passion

COPD Day 2017

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November 15th is the World Chronic Obstructive Lung Disease (COPD) Day.  Based on a study by World Health Organization (WHO) in 2015, COPD is responsible for “5% of all death globally that year” (WHO. Nov 2016).   When it comes to care for COPD patients, many names come to mind; One of these dedicated individuals is Mrs. Sheery Tse.

Sheery is an active RRT who works and volunteers with COPD patients at Markham-Stouffville Hospital and Scarborough and Rough Hospital (Birchmount site).

The first time I met Sheery was in May of 2017 at a social event for COPD patients, where she was facilitating it on her own time.  She is passionate about her work and is full of energy.  She is praised and respected by her patients and colleagues as she truly cares and advocates for her patients.  To get to know her better, I sent Sheery few questions:

  • When did you first hear about the respiratory therapy field? What made you decide to become an RT?  I heard about being an RT when I did some volunteering at HSC. There I ran into a high school mate who was working as a RT. After spending some time with her and the team, I decided to apply to Michener for the respiratory technology course as it was called many, many years ago.

 

  • What are some of your memorable jobs/roles so far?  In an acute setting I was always more interested in helping patients in the ER, providing care so they may breathe easier and giving a quick education of their puffer needs was very rewarding.
    Now I love doing education whether it’s in the COPD clinic or at a healthcare office, seeing the patients understand their airway disease and why certain puffers work and how is rewarding.

 

  • What are your career goals? (and do you feel that you have accomplished them?)  Given my age and how many years I’ve been in their field, I feel I have accomplished most of what I set out to do. Starting the COPD clinics in Markham and Scarborough from scratch has been very rewarding.
    There are still a few goals I would like to see happen, a support group with just patients input and more exercise sessions available would be the biggies. Patients self-management at home is another area I would to see happen too.

 

  • How did you get involved with patient education (with COPD patients)?When Dr. M. Forse first came up with the idea of having a clinic for COPD patients, it sounded like something I would enjoy. I applied and was chosen as the educator. Now came the challenge, getting certified as an educator and quite trained.

 

  • How does a typical day look like for you?
    Don’t think there is ever a truly typical day. It could be as simple as setting up for the clinic with patients charts and assessing the patients to triaging all new referrals, returning phone calls and emails from patients to meeting with pharma reps to hear what’s new, studies and of course being the nosy educator what’s on the pipeline for puffers. In between that I also need to triage patients into the exercise programs we have and call to see if they are willing to come in and for afternoons or evenings. Tuesday’s, Wednesday’s and Thursdays, I try to go to the exercise classes to provide some support and answer any question the participants may have. I’ve been called the “spy” as I do inform the respirologists if there are concerns about the participants, including possible flare up and low sats. Through these interactions we have been able to prevent patients from being seen in ER when the respirologists could fax a script for them, or as simple as asking if they started their on-hold meds. Low sats often, if they are with ProResp, I could get a RT to come assess on the track, other vendors, I ask the patients to contact their 02 providers and ask to be reassessed and the respirologist is informed.

 

  • What are some of the challenges and joys of working with COPD patients?
    Joys is seeing the patients in a follow up visit tell us how well they are doing, having the patients return from a trip they did not think they would be able to go on because of their airway disease, seeing how well they’re exercising. Challenges is trying to convince the patients they need to use their maintenance puffers regularly, and the same with those on 02. Most often, they are so used to being deconditioned and breathless, they’ve adapted to do without. Smokers are the biggest challenge, getting them to even think about quitting is often a huge step. Cutting back with each follow up is rewarding to hear, telling us they’ve actually quit is even more so.

 

  • Based on your experience, what are some of the common struggles for COPD patients, and how can RTs better assist these individuals?
    The most common struggle, is self-management and deconditioning. They’re breathless so often they feel they can’t do much. Try is one of my favourite word to use at the clinic and at exercise classes. Knowing if and when they need to be seen is a biggie too. They really are independent and don’t want to bother their healthcare team and often end up getting worse and needing to be admitted.   Providing tools for them to figure out if it’s a simple cold, a flare up or more is something all healthcare providers need to give so they may manage their disease better and hopefully not get to the point they become very ill.

