Improved. Part 3. ‘Foot Health’

This is the third part to a series of posts, titled ‘Improved’, aimed to assist with development and improvement of Respiratory Therapists and other Healthcare Providers as individuals and as clinicians.

I share recommendations and advice from Mr. Piyush Jadav, a healthcare professional with educational and work experience as a chropodist.  In my conversation with Mr. Jadav, I asked for any recommendations for clinicians who either work 12 hours long day/night shifts/ acute care, and/or to those who work sedentary 9 hours shifts/diagnostic/patient education.

In time for foot health month, this post is released in May.

Footwear Advice for Clinicians/Hospital Workers

First off, when speaking about footwear; the most important thing is comfort. I have told many patients about what footwear is the best or most appropriate for them. The biggest issue with compliance has to deal with the level of comfort.

When speaking about footwear, at the most basic level there are 3 shapes of “lasts”. A last is the structure on which a shoe is built around.


  1. Straight last
    1. most appropriate footwear is motion control (high torsional stability,  stiff heel counter)
    2. Most appropriate for patients with over pronation, low arch profile
  2. Semi Curved Last
    1. most appropriate footwear is cross-trainer (medium torsional stability, EVA midsole (dual or single))
    2. most appropriate for patients with mild over pronation
  3. C- shaped Last
    1. Most appropriate footwear is cushioning/running shoe/minimalist shoe
    2. Most appropriate with patients with high degree of supination, high arch profile


With respect to hospitals, these same examples can be applied. Mesh/net material in shoes is usually not allowed in some departments due to risk of infection and lack of protection. Shoes that are used for long periods of walking in the hospital or clinic setting should not be used to recreational activity. Footwear that is meant for running/exercising are designed to absorb more force due its high demands.

Look for footwear with either Velcro or laces which provide stability to the midfoot as well as the ankles. Slip on shoes provide little to no support and have a shorter lifespan.

The best time to try on shoes is closer to the evening because one’s feet do swell slightly during the day. This will ensure a proper fit.

Also, try to change socks at least once a day. Try to designate a pair of shoes for work only, allowing them to breathe overnight. This will prevent excessive odour and moisture from building into the shoe. Never wear your shoes without socks, this can harbour excessive moisture and may contribute to athlete’s foot.

A typical clinician/hospital worker can be on their feet for 8-12 hours per day. Standing for long periods of time has been linked increased pressure on peripheral blood vessels. In addition, this can lead to varicose veins or “bulging veins”. Some of the first symptoms may include cramping, muscle aches and mild swelling. An inexpensive option to help with this would be to use mild compression (10-15 mmHg) stockings which may help with relieving symptoms, which can be picked up without a prescription from the pharmacy.

Written by:

Piyush Jadav, B.Sc., D.Ch
Registered Chiropodist

Primary site of practice:
Uptown Health Centre
9325 Yonge St Richmond Hill, ON L4C 1V4
(905) 508 -8876


Please follow and like us:

Improved. Part 2. ‘Nutritionist’

studio photography of different fruits and vegetables on old wooden table

This is the second part to a series of posts, titled ‘Improved’, aimed to improve the life and work of Respiratory Therapist and other healthcare providers.

I share recommendations and advice from a friend who is a health professional with educational and work experience as a nutritionist.  In my short conversation with her, I asked for any recommendations for clinicians who either work long 12 hours long day/night shifts/ acute care, and/or to those who work sedentary 9 hours shifts/diagnostic/patient education.  I have added relevant resources to some of the suggestions so I recommend that you check out the reference section for additional information.

Regardless of the work-setting, clinicians get heavily involved with their responsibilities and may loose track of time and their food intake.  Nutrition can directly impact cognition, concentration and decision making (1).  My source, the nutritionist, suggests: stay hydrated, eat healthier, plan your meals, have healthier snacks, and give yourself time to adjust to healthy eating habits.

Stay Hydrated. Don’t ignore thirst. Drink water. Carry a container of water with you (at your desk/RT department). If you choose to drink other fluids, check out the 2014 guideline by Dietitian of Canada (2). This guideline suggests a daily water intake of  2.2 L for women and 3 L for men (19 years and older).

 Eat Healthier.  Eat more vegetables and fruits.  It also adds more fiber to your diet (just remember to increase your water intake with it).  Limit foods that are high in  calories, fat and salt.  Consider lean meat or alternatives. Check out Canada’s Food Guide for more details.

Meal Preparation. A main obstacle in healthy eating at work is preparation.  Prepare food in advance:  Purchase, prepare and cut your veggies before it is time to cook.  Use slow cookers or pressure cookers to better fit your schedule.  Cook higher quantity of food than needed and freeze it for later consumption (reference 5).  If you don’t have time to prepare a meal and have to purchase a one at work, cut up some veggies and fruits to take with you.

Snacks. No matter how busy you may get, take the time to eat something, e.g. instead of having cookies and chips, cut up some bell peppers and celery sticks. Pair it with protein such as almonds and walnuts. It is better than working on an empty stomach (impacting concentration and overall performance at work). (3 and 5 ).  Also when it comes to shakes, it is better to eat food than to drink it (chewing food improves the transmission of satiety signals).

