Transcription:
How Can Cardiac and Pulmonary Rehab Improve Your Health

Melanie Cole (Host): Welcome to Say Yes to Good Health with Memorial Hospital. I'm Melanie Cole, and I invite you to join us as we discuss how cardiac and pulmonary rehab can improve your life. Joining me is Tyler Hall. He's a Certified Respiratory Therapist at Memorial Hospital.

Tyler, I'm glad to have you with us today. I think that what you do, cardiac and pulmonary rehab is such an important part and people don't really know what they are. So, why don't you start, we're going to start this first half with cardiac rehab. So why don't you tell us cardiac rehab really is?

Tyler Hall, CRT (Guest): Yeah. Absolutely glad to be with you. So, the cardiac rehab obviously has to deal with the heart and we'll kind of get into the pulmonary side of it here in a little while. But for cardiac rehab, we do phase two, which is outpatient. So, people are coming from around the community that have had some sort of heart issue and, you know, they're coming in here every day for roughly an hour and then they're going home at night. So, it's not an inpatient thing where you're in the hospital. You know, you kind of come in and do your thing and leave after an hour. And you do that roughly three times a week.

The program is set up, it's a Medicare-based program, so the sessions run, you get 36 visits, which equals out to 12 to 18 weeks. So when you do the math there, it's three times a week for 12 weeks is 36 visits. The Medicare standard, I tell the people, they kind of give you a little leeway with the 18 weeks for doctor's visits or bad weather or, you know, whatever comes about, you just don't feel very well at all that day and you have to cancel. With that grace period, you don't just lose that day. We just make it up on the next day and that session kind of rolls to the end. So that's kind of the basis of, you know, your days here.

As far as what qualifies you for cardiac rehab, so, you have people that have had coronary artery bypass grafts. You have people that have had heart attacks or a heart valve repair or replacement, coronary angioplasty or stenting. It can be somebody that's had a heart or lung transplant and then somebody who was stable, chronic heart failure. So, those are kind of the stipulations. You have to have had one of these, they call them an event, to get into the program. As far as how you get directed here or whatever, it's typically by a cardiologist. So, we deal with cardiologists kind of all over our community and then, you know, some hospitals that are several hours away. But after the person has had the procedure, they've gotten out of the hospital, they're well enough to be on their own or with some help, you know, some home health help, they contact me and I basically take it from there. I verify their insurance is going to cover, because that's always the first question that anybody has is "How much is this going to cost me?" You know, so I verify the insurance is going to cover X amount, hopefully a hundred percent.

Once I do that, I get the history and physical from the doctor, the procedure notes of what exactly they had done. And then from there, we take it and we bring the person in and do an interview, which is no more than sitting down, meeting me, kind of telling them what they're going to be doing in the rehab, setting up dates and times that their visits are going to be. And after that, you know, we get started usually that following week. So, that's kind of, you know, in a nutshell, how things get started.

Host: Wow, that was an excellent explanation. So, Tyler, you mentioned something near the beginning called phase II. Not everybody knows what that really means. You've mentioned some sort of cardiac event, whether someone's had like a heart attack or, you know, they've had a transplant or they've got heart disease, for whatever reason their doctor recommends cardiac rehab.

Tell us a little bit about what those phases mean, because back in day, when was starting in cardiac rehab and doing it, you know, we got people right up the day of the event, day didn't, right? They used to stay in bed for a long time. But now, even right after a heart attack, someone gets up out of bed, starts walking around the hallways, then they get to go home and then they get to come see you. Tell us what those phases really mean.

Tyler: Absolutely. So there's really not a whole lot to it. There's I, II and III. So, the phase I is just simply the person has the event, let's say heart attack. And after they are stable and in the hospital, they do some work with them there. That's phase I. The person gets well enough and is able to go home.

Phase II is where I come in. So it's the outpatient, the person, hopefully, you know, is good to go. Things are functioning correctly and they can come in here on their own. They can drive, they can use our transportation services and do their course here. And then there's a third phase, which is a maintenance phase, which is you've graduated the cardiac rehab program and you are able to come use our facility, use our equipment. We basically do everything that we did in phase II, other than putting them on a cardiac monitor. So they're just here. I don't want to say it's just like a gym membership, but it kind of is. You know, they come in, at this current time with COVID stuff going on, they're being screened at the door. They have to wear a mask into and out of the hallways. But once they get in here, you know, these people are typically not younger for the most part. And they've had some sort of lung or heart issue. So, they're able to come in and maintain what they've gained in the program for as long as they want.