 

  • What are your thoughts on the latest 2017 COPD Guidelines and New Medications in the market? *
    New guidelines are constantly changing, latest is to decrease use of ISC with COPD patients unless they have at least one exacerbation a year to decrease the chance of getting pneumonia. When we first started the COPD clinic we had short acting puffers (Ventolin, Atrovent) ICS(Flovent) combo (Advair, Symbicort) and a LAAC(Spiriva) that just came on the market. Now we have choices, we can provide patients with the puffers they need in a device that is easier for them to use so compliance increases. There may be more I the future, good for the patients, more challenging for healthcare providers as we will need to know them, how they work and how to use them to provide better support for patients.

 

  • Any advice or final thoughts to share with RTs?
    Final words, healthcare is an amazing profession, there are many different streams available, even for RTs from in hospital, to clinics, to home care. Patients safety and wellbeing should be the most important thought in our work. Giving patients respect, support and information should be on going.
    The best review in the COPD clinic is when the patient comes in, and asks for a hug, calls you by your name and remembers what you said and did for them. At the end of the day, my hours spent volunteering means they get the support they need. From a simple support I have been given so much more I return from them. It is very rewarding, even in sadness when they pass. We have family call to let us know how much they appreciate all the support we gave to their loved ones.

 

Thank you Sheery for your dedication and hard work!

*To the readers of this post, please continue to refer to the guidelines and medication pathways provided by the facilities/organization you work at.  The answers provided my Mrs. Tse is to provide perspective and is not to replace the protocols provided by your employer or RT governing body.

Here are some useful resources I came across:

-Canadian Thoracic Society.  https://cts.lung.ca/guidelines

–Alpha-1 antitrypsin deficiency targeted testing and augmentation therapy (2012)
https://cts.lung.ca/sites/default/files/documents/cts/1.%20FINAL%20A1AT%20GUIDELINE%20APRIL%202012.pdf

-Managing dyspnea in patients with advanced chronic obstructive pulmonary disease  (2011)
https://cts.lung.ca/sites/default/files/documents/cts/1.%20CTS%20COPD%20Dyspnea%20Guideline%202011%20EN.pdf

-Optimizing pulmonary rehabilitation in chronic obstructive pulmonary disease (2010)
https://cts.lung.ca/sites/default/files/documents/cts/CTS_COPD_Guidelines_Pulmonary_Rehab.pdf

 

-The Lung Association. Various PDF documents to study, to print and to share.  https://www.lung.ca/lung-health/lung-disease/chronic-obstructive-pulmonary-disease-copd/resources

 

-RTSO- COPD. https://lungontario.ca/disease/copd/

-Global Initiative for Chronic Obstructive Lung Disease . https://cts.lung.ca/sites/default/files/documents/cts/1.%20CTS%20COPD%20Dyspnea%20Guideline%202011%20EN.pdf http://goldcopd.org/wp-content/uploads/2016/12/wms-GOLD-2017-Pocket-Guide.pdf

 

Farzad ‘Raffi’ Refahi
Nov 15 2017

References:

-WHO. World Health Organization. COPD. Fact Sheet. November 2016.

http://www.who.int/mediacentre/factsheets/fs315/en/

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Working as an RT – Mieke Fraser

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  To share the views of an experienced RT for Respiratory Therapy Week, I reached out to Ms. Mieke Fraser.  I first met Mieke when she was one of  the supervising instructors for  Ventilation Lab during my studies at The Michener Institute.  I also ran into her at various professional development events including the latest Better Breathing and Canadian Network for Respiratory Care (CNRC) conferences.  She is passionate, caring and an authentic RT.  Her wisdom is built from years of experience, which includes but not limited to Mount Sinai Hospital and Bridgepoint Active Healthcare.  She is also in the process of getting ready for her upcoming talk at the CNRC National Respiratory Care and Education Conference in Calgary.  I asked Mieke what it means to her to be a respiratory therapist.  This is what she shared with us:

 

I was working with an enthusiastic and engaging RT student yesterday that brought to front of mind what it means to me, to be an RT:

First, it’s the moment of connection with a patient and then if I’m lucky, the building of a therapeutic relationship with the patient and their family. We are fortunate to be able to treat patients across the health care system.  I value being part of the team that helps patients with the most fundamental actions of life – their breathing.

