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January 7, 2020 at 7:00 pm #21593Mark KoziolKeymaster
I recently wrote a column titled; “Better Breathing: A Respiratory Therapist Explains Pulmonary Rehab.” The column is based on an interview with my passionate respiratory therapist, Lynn Gorton RRT, RBBE. I contemplated breaking the interview up into 2 parts but I decided to lay the whole interview out in one forum topic. I believe the information she provides is valuable to our members.
What made you choose the profession of respiratory therapist? “I had a niece with a tracheostomy and took care of it as well as recognized my passion to help people.”
You exhibit passion when you perform your job duties, where does this passion stem from? “By recognizing that I can make a huge difference in their lives…by the comments that patients have given to me over the years.”
Why do you prefer the Buteyko Breathing Method? “Buteyko Breathing…This is a natural technique that calms and relaxes the airways. Nasal breathing moistens, filters and warms the air into the airways. Thereby decreasing inflammation with mouth breathing. It calms people and decreases their anxiety.”
Please state the differences in phase 1, phase 2, and phase 3 pulmonary rehab.
- “Phase one is in hospital teaching and coaching a patient to enter the program.
- Phase two is a cardiac monitored program that includes exercise and education for up to 36 visits You must have a proper diagnosis for insurance to pay for our program.
- Phase three is an out-of-pocket program that holds a patient accountable for exercising on a regular basis. It is also independent.”
What is the difference between cardio and pulmonary rehab? “Cardiac Rehab is for patients with a cardiac diagnosis such as MI, Heart failure, Stents, Valve Surgery or Replacement, Bypass Surgery. They have an exercise program that is designed according to a 12 minute walk test for up to 36 visits. The most important point is to increase their exercise capacity.”
“Pulmonary rehab is for people that have a certain number on their pulmonary function test that qualifies them with either obstructive or restrictive disease. They have an exercise program that is designed according to a six minute walk test for up to 36 visits. The most important points are to improve their breathing capabilities and shortness of breath and their endurance.”
Do you see a difference in the PF/IPF patient with regard to other lung disease patients including cancer? “The average patient that has IPF has a lower life expectancy and often a terrible cough. They require extensive conversations regarding breath retraining and cough suppression. They also should be instructed on the possibility of lung transplantation and newer medicines to help decrease the progression of the disease. They often require more of my time and expertise. I will do more reading to educate myself to help them.”
Is the IPF/PF patient given different expectations during pulmonary rehab? “Yes, they often breathe faster and more shallowly, hence more breathing retraining and cough suppression as stated above. Depending on their severity, they may need to rest more frequently and or use more oxygen which could include a non-rebreather mask or an oxymizer cannula.”
Many PF patients have anxiety because of their struggle to breath. How do you help them reduce their anxiety? “I educate them foremost that they are not the only person with anxiety due to breathing problems. Which can make them feel better toward not being alone. Decreasing their breathing, chair yoga, mindfulness and calming their breath will automatically reduce hyperventilation which causes anxiety. Keeping a little more CO2 in the airways, relaxes the bronchial smooth muscle and makes it easier to breathe.”
What do you tell the patient who is in an uncontrollable coughing period and cannot catch his breath? What can you do to bring him back to normal? “They must do breath holds, swallow against the cough, suppress the cough. Focus immediately and it will calm the cough.”
Does a persons low oxygen saturation automatically make them cough? “No, this is not the usual reason for coughing. Deep breathing, mouth-breathing, chronic secretions and habit are the general reasons for cough.”
What do you feel the most important exercise is for a patient in phase 2? “Aerobic exercise of all forms, pacing themselves and breathing retraining.”
When a patients oxygen saturation reduces where it almost makes it impossible to stand for a period of time, do you provide them exercises while in a seated position? Is this just as effective? “Frankly, we adjust exercise to all of our patients. Non-weight bearing exercise….such as any of the bikes or the nusteps, even the weights will be a great way to help them increase muscle mass and increase their endurance. When a patient doesn’t have to stand it will decrease their shortness of breath. We have to have their prescriptions fit all of their needs, otherwise they may not come back.”
Give me a synopsis of a typical phase 2 pulmonary rehab day including what is all measured. “Each of the patients come to class and hook up to the cardiac monitor. They have their blood pressure, oxygen and heart rate monitored on our computer system. They go from piece to piece of equipment for 3-10 minute intervals, depending upon their capabilities. We monitor their perceived exertion and shortness of breath on all the equipment. We check their BP 3 xs, and their pulse oximetry and HR. We can have up to 15 patients in the pulmonary classes. They end with a 30 min class on different educational topics.”
Your program is accredited, please give a description of what it takes to attain the accreditation. “We are accredited through the American Association of Cardio-vascular and Pulmonary Rehabilitation. We are re-accredited every two years. It takes lots of work and going through patient charts to make sure we are taking excellent notes and giving excellent care.”
Lynn added several comments:
My recommendation is to always try the different medications that are on the market right now. Which include Esbriet and Ofev. I have seen good responses to these medicines. All the patients should be in rehab and get their coughs under control. Also, keep their weight in check.There are so many studies and hope coming out prior to lung transplantation. The majority of people will do absolutely wonderfully with transplant if they put their mind to having a new normal.
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