• Message from Mary:
    An update on Uppsala and the European Respiratory Society (ERS) annual meeting in Stockholm, Sweden.
  • Have you thought about travel to Scandinavia but been concerned about the level of health care available? Fear not! Hospitals and health care for the pulmonary patient in Sweden, and other Nordic countries, equals that which you could expect to access anywhere in the United States. This report will focus specifically on Uppsala, Sweden. Uppsala is a university town of about 180,000 people, 70 km north of Stockholm. It has one of the oldest Universities in the world, teaching students since the beginning of the 1200s. (And I used to be impressed by the ivy-covered walls of Yale!).
  • It now has about 40,000 students studying in all the disciplines including, of course, pulmonary medicine. The buildings are a wonderful meld of the ancient and the modern, designed to educate and house those who study here. My favorite building was the circular medical amphitheater dating back before 1600. To help pay for the expense of the building, resembling a small Sistine Chapel in shape, tickets were peddled to the public for the privilege of viewing an autopsy. And we complain about too much gore in our entertainment! A very few "privileged" guests got a front row seat. Others had to struggle up very steep stairs to very narrow aisles, which still circle this glass-domed room. Here it is standing room only where your only support is a high, solid railing on which you can lean. We were informed that was to prevent squeamish spectators from falling down onto the autopsy table way below if they fainted! This architectural wonder is still used for lectures and receptions today. But not for autopsies. Uppsala University Hospital is clean, bright and modern with a staff that understands and speaks English. Communicating is no problem. Walls are painted white with lots of furniture in bright, cheerful primary colors. The pictures on the walls are also colorful and interesting, rather than the routine institutional types too often seen here. The light fixtures were ones I'd like in my own home.
  • One thing that made my eyes open wide was the staff cafeteria. Great furnishings, great food and interesting beverages. Along with the coffee, tea and coke you could also have a glass of beer with lunch. Fear not. Unlike our American brews, these are barely 1% alcohol. Sweden has very strict laws about driving under the influence of alcohol. A blood alcohol level of 0.002% can mean a large fine and the loss of a driver's license for 3 months. One glass of this light (in alcohol, not calories) beer can be safely consumed by our careful Swedish friends. Another difference in diet was flat bread and cheese severed at every meal, including breakfast and, European style, with desert.
  • The striking difference between Uppsala University and hospital, and one in America, was the parking lots. There were very few cars but thousands and thousands of bikes. None of the students have cars. Almost everyone walks, or more likely, rides his or her bike to school or work, including senior physicians and researchers. And that, my friends, is still their mode of transportation even in the rain, sleet, snow and ice that you find in this city part of the year. What do you do when it rains? Wear a poncho and hood. When it gets below freezing? Remember the mittens! When it's dark? Turn on the headlights and wear reflectors. And when there is ice and snow? Put snow tires on the bicycle and ride carefully! It is not hard to believe that you are in a country populated by descendents of the hardy Vikings.
  • I was fascinated to see very elderly ladies, gray hair flying and skirts billowing in the breeze, vigorously pedaling past me. This means other changes in life style. If you ride your bike to the grocery store you can't bring home bags and bags of groceries. Besides, you bag your own groceries and no box boys are around to help you to your bike.
  • Do you feel self-conscious when you need to use a cane? Come to Sweden. While you don't see too many single canes, one in each hand is common. Why? Well, to begin with, if you have an injury. it makes for better body mechanics and balance. And if you don't have a physical problem, it is a good way to keep in shape for the cross-country skiing that all Swedes do from early childhood. From 3 to 93, all age groups can be seen striding along using their poles, getting ready for the long winter season.
  • And what did I do while I was there for 3 weeks? Why, I walked along with everyone else, of course. (Prudence reigned, and I decided this was no time to enter the biking traffic.) It was a shock on my first jet-lagged day to find I had to walk 2 miles to (and back from) the University to give the first of my lectures. Especially when we had thunder, lightening and pouring rain on the way home. For a Southern Californian who hasn't seen rain in about 8 months it was true culture shock! So, what happens if you work in Stockholm, or want to spend the day there? You may be in charge of hamburgers at McDonalds or the CEO of a large firm but you still pedal your bike to the train station, where you park, lock it up, and hop your train commute to work. No wonder the obesity so prevalent in the States was noticeably almost non-existent in Sweden! And I strongly suspect that the few I saw were tourists from you-know-where.
