Host: Welcome to the Iowa Specialty Hospitals and Clinics ISH Dish Podcast, practical Health Advice from Iowa Specialty Hospital experts. We want to connect the members of our communities with the latest healthcare information that's understandable, relatable, and useful to your daily life.

Today on our podcast, this is an interesting topic that affects many, many people, in many, many households across the spectrum. We are talking about cardiopulmonary services. And just a little background for everybody before I introduce our guest. The Cardiopulmonary Department at Iowa Specialty Hospitals and Clinics strives to provide a better quality of life for our patients that have been diagnosed with heart and lung health conditions.

Iowa Specialty Hospital employees experienced cardiopulmonary specialists that are dedicated to providing their patients with the best medical care available today. Our Doctors and specialists work hard to provide cardiopulmonary services and treatments to reduce health risks and give our patients longer and happy lives and healthier lives. Right? So as you heard, our guest is here with us today and her name is Kristen Brott, welcome to the show.

Kristen Brott, RN-BSN: Yes, thank you.

Host: We had a little trouble connecting, but you are finally here. Yes, and I'm so excited. This is your first time podcast.

Kristen Brott, RN-BSN: Correct.

Host: So this will be fun. Kristen is an RN, BSN. So you have your registered nurse and your bachelor nursing degree, correct?

Kristen Brott, RN-BSN: Correct.

Host: And you work in our cardiopulmonary department, primarily in Belmont, but also in Clarion?

Kristen Brott, RN-BSN: Correct, so both hospitals. Thanks for having me, Gina.

Host: Absolutely. So give us a little background on who you are, maybe how you came to work in cardiopulmonary, and I'll just let you take it from there.

Kristen Brott, RN-BSN: Absolutely. So I have been a nurse for five years. I graduated in 2017 from Northwestern College in Orange City. My first job was actually for a company called Universal Pediatrics. So I was doing in-home care for children. Did that for about a year. My husband grew up in Wright County. Always wanted to come back this way. So, yeah, so we came back to this area in 2018. I was just looking for something different. Seeing what the options were. There was an opening in the cardiopulmonary department and so I've been down in that area now for five years and it's been great.

Host: It's like a party down there, right?

Kristen Brott, RN-BSN: It it is. We have a lot of fun. The patients are a lot of fun. The team's a lot of fun, so it's a really nice place to be.

Host: My department used to be in the basement of the hospital in Clarion. Okay. And it was constant laughing and celebrating in the cardiopulmonary department across the hall.

Kristen Brott, RN-BSN: Yes. Yes That is us. We celebrate everything big and small.

Host: Yeah. Which is so cool. And then so the patients went and they would come in for cardiac rehab you know. Coming in to work out and do all their things. It was just fun. Like they loved coming and of course, Monica Christensen is down there and has to give everybody hugs.

Kristen Brott, RN-BSN: Yes. Yes. She is known for her hugs. Absolutely.

Yeah,

Host: I don't know how she made it through COVID.

Kristen Brott, RN-BSN: Yeah, it was rough for her at times. Yes. Yes.

Host: Okay. So let's start off and talk about the first thing then that we have touched briefly upon is cardiac rehab. What is it?

Kristen Brott, RN-BSN: Yes. Yes. So cardiac rehab is primarily what I focus in and we are an exercise based component for health that is geared at patients who have had a cardiac event. And by that we mean anyone's who has had a heart attack in the last year, a stent placed, valve work done, any bypass surgeries, maybe someone who's even had a heart transplant, suffers from heart failure or even stable angina.

So those are the main population of patients that we will see within cardiac rehab. And our main component is exercise with

Host: them.

Okay. So, and the rehab portion is after the event, not a preventative.

Kristen Brott, RN-BSN: Correct. So it is after the fact. And we like to say that we have three pillars within cardiac rehab and within our other rehab services as well.

So we are first and foremost looking at exercise. And then our second pillar, we look at education. So we are talking with patients on what are some risk factors and things that they can manage, looking at their diet, their sleep habits, their blood pressure, their cholesterol, their stress management, all of these things that play into our overall health.

