Happy 2021!

I am going to make this post a quick one as I feel 2020 has already dragged on way too long. I will remember 2020 as a unique year and look forward to my journey in 2021.

If you are still reading this post, let me share a few personal notes about 2020.

This past year gave us an opportunity to recognize the hard work of front line workers.

Along with those directly and indirectly impacted by COVID19, physically and mentally, my heart also goes to all the individuals and businesses who suffered financially.

I have talked about my journey through my deployment during the first wave, and will not discuss it in this post. However, I will re-emphasize the importance of self-care. Since, the first wave, I have signed up for Audible, where I listen to a new audiobook every month. Think Like a Monk and A Promised Land are the last two audiobooks that I have listened and enjoyed. My mind during the drive to and from work is now quiet, peaceful and happy.

I would like to take a moment to thank you for following my blog. Also, thank you to all those who have directly and indirectly supported my online presence!

Happy New Year!

Farzad Refahi

Dec. 31, 2020

Let’s read an article a month –December 2020

The cropped screenshot of the first page of the article. It also includes the URL or link to the article.

Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

Link to the article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3029208/

Link to the blog post: https://respiratory.blog/lets-read-an-article-a-month-december-2020/

This month I found a great piece to share with you.  This one is a case study. The authors of this paper have tried to “report a case of a middle-aged lady who was initially misdiagnosed as having acute asthma after brief tracheal intubation” (p.1). 

Tracheal stenosis mimicking severe acute asthma

Ali Bin Sarwar Zubairi, Babar Dildar, Shahid Javed Husain and Mohammad Faisal Khan

BMJ Case Rep. 2010; 2010: bcr1220092517.

Link to the article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3029208/pdf/bcr.12.2009.2517.pdf

Reasons you may find this article interesting 

  • Tracheal stenosis post intubation is rare but it can happen.  To make the case even rarer, this lady was intubated for less than 48 hours. 
  • This article includes images that are interesting to view.  Two are from the bronchoscopy view of the narrowing (Figures 1 and 2. on pages 2 and 3).  The other image is a CT scan of the neck which shows the tracheal stenosis (Figure 3 page 4).  I greatly enjoyed seeing the visual aspect of this case!
  • I enjoyed reading the differential diagnosis from her ER visit:
    “New-onset severe asthma, bilateral vocal-cord paralysis, foreign-body aspiration, tracheal tumours, post-intubation/tracheostomy tracheal stricture, Wegener’s granulomatosis, obstruction of trachea or mainstem bronchi due to external compression from mediastinal tumours or adenopathy” (p.2).

I encourage you to read this interesting and short case study as the authors also review the potential reasons why this stenosis occurred and also the potential treatment options.

If you enjoyed this article, consider liking this blog post and sharing it with others who may benefit from it.

Happy learning and reading!

Farzad Refahi

December 1st, 2020https://respiratory.blog/lets-read-an-article-a-month-december-2020/

Happy learning and reading!

Farzad Refahi
December 1st, 2020

Think Like A Monk

Photo by Farzad Refahi

Recently I studied Think Like a Monk by Jay Shetty. I liked it so much that recently bought it as a birthday gift for someone.

I purchased this book as I am always looking for ways to improve to become a better version of myself (as a person and a clinician).

These are the top three reasons why I enjoyed this book:

  1. The guidelines provided in this book have helped me reduce decision fatigue. I select my clothes the night before. My mornings have become simpler, more peaceful and more focused on goals I have set myself. A more peaceful mind has given me a much bigger buffer to deal with my daily stressors.
  2. Our training involves many processes, systems and algorithms. These are in place to minimize errors. Despite all that, we make mistakes sometimes. Clinicians are humans after all! This book empowered me to be able to forgive myself. Now I feel lighter, I can trust myself more, and can further improve as a person and as a clinician.
  3. Jay Shetty has helped me to be more present. This has allowed me to enjoy life more fully. I can clean my teeth and actually focus on the task at hand instead of just brushing with my mind all over the place. Have you ever heard of the saying “drink your food and chew your drink”? Jay will go in more detail but I can tell you that now I try to enjoy my food no matter how simple it is. Being in the present has also enabled me to focus on my relationships with important people in my life, such as my wife, family members and patients.

If you want to study this recommended book, use this link. If you decided to purchase through this link, it will support me in to continue producing quality content on my blog.
Happy RTing!

Farzad Refahi
Nov. 07, 2020

Let’s read an article a month – November 2020

Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

Link to the article: https://erj.ersjournals.com/content/erj/56/2/2000418.full.pdf

Link to the blog post: https://respiratory.blog/lets-read-an-article-a-month-november-2020/

This month I found a great piece to share with you.  This one falls under COPD. The objective of this paper is to “ assess the role of sensitisation on clinical outcomes in COPD using a large Asian cohort recruited across three countries, and, for the first time, assess the influence of environmental allergen exposure using a metagenomics sequencing approach.” (p2).