I just recently had a lady in here this morning. She was my first patient ever. I've been with the hospital almost 10 years. So off and on, she's been very consistent of coming in usually two to three days a week and utilizing our equipment and our space any day, any time she wants. So, that's basically how the three phases breakdown, is it's in the hospital, then it's outpatient and then it's maintenance.

Host: Okay. And I want to get into Memorial Hospital's free maintenance feature of the program. But before we do that, tell us a little bit, you mentioned about that it's sort of like a gym and, with COVID obviously, we're doing testing and whatever, you know, just monitoring, checking temperature, that sort of thing. Is it a class? Is one-on-one? Is it like personal training? I'd like you to tell us a little bit about what people can expect from Memorial Hospital's Cardiac Rehab Program. What exercises? What are you doing with them?

Tyler: Sure. So it is like a class. You know, there's some education going on. It can be one-on-one. Again with COVID, we kind of broke it down to that, especially in the height of everything. It was one patient and myself at time. Our current standards now, are we are basically full go open for business. So, there are times where it will be, like this morning which is a Thursday, it was just myself and one lady. But on our Monday, Wednesday, Fridays, which are our typical patient days, I can have anywhere from three, four patients. Yesterday, I think we had some-- like I get a spouse that brings her husband. She's welcome to come in. You know, I'm not going to make her sit in the car for an hour so she's welcome to come and sit down. So at times, I'll have five, six, seven people in here at a time. You know, but it's all about what the person's comfortable with. You know, everybody's different and if they specifically want a one-on-one time, absolutely, you know, we can make it work.

So yeah, it is a class. We provide education on nutrition, medications, making sure they're taking the stuff correctly. What exactly they had done or procedures that they had. Then as far as the exercises go, treadmills, recumbent bikes, we have a lateral trainer, which is where your legs kind of go sideways. It's kind of a wax on wax off thing, is the easiest thing to think about, and then some NuSteps, which are, you know, pretty standard in most rehab facilities. So, that's kind of the jist of it. You know, so we take blood pressures, oxygen levels, monitor their heart rates and rhythms continuously throughout the day.

Tyler Hall, CRT (Guest): Well, it's a good closely monitored Tyler. Also the comradery in those classes, I remembered because it's older people generally, then that comradery really helps each other because the thing I love about cardiac rehab is that it is upbeat. You're you're recovering. It's not something downhill, something So before we finish here with our first half of the show, tell us a little bit about the hospital's free feature of the that mean?

Tyler: Yeah, absolutely. So like you said, it is a comradery thing. I've got patients in here that have built strong relationships and it kind of shows them that, "Hey, I'm not the only one going through this." There's people from 40, 50, 60 up to 90. And it kind of gives them that ease of mind, that "All right, I can get through this." As far as the free maintenance goes, it is what it is. You know, like I said, it's come in, use our equipment any day, any time. And we are one of the only ones around the area that I know of that where it's a hundred percent free. I don't charge anything. You know, I figured through their time in the hospital and their insurance and all that, they've more than paid for coming in and using this stuff for an hour. And we're continuously, you know, in healthcare, telling people "You need to eat right. You need to exercise" and this. We don't want that to just happen in the 12 weeks they're here and then they quit. We want that to become a lifestyle where they do this stuff multiple times a week for essentially the rest of their life.

Host: What a great part of the program that is, because as you said, it's something has to become a part of their life and a behavior, right. And learning how to eat right. And Tyler, now I want you to tell people what pulmonary rehab is, because I don't think everybody, we've heard the term cardiac rehab from a heart attack, you know, but what is pulmonary rehab? And when that be used?

Tyler: Sure. So pulmonary, it is, it's kind of a, it's not a new concept, but it's, you know, when I talk to people about, I say I'm a respiratory therapist, but I do cardiac and pulmonary. They associate cardiac with the heart and pulmonary with the lungs. But as far as what it is, people just don't have a clue.

