The PulmonaryPaper Dedicated to Respiratory Health Care January/February 2015 Vol. 26, No. 1 Happy Valentines Day! Table of Contents We are hiding The Pulmonary Paper logo on our front cover. Can you find it? Featuring For Fun 03 | Editor‘s Note 13 | Two Recipes to Try! 04 | Calling Dr. Bauer 28 | SeaPuffer Cruises Plan a vacation and 06 | The Ryan Report leave your cares 08 | Ask Mark Your Health behind you! 10 | Fibrosis File 12 | Maintaining Weight with COPD 18 | Sharing the Health 15 | Bronchiectasis 30 | Respiratory News Basics 17 | New Quiz! 22 | 2014 Tax News 25 | Flu News 26 | Testing for Radon Gas in Your Home Live Longer! Breathe Easier! Improve Quality of Life! Even Look Better! Talk to your doctor now about the benefits of Transtracheal Oxygen Therapy! • Improved mobility • Greater exercise capacity • Reduced shortness of breath • Improved self-image • Longer lasting portable oxygen sources • Eliminated discomfort of the nasal cannula • Improved survival compared to the nasal cannula You’ve suffered long enough. Ask your doctor about TTO2! For information call: 1-800-527-2667 or e-mail [email protected] www.pulmonarypaper.org Volume 25, Number 6 Editor’s Note artha from Virginia recently wrote saying, “I know I should exercise and have made it my number one Mresolution.” We hope you achieve your goal, Martha! The three things on our goal list are to educate, empower and encourage you to continue to enjoy life despite obstacles that you may have to overcome. Bob McCoy RRT of Valley Inspired Oxygen in Apple Valley, MN, put things into perspective recently when he talked about people’s reluctance to wear oxygen at an American Association of Respira­ tory Care meeting. When a person who needs glasses puts them on, he is no different than a person who has 20­20 vision naturally. Glasses level the playing field and put everyone on the same “There is no footing. remedy for love but to Time equals tissue – the sooner you give your body the oxygen love more.” supply it needs, the less tissue damage there will be. Why do Henry David Thoreau health professionals and insurance companies wait until the point where your oxygen is very low to say, “Okay, now we are going to prescribe oxygen for you”? What if that happened with your vision? You would have to wait until you are walking into walls before they would say, “Okay, let’s order some glasses for you”. Being educated about your respiratory condition and treatment plan options empowers you. You are the one in control of your team. It is up to you to be a good leader in 2015 and beyond! Leaders also are known to have a softer side. Remember the romance. There is always time for romance – no matter how small the ges­ ture. The impact of letting someone know you care can be huge. Our cover couple Joy and Fran Lynch from Edmonds, WA, live the romance every day! Hard work pays off! My son, Ben, recently earned his MBA from the University of Tennessee and his family couldn’t be prouder! January/February 2015 www.pulmonarypaper.org 3 Calling Dr. Bauer … s we start the new year, I would like to share some of the guidance I give my patients about when to call and what to Ado in case of an emergency. At the end of every clinic visit, I tell them to call me if they have any new breathing concerns. Dr. Michael Bauer I am contacted when there is more shortness of breath than usual or if they are experiencing chest discomfort. The first questions I ask are: “What does your sputum look like? Are you coughing up more amounts than normal? Is it dark colored or bloody? Do you have a temperature?” More and more, patients have portable oximeters at home to measure oxygen saturation. A marked reduction in oxygen levels can be concerning. Answers to these questions help us decide if an antibiotic should be prescribed over the phone. Some of my “informed” patients will be given a prescription to be kept on hand at home in case they can’t get a hold of me or for an emergency. I always encourage them to call first if at all possible. It’s too easy to take an anti biotic too often these days. Overuse of prescrip­ tions can result in resistant infections. I’m less inclined to recommend antibiotics if there is no concurrent fever. Many of my patients are on chronic steroid inhalers and/ or oral prednisone. I try to discuss a plan in clinic for increasing the dose of inhalers when breathing symptoms become worse. A burst and taper of prednisone is often helpful, but again, I really like my patients to call before we mutually make this decision. Most patients with chronic lung disease know when