Environmental fungal sensitisation associates with poorer clinical outcomes in COPD

By:  Pei Yee Tiew, Fanny Wai San Ko, Sze Lei Pang, Sri Anusha Matta, Yang Yie Sio, Mau Ern Poh, Kenny J.X. Lau, Micheál Mac Aogáin, Tavleen Kaur Jaggi, Fransiskus Xaverius Ivan, Nicolas E. Gaultier, Akira Uchida, Daniela I. Drautz-Moses, Huiying Xu, Mariko Siyue Koh, David Shu Cheong Hui, Augustine Tee, John Arputhan Abisheganaden, Stephan C. Schuster, Fook Tim Chew, and Sanjay H. Chotirmall

European Respiratory Journal 2020 56: 2000418; DOI: 10.1183/13993003.00418-2020 https://erj.ersjournals.com/content/56/2/2000418?etoc

Commonly used abbreviations in this article include home dust mite (HDM) and Global Initiative for Chronic Obstructive Lung Disease (GOLD).

When it comes to restriction to environmental sensitivities, asthma is the first in my mind.  This article reminded me that people with COPD may also benefit from the identification of their sensitivities and in turn limiting their exposure to them.

Top 3 Reasons why I enjoyed this article

>> Individual care. There are so many variances in personal experiences with diseases. This article is an example of this.  “Sensitisation responses and their respective allergen profiles exhibit geographical variation, largely determined by climate, environment, genetics, cultural and social practices and account, at least in part, for the variable reports in the COPD literature“ (p9).

>> I value the effort by these authors to exclude asthma/ACOS patients as it increases the value and accuracy of their study.

>>  How caring for patients, especially those prone to exacerbations may take indoor and outdoor irritants into consideration:  “… we observe that the outdoor and indoor (home) environment serves as an important reservoir of fungal allergen exposure translating to sensitisation responses to outdoor air fungi in a subgroup of COPD patients. Indoor (home) environments demonstrating a higher fungal allergen burden associate with greater COPD symptoms and poorer lung function illustrating the importance of environmental exposures on COPD outcomes.” (p9)

This article is a great reminder of how we need to look at each patient as a person with a unique circumstance, genes, environments and living space.  With a better understanding of the impact of fungal allergen exposure in some patients with COPD, clinicians have more variables to assess and monitor. 

Happy learning and reading!

Farzad Refahi

November 1st, 2020


Thank you -RT Week 2020

Photo by Wilhelm Gunkel on Unsplash

Thank You – RT Week 2020

It is my tradition during RT Week to sit back, reflect, and thank those who have made a positive impact on my respiratory therapy career over the past year.  

As I finish my third and final year as a Director with the Respiratory Therapy Society of Ontario (RTSO), Nancy Garvey’s name comes to mind.  Nancy recruited and mentored me three years ago and I am very grateful to her.  I have witnessed the amazing work of many individuals who not only prevented further financial turmoil but brought stability and growth for the organization. This stability helped the organization to provide resources and advocacy for RTs during the 2019-2020 pandemic.  There are many great people within the organization so it is hard to name just a few for this post: Gino DePinto, Sue Martin, Kelly Hassall, Shawna MacDonald, Sue Jones and Susan Aikenhead.  It has also been nice to begin working with Megan McFarlane, Paula Smith, Greg Donde and Wendy Foote!  Tony Kajnar is also part of the team, and also continues to contribute to our profession in various organizations!

I had a unique opportunity to join a team of panelists in the creation of a joint statement by CTS and CSRT.  Thank you, Carlyn McCoy, Micah Cooperberg and Elizabeth French for this opportunity! https://www.csrt.com/wp-content/uploads/CTS_CSRT_COVID_PFT_Final-July12_2020.pdf

Many RTs volunteered to share their insights and experiences with me over the years and I am very grateful to them! Over the last 12 months, I spoke with  Rachel Nesbitt, Kelly Hassall and Dave Wall.

Thomas Piraino dedicated his evenings for a period of time to RTs, assisting with their questions during the pandemic. I am thankful for the sense of reassurance he brought to me and the RT community. 

As always, a big thank you to my lovely wife, Jessica, who continues to support me in this journey. 

I began this blog to help RTs, and I wouldn’t be here without the help and support of my amazing followers.  Much appreciation and love to you all!

Happy RTing!

Farzad Refahi
Oct. 25th 2020