Pulmonary Rehabilitation Improves Quality of Life
Helping Patients with Chronic Lung Disease Breathe Easier
This article was first published in Health View, 2002.
She loved to fish. Yet with lung disease so debilitating that she could barely walk without straining to breathe, the elderly woman couldn't imagine ever venturing out to the pond and baiting a hook again.
Susan Dowdy, on the other hand, refused to accept that the woman had to give up fishing. As Clinical Coordinator for Carolinas Hospital System's Pulmonary Rehabilitation Program, she looks beyond the limitations that have stymied her patients with chronic lung diseases. Though progressive disease processes have weakened them and impaired their ability to perform basic everyday activities, the program focuses on the possibilities rather than the prognoses.
CHS Pulmonary Rehabilitation Program Staff (left to right) Susan Dowdy, Barbara Garrick, Dana Jacobs, Teresa Feagin, Dr, Mark Barnard, Ruth Terrio, Wanda Player and Heather Walston.
"Patients with chronic lung disease become more and more sedentary as their disease progresses. If they try to do anything, they get short of breath," explained Dowdy, who has almost 20 years experience as a certified respiratory therapist. Designed for people with lung diseases such as emphysema, chronic bronchitis, pulmonary fibrosis, lung cancer and asthma, the rehabilitation program improves patients' ability to carry out daily tasks and allows them to breathe and function better.
Through tri-weekly exercise sessions, participants work to gradually and steadily improve their physical condition within the limits of their disease. Vital signs are monitored while they exercise, including a finger probe that continuously reads their 02 saturation, a crucial measure of how well the red blood cells are receiving oxygen. While many patients come into the program requiring oxygen treatment, either on a partial or full-time basis, it's not uncommon for them to be able to reduce or eliminate the need for oxygen use. Though their lung disease cannot be cured or its effects reversed, their active participation can make a major impact on how they function on a day-to-day basis.
While all participants complete at least three months of pulmonary rehab, many stay over a year and continue with a pulmonary maintenance program once they have met their initial goals. Goals are set by each patient, and are as individualized as the 75 men and women who are currently enrolled. For one it might be the ability to return to volunteer work, for another the opportunity to play golf again. For 66-year-old Pete Granger, who attended his first session last April, the objective was simple and straightforward. "When I asked Pete for his goal, he didn't blink. He wanted to get off his oxygen," Dowdy recalled.
After surgery to remove a cancerous lung a few months earlier, Granger had been reliant on oxygen 24 hours a day. An oxygen-generating machine was his constant companion, tethered to him by forty-feet of plastic tubing. If he left home, a portable tank with a two-hour supply of oxygen went with him; a spare tank was stored in the trunk. The situation didn't do much to accommodate the travel that he and his wife, Betty, had enjoyed so much the past few years.
So Pete got to work, learning breathing techniques to decrease his shortness of breath, exercising to build strength and endurance, and attending three-hour educational classes with his wife. Through the classes, taught by various members of the interdisciplinary rehab team, he gained a greater knowledge of his lungs and how disease impacts their normal functioning. He learned relaxation techniques and how to control panic if he ran into difficulty breathing. He found out how what he eats can affect his ability to breathe.
Betty Granger's attendance at the classes isn't unusual; in fact, the staff encourages it. "Family support is very important in any chronic disease process," said Dr. Mark Barnard, a pulmonologist on staff at Carolinas Hospital System and the Medical Director of the Pulmonary Rehabilitation Program. Dowdy added that the education process provides family members with helpful insights on how lung disease affects their loved one. "They don't understand why mom can't keep up at the mall or doesn't even want to go anymore. And it's important for them to be aware of how much more prone these people are to lung infections. It's so easy to contract colds or the flu from grandchildren, for example," she said.
Nine months after he joined the pulmonary rehab program, Granger is a far cry from the man who felt terrible after just a few minutes on the treadmill and doubted whether he could really be free of his oxygen tank. "Pete was so afraid that he and his wife would never be able to travel again, and that had taken a lot away from his life," said Dowdy, who noted that fear is a common issue with many of her patients. "Most of them have experienced an acute episode in which they panicked because they could not breathe. They are so afraid of ending up back in the hospital or needing a machine to breathe for them. They're afraid they will never be able to do the things they want to do again," she said.
As patients attend week after week, they find comfort in the fact that the men and women beside them are dealing with the same life issues. "When they are exercising together and one mentions he or she is having a hard time breathing, and the other one says, ‘I know what you mean,' they really do," said Dowdy. "They become very close and support each other. It's kind of a family atmosphere," added Dr. Barnard.
For Granger, his fellow participants provided a needed perspective. "With one lung, you think you're in bad trouble. Then you find out you're not the only guy, that people have lived years and years with just one lung." After only two months he was able to achieve his goal of discontinuing the use of oxygen on a continuous basis. Nine months later, he's still actively attending, "just building up more and more strength every time I go."
Dowdy is delighted with Granger's progress. "He's like a different person. He and his wife are traveling again. At least once a month he lets me know that he's going to miss a Friday because they are going to Charleston or the mountains or somewhere. He's just enjoying life again." She's quick to put the credit for his success where she sees it due. "Our patients succeed not so much through what we do; we just show them the way. We are the encouragers and the educators, but they are the ones who do the hard work."
Granger agreed that he worked hard, but insisted he couldn't have done it without the careful supervision of Dowdy and her staff. Their constant presence gave him a sense of security, as they observed, monitored, and made recommendations as needed "They're like guardian angels," he said.
For more information on the Pulmonary Rehabilitation Program, please call 674.2242.
Recently, Carolinas Hospital System was awarded program certification for the Pulmonary Rehabilitation Program by the American Association of Cardiovascular and Pulmonary Rehabilitation. This honor distinguishes the program at Carolinas as one of only two in South Carolina that have met the rigorous requirements required to attain national certification. We congratulate our outstanding staff for their hard work and dedication to our patients.
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