Looking to make modifiable lifestyle changes to hopefully prevent any future event down the road. And then our third component looks at support which is, we hope through our department that we are supporting our patients, but we offer exercise in a group setting. So they are with other people who are walking the same heart disease journey, even if they haven't gone through the same event, there's someone in the chair next to them that can relate to what they're going through, and they can find support within one another. So those are the three pillars that we really push for within our rehab services.

Host: That support factor has to be huge.

Kristen Brott, RN-BSN: It is, it's a huge, huge component, especially when we look at the mental health aspect that comes with any type of illness. Whether that illness be a short term illness that catches them off guard, like a heart attack or something long term that they've been managing, like heart failure. Those are really trying things for the patient and their family and loved ones. So we really want to offer support to these patients.

Host: I know how beneficial it is to have our orthopedic knee, hip replacement audience, you know, our patients work out together and rehab together because it's like, I'm not the only one. And I would imagine that some strong bonds and friendships are created.

Kristen Brott, RN-BSN: Absolutely. Absolutely. And it's really fun to see that blossom. And within all of our rehab services, we offer something after you've completed the program that's called Fit for Life. So that's just a maintenance type exercise program. We call it a free for all gym is, is kind of what it's like.

But, you come in and you get your vitals checked with exercise and then, you just come in and you have the supervision of someone in healthcare in case something were to occur, but then the patients can come in and just exercise as they would like to do as much or as little within that hour of time.

And that's another way that we've really seen patients carry on with one another and the support continues into that Fit for Life class where friendships are really built and made. So that's really fun.

Host: Very cool, yeah. And so I'm assuming that so, so say that John Doe has a heart event.

Kristen Brott, RN-BSN: Mm-hmm. mm-hmm.

Host: And his provider then recommends that they come to your department for this cardiac rehab program?

Kristen Brott, RN-BSN: Right. Great question. So the referrals can come from primary care physicians or they can come from cardiology or pulmonary teams. If we're looking at cardiac services or pulmonary or respiratory type services. So, again, most of these referrals, especially on the cardiac end are looking at within a year. Respiratory is maybe a little broader. We can look wider than a year. And then for pulmonary services specifically, those are looking at our COPD patients. So again, that referral could come from your primary care physician or that may come from a pulmonologist or something if you're following in that regard.

Host: Okay. So let's just keep that conversation going then. So let's talk about pulmonary rehab. What does that entail?

Kristen Brott, RN-BSN: Yes, so pulmonary and respiratory rehab, they are two separate kind of umbrellas, but they are looking at more of our respiratory patients. So for pulmonary rehab, those are your specific COPD patients. There is specific criteria that needs to be met in that regard. And again, that's where your physician would know that within the referral and then respiratory rehab or respiratory services, that is something that we can catch those patients who have shortness of breath with activity. Shortness of breath is our main one there, but it can kind of be your catch-all if you don't have specific COPD.

Host: So in either of those with pulmonary and respiratory, we are talking about lung function then.

Kristen Brott, RN-BSN: Correct. So that's what, that's what we're looking at there. And within all of our rehab services, we're looking at up to 36 sessions. Is how that will look with most patients.

Host: I'm curious. I have a family member who was recently diagnosed with, like farmer's lung. And I don't know where that diagnosis came from, but it's really, and it wasn't from years of being out in the field, it was from years of taking corn and beans to like an ethanol plant. Yeah. And all of the mold and the things that get stirred up when she was making those deliveries. And that's kind of scary. Yeah. And we have a very high population of agriculture here. So,

Kristen Brott, RN-BSN: Correct environmental, I mean just environmental things that we're exposed to that, that population of people would fall generally more under our respiratory type services. But yeah, so that's a need that could be met there.

Host: So what kind of things would you do for somebody like that?

