As the President, I have tried to improve communications across our state.  I contacted the 33 hospitals in our state that have some type of respiratory care.  From this, we now have a better idea what is needed in the state.  You know what that is?  More bodies and less apathy.  Throughout the United States, the AARC hears that there are not enough RCPs, and are concerned (rightfully so) about losing what little reimbursement there is for respiratory care services.  Of all of the RCPs who practice throughout the nation, very few actually do any thing about letting Washington know what we do and why we are needed.  Yes, the AARC has a lobbyist who is there letting folks know but this is not enough.  We all need to contact our Senators and Representatives to encourage them to understand why we are vital in medicine and how we save money and days hospitalized.  The ISRC has a tentative meeting set up with Senator Craig’s Health Person Lisa Kidder for the week of Christmas.  We will have about 30 minutes to get the information on what we do and how we do it to Senator Craig through her.  Please help us and get in touch with your Senators and Representatives to extol our virtues. 

SO….

Keep plugging for RC,
Keep plugging for ISRC, and
Keep plugging for AARC.

Connie, tag, you’re it.
Renie

Dr. Nik came to us from Kota Bharu, Kelantan, Malaysia where he is an Associate Professor and Department Head of Anesthesiology and Intensive Care in the School of Medical Science at the University Sains, Malaysia. The medical center where he practices has 700 beds with ICU/CCU combined with 20 beds. Respiratory Therapists are not trained or working in Malaysia. The goal of his visit to the United States was to learn about starting a formal respiratory therapy training program. During his time in Cincinnati, he was able to meet and talk with Dr. Koga, our first International Fellow, about starting a school of respiratory therapy.

Quotes from Dr. Nik: “Being chosen as  an International Fellow with a opportunity to visit the greatest country in the world is like winning the lottery.” 

“I want to be able to speak in front of a group of my peers and be relaxed like Jeff Anderson from BSU.”

Dr. Nik was a delight during his visit. He has invited us  to visit him in Kelantan.  Thanks to Dave Shuldes, Renie Johnson, and Lonnie Ashworth to just name a few of the RTs who welcomed Dr. Nik to Boise.  A special thanks to Nola Darling who encouraged me to be the city hostess.

My first sleep study for RLS (restless leg syndrome) was a total shock.  “Sleep Apnea” with periods lasting 99 seconds and hypopneas lasting more than three minutes.  Could have blown me away!  CPAP was started with Clonapin (1 mg this time).   CPAP was increased up to 20 cmH20 as time went on, making it very intolerable.

My second sleep study revealed that the CPAP wasn’t working.  ENT time.  The UPPP was as much fun as everybody says it is—NOT!  Still I had to use CPAP, and still it wasn’t working according to my third sleep study.

My dentist had an idea, jaw thrust – pull my jaw forward and life would be better.  The Silencer sleep appliance is a great adjustable titanium mouth device that works on normal people.  It pulled my jaw out of place and made my TMJ very painful.  By the time my jaw lined up again, it was time to put it back in and use the CPAP (still on 20 cm).  By this time, my physician was as concerned as I was and ordered a CT scan with and without my mouthpiece.  The Silencer opened my airway a grand total of .5 cm.

Stanford was my next stop.  The physician there was as pleasant as they come.  He did, however, tell me not to use the mouthpiece due to my TMJ and associated pain and non-fitting teeth.  He scoped out my throat and showed my where my obstruction was – in my tongue of all places.  He did seem to think it was repairable.  I said GREAT!

On to Saint Alphonsus in Boise.  What a fabulous facility.  Thanks to the whole RT staff.  Connie could not have been any better or more supportive (along with the whole department).  I had a great time there and the food was wonderful.  The procedure I had was in two parts.  1.  The Geneoglosus Advancement (the front muscle of your tongue is pulled out through your chin).  2.  The Hyoid Suspension (the back muscle of the tongue is attached to the Hyoid bone, so they reposition it farther down the airway).  Thus they stretched my tongue.  All was well until Mr. Abscess made a visit into my throat incision.  I awoke three days later at EIRMC with three drain tubes in my throat and one in my mouth.  IV antibiotics at home for three days and orally for 10 days.  The infection cleared up and I failed my next sleep study.

By this time, I was up to 2 mg of Clonapin and Amytriptoline and CPAP.  The CPAP was getting on my nerves because of the mask and chin strap had to be so tight that the marks on my face would linger until noon, looked real cool.  Still on 20 cm.  Failed another sleep study.

Time to get serious.  Trach time.  If I would have known how simple and painless this procedure was, I would have done it three years ago.  Every surgical procedure so far was not reversible.  This is.  If I get tired of it, I pull it out and do the procedure over again because I wouldn’t be able to sleep.  So what if I have a little button in my throat, my obstruction is bypassed and I can breathe and sleep.  Trach care is not a big deal since I only have a button.  Twice a day I clean it out; every week I replace it.  Two hours of sleep can tide me over for a whole day now, whereas 10 hours previously did me no good at all.  By noon, I was fighting to stay awake.  I actually fell asleep once during a PFT I was performing on a patient.  How embarrassing.

