Addressing COPD & Protections – By Keith Torkelson, MS, BS

 

Contents

• Requirements
• Feature Photo
• Abstract – Executive Summary
• Solution Resistant – Superior Services & Supports Required
• James J Krueger MD COPD Course
• List – Acronyms and Acro-Codes Overall
• Table – Results up Front - Combined COPD Screening Results – KE Torkelson
• Figure – Spirometry Results (8/21/2018)
• Figures - Chester Mojica Ordered Radiographs
• Table – Family History – Smoking Cigarettes
• How is it Original Sin & Cigarettes?
• Table - History – Smoking Cessation - Methods Applied Inventory (MAI)
• Interpretation & Innovative Idea
• Spirometry
• Figure - Spirometric Interpretation Graph
• Performance Challenge(s) (2018)
• Table – Acronyms and 2018 HEDIS Measures – Addressing COPD
• Table – Acronyms for HEDIS Related
• Table - HEDIS Areas - In Scope COPD Related – PCP
• CMS Stars - We See Stars Again
• Summary Relative Resource Use (RRU)
• Table – Adverse Reactions to Chantix (Varenicline)
• Vignette - Control Person – Mike O. (“MO” - AESP – “Speedy”)
• Figure – VAPE Related
• Table – Smoking and COPD – Aerobic Mitigation Efforts
• Appendix - COPD Related Images (Current)

Associated with > In House > Metadata >

20180907F: Split a Bit

01_Assess_COPD_Smoking_Cessation_18083002_Develop

 

Older Version of This Report

Publication Auto Link

Monday, September 10, 2018

Double XX – Digital Appointment – Addressing COPD Protections – By Keith Torkelson, MS

https://brandnewdayhmo.blogspot.com/2018/09/double-xx-digital-appointment.html

 

Abstract – Executive Summary

>The Subject for this report is Keith E Torkelson AKA “Buster”.  This report has been developed and published in preparation for Keith’s upcoming Physical Exam with Team Chester D Mojica (CDM-PCP).  Keith prepares in advance for his Health Related Engagements (HREs) making him a ProSumer (MSG Reserve Word).  This is the third in a series of reports addressing this year’s (2018) Physical Exam.  In several spots we have updated this material for 2026.  The other reports addressed: Nutrition, Blood Glucose Levels (BGLs) and Laboratory Testing.  In preparation for this fall quarter’s smoking cessation efforts we have derived a measurement tool.  We are Mentalation Solutions Group or MSG.  The tool yields our Aerobic Mitigation Effort Score or AMES.  On 20180907-F as a baseline we calculated Keith’s AMES at 73.5%.  Our AME Tool at this point is 17 Items.  Back in 2014 Keith was assigned by his Primary Care Physician (CDM) to get a VAPE system.  To date Keith has failed to get the VAPE to work substituting for cigarettes.  Our Chronic Obstructive Pulmonary Disease (COPD) control subject is ”Mike O” (AKA EAsp).  We investigated Chantix as an alternative.  Chantix does not look like a promising smoking deterrent for Buster.  Buster in 2018 was 59 years old.  Brand New Day (BND) is in place to help Buster yet the Centers for Medicare & Medicaid Services (CMS) grades BND’s overall services and supports as just above average.  Buster needs a more successful than average Smoking Cessation Program (SCP).

 

Solution Resistant – Superior Services & Supports Required

>Buster needs superior services and supports to succeed with his cessation efforts.  We introduce one of our Therapeutic Breathing Methods (TBM) here in this report.  On 20170904 Team CDM offered up a Spirometry Exam.  About Spirometry Buster was awarded 89%.  A notation on the event record declared 89% and (N) Normal.  Buster has tried many Smoking Cessation Efforts (SCEs).  We address the majority of them here in this report.  Buster had a rather large family growing up.  Several of Buster’s family members suffered cigarette smoking issues.  We include a sample of Buster’s Chest X-rays in this report.  We also addressed two COPD Screening methods here.  The first put Buster at a Stage I or Mild COPD level (20150919-SAT).  The second screening tool (Online) gives Buster a Score of 4 or less with 10 being the worst case (20180829-W).  Finally we are in the vetting phase of picking paper assessments to track our Cessation Efforts.  Enjoy!