So it's a program once again, a Medicare based program to help people deal with whatever lung issue they have. So, the typical people that I see, COPD chronic obstructive pulmonary disease is by far most prevalent here. We also deal with people with chronic bronchitis, pulmonary fibrosis, emphysema, asthma, lung cancers, that kind of stuff.

And basically what we're trying to do is one teach them about the disease and the progression of the particular disease that they have, but more importantly, how to deal with that disease. You know, it's one thing to have it and say, okay, I've got COPD. I smoked for 40 years. You know, it's gonna get worse, but what do I do about it?

There is some help out there and programs like pulmonary rehab, where it is an exercise based program such as or the, you know, essentially the same as cardiac rehab, but it's focused more on how your lungs function, how they're supposed to function, how that person's lungs are functioning. And then how are you going to able to live life and do the things that you enjoy doing when you have a lung disease?

You know? And, and it's nothing major, like they want to run a marathon or something like that. It's more, how am I going to be able to do my housework? How am to be able to do my yard work, going grocery shopping in the typical day day things. I think people who don't have lung disease and younger people, we don't even consider, you know, we just live our lives, but these people, everything they do, short of breath, makes them fatigued, makes them just completely out of energy. And we try to up a program with them to say, hey, this is manageable. You need to do these things in order to help yourself out. And just like I said, in cardiac, this is something you need to do, not for a couple of weeks, but for essentially rest of your life, you know, if you really want to get better.

Host: Well, certainly true. Now, how does somebody, you told us that it's a Medicare based program and you talked about cardiac rehab before, but how does someone get referred to the program at Memorial Hospital? What has to happen? Is this something the doctor makes the referral? Do they have to like cardiac program have to have had an event or just suffer from one of those pulmonary diseases?

Tyler: So it's a little more, I would say, loosely based, the person is free to call myself, any time. Whereas cardiac rehab, it's not typically like that, you know, you had to have had something happen. This is you know, we'll just use Joe as an example, Joe is having trouble getting around the house. He's having breathing when it's hot and humid or when it's cold and windy, he's free to call me.

Host: So Joe doesn't have to have a doctor's referral to call you?

Tyler: No, does not have to it.

Host: That's good.

Tyler: I would say typically does, you know, from a pulmonologist, a doctor, something like that, but by no means, do we have to. We director here, Dr. Popelo that's, you know, willing to look into the person, get a history and physical on them. The person doesn't have to have a pulmonary function test. We do those right here at Memorial. And that's something I can order. So we basically it down to, we make it as easy on the person getting in. They don't have to do really footwork.

all, once we have their, you know, basically their name. I can look into it and get them started hopefully very soon. Once again, check the insurance, make sure they're going to cover the service. Once that's done, I get them a pulmonary function test, if they don't have one, then I get a history and physical and we do an interview again, we're coming in, meeting me, kind of explaining the program, dates, times, all that kind of stuff, setting up a schedule. And then from there we, we take off.

Host: Wow. And it's great that they don't referral. So listeners, you can just certainly call Tyler at (217) 357-6836 to get connected and start a Pulmonary Rehab Program, if you are suffering from COPD or asthma, or one of that Tyler just referenced. So, how does it differ from cardiac, it's an based program, pulmonary, I mean, there's things that go on, right. Do you with them breathing, on inhalers correctly? Because not everybody knows how to use those. And tell things us a little bit about how differs from a cardiac exercise program.

Tyler: Sure. So they are very similar. But they're also different if makes any sense. The exercise, the machines and stuff all the same. So I do pulmonary and cardiac in the same space here. But how differ is, like said you, we're doing education with cardiac patients on how the heart functions and what they had done. It's the same thing. On the other hand with pulmonary, let's say you've got COPD. What is COPD and how does it progress and how long do I have, stuff like that are always questions? Yes, we, we work on, how do you take your medications? Cause like you said, there's I don't know a bunch of different options of inhalers and dry powder inhalers and that kind of stuff.

I'm not taking anything away from doctors or nurses or therapists or whatever, but quite often the people come in they, I say, have you used your rescue inhaler? Have you used your Spiriva or whatever it is and they, oh yeah, I've used it four or five times today already, and it's nine o'clock in the morning.

