other students in disciplines that routinely rely on the stethoscope. Additionally, it takes more training to use the ultrasound devices than it does a stethoscope. This could slow down a medical student's progress in school, and would open up more opportunities for misdiagnoses at the bedside.

In my opinion, I am all for technological advancement. However, I think saying that the stethoscope is on its way out any time soon is a little premature. I think that many older therapists will have a hard time leaving their "ears" in the car or locker and learning to use the new technology. I think that some patients may not welcome the change, either. While I do believe that ultrasound technology has its place in medicine, I am not retiring my tried and true money maker just yet, and would suggest you do not, either.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, Mo.

2 comments »     
Tax Tips for RTs
January 20, 2014 9:50 AM by Jimmy Thacker

The first of the year has come and gone, and it is time now to start thinking about everyone's favorite subject; income taxes. Talking with some of my friends, I notice there is a lot of confusion about taxes.

Now, you should note that I am not an accountant, a CPA, or a tax professional. I am a guy who has made a living traveling throughout most of his adult life, either with the military or as a respiratory therapist. It is always best to consult a tax professional because each state has their own set of rules, and at times, will interpret the federal regulations differently. I want to introduce you to two terms that could save you some confusion; tax home and reimbursement.

Your tax home is an area where you live. If you take your physical address and draw a circle around it approximately 60 miles out, that is your tax home. Why is this important? Many of us would like to claim mileage reimbursement. Good plan, but if your mileage is within your tax home, it is not eligible to be listed as a deduction on your income taxes. That is a part of doing business. So, particularly for you travelers and "prn" folks, even if you drive all the way across your city to work, unless you go outside that 60 mile radius on your map, the gas you use is just something you have to absorb as the cost of having that job. The other thing you must look at is whether or not you were reimbursed. Travelers often travel far outside their tax home, but if your travel company reimbursed you for your mileage, then that mileage is not eligible to claim on your taxes. Anything you are not reimbursed for, such as if you travel 600 miles but your travel company only reimburses the first 400, may be tax deductible. Most travel companies have someone you can talk to about your taxes.

Reimbursement can mean the difference between paying taxes and getting paid taxes. All year long, if you bought a pen to use at work, if you buy a new lab coat, a new set of scrubs, or anything else your facility does not pay you for, it can be listed on your taxes as a deduction in most cases. Some jobs required specific clothing and may provide you with a clothing allowance, wiping out your tax deductions. If this is not the case for you, keep those receipts (in case of audit) and deduct those expenses from your personal income tax at the end of the year.

In my opinion, we need to optimize our profits personally. That is why I went back to get my MBA. I wanted to better understand not only how to make more money, but how to keep more of that money in my pockets. Again, as I have said before, the devil is in the details. For instance, if you plan on deducting mileage, you must keep a log book of every trip you take anywhere, including the grocery store and the bicycle shop, unless you have one car that you always use for work. Research what your state requires. Talk to a tax professional. Make sure you are maximizing your profits for the important work that you do, and keep more of that money in your pocket instead of giving it to Uncle Sam.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, MO

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Medicare Respiratory Therapist Access Act
January 13, 2014 11:58 AM by Jimmy Thacker

This year, the AARC will start lobbying in earnest for House Resolution 2619; the Medicare Respiratory Therapist Access Act, known as HR 2619. It is a part of a long-term strategy to improve the presence of respiratory therapists on Capitol Hill and in a hospital, DME, or doctor's office near you. 

I spoke with Sheryl West of the AARC about some issues; some on the record and some off. She is highly intelligent, well-read, open to discussion, and extremely articulate in her support not only of this bill, but of our profession. I thank her for the hour I took up on what I am sure was a busy Monday morning. 

One of the misperceptions that I had, and I think many CRTs have, is that the AARC is working overtime to push us out of the field of respiratory therapy. Not true. The AARC has gone to extremes not only to protect the CRTs, but to allow them to continue working. What, then, is the bill about? It's about projecting respiratory therapy in the same light other disciplines in the hospital are projected, such as radiology, physical therapy, occupational therapy, and others. 

So here's a wake-up call for every CRT working; the AARC is not the end of your career. Sadly, only a little over a third of us working in respiratory therapy are members of the only professional group that is lobbying for us, and may perceive HR 2619 as a threat to their jobs. Again, not true. HR 2619 seeks to get recognition for the unique and specialized work respiratory therapists do, both in and out of the hospital. That is it in a nutshell, as I understand it. I have heard from so many who hold the CRT credential (like me) that this is the equivalent of the apocolypse for CRTs, and another slap in the face for the CRT, and it really is not. It is true that unless you hold the RRT credential and a bachelor's degree in a medical discipline that there could be some tasks that you cannot perform, particularly outside of the hospital walls, and receive payment for. You can still do the task, you and your employer just may not be reimbursed all you could be with the CRT credential as opposed to the RRT. 