Kristen Brott, RN-BSN: Yeah, our rehab services, cardiac or respiratory they're pillared in the same way with the exercise, the education and the support. There's just a few extra things we do with those respiratory or patients that are looking at more of the lung function. We do something, we call it the pipe, but it's to work on proper breathing techniques with exercise and, with out exercise as well, just really making sure we're utilizing the lungs to, to the best capacity that we can. And those patients are provided that device with, within rehab, and then they have one for rehab that we use, whether we're warming up or cooling down or, and then they take one home as well and we encourage them to use it a couple times a day on the off days because not going to hurt anything. And I like to kind of almost compare it a little bit, it's not the same thing, but those incentive spirometers, those patients that after they have surgery, they're sent home with those to prevent any type of lung infection and things. So we, we want to be working on proper breathing techniques and we focus on that with those patients.

Host: The whole time you're talking, I'm thinking, you know, it's too bad that we don't know these things before we have the event. It's so easy to do the preventative, but again, it's not because we're so busy and maybe we don't know how to do proper breathing, which maybe leads to posture and just protecting yourself.

Kristen Brott, RN-BSN: Yes. Yes, it is really, true. It's sad that it falls that way. And that's why we can't turn back the hands of time, when patients come. Yeah. Sadly, sadly. But we can't change what's been done for those patients, but we, what we really are hoping to do with the education component is truly educate, share those things. Share what to be looking for, share when to seek out your physician if there's something going on. We really want our patients to feel empowered to know when to ask for help and when something may be wrong, and how to start making better lifestyle. Yeah, choices and changes to prevent anything in the future if we can.

Host: future. Perfect. That's great. Outpatient stress testing, what is this?

Kristen Brott, RN-BSN: Yes. So those are for those patients that are maybe suffering from shortness of breath, chest pain, dizzy spells, maybe they have that family history of heart disease and they have known high blood pressure and diabetes for years. So we can do outpatient stress testing as a way to look for any abnormalities that could be going on from a cardiac standpoint.

And we have two different types of main tests that we do. There's traditional stress testing, which is maybe what people are more familiar with. You get up on a treadmill and yes, and you run. And so that's the first type of stress test. And then we also do what is nuclear stress testing. So that can be done with some images, so that gives us a little more invasive look at what's going on within the blood flow to the heart and things of that nature.

And something else we offer is stress echoes as well. So again, you're running on the treadmill. But the imaging portion is an ultrasound of the heart. It's the echocardiogram instead of nuclear images. Again, all of that would be referred either by a cardiologist or your primary care physician or maybe even someone out of the emergency room. You know, if you come through with, chest pain through our ER.

Host: It is amazing the technology today.

Kristen Brott, RN-BSN: It is.

Host: That probably didn't exist all that long ago. Right. You know, blows my mind. so when you come in for these stress tests, I know that sometimes they can put a monitor on you when you go home.

Kristen Brott, RN-BSN: Correct. Absolutely. Yes. So those are our Holter monitors, and those can be worn for as little as 24 hours or up to two weeks, 14 days.

So those, again, are, are for that same population of people. Maybe they're having the stress test because they're having some chest pain and some dizzy spells. We're not going to have the result of that test back right away, and they're still having some of those symptoms. So let's keep a longer eye on the patient and have them go home with this monitor that's watching their heart rhythm for whatever duration of time the physician has allotted and then we get that report back and we review it and we get that onto the cardiologist or we get that back to the primary care physician. And if there were any abnormalities detected, then we can take some next steps and get them hooked up with whoever would be appropriate after the fact.

Host: Great. Again, amazing technology. Yes. Just crazy. are they doing that by Bluetooth yet or is it still the

Kristen Brott, RN-BSN: I I feel like that'll be in no time. Right. You know, the old style Holter were all these cords and wires and people had a little fanny pack on their side and patients, they didn't like that. It wasn't very user friendly. You couldn't shower with them and things like that. And now we're to, it's just a little monitor that gets placed right down the middle of the chest, over the sternum and no, no cords, very discreet. No one even knows you have it on and you can shower with it. You can go about your normal day to day. So,

Host: This is crazy.

Kristen Brott, RN-BSN: It's the advancement is amazing, and patients love it.