This, however, is not the end of the story.  My RLS is still a big problem.  I failed another sleep study so my physician started me on a Parkinson's medication.  Mirapex is working (along with the 2 mg of Clonapin).  Mirapex at .5 mg TID seems to work for me.  Some people may need more or less than I do, but I can rest now without my legs tearing me apart.

It has been a long battle for sleep but I have learned something.  I work evenings at the Sleep Disorder Center for Eastern Idaho hooking people up for their sleep studies and can sympathize with their problems.  I now enjoy my work because I feel rested.  That and my family life keeps me busy. 

I should end this paper with some personal data.  I am 46, 68” tall, 152 pounds, neck size is 15.5 inches and the only time I snored in any sleep study was after my 99 second apneas.  I ride my bike to work sometimes twice a day and run two miles at least four times a week on our treadmill  I do not fit the profile of Sleep Apnea so remember it is not only the typical people who have sleep apnea, some of us atypical people do too.

Thank you to:
Dr. Christensen who listened from the start, then listened and listened and listened…
Drs. Amour and Shrader (my bosses) for their help and concern
Dr. Larson, D.D.S. for going where no man has gone before
Dr. Nelson Powell (Stanford) for showing me my own deep throat 
Mr. Matthew Schwarz (St. Alphonsus) I wish it had worked, although it didn’t hurt
Dr. Affleck for saving my life (from the abscess)
Dr. Hinckley for fixing me
Staff at I.F. Surgical Center, they are fantastic
Staff at St. Alphonsus are the best, thanks Connie
Staff at EIRMC, abscesses are no fun, but they are healable
Sandi Jackson, the best Sleep Tech ever, without whose help I’d still be sleepless in I.F.

Memorial Hospital
Weiser – Contact Connie Graham – 549-0370

St. Luke’s Regional Medical Center
Openings in NICU, PICU, Peds
Boise – Contact Dave Shuldes – 381-2155

VA Medical Center
Full-time nights, full-time PFT
Boise – Contact Nola Darling – 422-1356

16th Annual CNMC Symposium on “ECMO and Advanced Therapies for Respiratory Failure”
February 25 – March 1,  2001
Keystone, CO
Robin Muir (202) 884-3314
 

47th Annual International Respiratory Congress
December 1-4, 2001
San Antonio, TX

The interim treasurer reported a net worth of $24,962.62, which is about $3000 above last year at this time.  Questions regarding the report were fielded and answered.

Committee Reports:

• Web site – It is still very basic.  Lande’s wife can set up a web site as a school project for free.  Initial setup costs $400-$500.  A motion was passed to have Conrad Colby contact Lande to see about getting this done.
•  Delegates report – Nola and Bob reported on the national meeting in Cincinnati, Ohio, on October 5-6, 2000.  The national office has been advised to set up an e-mail system for legislation that needs attention right away.  The full delegates report is attached.  Nola has the national budget if anyone is interested.
•  PACT – Report from Jan.  The ISRC will contact the AARP to be part of our legislation issues.  We need to get other big groups involved.  We need to continue to contact our legislators.  Idaho has done well in contacting them.  Ask the legislators to vote against the Balanced Budget Amendment because it does not include reimbursement for respiratory care or pulmonary rehab.  It is not definitive towards our services.  As of November 3, 2000, HCFA will consider individual characteristics for payment of pulmonary rehab.  Then there will be a two year transition rate until April, 2001.
• Membership – There are 11 new members for a total of 152 as of October 31, 2000.  The nationwide membership averages 25%.  Individual contact is important.  Nola has the AARC packet of information about membership.  You may borrow it from her or obtain one from the AARC.  Respiratory care needs to make its presence known in the hospital and home care settings, so that when the question comes up about why there is a need for respiratory care, we are able to answer that this is what we are trained for.  It is not just because we have a license.
• Scholarship – It was decided that the information should be on the web site and that a description of Donna should be included.  It was also requested that another qualification for the applicant was to be a student  residing in Idaho.

There will be an ISRC meeting set up with Senator Craig.  Renie will contact members when this has been set.  Issues that were brought up for possible discussion include:  Pulmonary rehab reimbursement, a job description for respiratory care, how having respiratory CPT codes will save money by having the respiratory therapist take care of patients and will help to keep them out of the hospital.  Submit any other ideas to Renie via e-mail.

Steve reported that the Gooding Hospital has a breakfast for local legislators in the spring.  He can also bring up these same issues at that time. 

Old business: 
Renie read the mission statement that Duke thinks is already on the web site. It was decided to adopt that one for Idaho. 

Smoking cessation – St. Joseph’s in Lewiston has a program that Bob put together with information from the Mayo Clinic.  Their health department has money for the program.  If anyone is interested in getting a program of their own going, contact Bob for any information you may need.

The meeting was adjourned.  The new president, Connie Leavitt, will set up the next meeting for the new year at a later date.

Respectfully submitted,

Ramona Sailor
ISRC Secretary Elect