You have to understand a little about politics. Any MBA will tell you that politicians and businesses in general care about three things: how to save money, how to maximize profits, and how to pay for your new idea. Studies are underway to determine a cost benefit for having those with advanced credentials and advanced degrees provide some, and the key word is"some," medical care. This in no way has an effect on the CRT doing his or her work in the hospital, rehab facility, DME, or other areas. Even those hired by physicians in the office will not be put out of a job based on this legislation, though the physician may decide to find an RRT to maximize their ability to get paid by Medicare. That is an employer decision, and not a ramification of HR 2619. Other insurance companies, such as Blue Cross Blue Shield, Aetna, etc, will likely follow the tracks of Medicare, as they always have.

One of the misperceptions I held until talking with Ms. West is that the AARC wants to divide up the CRTs and the RRTs. I wrongly perceived this bill as yet another attempt at doing just that. I was wrong. hat is done enough at the respiratory care manager level, who seek to hire only RRT's, or at the state level, as in the case of California where CRTs are unwelcome.

Even though I do not like this, I do understand that it is an organizational responsibility to look out for the welfare of the people, the patients, and the organization at whatever level you find yourself prominent in. Though I may not agree with you, if you are a respiratory manager who feels that hiring only RRTs or those
who will get their RRT in the next six months raises your level of care, you owe it to yourself and your organization to use that as a basis for hiring only RRTs.

CRTs, myself included, have had opportunities to go on with schooling and get the RRT credential. Whatever reason a CRT uses to avoid doing that (mine was serving in the military; no opportunity for school) is the bed you have made. Now you must lie in it. This is not a new trend; the push for elevating the profile of respitarory therapists has been around for a while, so if you ignored it or just chose to live in denial, then shame on you.

What HR 2619 does is specify that work done by a "qualified respiratory therapist" can be reimbursed at a higher rate than than it is when performed by someone that is not "qualified" according to Medicare standards. Some RRTs will be affected, too; not all RRTs have a bachelors degree in a health related field that Medicare will decide is acceptable under the term "qualified." The point is this is not a bill that excludes the CRT; it does not address the work of the CRT at all.

In the past, I have been critical of the AARC for dividing up the profession, waging an "us and them" war behind the scenes. I was wrong. The AARC,
as our only professional representative on Capitol Hill, is trying to use the playing field they have in front of them, Washington D. C., in the best manner
to advance all of respiratory care. 

In my opinion, all respiratory therapists need to show their support for HR 2619 by writing their politicians. The AARC has graciously offered an FAQ page on their website (http://www.aarc.org/, look under governmental affairs) which addresses not only concerns from CRTs, but also provides a good case for why this is a good bill for all of us. Even if, for whatever reason, you are not a member of the AARC, you can log on and read the FAQ's. Even if you are not a member, you can have your say about your profession with your politicians; the AARC even has a template you can use and a list of politicians representing you on their website. Politicians are supposed to represent us. If you decide to have no voice, you cannot complain when your voice is not heard.

Use your voice, support HR 2619, join the AARC, and do some homework on issues that present you challenges both on the AARC website, and on your own through congressional and senatorial websites, watchdogs, and by keeping up with professional news. It is through excellence and continued education that we get respiratory therapy the respect it deserves and secure our futures.  

That's just my opinion,

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

Windsor, MO



 

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Natural Aids to Quitting Smoking
January 6, 2014 7:04 AM by Jimmy Thacker

One of the more common New Year's resolutions is to stop smoking. Any time is a good time to quit. Some make it a pledge for the new year, while others take advantage of the Great American Smokeout. Others use birthdays, anniversaries,
or other holidays. If your New Year's resolution was to be a quitter, you may be interested to know of some natural methods can help you. 

Oats are good for you. Everyone knows that. But did you know that oats lower cholesterol and contain chemicals that reduce stress, which could help you get over the urge to light up. Cayenne pepper desensitizes the respiratory system, thwarting the urge for nicotine. Ginseng releases dopamine; the same chemical that makes us feel relaxed after having a cigarette. St. John's Wort has a 37.5% percent success rate, when combined with smoking cessation counseling, in helping people kick the habit by combating depression.

Herbal cigarettes still carry the stigma of smoking, but do not have the harmful side effects of nicotine because there is none in them. Lobelia fights nicotine withdrawal. Hyssop clears mucus congestion, particularly in COPDers and alleviates the hysteria some feel when stopping. Valerian can help with insomnia, often associated with quitting. 

Once you've quit, you will want to go into "repair" mode. Smoking destroys vitamin C, so a supplement may be a good idea. Vitamins A and E can help repair damage to the mucus membranes. Coenzyme Q10 can help oxygenation to the brain that may have been damaged during your smoking years. 

In my opinion, there are several ways to quit. Cold turkey, with medications, hypnosis, and herbals. You have to choose what is right for you. Every person is different, and just because they practice something different than what we read in text books does not make them wrong. As respiratory therapists, we should all be informed and support anyone trying to quit, regardless of their method.

That's just my opinion,
Jim Thacker, MBA, MHA, CRT, AE-C
Windsor, MO

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