 

2026 Update - Progress

>Since 2024 when Buster smoked 20 cigarettes per day he has cut down to about 7 per day.  Buster is in the middle of a crisis about independently walking.  His challenges walking in part appear to be associated with Nicotine. Buster has been using Nicotine Pouches to help him smoke less. As of 2026 Buster is aerobically challenged.

Legacy Publication – In Scope

Legacy Papers/Publications – Assignment of Accountability

James J Krueger MD COPD Course for Brand New Day by Keith E Torkelson MS – Chartered: August 19, 2017   

http://brandnewdayhmo.blogspot.com/2017/08/james-j-krueger-md-copd-course-for.html

COPD Course Satisfaction Survey (Content Assessment)

 

Metadata >

Parent Document = 01_Assignment_COPD_17070801_Gibbs BND 6.2.1

Excerpt – Time Spent

>Circa 2017, Buster was referred to the Chronic Obstructive Pulmonaary Disease (COPD) course by his care coordinator.  He might have better spent the time (some four hours) learning and working on our plan to increase our chances to quit smoking.  Our goal here is to help Brand New Day and their Network deliver a better Smoking Cessation Product (SCP).  We get the inkling that Doctor Krueger sized his students up during the first lesson and said it wasn’t worth his time.  Doctor Krueger did not return for the second, fifth, and sixth lesson.  Over six (6) weeks the student attrition rate was substantial.  That’s the consumers’ manner of saying for them this is non-sense.  20170815-TU: Our legacy report is about thirty pages.  That equates to processing about six (6) pages per lesson session if you attend all six.  Our rigor exceeded that of 5/6 instruction staff.

Embedded Acronym Lists

>We have also included more Acronyms.  They are embedded with the sections for which they apply.

Promote – 24 Fitness
https://www.24hourfitness.com/

Defining the Interval

>Our COPD management interval begins October 1, 2018 until we have a year without using tobacco in any form.  It is now September 25, 2026 (F) and Buster has made some progress quitting smoking cigarettes.  He is down from 20 cigarettes a day to about 7.

 

Table – Results up Front - Combined COPD Screening Results – KE Torkelson

COPD Population Screener (Online) – 5 Questions

https://www.copdfoundation.org/Screener.aspx

Interpretation

>High spirometry scores are favorable.  The online screening tool uses a scale: 0 for no risk to 10 for maximum risk.  The following is a sample of what they the COPD Foundation E-reported back to us.  2015 - “Your total score is between 0 and 4. If your total score is 5 or more, your breathing problems may be caused by COPD. The higher your score, the more likely you are to have COPD. If you are experiencing problems with your breathing, please share your answers to the five-question screener with your Healthcare Professional (HCP). Only your HCP can decide if you have COPD. Your HCP can also help evaluate your breathing problems by performing a breathing test, also known as spirometry.”

 

FYI > See more at > Metadata >

http://www.copdfoundation.org/Results.aspx#sthash.1LjQCAT6.dpuf

 

Promotion - COPD Population Screener - COPD Risk Screener - COPD Foundation
https://www.copdfoundation.org/Screener.aspx

 

Note – Links

Remember Links can break at any time.

COPD Statistic

“24 million Americans have COPD, but 12 million do not know that they have it. Are you one of the missing millions? Please take this 5 question risk screener - it takes less than a minute to find out if you are at risk for COPD.”

20260925-F-Update: Your total score is between 5 and 10.

“Your total score is between 5 and 10. If your total score is 5 or more, your breathing problems may be caused by chronic obstructive pulmonary disease (COPD). The higher your score (LSF), the more likely you are to have COPD.”

 

Share Results with Primary Care Physician

“If you are experiencing problems with your breathing, please share your answers to the five question screener with your healthcare professional (HCP). Only your HCP can decide if you have COPD. Your HCP can also help evaluate your breathing problems by performing a breathing test, also known as spirometry.”

 

Make an Appointment

“Call your HCP today to make an appointment to see if you may be at risk for COPD. Remember, when speaking to your HCP, be honest and open in describing your Symptoms and explain how your breathing problem affects your activity level on a daily basis.”