Habits. Keep in mind that any behavioural change, including improving dietary intake, requires time and practice. Set SMART goals (Specific, Measurable, Attainable, Rewarding, and Timely) .  Take small steps, keep motivated and enjoy!

Thank you to my nutritionist source (anonymous, so her opinions would not reflective of her employer(s) ) .  Also, a thank you to my followers for allowing me to be part of your  personal or professional development and growth.

Resources and references:

  1. Friedman, Ron. What you eat affect your productivity. October 17, 2014. Harvard Business Review.
  2. Guidelines for Drinking Fluids To Stay Hydrated. Nov 27, 2014. Dietitians of Canada.—Know-when-.aspx
  3. 10 Nutrition Tips for Shift Workers. Dietitians of Canada. 2013
  4. Miller, Carla. Changing Your Habits for Better Health. June 2013. NIDDK (NIH).
  5. Canada’s Food Guide
    Limit these:
    Fast and Easy Meal Ideas:
    Planning Tips:
  6. Getting Started: Setting SMART goals.  Alberta Health Services. Mar 2012.
  7. Image credit. Freepik.


[End] [Farzad ‘Raffi’ Refahi HBSc/RRT/CRE. April 02, 2017]


Please follow and like us:

Improved. Part 1. ‘Personal Trainer’

The Gym
Over the past few years, I have worked in various settings such as acute care, pulmonary function testing and patient education.   My experience varied from working in an active 12-hours long day or night shift in the ICU/ER setting to a more sedentary 8 to 9-hours “office job”/shift in pulmonary function testing and patient education.  I faced different challenges in each setting.  For example, around the 4th month working in ICU/ER, I noticed that wearing quality footwear will have a significant impact by reducing discomfort, and indirectly improving my energy and concentration levels.  On the other hand, during the less physically demanding shifts at PFT, I felt a total body fatigue and discomfort that stems from sitting for prolong periods of sitting down (i.e. reduced mobility and sedentary aspect of PFT/Patient Education setting).  In an attempt to improve the quality of life of my fellow clinicians, I reached to various healthcare professionals to get their advice (which I will share in a series of posts titled ‘Improved’).
In this post, I share the advice, tips and wisdom from a Personal Trainer.  Keerthanan Kugathasan is a personal trainer equipped with latest knowledge from his studies at York University’s Kinesiology and Health Science program.  The following is a summary of his recommendations:

Working long sedentary hours a day can be detrimental      to your body and health. Sitting more than 8 hours a day has been proven to increase the risk of muscular skeletal diseases, obesity, diabetes, cancer, heart disease and kidney disease (CDC.  2015). The spinal cord of the human body also puts up a huge strain, constantly in a curved position while you sit at your desk. This can evidently lead to poor posture when standing and sitting. Large muscles and joints, especially the ones located in the hip/lower region of the body, also tend to tighten up, as there is not much stretch or strengthening occurring as you remain sedentary in a sitting position for a significant period of time (AAOS. 2013).

In relation to the respiratory therapy job, there are days when clinicians endure a full 8-9 hour shift with not much physical activity. Although both the Acute and Diagnosis/Education job settings have differences in terms of hours and the amount of time you’re sedentary, it’s important to try and increase movement for the body so muscles and joints do not adapt into a sedentary setting.

My recommendations if you work long hours in a sedentary position:

  • Add more activity to your day… starting with your commute. If you take the subway to work, get off a few blocks before your workplace so you can arrive to work with great, positive energy after that short walk. Also, try alternatives routes to your desk, such as taking the stairs instead of the elevator.
  • Being active during your break! Instead of hanging around your desk and indulging on snacks, take these snacks on the go while you take a brisk walk either outdoors or even around the office! Not only will your muscles get activated, but you’ll be feeling a lot more awakened in the mind!
  • Take time-outs every 30 minutes to stand up and have a quick stretch! Sitting for long periods of time can interrupt proper blood flow to all your muscles. Standing up frequently and stretching all the tight muscles on your body will allow blood and oxygen to flow thoroughly around the body.
  • Organize the lay-out of your office space so you have to stand and walk over to machines such as telephones, printers, and medical equipment. Simply moving everything out of reach will allow more activity from your body
  • If your work place allows this; use a medicine ball instead of your usual chair when sitting at the desk. Not only will this fix up your posture, but you will also be working your core muscles trying to balance on the ball.
  • A fun one: When there is available time to use the equipment in your job setting, try testing out your VO2 max! The office can also incorporate a contest among all employees to see who gets can achieve the highest!


Remember, you spend a great chunk of your adult life at work! Therefore, it is important to take care of your well-being and body while doing so.

-Keerthanan Kugathasan (Personal Trainer)

For further questions or advice, please email:


>AAOS. Lower Back Pain.   December 2013

>CDC. Physical Activity and Health . June 04, 2015

[End] [Farzad Refahi RRT. . March 19, 2017]


Please follow and like us:

CSRT Conference. May 2017. Halifax.