So you have give them an education on this is how you take it. This is when you take it and why you take it and you know, you kind of see their eyes light up and they're like, oh, well, that makes sense. I've just been taking it, you know, let's say a rescue, a maintenance inhaler where they're supposed to take it once, twice a day.

They've been taking it every time get short of breath. So that does happen. And that's something that needs corrected because the medications, if taken the right time, are going to help, but if you're taking them more, you're going to run out. They're going to kind of wear off and not work as effectively.

We also use different breathing devices to help increase their lung capacity, strengthen their diaphragm. Just different little techniques like that. And some simple breathing techniques that we naturally kind of do as you get more short of breath, but you don't know you're doing them. I kind of explain those processes and hopefully they'll implement them throughout their day.

Host: Now, tell us a little bit now about the, the free maintenance feature of this program and how do you work with patients? Because I imagine smoking cessation is a big part of this.

Tyler: Sure.

Host: And especially in the maintenance feature program as a followup, people to continue those healthy lungs long as they can. So tell a bit about how you work with that of the program.

Tyler: So smoking cessation is a part of program. You know, if you're coming in and exercising and doing everything we're telling you to, and then you're going home and smoking cigarettes that you know, you're kind of defeating...

Host: defeating the purpose as it was.

Tyler: Absolutely. So, I'm not one of them people who's going to harp on you and tell, you gotta quit. You gotta quit. You gotta quit. I don't think that works. You know, I'm just, I'm young enough and I'm a male, so I'm stubborn and hardheaded. And if somebody is saying, hey, you can't do this, don't do this, don't do this. You know, the rebellious side of me is probably going to go, well, you know, I'm going to continue doing it anyway.

So I don't take that approach. It's more of a coaching like, hey, this is why you shouldn't do it. And these are the benefits that you could see if you quit doing this. So, you know, and it kinda it's case by case basis on how much they smoke and how close they are in setting quit dates and that kind of stuff.

So, and I tell people that it's an individual based program. There's nothing that says you have to meet these requirements in X amount of time. I see people that are higher functioning, you know, they can, they're early in their COPD or their lung disease and they can function, but they've noticed, hey, this is getting a little bit harder, but on the flip side, I've seen and have people that are severe COPD or they're, I don't want to say end stage, but they're, they're later and more advanced in the disease that it, everything. And I mean, everything getting up and going to the bathroom is a struggle for them. So making it an individual based program where they don't have to go as fast or go as hard as the person them on the next machine really kind of puts them at ease. Cause at first they're anxious like, oh, you know, Betty's doing minutes 20 on the treadmill at this speed. And I'm only doing two, like I'm just not fast enough.

Host: Sure. That's a common thing where people.

Tyler: It happens all the time.

Host: Everybody that's right now. So in just this last minute here, Tyler, and what a great program. I love what you do for a living. So please just wrap it up with your best advice for people about Cardiac and Pulmonary Rehab Programs at Memorial Hospital.

Tyler: Absolutely. So I guess for a wrap up here is take advantage of programs like this. You know, they're all over the country and they are, I don't want to easy to get into, but they are very, very beneficial programs that if you just put in a little bit of work and you take the time to just show up, we'll take it from there. And that's what patients is the hardest part is getting in the door here. Once they're in the door, we take it over and things that will very, very smoothly, but got to make, you have to make it a priority. I hear it a lot that we'll, I've got this, and this and this going on.

I don't know if I can do it. And I always tell them, that's fine. I understand there's going on in life, but have to make yourself a priority because the other stuff's not going to get done if you don't take care of yourself. They really have to make it a priority to, you know, make themselves the priority. If that makes sense, you know. Take care of yourself first and then the other stuff will come, but you got to get started now.

Host: Great information and so beautifully put Tyler. Thank you so much for joining us and telling us all about the program at Memorial Hospital, and to learn more about Cardiac and Pulmonary Rehab at Memorial Hospital or to make an appointment with Tyler, you can call 217-357-6836 and you can always visit our website to learn more at mhtlc.org.

That concludes this episode of Say Yes to Good Health with Memorial Hospital. We'd like to thank our audience and we'd like to invite you to download, subscribe, rate, and review on Apple podcasts, Spotify, Google podcast. We have so much great information in our Memorial Hospital podcast library as well.

This is Melanie Cole. Thanks so much for listening.