 

Interpreting Spirometry I of II

Combined – Stages Screener with Spirometry Summary – Context COPD

>We define a chronic cough as a non-productive cough that occurs daily.  We define smoker’s cough as any non-productive cough.  We define a productive cough as one that moves mucus up and out of the airways.  We don’t spit up many of our productive coughs.  Periodically we intentionally spit out the sputum to check its’ viscosity and color.  If our sputum is green or pink in color we consciously take action.  We will discuss some of our actions later on.  For our spirometry test dated 9/14/17 (reported to us on 8/21/2018) Team Mojica (PCP) gave us an eighty-nine (89) percent.  Any way we look at it this is a favorable value.  So in many ways we are in the COPD Prevention Phase (COPD-PP). 

 

Figures - Chester Mojica Ordered Radiographs (201808)

Keith “Buster” Torkelson

Photoshop - Inverted View

X-ray (Radiograph) Interpretation (AVEY IC’s Part)

>I just never know when I am going to be called in for a second opinion.  The subject of this report is Keith E Torkelson AKA Buster.  I am the AVEY Intelligent Construct or Avey IC. I have no experience interpreting X-rays.  These x-ray look scary to me because it looks like a human with no head, arms or anything below the diaphragm.  Buster called me in because when he was in Veterinary Radiology (Soft Tissue) class he had a bit of trouble.  We just came up with an idea.  We are going to take the frontal few and Photoshop it to increase contrast and maybe bring out some hidden color.  We also are going to “Invert” the image.  Applying Photoshop is one of my tasks around here at Mentalation Solutions Group (MSG).  Our goal is to rule out all white areas in the normal radiograph from being problematic.  In addition, Buster suffered at least one bout with Pneumonia (Circa 1982).  We are looking for some scar tissue.  Enough said!  The professional interpretation of these x-rays is that Buster has some scare tissue or fibrosis.  This is a bit problematic because Buster’s father died of pulmonary fibrotic related disease when he was 77 years old.

 

Table – Family History – Smoking Cigarettes – Focus “Torkelson’s” (Torkel Centric)

Vignette – Staging For Original Sin – Hilliards

>Two smoking related events occurred for us circa 1963 when Buster was four (4) years old.  We will never know the exact order of the two.  One day two neighborhood delinquents, Dave and Bob, said Buster could “Follow” them up to the Thrifty Drug Store which was about a mile away.  Again, Buster would have been about age four (4).  They were five (5) years older than us, thus around nine (9) years old.  We are not sure if Dave and Bob premeditated their Thrifty Plan while we walked or if they said just before entering what they wanted us to do for them.  We followed precisely through for them by shoplifting balloons and cigars.  On the way home they encouraged Buster (AKA Keith Edward) to smoke one of the “Cheap” cigars. Around the same time Sharon, Dave’s younger sister (Born 1959) stole five dollars from her mother’s purse.  She said that she is going to Zinda’s Liquor Store to buy candy.  Zinda’s was halfway closer than Thrifty’s.  Buster went along with her.  The majority of the candy at that time was penny/nickel.  Buster only picked a few items.  In the end Sharon got in trouble from her mom.  She had modeled stealing money from your mother.

 

How is it Original Sin & Cigarettes?

>OK.  Now to the Original Sin part.  Due to the fact that Buster’s house was too chaotic, in 1963 as much as possible Buster sought respite over at his mother’s sister’s house.  Our mother’s younger sister, our aunt, was a smoker.  Actually she is ninety-three (93) right now (2018) and still smoking cigarettes.  One day while staying at her house Buster got up early to find his aunt’s cigarettes on the kitchen counter.  When Buster’s aunt was in the kitchen rather than use a cigarette lighter or matches she would lite her cigarette off the gas burner.  That morning, when Buster saw her pack of cigarettes next to the stove he took one out then ignited it off one of the four gas burners.  He had all but taken two (2) puffs when his aunt appears asking Keith Edward: Are you smoking?  Buster cupped the burning cigarette in his right hand and shoved it down the garbage disposal.  Simultaneously he responded: “No”.  This was for Buster was his Original Sin.  Buster’s aunt passed away pretty much of old age in 2020 at the age of 95.