Working on my presentation for the upcoming CSRT Conference in Halifax. Thursday May 11, 2017. 10:45 am. Leadership Forum. 

Working with Multi-Generations in Health Care.

See you there! 

Please follow and like us:

Dive in and Save

lifeguardFarzad Refahi Feb 17, 2017


“The first experience of intubation on a manikin was so fun!”

These were my initial thoughts after trying intubation on a manikin for the first time on Feb 13, 2012 at The Michener Institute. My first intubation in a simulation setting. “So Fun”.  Reaching for the laryngoscope with the left hand, sliding the tongue to the left.  Recalling to lift up and NOT to bend the wrist. To pass the tube through the cords.  To establish an airway. To intubate.  A palpable excitement in the clinical laboratory as my classmates took turns to attempt this skill.    Somehow it made us feel powerful, and closer to becoming a Respiratory Therapist, an RT.

This post is a self-reflection, a personal opinion, and does not represent the thoughts and the beliefs of my employers.  I will make references to intubation as a unique RT skill, without suggesting that it is the ultimate required intervention.  Also, I will draw on my experiences and insights as a lifeguard and a respiratory therapist, without any attempts to fully describing the responsibilities of each job.

When I read my Facebook post from 5 years ago, I started to think about my role as an RT.   I realized that my views and thoughts have shifted, or expanded to be more accurate.    I had gone through the same realization some years ago about a similar case.  I started recalling my training and work as a lifeguard.

To be a lifeguard.  To recognize the signs of struggle, to make that dive, and to save someone.  Many swimming classes and training sessions prepares one to become a lifeguard.  The idea of being able to save someone is a strong motivation to jump through all the hurdles and requirements.   However, when you complete the training sessions and start working as a lifeguard, you realize that the ability to ‘dive in and save’ , is only a very small part of your actual shift.  Does that take away from the skills and abilities of a lifeguard? Absolutely not.  But one quickly learns that there are many more processes in place to make someone a quality lifeguard.  The meaning of ‘saving’ someone shifts and expands.   Once trained, lifeguards are equipped with many skills to approach and intervene with the situation at hand.  However, most of the shift is spent on preparation and monitoring.  Yes.  Lifeguards spend most of their time preventing the opportunity to do the glamorous ‘dive and save’.   Time is spent to scan the swimming pools before the beginning of the shift: scanning for any loose bricks, sharp corners, water quality and levels.  During the shift, they monitor any risky behaviour by the patrons. They move around to have a clear view of those in the water.  Lifeguards have learned to expect and predicts certain patterns.  In case of emergency, they use the skills and routines that they have spent hours practicing.  Once the incident is dealt with, they spend time documenting and communicating with appropriate staff.  The incidents are monitored to recognize any patterns.

I had a very similar insight when it came to practicing respiratory therapy. After finishing my undergraduate studies and then few years of respiratory therapy program, I became an RRT.  I learned that if intubation is the required intervention then RTs are willing and ready to perform the task.  However, just like my lifeguarding experience, a lot of effort is spent on recognition, monitoring and prevention. After performing any required intervention, RTs educate and follow-up to prevent the repeat of this incident.    With additional knowledge and experience, one stops thinking about one specific event and start thinking about the bigger spectrum of care.
Let’s imagine that you are an RT responding to a page for intubation of an Asthma exacerbation.  The initial nebulizer and oxygen therapy treatment has failed, and deterioration has continued; Intubation has been selected as the next intervention.   You intubate and ventilate, and the team uses the appropriate pharmaceutical therapy to help the patient.   Your job as an RT may have been done for that instance, but you soon realize that there is a whole system in place that will continue to take care of this patient.   Your colleague may be called in during discharge to review an Asthma Action Plan with the patient.  This patient goes home and returns to his/her daily life.      He/she books an appointment with an RT, a certified respiratory educator, to discuss the recent events.  During the session, spirometry is done to compare the current values with his/her baseline.  A review of the current puffers is done.  Puffer techniques are assessed, corrected and/or reviewed.  The action plan is reviewed and modified as needed.  A list of triggers is updated, and plans to prevent these triggers are discussed.    Our patient is monitored by a team of RTs/CRE/Respirologist/MDs/nurses/Pharmacists who look after him/her.  If all of the above fails, then we know there is a team of healthcare providers waiting in the emergency departments and ICUs to assist and treat such exacerbations.  Preparation, monitoring, interventions, and follow ups.

Through my short RT career so far, I have worked in acute care, pulmonary function testing and sleep apnea education/CPAP. I have had the opportunity to view our role from a wide spectrum.  It is comforting to know that this system of prevention, treatment, and follow up is active in all the settings.   While this system is not perfect, there are caring people who are trying to make improvements.  By thinking about the bigger image, and staying humble, we can be a better member of this spectrum of care.

In hindsight, the thought of diving in and rescuing someone via intubation seems glamorous and ‘fun’, however, it is but one aspect of being an RT. Respiratory Therapy field is expanding and we are the driving force behind it.


Please follow and like us: