Transcription:
Pulmonary Rehabilitation

Prakash Chandran: Welcome to the Champions for Wellness Podcast brought to you by Gerald Champion Regional Medical Center. We believe knowledge is the key that opens the door to a healthy life. I'm your host Prakash Chandran. Today we'll be discussing pulmonary rehabilitation and joining us to discuss is Leticia Duran, a respiratory therapist in the cardiopulmonary department at Gerald Champion. Leticia, thank you so much for joining us today. I really appreciate your time. Let's get started with the basics. What exactly is Pulmonary rehabilitation?

Leticia Duran: A Place where patients can come to, to get rehabilitated. After maybe being diagnosed with a pulmonary disease. We meet for 36 sessions, which averages out to 18 weeks and we meet twice a week for up to hours. And it's for a patient that has maybe not really been working out, maybe even somebody who has been working out, but who has recently been diagnosed or has been diagnosed for quite some time to get knowledge on their lung disease.

And we help them develop some. Personal goals that they may have. And we just really, really educate them on their disease that they've been diagnosed with in a gym type atmosphere. They come in, we monitor their blood pressure, their oxygen levels on a monitor. So we're constantly watching them to make sure that they're not gonna have any issues with their medical piece there. And they are with other patients and it is in a small type group.

So you don't, you're not overwhelmed with so many people, you are getting an individualized type care. And I am, privileged to work with two other nurses there in the gym type atmosphere. So it's not like a regular gym. It's very specialized in pulmonary diseases and rehabilitating them into a broader spectrum of their good health. What they can optimally achieve with just coming to the gym and comparing them to just, being at home, not really living an active life, maybe a seditary life. So it just helps them to be where they can be the best they can be.

Prakash Chandran: Yeah I love that. Now up at the top, you mentioned that people who might have pulmonary lung diseases, they're the ones that come in for the rehabilitation. Can you talk at a high level about what those diseases are?

Leticia Duran: Yes, I would love to. We actually have some guidelines that are set by Medicare and they are, obstructive and restrictive diseases and other diseases. Most importantly, what I wanna mention to you is we're working with post COVID patients. We have found that after patients have had, they become very debilitated after that diagnosis and we help build them up to maybe what they were before they wound up getting diagnosed and even better, believe it or not. Other obstructive diseases are like COPD, persistent asthma, bronchiectasis, persistent fibrosis.

And on the restrictive disease side, we have like pulmonary fibrosis, Cycoidosis and some neuromuscular type stuff like Parkinson's disease, multiple sclerosis. And then we also even have patients that come in that are anticipating maybe a lung transplant people who have pulmonary hypertension. That kind of thing. So it's really, really broad, so a lot of times people do struggle with some type of lung issue and, they can call our department and we are happy to see, or they can even speak with their physician and they can see if, maybe they could be a good candidate for our program.

Prakash Chandran: Yeah, it's amazing, kind of the broad spectrum of diseases that you treat. And even if you've had COVID, it seems like you're able to get help through this rehabilitation. You started to touch on it, but let's maybe unpack a little bit, what exactly are the benefits of going through pulmonary rehabilitation?

Leticia Duran: Well, the benefits are like I had told you, we really kind of focus on getting patients, personal goals, taken care of barn and utmost. And a lot of times PE people come in and they say, you know what? We have no energy, it's hard to breathe. We'd love to come off our oxygen that we're so dependent on. We haven't been able to do hobbies that we enjoy, that kind of thing. So we say, you know what, let's work on this and, believe it or not people even though these results aren't, it's ,kind of like a fine print thing, even though they're not common.

There's a lot of people that have been able to come off their oxygen just by coming to our program. There's people that before our program were only able to get to their mailbox. And then after our program, they were able to walk all the way to Walmart and back to their home, even after shopping. So it's amazing to see the progress that patients make. And, you know, on our end we teach them, how to prevent yourself from getting sick, identify whether or not their symptoms are worsening coughing techniques, how to properly use your nebulizer, your inhaler.

There's just so much that we educate patients on and what's really neat too, is when you come in, it's a very social type atmosphere. So a lot of our patients who don't are seditary at home and they don't have any type of interaction with people on a regular basis. And we honestly develop really good friendships with our patients. And we are there as a resource for them, even after they complete our program, we have what they call phase three. And that's when you graduated our program and you just wanna come work out under a medical direction. They can come in also, and, they pay like a small fee to come and work out after that. Cause it doesn't go through the insurance at that point, but it is just awesome.

Prakash Chandran: I love to hear that. And it really sounds like so much amazing work that happens during the rehabilitation sessions. Can you talk a little bit about what actually occurs when someone comes into a session?

Leticia Duran: Yes, what happens is the first thing that that people do is when they come in, we have them sit in a couple chairs. And what we do is we take their blood pressure. We put them on a wrist monitor that tells us their heart rate and their oxygen levels. From there we do light weights. We do some warm up exercises. And then from there we go into some cardiac machines that we have there. We have like, the recumbent bikes, we have treadmills. We have what they call arm kilometers. We have like an array of machines that the patients get onto.

And what we do is we encourage them to actually stay on the machines 30 minutes at least, if not more. So they're actually in the gym up to 60 minutes in total because after they're done with that we have them actually when they're on the machines, they give us their perceived breathing. Effort and how their perceived exertion is. So we actually gauge how well they're doing on these machines as to whether or not we could maybe increase their level, their intensity, their time on the machines.

That kind of thing. That way we know we're pushing them to the next level with each visit that occurs. From that point, we go ahead and do a post vitals on them and, it's nice is we have juices and drinks and water and snacks if they need it. It's, a really neat thing. And then we share a few laughs. We play a lot of music, we get silly in there and it is really fun. For us that work there, I know I also speak for the nurses. It feels like it almost feels ridiculous for getting paid for what we do, because it is so much fun. And to see the progress the patient makes is priceless.

Prakash Chandran: Yeah, I absolutely love that. And thank you so much for everything that you do. I did wanna ask you, you mentioned some of the breathing techniques that you teach people. Can you go into those a little bit? Like, what does that look like?

Leticia Duran: Well, the one thing that we do really push is called perslip breathing. And that's where you breathe in through your nose. Hold for a few seconds and exhale a little bit longer with patients with COPD. It's easy to get the air in. Not so easy out. And the majority of the people that we do. Do have COPD. However other people that I had mentioned other than the COPD diagnosis, they also benefit from that type of breathing also because it's slow controlled, really fills up that lung capacity, and empties it just the same.

And it really helps increase your oxygen levels, which is really, really good. And when you're breathing this deep, many meaningful breathing, we know that you're breathing accurate and that the oxygenation comes along with it. And I tell people we want you to smell the roses, blow out lots and lots of candles. That's what we'll always tell people. And when they're on the machines, you'll see a lot of times people not really breathing deep, cause they're so focused on what they're doing. So that's where we kind a step in.

Hey, are you doing your deep breathing? Oh yeah. Thanks for the reminder. You know? I'm so focused on what I'm doing, that I'm forgetting to breathe and then once they start getting breathing really, really good, we've noticed that their oxygen levels are coming up really nicely. And then at that point we're able to actually start titrating their oxygen levels down. For instance, if they're on three liters, with constant monitoring and exercise, we're able to maybe put that down two.

If not one, and then some people can actually come up their oxygen. And with that deep breathing that I was telling you about, they're actually able to successfully come off their oxygen.

Prakash Chandran: Yeah, that's amazing. And from what you're talking about, it really does all sound like upside here. Are there any risks at all that people should be aware of by coming to pulmonary rehabilitation?