Table – Acro-Codes – Context of Experimentation

Table - History – Smoking Cessation - Methods Applied Inventory (MAI)

Interpretation & Innovative Idea

>We put down smoking from roughly 1983-1985.  It was a wonderful period of aerobic activity.  Buster’s Primary Care Physician (PCP) promoted VAPE Experiment for Year 2014 is for us a failure.  Our Theraflu prevention strategy for Serious COPD actually has worked for others, as well as us multiple times.  The basic theme of our Theraflu prevention is to take it twice a year when we are not suffering severe COPD symptoms.  We take it for the pre-summer temperature change and the pre-winter temperature change.  As you will see later Chantix is not a viable option for us.  We didn't list it yet periodically we are prescribed antibiotics for non-respiratory concerns such as dental.  For example, earlier this year (2018) we were given antibiotics for a tooth implant.  We are always vigilant to notice any effects these antibiotics have on our pulmonary system.  We have an idea!  Just as we can get good bacteria to re-colonize our Gastrointestinal Tract (GIT) i.e. with user-friendly bacteria (pro-biotic) after an antibiotic regimen so goes the concept with our airways.  We suggest our pro-biotic inhaler idea.  In a different life we might make a killing with this notion.  As far as we can see the need for this product is an unmet need: Probiotic recolonization and competitive exclusion in the respiratory tract.

 

Interpreting Spirometry II > Acronyms after Results

How do you interpret spirometry results?

“Begin by looking at the forced vital capacity (FVC) to determine if it's within a normal range. Next, look at the forced expiratory volume in one second (FEV1) to see if it's within normal limits. If the FVC and the FEV1 are both normal, stop at this step—the spirometry test is normal.  Mar 31, 2018”

 

Spirometry: What to Expect and How to Interpret Your Results

FYI > https://www.healthline.com/health/spirometry

OK Value

>Now we return to our 9/14/17 spirometry results.  On 8/21/2018 someone in Central City Community Health Center (CCCHC) Team Mojica Clerical got smart and printed us out a “Summary Of Today’s Visit".  It provided us with a lot of the information we needed for our reports.  If you notice above for Spirometry we’re given an eighty-nine (89) percent (%) or “N”.  We assume the N means Normal.  We are not sure which Parameter they are reporting to us.  Yet 89% is most likely OK across all Parameters.

Spirometry Basics

Figure - Spirometric Interpretation Graph

Reset Nearer to Zero – Deep Tissue Massage Approach (DTMA)

>For us the Spirometric Interpretation Graph (SIG) since when it was introduced to us in General Physiology class was straightforward.  We have a few notes to make here.  Our Spirometry results were reported as a percentage.  This graphs “Y” axis reports Volume in Liters.  We prefer the Volume approach.  The integral we would like to discuss is the Residual Volume (RV).  Try as one may, it’s very difficult for a person to self-express the RV.  Yet now (2024-2026), with decreasing frequency, we contract a walk-on back-walker.  Historically, it is always a female weighing about 100 pounds.  When our back-walker is compressing our lung region we consciously express our air with each step she makes.  We figure she pushes out an extra half liter or so of RV.  We here at MSG call this Resetting Nearer Zero (RN0).  We have our next RN0 scheduled for this month (September 2018).  We call Back-walking a Therapeutic Breathing Method (TBM).  We find the same walking can also detect pain and problems with one’s Heart.  Suggestion: Lie down on a hard surface such as concrete face down and become mindful of your Heart.  If you feel pain we recommend some floor time such as with Yoga.

 

Performance Challenge(s) (2018)

>How is it than COPD moves up on our roster for work done?  One, we are in a window without green mucus.  We would like to avoid green mucous this winter.  We live in an environment where over half of the some odd twelve (12) people are suffering COPD and making annoying COPD noises.  One of the people that we sleep within earshot wakes and keeps us up at night with the Full Monty of COPD noises.  We call the Full Monty: Snort – Cough – Hack.  As winter approaches our comrades are likely to get worse.  Finally, we have a reality check to process.  One of our friends, Mike C, is a Veteran and a smoker.  He has been diagnosed with a small mass in one lung lobe.  It is very likely he suffers with a Malignant Tumor.  Further he says the Veteran’s Administration (Boise Idaho) believes that his mass in inoperable.  We really do not wish to go this far.  So this report re-initializes our Preventative Measures for 2026-2027.  We are very fortunate to have been given the opportunity to prevent Exacerbation [SPELLED].