Host: I shouldn't be so surprised because I think my iPhone can do an EKG or an E something now.

Kristen Brott, RN-BSN: Yes. Yes. Oh yes. And there's this thing called Kardia too. I don't know if you've seen that advertised, but it's essentially, it's a little pad that you can purchase at home and you just put your index and your pointer finger, yeah. Of both hands. And you just place it there for 30 seconds to a minute and that gets a full EKG too right at home. And I've actually had a couple patients that have come through my program that have purchased that monitor.

Host: Do you feel like it's accurate?

Kristen Brott, RN-BSN: From what I have seen of it, it's pretty reliable. It's really going to catch that atrial fibrillation or atrial flutter. That's what, my patients have detected with it. So really interesting. And things the patients have readily accessible at their fingertips.

Host: Crazy. Okay, so we talk about the halt, Holter yes.

Kristen Brott, RN-BSN: That, yes. The

Host: That's what we talked about. Correct. So that's an at-home device. And then, so another thing that typically would be done at home or now in the sleep lab are the sleep studies.

Kristen Brott, RN-BSN: Correct, correct. We offer those what we call home sleep studies, and those are, again, all of the services that we provide are referred either from a specialist, the cardiologist, or the pulmonologist.

Host: So, I'm not just going to walk in and grab one.

Kristen Brott, RN-BSN: Sadly not, no. These are going to be referred from your primary care physician or some physician that you have seen. And the main thing that would qualify you for a home sleep study, would be snoring. You know, hear someone saying, oh my goodness, my spouse just snores all night long. And so we would want to screen for any type of sleep apnea and apnea is those moments where we quit breathing in our sleep.

That's what this type of test is looking for. You take this home, you wear it overnight, there's a band that goes around your chest under your armpits, and then that's going to monitor your chest rise and fall. And then you also have a nasal cannula that goes in your nose and a little pulse oximeter on your finger.

And so those are the three components to that. We walk patients through how to place it when they're in the office with us, and then they feel comfortable putting it on at home.

Wear it overnight, bring it back to us the next day. We complete a download, and again, if anything abnormal comes back, we pass it back to the physician and, we get them hooked up with, whatever the next step would be. For those patients that maybe have abnormal home sleep studies, you know, maybe recorded multiple apneic episodes or moments where they quit breathing, they could be recommended on to the inpatient sleep lab. Those tests are completed for us at our Belmont location. And those are really nice that it's local. Patients like that they can keep the care in the area.

But then if you are referred on to the sleep lab, that's where our sleep tech, Debbie, she's going to be working with you and doing either a CPAP titration or a BIPAP titration and seeing what kind of needs you may need in that regard. .

Host: So as a wife, I can't just refer my husband. He has to go through his provider, right?

Kristen Brott, RN-BSN: Correct. Correct. So yes, we, you would have to meet with your physician, discuss the concerns, have that clinic note, and then they can be be seen.

Host: I know anybody listening to this is thinking the same thing.

Kristen Brott, RN-BSN: Yeah. They're thinking, can I just drop them off at the door.

Host: Right. And then was thinking, well, if I had to have a full sleep study at the hospital, could I bring a cat because they sleep with me and you know, we want to keep it as normal as possible.

Kristen Brott, RN-BSN: Right?

Host: I'm sure there's some rules against that. Yeah.

Kristen Brott, RN-BSN: You know, we've never had a cat brought up, so I, I don't know. There There, may be wiggle room. Who knows.

Host: Okay, the last thing that I have on my list to ask about were the pulmonary function testings.

Kristen Brott, RN-BSN: Correct, correct. So that's another service that we offer. A respiratory therapist would complete that type of study, and that's a diagnostic type tool. So sometimes that is ordered by the pulmonologist, maybe before an upcoming appointment just to establish a baseline so the doctor has some information going into the appointment, how they might want to direct the care. But other times that may be looking to confirm if there's any type of asthma going on or anything in that regard. So really the overarching theme with those pulmonary function tests, or PFT's as we call them, is that we are looking for any obstructions or restrictions within the airway. That's the main goal with these type of type of exams.