Leticia Duran: Well, not really the reason why I say that is because we always get an order from a physician first. So when the physician puts in the order, he's saying, you know what? This patient is able to come to your program has been assessed and is able to physically make this program. So the risk may be you. I actually can't even tell you any risk, one thing I do wanna mention in the gym, we clean the machines after each use. Patients are, recommended to wear a mask. However, they don't have to, however, all our patients are COVID tested and also vaccinated.

And if they are not vaccinated, we actually do their COVID test every week. So we make sure that it is a safe and clean environment for our patients. I can't really see any downside to it. The downside may be, you may have a patient that is ill often, so they're not able to attend regularly. So with their infrequent attendance, may be not getting the most benefit from the program. But other than that, I really, at this point, can't see any downside to this.

Prakash Chandran: Yeah, it doesn't sound like it, but I always like to ask, especially when you're doing physical activity, but given the fact that everyone is monitored, it doesn't seem like anything could happen. Right?

Leticia Duran: Exactly. And then we do a first assessment. It's called a six minute walk test where we develop a baseline for what they're able to do. But not only that, we go through their medical history and detail their medications. We go through how much knowledge they have on their disease. How, you know, if they use a patent machine at night, I mean, we really dig deep into their health history. So for instance, if you have maybe a bad joint, maybe you have like rotator cuff issue or a total knee replacement. We'll know that right when you start. So we know, Hey, this person has a bad knee.

They may not be able to do very well on the treadmill. So maybe we can kind of skip that and go on another machine that they're able to do. And we tell patients, please, please, please, if you start to feel anything abnormal, Let us know, so we can, assess the situation, to make sure that you're not having any issues there. And then what's really nice is we are in the hospital, so if there's any kind of problem, for instance, if a patient has chest pain or, has some type of exacerbation, we can send them directly to the emergency room, which is really nice. There in our facility. So we have that in, arms reach.

Prakash Chandran: Yeah, that's awesome. And the final question I had was just about length. You mentioned 36 sessions, 18 weeks, twice a week for up to an hour. Does everyone get prescribed that regimen or does it depend on the individual patient?

Leticia Duran: It depends actually on the insurance, as far as the patients are concerned, they would benefit from the whole 36 sessions. But if there's an insurance issue, that's where we kind of run into some issues and we don't run into that too often, but sometimes for instance, a veteran who may come to our facility may only have an extended period of time where maybe they need to finish their sessions within three months. And then at that point, the VA is really good about extending that out so they can complete it.

But other than that, usually all insurances will pay. The unfortunate part is their sometimes copays, which hinders people's ability to go. But the hospital is really, really good about working out payment options for patient. They also have like the indigent funds, and I'm not too sure if that qualifies for that or not, but our hospital is so willing to assist patients with any kind copays they may have.

Prakash Chandran: Okay. And just before we sign off, just given all of your experience and all of the patients that you've seen as a respiratory therapist, what's one thing that you know to be true, that you just wish more patients knew before they came in to see you?

Leticia Duran: I wish that every patient knew in our area, that one, that this service is available for them. This program is here for them. So the reason why, I feel this podcast is very important, is to get that information out to those who may not be aware of our program. And, I want people to know that if they do decide to become a part of our program, you get what you give. In other words if we're not pushing you, you're not pushing yourself. You may not reach those limits that you are wanting to achieve within yourself.

So it's something that's self driven and yes, we're here to cheer you on and really help you reach those goals. But it also takes a huge commitment on, on the patient's part by attending regularly and trying to push themselves a little bit harder. And what's nice is we're able to monitor them to make sure that they're not in any kind of danger medically, that they're not gonna cause any harms to themselves because they're being monitored so closely. So I would just love for people to be aware of this program and take advantage of this program that we have available for them.

Prakash Chandran: Well I think that is the perfect place to end. Thank you so much for your time and the education today.

Leticia Duran: Thank you, thank you so much.

Prakash Chandran: Thank you for listening to Champions for Wellness, local caregivers, educating our community. If you've missed one of our podcasts, you can go to gcrmc.org/podcast. My name's Prakash Chandran, thanks again for listening. And we look forward to you joining us again.