Educate. Build Strength. Breathe Better. Pulmonary Rehab
Over the span of almost 16 years, I have been very fortunate to have been working as a respiratory therapist in Richmond, VA. When I first started my career, I couldn’t wait to work in adult critical care. The intensive care unit was where I thrived and felt like I made a difference in the care of my patients. After gaining a few years of experience under my belt, I was lucky enough to be chosen to work in the pediatric and neonatal intensive care units. I loved my “tiny” patients as they were my own. I was in my element but there was something missing… a personal connection with my patients. I wanted to know their goals, about their families, and get the feedback that I was making a difference in how they were feeling overall. Sure, this may seem selfish in a way, but a “job well done” and the job satisfaction that I craved was missing. I was fortunate to have an opportunity to come work in a pulmonary rehab center. And in honor of Respiratory Care Week, I wanted to talk to you about my job as a Pulmonary Rehabilitation Coordinator, what pulmonary rehab is all about, and what you can gain from participating in pulmonary rehab. This isn’t a sales pitch, it’s my passion.
So, to start off, I want to say that not everyone with a lung condition needs to exercise at a pulmonary rehab. Yet everyone with a lung disease needs to exercise. I smile when I am meeting a patient for the first time and they ask me, “How long do I need to exercise?” My response, “Does forever seem too long?” Seriously though, the more you can do to maintain your strength and endurance the better. Pulmonary rehabilitation may only be covered by your insurance (depending on your plan) for a set number of visits. Some centers do offer a maintenance program which may allow you to stay longer but a vast number of centers only treat you for the number of visits that your insurance will cover. With this knowledge, you need to continue using the information that you gained from the program as well as what you can learn from support groups and wonderful educational sites on the internet like BreatheLiveFit (Pardon the shameless plug. Ha!) However, when someone’s diagnosis starts to limit their activity or effect their wellness, pulmonary rehabilitation may be the prescription for getting them or keeping them on track with their strength, endurance, and overall well-being.
The Initial Assessment
Before you can begin your exercise program, you will be asked a multitude of questions about your health history. Your rehab coordinator wants to find out if there are any “red flags” that might not make you a candidate to participate in the program due to a safety issue or other health concern. They are also trying to find out what areas in your normal activity of daily living that you are having the most difficulty doing. This meeting with your rehab coordinator is crucial to putting together a plan for a perfectly tailored pulmonary rehab program. I love it when spouses or partners come with the patient to their first rehab session. I get to hear some of the concerns from their closest loved ones. These folks can also be great at recalling crucial health history information that may be inadvertently forgotten or not mentioned. Be honest during this conversation. Trust me when I say, “I have heard it ALL.” From difficulty bathing, to breathlessness during sex, to feelings of depression and anxiety… this is the appointment where you get it all on the table. In the right professional space, you will feel more at ease talking about your concerns.
Areas of Focus
Education - In my opinion, you can’t know too much about your lung diagnosis. The foundation of every good pulmonary rehab program is the education on how to manage your lung diagnosis. After all, what is “rehabbing” good for if we don’t know what to expect with our lung condition and how to manage its symptoms on the home front. The education piece, as a respiratory therapist, gives me joy. I absolutely love the “light bulb” moments when a patient’s face illuminates. Those “I never thought about that” and “That really helps out a lot” moments are the pat on the back that I absolutely love. I would say the best thing to remember when you are listening to tips and education is to keep and open mind. Not every suggestion is going to work for everyone. Clinicians in pulmonary rehab, like myself, pride ourselves in breaking down the info into layman’s terms. We help to debunk any false claims out there and much more importantly give the patient hope and empowerment on how they can personally manage their condition.
Exercise Training – This is the basis of most pulmonary rehab programs. Clinicians will work with each patient to increase their strength and endurance. Improving strength and endurance in the rehab setting should translate to activities patients do in the home setting. Emphasizing pacing, body mechanics, and self-assessment are all incorporated into this area of focus. Your exercise program will be tailored to your current level of conditioning. Slowly over time you will see results. Remember: Rome wasn’t built in a day so don’t expect overnight results. As with any exercise program, it takes time to see improvement. Set realistic goals. For instance, make a plan to walk 1 extra minute per visit or increase your weight repetitions by one each visit. Setting realistic goals gives you a feeling of accomplishment and shows progression over time.
Medicine Management- Taking the right medications the correct way. Many times, my patients are taking their medications in an order that doesn’t allow them to reap the benefits. Other times, the way in which they are taking their breathing medications isn’t effective. The clinicians in a pulmonary rehab will take the extra time to review each lung medication, how to take it, and give advice as to when the medication should be administered.
Breathing Retraining- There are a few breathing techniques like pursed lip breathing and diaphragmatic breathing that may help a person get through and activity or recover from their shortness of breath faster. By training the patient to use these techniques effectively, patients start to gain more confidence on how to manage their everyday breathlessness with a little more ease. It will take conscious thought to employ the use of these breathing techniques if you plan to use them as it isn’t a natural way of breathing when we are breathless. (For more information on breathing techniques see my blog The INs and OUTs of Breathing Techniques)
Nutrition Counseling- Pulmonary Rehab is a great place to learn about what foods are going to make you feel your best. Often time a patient’s diagnosis is complicated by an inability to gain or lose weight and/or an additional diagnosis of diabetes. Depending on the size of the pulmonary rehab program, they may have a dietitian on staff or a pulmonary rehab coordinator can work with your physician to refer you to dietitians and nutritionists that can assist you in reaching dietary goals. Eating the right food not only helps fuel your body but it can help you to breathe easier and stay well.
1. Will I be provided oxygen for exercise?
Each program goes about things a bit differently. However, most pulmonary rehab programs will provide you oxygen for exercising. The goal for oxygenation in most cases is to keep your oxygen saturations 90% and above. Sometimes when transitioning a patient to their own fitness facility your therapist may have you exercise utilizing your own tank or portable concentrator to make sure you are comfortable and are able to maintain your oxygen saturations in a safe range.
2. How much will this cost me?
Some insurances including Medicare cover pulmonary rehab for a set number of patient visits. The best thing to do is call the rehab center and your insurance company to verify your level of coverage and what out of pocket costs that you may incur.
3. How do I know if pulmonary rehab is right for me?
If you are interested, I would discuss it with your pulmonologist. They will let you know based on your level of conditioning and your lung condition whether it is a right fit. Don’t wait until your physician addresses concerns of deconditioning and breathlessness on exertion.
Thanks for Reading!
If you enjoyed this blog, I invite you to check out some of the topics I have covered in the past
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