Secondly, because I can make a human connection with them, and then help them with something as important as their breathing, I believe I can ease their suffering (maybe just a little or in some cases immensely).

We are a highly skilled and widely experienced profession.  As a brief example: in a given week, I could be optimizing ventilation for a patient in ICU, helping to protect lungs from injury and allow healing, recovery, and growth in NICU; providing treatment in the ED for patient with acute exacerbation of their chronic respiratory disease; providing education and facilitating greater self-management to that patient with chronic respiratory disease; counselling a patient towards smoking cessation; and, helping facilitate a peaceful death.

And finally, as a RT with a few years of experience, I value being able to share my experiences, my approach, my wisdom, my perspective, my skills and knowledge to the next generation of RTs.  Showing them how to assess a patient, to look at the details but also see the big picture, to make the differential list, to respectfully touch during assessment and treatments, to listen and connect with our patients, and so much more …

I am proud of the valuable role we have within a multi-disciplinary team, at times overshadowed by the larger-in-numbers presence of nursing and physicians.  I would have to say that those individuals – the patients and families – with whom we make that moment of connection know we are different, and maybe just a little bit special, for we intimately assist them with the most precious piece of their life – their breath.  For when you can’t breathe, nothing else matters.

Mieke
Mieke Fraser, BSc RRT CRE

Thank you Mieke for taking the time to share your thoughts with us!

Happy RT Week!

Farzad ‘Raffi’ Refahi
Oct 25, 2017
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Influential People In Respiratory Therapy: Andrew Wroblewski

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There are many individuals contributing to the field of respiratory therapy who I may not know about as I have been practicing in the field for only a few years.  In my journey to learn more about this field and the people involved, I reached out to Mr. Andrew Wroblewski.
-YouTube (The CPAP Gentleman)

Andrew is a Respiratory Therapist and producer of a successful YouTube channel called ‘The CPAP Gentleman’. He has used his work experience of helping Obstructive Sleep Apnea, OSA, patients to create educational videos for patients. He has summarized and simplified relevant information into entertaining segments.  The topics range from “What is Sleep Apnea?” to “Nasal Bridge Irritations”. His first YouTube video dates back to Feb 2016. He is a dedicated, driven and successful RT who is contributing to patient education and the growth of our field.  He was kind enough to answer my questions.

1. How did you find out about the respiratory therapy field? What made you decide to become an RT?

I found out about the profession through a friend of my father’s. He graduated into the field about a year before I started, and currently works in the Hospital for Sick Children in Toronto.

I was one of those guys that had no idea what to do with his life upon finishing high school. My strengths and interests were in Biology and Physiology courses, so my parents and councillors suggested I go into healthcare. Respiratory Therapy seemed like an outgoing field with many different areas to work in.

 

2. a) Can you tell us a little bit about your YouTube channel? How did you come up with the idea? How did you get involved with it?

After many real-life encounters with actual patients diagnosed with sleep apnea, I grew to learn of the common issues people face with PAP therapy. Some were even fearful of the treatment, so I wanted to re-assure them and others in the world that sleep apnea was nothing to be scared about. The only way to do this was to educate them in a fun and informative way. And thus the character was born.

I believed that YouTube was the best option to communicate my message, and something that wasn’t being utilized to its fullest potential by other clinicians. I aimed to fill that void, and if I could help just one person by doing it, it would be worth it.

 

2. b) What are some of the challenges and satisfactions of making educational videos?

