Being Well 1216: Cardiac and Pulmonary Rehab
20
January

By Adem Lewis / in , , , , , , , /


[music playing]
Lori:They’re the ones who raise the bar. The ones dedicated to providing care in the
most demanding of circumstances. The ones that understand the healing benefits
of kindness and compassion. They’re the people of Sarah Bush Lincoln,
and they set the bar high. Sarah Bush Lincoln, trusted, compassionate
care, right here, close to home. Male Voice:Carle is redefining healthcare
around you. Innovating new solutions, and offering all
levels of care, when and where you need it. Investing in technology and research to optimize
healthcare, Carle with Health Alliance, is always at the forefront to help you thrive. Rameen:
Meeting the ever changing in healthcare needs of our communities. Paris Community Hospital/Family Medical Center
is now Horizon Health, with the same ownership, management, providers and employees. Horizon Health provides patient care and promotes
wellness to the communities of East Central Illinois. Jeff:
At HSHS St. Anthony’s Memorial Hospital we are at work transforming heart care, rebuilding
knees and hips, delivering new generations, and focused on providing healthcare to you. We are HSHS St. Anthony’s Memorial Hospital. Ke’an:
Hi, thank you so much for joining us for this episode of being well. My name is Ke’an Armstrong and I’m your host
today. We’re going to be talking about cardiac rehab
and I have some folks joining me from Horizon Health in Paris. I have Morgan Kincaid, a rehab supervisor
and doctor of physical therapy. I also have Shannon Jones, a cardiac rehab
nurse, and on the end over there we have Mike Marx who is a registered respiratory therapist
and the respiratory managers. So we’ve got a full group of people today
to talk about cardiac rehab. I’m excited because I think this is something
that people may not know that is available if they’re having some issues. So I want to start off with what exactly is
cardiac rehab? Shannon:
Well, cardiac rehab, it’s a medically supervised program and it’s for patients that have recently
undergone a cardiac event, whether it be a heart attack or stent placement or open heart
procedure. We offer two different phases in cardiac rehab
and phase two is for recent procedures and that entails usually a 36 week program and
or 36 sessions, excuse me. And they tend to come about three times a
week and they are closely monitored. They’re put on the monitors. And then we also offer a phase three program,
which is more for the patients that have been… They’ve had a cardiac event but it may have
been several years ago and they’ve already finished the phase two and they wanted to
continue with the phase three program. There’s three components that we tend to focus
on with the rehab. And the first component is an exercise plan
that we tailor for their needs. So we do an assessment, we do a fitness profile
and we don’t just look at one aspect of things, but when we’re looking at their strength,
their endurance, their flexibility and then we tailor the programs best to suit their
needs. Number two, we focus on education, which is
not just the exercise program but also nutrition and smoking cessations medications that they
may be on. Also, it may be things leading up to cardiac
events. So it’s a well-rounded type of program. The third and final is we focus on emotional
and social support. So, and that being we want to make sure a
lot of people that have these events, they’re nervous, they don’t know what to expect and
we want to be there for them to offer the support. They may be anxious, they may be a little
depressed and it’s our job to try to counsel on through. Ke’an:
That. Sounds really good and helpful for these people
because they’ve already gone through something pretty scary with their heart. So knowing what to do and how much to do. I mean that all plays into this. It sounds like, would either of you like to
add on to what she just mentioned? Mike:
Yeah, I’m sorry, go ahead. Morgan:
The benefit of our program is that we live in a rural area and so most of our patients
have to drive at least 30 minutes if not an hour, hour and a half to get to their cardiologist. So our cardiac nurses act as another check-in
for those patients. So those patients are seeing them three times
a week. So it’s a safe environment for them to be
able to start doing those activities they want to do again, whether that’s golfing,
whether that’s playing with their grandkids, no matter what activity they want to get back
to, they can offer we starting up those activities in a safe environment. So they are monitored when they’re there. So they’re starting… You’ve got to start small and work your way
up. But they’re monitored. And so if something were to happen or there’s
something they’re starting to see their vitals are changing, then they could catch that early
on and they would be in the right place they’re in a hospital setting. So they can catch those. And then they’re just that check-in point. Especially, those post-op patients, they can
look at their incisions and make sure there’s no infection or all those little things that
you have to do postoperatively. Our cardiac nurses can keep an eye on that
so that the patients are in a safe environment and can have a medical professional to bounce
ideas off of. Okay. Should I be feeling this way or is this okay? The cardiac nurses have so much experience,
especially in cardiology that they can reassure them that that’s normal. It’s normal to take a little bit of time to
build back up, back to yourself. So Ke’an:
Okay. Mike, did you want to add onto that as well? Mike:
I was just going to say we have a really good staff. They’re professional, they all have a very
good track record helping patients and that’s why we’re excited also to add the pulmonary
side to the rehab. It’s a little slower for the patient. We want to build them up slowly so they can
work their breathing and their quality of life is at the end. That’s what we’re looking to do is increase
the quality of life. Ke’an:
Okay. So do they start out with cardiac rehab and
then they move into the pulmonary side or do they work hand in hand along the way? Mike:
We work alongside cardiac rehab, but we talk anybody basically that’s having any kind of
breathing difficulty that they know it’s slowing them down in life. And what we do on the cardiac side, they want
to push them a little harder to get the heart up. On the pulmonary side, we go slow and just
slowly up hill and we want to get them to where they’re stronger, easier for them to
walk, easier for them to play with their grandkids. It’s that whole quality of life we’re going
to get them to improve their quality of life, so. Ke’an:
