Aloha … from BethCBreathing new life into damaged lungs
Hard-to-find pulmonary rehabilitation program begins at Gifford
After 25 years caring for area residents,
Dr. William Minsinger retires from Gifford
RANDOLPH, Oct. 13, 2009 – Gerald “Rory” O’Connor’s South Royalton farmland is typical of Vermont topography. It’s hilly terrain rises and falls.
For most people that would not be problem, but for O’Connor it has become one.
“I had in recent years noticed that I had trouble breathing after any exertion. If I try to go too rapidly up a grade, which to most people would be nothing, I start to breath hard,” says O’Connor.
An uncomfortable feeling of “restriction” accompanies his gasps for air, says the 80-year-old who went to his Gifford Medical Center doctor for answers.
A pulmonary function test in the Randolph medical center’s Cardiopulmonary Department confirmed O’Connor’s lungs were not functioning as well as they should.
“It showed up that I had a fairly substantial loss of breathing capacity,” says O’Connor, whose problem has only worsened over time.
Recently, O’Connor’s doctor offered a possible solution. An e-mail in the provider’s Gifford inbox announced the start of a new program at the hospital: pulmonary rehabilitation. The doctor, David Pattison, referred O’Connor to the program and now every Monday, Wednesday and Friday afternoon he is huffing his way back to good health, or at least trying to.
Pulmonary rehabilitation – offered in few locations in Vermont – is medical therapy for chronic respiratory diseases, typically chronic obstructive pulmonary disease (COPD).
A mix of chronic bronchitis and emphysema, COPD typically affects long-time smokers later in life and worsens with age.
A journalist for four decades, O’Connor used to be a smoker. “I gave it up about 20 years ago, exactly 20 years ago, but the damage has been done,” he says.
For a person with COPD, a walk as brief as to the mailbox can be exhausting. O’Connor is not nearly that bad off yet, but others who are taking Gifford’s pulmonary rehabilitation program, or hope to in the future, can attest to the daily struggles of living with COPD and the frequent hospitalizations.
Pulmonary rehabilitation aims to better both. It combines exercise and education to decrease symptoms and hospitalizations, increase exercise tolerance and improve quality of life. The program addresses medical, physical, emotional, social and nutritional needs, Gifford pulmonologist and pulmonary rehabilitation Medical Director Dr. Marda Donner says.
“The cornerstone of the program is exercise. We’re hoping to improve patients’ ability to walk, go up stairs and do just regular daily activities,” says Donner.
Through the use of two treadmills, an elliptical trainer and hand weights in the hospital’s stress lab and by climbing stairs, patients like O’Connor are working to improve their strength and are being taught techniques to combat shortness of breath and better manage the anxiety that comes with it.
“What they learn through the program is a certain amount of shortness of breath can and will be tolerated,” says Donner.
The program spans 10 weeks and Donner evaluates each patient before they enter it to determine if rehabilitation is appropriate for them. The evaluation process includes a pulmonary function test, chest X-ray, EKG and six-minute walking test.
If Donner’s review of those studies determines the patient is eligible to participate, Donner outlines what she calls the patient’s pulmonary “prescription” detailing the patient’s starting abilities and individualized goals for incremental improvements.
And improvements are expected.
“Studies have shown that if you complete this 10-week program, the benefits can last up to a year,” says Pam Caron, Gifford’s director of ancillary services.
“Their quality of life will improve greatly,” adds Cardiopulmonary Department Supervisor Stephannie Welch, a respiratory therapist, “and it gives them the interaction they might not have otherwise. They get the motivation and support from the people around them.”
After 10 weeks of thrice weekly exercise and education the initial program ends, but Donner notes the patient’s work cannot for ongoing success. For longer lasting results, patients will be put on a maintenance program, which they can also do at the medical center.
O’Connor, who was walking at a remarkably brisk pace on the treadmill when we caught up with him, says that without the program he’d be sitting. “If left alone, I’d probably be sedentary, because I like to read,” says the retiree and hobbyist beekeeper.
O’Connor joked and laughed with the respiratory therapist leading the program, Jenell Cassinell, as she routinely checked is blood oxygen level. “I’m certainly enjoying it,” says O’Connor, who hopes to be enjoying another feat soon.
His goal when he completes the program is to hike a well-known Vermont peak.
“What I would like to do, before I get too feeble, is climb Camel’s Hump. I’m hoping I’ll get enough breathing capacity to do that,” he says. “If I could get up there, it’d be like going up Everest.”
A generous gift
The Cardiopulmonary Department at Gifford received a generous gift to help launch the pulmonary rehabilitation program.
The gift is from the Melissa Andrews Trust. Melissa Andrews was a Northfield woman who lost a child to tuberculosis. When Andrews died in the 1920s, she left a small trust to be used to prevent and cure tuberculosis.
Since, the trust’s scope has expanded to include the prevention and treatment of respiratory illnesses. High school classmates and long-time Northfield residents Mike Demasi and Bill Lyon serve as trustees, giving big with what started in the 1920s as a small amount.
The trust’s latest gift is $30,000 toward the purchase of new pulmonary function test equipment at Gifford.
“You can image how enjoyable this is for us,” says Demasi, who was greeted by plenty of smiles and words of thanks when he and Lyon arrived at the medical center to deliver the $30,000 check. “It’s nice to be able to do something positive, especially with all of the negative things that are going on in the world.”
Pulmonary function testing is used to diagnose lung disease and is a diagnostic tool to determine eligibility for the new pulmonary rehabilitation program at Gifford.
“A person goes to a (health care) provider and complains of shortness of breath. That’s the number one complaint that leads to a pulmonary function test,” explains Gifford respiratory therapist Dan Pritchard. A history of a lung ailment, asthma or an older person who is a long-time smoker may also be tested.
Gifford’s former machine, also bought with support from the Melissa Andrews Trust, performed the same tests as the new machine, but lacked capacity for larger individuals, someone in a cast and the claustrophobic.
The new machine offers an external method – outside of the machine’s plethysmograph glass chamber – to test patients’ lung volume, including the residual volume of air in their lungs.
“Our new set-up will allow us to do a complete evaluation on a patient without a body box,” Gifford pulmonologist Dr. Marda Donner said.
The new chamber is also larger, for larger patients, and the machine “has increased capabilities. Particularly its software has upgraded significantly,” Donner said.
It will also be far cheaper to maintain than the old machine, which had become very difficult to find parts for and to repair.
Pritchard credits the Melissa Andrews Trust with completing what has been a transformation of the pulmonary department’s equipment and services.
“They are single handily responsible for that last 10 percent of making this a Class A operation,” Pritchard said. “I get giddy about it. Where are we? Are we in heaven here?”