  • Liquid and portable oxygen are readily available. However, it is prescribed only for patients who have an oxygen saturation below 88% or a blood gas PO2 below 55 at rest. Desaturating with exercise is not an acceptable reason for being put on oxygen in Sweden. (This is one area where we may have a disagreement with our Swedish colleagues...more research is needed in this area.) General practitioners refer patients to a pulmonologist when indicated, or when they find an FEV1 under 50% of predicted. If you are unlucky enough to have been hospitalized here in the States, you will be familiar with the one or two bed units in most hospitals for those who are not aren't critically ill. You will find a similar set up in Sweden. The difference? You are encouraged to walk to your meals in a small, pleasant dining room. A staff member will roll you there in a wheel chair, but we know that all of you would much rather walk, wouldn't you?
  • What about travel in general? Like many other countries, getting around is not especially easy for those with handicaps. Many streets and sidewalks are constructed with picturesque old bricks. Escalators seem rare, as are moving sidewalks in airports. Stairs seem more common than elevators or escalators. The contrast between cold air outdoors and the heated air of interiors can trigger runny noses and maybe even some wheezing in those of you susceptible to rapid temperature change. Also, while Swedes smoke much less than Southern Europeans, there is still more smoke than a Californian is accustomed to.
  • As to tolerating international air travel, be sure to get flu shots before flying. The re-circulated low humidity of air in a plane that you are stuck in for 11 or so hours makes you susceptible to catching things. I never get colds, except occasionally after an international flight. This time I got one coming and going. Of course, getting stuck for hours on the tarmac didn't help. Neither did the flight aborted by loosing an engine, flying around to empty the fuel tanks over London (!) before landing again, and hanging around until the next day for another plane help any. These things can happen when you fly and you need to be prepared to go with the flow. Or rather, the lack of it!
  • But it was a great trip, thanks to our Swedish colleagues, and in particular to Margareta Emtner, PT, PhD and her wonderful family. They all opened up their homes and hearts, giving generously of their time, to make our visit so special. A great big "Tack" to all of you for your wonderful hospitality.
  • What about the ERS conference in Stockholm? As always, part of the enjoyment of these international conferences is resuming friendships and exchanging information with our colleagues from other parts of the world. It was wonderful to again see Dr. Attila Somfay of Hungary, who has gotten his PhD as a result of the research he did with us at Harbor-UCLA. He joined us (Dr. Rich Casaburi, Dr. Bahman Chavoshan, Dr. Janos Porszasz and Dr. Brian Tiep) in lectures we delivered as part of a half-day symposium we presented to the Pulmonary Division at Uppsala University. We were so pleased with Attila's success in encouraging early diagnosis of pulmonary disease and in starting the first pulmonary rehabilitation program in Hungary. Rich Casaburi visited his hospital in Szeged, Hungary last week, where he presented a research lecture and was greeted with fine hospitality. Next year I hope to visit his rehabilitation unit and lovely hospital.
  • We also had the pleasure of touring Uppsala University with our friends Tetsugi Watanabi and Nobu Otani of the Teijin Company from Japan, who were accompanied by two pulmonary physicians from Japan, Drs. Hiroshi Takahashi and Yashuro Yoshiike. As usual, we met them often during the conference. They are committed to improving the care of pulmonary patients in Japan.
  • It was wonderful to again see Dr. Audhild Hjalmarsen of Tromso, Norway. Tromso University has a fine rehab program. It is located 600 miles above the Artic Circle, and visiting it 10 years ago was one of the exciting events in my life!
  • It was also good to see Dr. Jan Zelinski of Poland, plus too many others to mention. Why do I tell you about these people you have probably not met? Because we want to impress on all of you, the international interest and concern about pulmonary disease and rehabilitation. Emphasizing the need for pulmonary rehabilitation, and the increasingly positive attitude about