Time, time, time. Everything from coming up with script ideas, to video production, and post-editing takes up a lot of my free time. I don’t always produce in a noise-free environment either, so extra care needs to be taken to ensure videos come out in respectable quality. I hold myself to a certain standard, and strive to improve things whenever I can. The satisfaction comes directly from the people I help! I get a big smile on my face every time someone leaves a comment thanking me for my efforts. It also gives me the motivation to continue doing what I do.

 

2. c) How much time is required in making an educational video (roughly how much time is spent in research/script, recording of the videos, and editing)? Where do you find the time to do that in your already busy schedule?

It really depends on the topic I’m covering. Generally the research/script takes the most amount of time. If I’m very familiar with a particular topic, I can produce a script in a single day. If it’s something I’m not too sure about, it may take upwards of a week or more. Video production generally takes anywhere from 2-6 hours depending on the length of what I’m discussing. Video editing takes a similar amount of time. Sometimes I’m stubborn and I want things a certain way, so there’s been times where it’s taken days.

I don’t know where I find the time! I have many things going on right now from participating in multiple on-call programs to learning a new language. That’s probably why I’m only able to produce an average of one video per month. Hopefully my subscribers don’t mind!

 

2. d) Any thoughts/suggestions/comments for those who are thinking of starting their own educational related videos?

I would highly encourage others to participate in video production for the purposes of education. YouTube is a great avenue through which to do this, and also easily accessible through all hours of the day. I would recommend to start simple. Perhaps audio only, and images that relate to what you’re discussing. This way you don’t have to stress out about learning everything from proper lighting, sound production, and video quality. Not to mention, editing is a little more complicated when there’s a real person in front of the camera.

You’ll also save a lot of money! Cameras, lighting, microphones, backdrops…it all hurts the bank. But I’ve already healed from those wounds so it’s okay.

 

3. You work in the home oxygen and CPAP settings; Any advice or recommendations for RTs who are thinking of or may consider working with OSA patients (i.e. CPAP)?

Most OSA patients that you deal with, are for the most part, healthy. This is a far stretch from other environments respiratory therapists work in such as intensive care, emergency, and operative departments. This allows you a relatively stress-free environment where decisions do not have to be made quickly. You’re also able to communicate with your patients more effectively as they are fully alert and able to breathe on their own. I do recommend working on your customer service and interpersonal skills, as this will go a long way in developing a relationship of trust between you and your OSA patient.

 

4. You have vast knowledge and years of experience in improving the quality of sleep of your patients. Any advice for Healthcare Professionals (HCP) (i.e. How can they improve the quality of their sleep)?

Make sure you have good sleep hygiene. You should try to be consistent with bed times as often as possible. For some HCPs, this can understandably prove to be difficult due to varying shiftwork. Sleep duration is also important, and you should aim to get at least 7-8 hours of sleep per day. An average sleep cycle is around 1.5 hours, and you need five of them for the body to be ‘fully restored.’

Don’t drink coffee or workout too late! It can be difficult to fall asleep otherwise. And finally, if everything else is in check but you’re still feeling tired, make sure you get referred for a sleep study. You may have an undiagnosed sleep disorder that is effecting the quality of your sleep.

 

5. Any final thoughts or message you like to share with RRTs and HCP?

Do what interests you in your respective field. I know that seems sort of obvious, but many of us work in areas we don’t necessarily want to work in. This can be a result of the current job market and what’s available, or what others think is best for you. In the field of respiratory therapy, acute care is highly prioritized above all else. Home-care is sort of an after-thought. I personally had just two days to experience the home-care setting during my clinical rotations, but that was enough for me to make up my mind.

Don’t worry about passion, or lack thereof. Passion behind your work comes from experience, and a supportive environment. Work hard, play harder.

Thank you Andrew for sharing your views, recommendations and perspective.  Keep up the great work!

Image credit:  https://www.youtube.com/channel/UCO2DkdV_758nYdnuSc6wuLQ (accessed Sep 17, 2017 )

Farzad ‘Raffi’ Refahi
October 1nd 2017

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