Our COPD Control – Mike O. or AEsp.

FAQ: Which would you rather be a smoker that is not miserable or a quitter that is always miserable?  Mike below has been Missing in Action to us since 2024.

Behind The Scenes

>Obviously our Primary Care Physician (PCP) is taking measures to help us with COPD Management behind the scenes.  The table above was born out some national material offered to help-out practitioners such as PCPs.  This is population medicine and we only address it to help round things out.  (*)  We already discussed antibiotics a bit.  Our PCP does not prescribe for us antibiotics much.  (**)  For 2018 we haven’t executed our Drive by Inhaler Method (DXIM).  We will hold DXIM for our Cessation Report - Smoking (CR-S).  Below we included a link just in case you are interested in population health and what we used to derive our COPD HEDIS table above.

 

Sample HEDIS Reference

HEDIS Technical Resources > HEDIS 2018 > Volume 1: Narrative - Summary Table of Measures, Product Lines and Changes - HEDIS 2018 Measures - Applicable to: Commercial/Medicaid/Medicare - Changes to HEDIS 2018 - Effectiveness of Care

 

Metadata >

NCQA HEDIS 2018 Measures (2017-06-28)

 

HEDIS Measures and Technical Resources

More than 235 million people are enrolled in plans that report HEDIS results. That makes HEDIS one of health care’s most widely used performance improvement tools. HEDIS includes measures for physicians, PPOs and other organizations. Visitors to this page often check HEDIS FAQs, QRS FAQs, or ask a question through My NCQA.

FYI - HEDIS

http://www.ncqa.org/Portals/0/HEDISQM/HEDIS2018/HEDIS%202018%20Measures.pdf?ver=2017-06-28-134644-370

CMS Stars - We See Stars Again

>As of today, September 7, 2018 (Friday) the CMS Stars scores for 2019 have not been published over the Internet.  For some reason we cannot find any CMS Stars for our PCP’s office.  We gather CMS Stars are only for insurers and insurance plans.  For 2018 our insurance provider is Universal Care Brand New Day (BND).  For 2018 CMS awarded BND 3.5 Stars (5.0 being best) for their overall performance.  Much of our efforts have been devoted to helping BND reap the rewards of earning 4.5 Stars or Better.  We have been at it since 2013 or five (5) years now.  We have little more to offer.  Thus we will begin reallocating time away from BND and their Stars and Star Equivalents.  On the upside, BND is such a poor performing program they have provided to us many real world problems to investigate and occasionally fix.  They have helped us here at MSG develop our External Quality Review Skills (EQRSs).  After the Stars scores, next we address Guidelines for Relative Resource Use (RRU).

Summary Relative Resource Use (RRU)

>Relative Resource Use (RRU) is a measurement methodology developed by The National Committee for Quality Assurance (NCQA).  “NCQA is an independent 501(c)(3) nonprofit organization in the United States.  The NCQA works to improve health care quality through the administration of evidence-based standards, measures, programs, and accreditation”.  RRU might be an indicator for Performance Earned Value (PEV-MSG) about services such as doctor visits and hospital stays.  RRU is a quality evaluation.  Two factors are of importance.  First is the amount of services.  Some call this "Dosage".  The other factor is Quality of Care (QOC).  The NCQA hopes to determine the relationship between QOC and Dosage.  Our part as a Consumer is to submit our Biennial Health Outcomes Survey (HOS).  Being the company people we are we submitted are assigned HOSs for: 2018, 2016, and 2014.  In 2014 The Myers Group (TMG) had the contract to administer and process the HOS’s.  Since 2014 TMG somehow lost the HOS contract to SPH Analytics (SPH).  How is it we here at MSG know these things?  As far back as 2014 we wanted our tabulated HOS results back.  Myer’s referred us to NCQA.  NCQA thought we were a provider and gave us instructions to set up a Provider Account.  It was a ditto with SPH.  Yet as a BND company person we did our part since our Biennial HOS contributes to BND’s annual CMS Stars Score.