they can manage problems at home. I know most of my patients well enough Question for Dr. Bauer? that when I get the call, “Dr. Bauer, I really need to see you soon,” You may write to him at The Pulmonary Paper, I make room for a clinic visit. On the other hand, when you can’t speak PO Box 877, Ormond in full sentences, if chest pain is severe and saturations are dropping Beach, FL 32175 or by email at info@ quickly, it’s time to come to the emergency room! pulmonarypaper.org. 4 www.pulmonarypaper.org Volume 26, Number 1 ] January/February 2015 Oxygen Therapy for the 21st Century “Two roads diverged in a woods, www.pulmonarypaper.org and I – I took the one less traveled by, And that has made all the difference.” Robert Frost Isn’t it time you took the Road Less Traveled? Oxy-View Oxygen Therapy Eyeglass Frames [ Call Toll Free (877) 699-8439 or visit www.oxyview.com 5 The Ryan Report his issue’s article is going to be a little bit different than the norm. In November 2014, I had the opportunity to visit Tokyo, TJapan, on a work­related trip, and I felt some readers may be interested in the experience. For those that do not know, I work for a small company, Valley Ryan Diesem Inspired Products (VIP), based in Apple Valley, MN. Among other services, we are known as an independent testing house for a wide variety of products in home respiratory care. Home oxygen systems, ventilators, CPAP machines, CPAP masks … you name it, we’ve probably tested it at some point. Recently we were invited to visit the facilities of one of our clients in Japan. We have worked with this group for several years, and the relationship has proven to be mutually beneficial. And while several of their staff have visited and worked with us at our facility, we had not yet been able to make the journey across the Pacific. When a chance to give a presentation on a variety of topics related to home respiratory care and equipment was given to us, we had to jump on it. In Japan, home oxygen therapy has only been available since the Ryan Diesem is Research mid ­1980s, and the number of Japanese citizens on home oxygen Manager at Valley currently is around 150,000 (compared that to over 800,000 home Inspired Products, Apple Valley, MN. Contact Ryan oxygen users in the U.S.). Like the U.S. home oxygen market, the at rdiesem@inspiredrc. majority of Japanese oxygen users have a stationary concentrator in com with questions or the home. Tighter noise regulations mean Japanese concentra tors com ments. tend to be quieter than their U.S. counterparts, but the trade­off may be increased size and weight. For those with portable systems, most Japanese oxygen users are given cylinders with continuous or pulse regulators. Home fill devices are not allowed in Japanese homes, so cylinder deliveries are needed when tank supply is low. There are a handful of portable oxygen con­ centrators (POCs) and liquid oxygen (LOX) options available, but they are not yet widely used. 6 www.pulmonarypaper.org Volume 26, Number 1 benefit to the home care dealer than it was to the oxygen user. With the advent of Portable Oxygen Con­ cen trators (POCs), which manu facture their own oxygen, savings ratio is no longer the buzz term it once was, at least in the U.S. In Japan, however, savings ratio is still a big selling point for devices with pulse oxygen delivery. A majority of the pulse devices available in Japan feature a minute volume delivery algorithm (i.e., the volume of oxygen delivered per breath decreases as the user’s Ryan Diesem, left, with Bob McCoy, Managing Director of Valley Inspired Products breath rate increases) which will give a higher oxygen savings ratio. Using data and For our visit to Japan, we were asked to information we have collected over the years, present information on the numerous I tried to impress upon those listening that changes occurring in the U.S. healthcare oxygenation capability should trump savings system as well as the current equipment ratio when marketing OCDs. landscape. I was given the lecture floor to There is nothing wrong with a device that discuss the wide variety of home oxygen utilizes a minute volume delivery method, equipment and the benefits and limitations but showing that the device can sufficiently of each type of system. In a later meeting, one oxygenate the user is more important in the topic of particular interest was the concept of long run than promoting its savings ratio. “savings ratio”. Savings ratio refers to the amount of In the end, our presentations and insight ox y gen “saved” when using an oxygen were well received.