Host: Okay. Is there other services that you guys offer that we haven't talked about?

Kristen Brott, RN-BSN: Oh goodness. These are our main ones. These, are the main services that, that we highlight through our two locations in Belmont and Clarion.

Host: I can imagine that you're very busy.

Kristen Brott, RN-BSN: We do stay steady. We stay steady. And backtracking a moment, Gina actually so of course cardiopulmonary department, we are coming out of COVID. That was new with us. So just to hit on that for a moment, if you're someone who had COVID and are having what we call those residual symptoms, you can actually be seen with us through our rehab services. So that's just a nice that's something newer since the emerge of COVID. COVID is a covered diagnosis within our services.

Host: I know there's a lot of talk about long covid that people still suffering. That's so sad.

Kristen Brott, RN-BSN: It is, it is. And we want to, again, like we were talking, the support, cause that can be physically draining to go through those symptoms as well as emotionally. So it's nice to get connected with services that hopefully can help you start feeling better or at least learning ways to help your, yourself a little bit and manage some things. So that would be another population, that we are, servicing now more so than, prior to 2020.

Host: Oh, absolutely. Yeah. Talk to me a little bit about the team members. What's the staffing look like other than that they're just fun to be around.

Kristen Brott, RN-BSN: Yeah. Yes, yes. So our staffing we have a primary nurse in Belmont, which would be myself, and then we have a primary nurse in Clarion, Sarah Spelmeyer. So again we're covering the same services. We just each have our own house and then we have respiratory therapists. Would you like me to name them all or, yeah, I, let's see if I can do it here. We have some travelers on board, so, our full-time staff for that. We have Lisa Cool as a respiratory therapist and Carmen Tripp. And then we have Elena Clay as a, part-time respiratory therapist. And then we have a couple travelers right now. We have two by the name of Andy and I cannot remember their last names at the moment, so I apologize. And then we have one in training with us right now, Missy. And then of course we have Monica on board as well. And then we have a prn Jimmy, who's also helping us out. So we have some great people on board right now. And I can't exclude Dawn Butler. She manages. She is, she holds us together. She manages everything from sun up to sundown. She knows every name that you could even say to her of, of any order that's come across her desk. So, we have to give hats off to Dawn Butler for keeping our ship afloat and keeping an eye on all the orders and referrals that come through so the therapists and nurses can keep humming all day long. So we have to give hats off there.

Host: Is there ever a time when somebody would call you guys directly or are you just all referrals from people's own providers?

Kristen Brott, RN-BSN: Yeah, we are referrals. Okay. Yes cause there just needs to be the qualifying diagnoses there. There's just some specific hoops and so they come through the physician in that way, but great question.

Host: Okay. Anything else for the good of the conversation? I've so much enjoyed learning all of this and talking to you. This is great.

great

Kristen Brott, RN-BSN: Yes. Well, thank you again for having me. It's, been really fun to highlight and share our services because I think people are familiar that the hospital has the cardiopulmonary department and they might be familiar with the fact that the respiratory therapists come up and see patients on the floor, do their breathing treatments, maybe come through the ER and offer things in that regard, but they don't maybe know all of the outpatient services that are provided within our department. So, really fun to highlight and share all that we have to.

Host: Absolutely. And I will tell you that I looked up this information before we had our conversation today and all of this is on our website. So if anybody out there needs a refresher, it has more information just needs to dig in a little deeper, just go to Iowaspecialtyhospital.com and then there are services tab and you can find it all right there. Yep. okay. Thank you so much for coming today.

Kristen Brott, RN-BSN: Yes. Thank you again for having me, Gina.

Host: Absolutely. Thank you for listening to Iowa Specialty Hospitals and Clinics ISH dish Podcast. For more information on the topic we discussed today, visit us on the web at iowaspecialtyhospital.com. There you can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa Specialty Hospitals and Clinics, and explore all of the services that we offer. For the Ish Dish Podcast, I'm Gina. Thanks for tuning in.