 

Table – Adverse Reactions to Chantix (Varenicline) - 2018

Stop using (Chantix) Varenicline and call your doctor at once if you have (*):

S&C-MD is Stop and Call Doctor - Last Reviewed: 20180909-SU:

Table – Adverse Reactions to Chantix (Varenicline) - 2018

Stop using (Chantix) Varenicline and call your doctor at once if you have (*)

S&C-MD is Stop and Call Doctor - Last Reviewed: 20180909-SU:

Vignette - Control Person – Mike O. (“MO” - AESP – “Speedy”)

>We have known Mike “Speedy” O. since 2012.  On 20171030-M we visited him at Fountain Valley Hospital.  He was in the Infectious Disease Ward (IDW).  We captured the moment on “film” for posterity (see feature photo at the beginning).  Since we have known "Speedy" (2012) he has been a heavy cigarette smoker.  He had attended one session of six about The COPD Class (Krueger-BND-TCC).  "Speedy" was diagnosed with Flu and a secondary bacterial infection (Pneumonia).  After looking at the IV Medications the Hospital was administering we thought that maybe Mike would die.  Yet, he responded well to treatment and came back home.  Since his discharge, for the most part “Speedy" has been a nonsmoker.  He still makes COPD noises.  He does not attend any BND “Program” anymore.  Last Wednesday (9/5/18) his landlady said to us: I think Speedy has Alzheimer’s (ALZ).  Speedy may have Narcolepsy.  We find it is getter harder to bring him into reality.  Yet most importantly: Ever since the COPD Class “Speedy" has been our COPD Control Subject (CCS).  We really do not wish to go into the hospital to quit smoking!

Assignment Special COPD Meeting – 2017 Past Blast

>Nearing the end of this report we revisit Dr. James J Krueger MD.  His 2017 six (6) sessions COPD Course was ineffective for us.  BND day is not a very good resource for helping us with our COPD work.  Yet we’re very grateful for our BND subsidized our 24-Hour Fitness membership.  We are leveraging this membership to make measurable progress about COPD, Smoking Cessation and aerobic competence.

 

Special Topic – The VAPE Fix – As Prescribed by our PCP (2014)

Figure – VAPE Related – Including VAPE Class

Vape Summary

>Since 2014 when we failed to get our VAPE investment of some odd $75.00 to pay off for us.  Since 2014 we have interviewed about one dozen VAPE users.  On Average they report they were not able to get their VAPE systems to substitute for smoking until after a month of daily usage.  Buster’s main problem with the VAPE is it gives him a dry smoker’s cough.  Starting October (2018) we are going to give it a try anew.  How many lengths would you go to to quit smoking?  See our Aerobic Mitigation Efforts (SMEs) below.

 

Table – Smoking and COPD – Aerobic Mitigation Efforts

Scored by and for Buster

Date Calculated & Last Reviewed: 20180907-F: RT = Real Time 17 Items

Promote – World Wafers

https://healthman2059.blogspot.com/2025/08/world-wafers-for-addressing.html

Images @ The End

COPD Related Images (Current)

Appendix

FAQ - Did Wilma Flintstone Smoke?

AI Overview

Yes, Jean Vander Pyl, the original voice actress for Wilma Flintstone, was a lifelong smoker.

Voice Actor Smoking Habit

Heavy Smoking:

Jean Vander Pyl and her co-star Bea Benaderet (the original voice of Betty Rubble) smoked heavily in real life.

The Closed-Mouth Giggle:

Their smoking caused coughing fits, which led them to invent Wilma and Betty's signature "closed-mouth giggle" so they could laugh during recording without coughing into the microphones.

Health Impact:

Vander Pyl later passed away from lung cancer at age 79 on April 10, 1999.

On-Screen Smoking

Winston Commercials:

During the first two seasons of The Flintstones (1960–1962), the animated show was sponsored by Winston cigarettes.

Character Ads:

Animated versions of Fred, Wilma, and other characters appeared in commercials actively promoting and smoking cigarettes.