Yeah, that sounds good. Morgan:
Two separate programs. So one is cardiac rehab is for someone who’s
had a cardiac event. Most of the times insurances are covering
in the past year. So that could be like Shannon mentioned, a
heart attack, a valve replacement, an open heart surgery, heart failure, even as intense
as a heart transplant. So that is the cardiac side and then pulmonary
rehab, they have their own diagnoses, which Mike can… Mike:
Anybody that’s diagnosed by their physician with any breathing problems, we will take
them, assess them and see if this is the right program. And again, we do the same thing. We make a detailed plan of action per each
patient. So we don’t put everybody in just the same
thing. Ke’an:
Right. Because everybody’s different and everybody
has different issues. Mike:
So we get that plan together, we talk with their physician and once we are on an agreed
plan, then we go ahead and bring them in and start them. Ke’an:
Okay. So do the cardiologist, the pulmonologist,
the rehab nurse, the physical therapist, all of you work as a team together? Mike:
Yeah. Morgan:
Mm-hmm. What’s great is that our patients love that
group atmosphere. We have a group of guys, I call it like the
men’s coffee shop because there’s these group of guys that have been coming for 15, 20 years,
those phase three years who… They finished their phase two program where
they were on the telemetry and we can continue with them. It’s a private pay program, but they can continue
just like a gym membership. But we’re monitoring their vitals and those
guys, they make sure that they’re the same time and it literally is a coffee shop for
them where they can come and they like that group atmosphere because they’re encouraging
each other and they can just carry on what they’re doing, their day to day activities. Ke’an:
Well it’s probably nice to bounce off of one another too, like some of the things that
they’re struggling with or some of the things that they can help each other with in daily
life that maybe just comes up among their conversation. So I’m glad that you mentioned that it was
monitored and it’s happening at the hospital. Does any of this happen outside of the hospital? Do they have things that they need to do at
home as well, like exercise, homework, or different things like that? Mike:
Basically on the diet, it’s really up to them once they go home. But we really stress a good diet. We have a lot of education during the classes
to help them and on the pulmonary side, as they do on the cardiac, we go through the
medications, make sure they’re taking them right, make sure that each medicine goes with
the other one. So we pretty well make a plan of action for
each patient, even for their home life. Ke’an:
Okay. So when you say that there is monitoring going
on, is it a monitor that they wear? Talk me through that and what that looks like
for the cardiac and the pulmonary. Shannon:
The phase two, our phase two patients do wear heart monitors. So initially they come in, we do an assessment,
we set them up with the program and tailor it to their needs. We do frequent vital signs, we always do a
resting vital signs. Then we do vital signs while they’re exercising,
we want their heart rate to substantially be about 30 beats faster than their resting. And then we’ll do a recovery vital signs. So they’re wearing the monitor throughout
the whole thing. We have one nurse… At Horizon Health, we have two nurses that
are available and one of the nurses watches the monitor the entire time. She’s really just looking for any abnormality
or any change in the rhythm and that’s why it’s important for them to have cardiac rehab. Because with that being said, if we catch
something, we’re able to call the cardiologist right away and we’re also able to inform the
patient of what’s going on and get them the treatment that they may need. Ke’an:
Yeah. Which is very scary for I think people who
have just had something done because I had a friend that went through this and she was
so anxiety ridden. I don’t know how far to push myself. I’m scared I’m going to do some more damage. I’m scared something’s going to happen to
me. So, once you get them to a point where they
are feeling more comfortable, I think that that helps in so many ways. Shannon:
Yeah. It does. Ke’an:
Did you want to add onto that Mike? Mike:
On the pulmonary side, we push our patients to go slow where they want the heart to race,
where we don’t necessarily want our pulmonary patients to get a heart that’s higher. We kind of go slow and we build up as time
goes by. So it’s little different. But it’s the same that we keep the same… Somebody there taking vitals throughout the
whole time. We use a pulse-ox which shows the oxygenation,
we keep pretty close tabs on the pulmonary patients, so. Ke’an:
All right. Sounds good. So let’s say that somebody is coming in, they’ve
been diagnosed I guess by the physician or the cardiologist or the pulmonologist and
then they’re put on this treatment plan or this rehab plan. So, and everybody’s different that we know. So walk me through an experience, if somebody
comes in, what are some of the things that they will actually be doing during rehab. And give me an example, if they had a heart
attack or if they had a stent or something. Give me a little bit of variation here and
some different examples. Shannon:
Sure. Well, first we set them up, we do an initial
assessment with them and based on their assessment and their physical abilities, we’ll set them
up with the program and we walk them through different low impact exercises. But we want to incorporate aerobic activities,
which incorporates the treadmills, the stationary or recumbent bikes, our UBE machines. And then we also want to focus on a little
bit of strength training too where as they are advanced, we’ll start with using some
weights. Necessarily, people that have had open heart
surgeries, we’re going to wait on the weights, we’re going to go a little slower with them
and we’re going to tailor the exercises. If they are having a hard time when they’re
on the treadmill, they’re going to take breaks and they’re going to take it at their own
pace. And then gradually they’ll see themselves
progressing and we use a fitness profile report to initially start to see where their level
is and then we revisit that profile every month to see how they’re progressing. So based on that, someone with a stent, they
may be able to, go the full 30 minutes without stopping at all. Ke’an:
Okay. Now there’s cardiac rehab always necessary
after something or is it just depend on the person? Shannon:
It depends on… I mean, I personally think that it’s definitely
necessary for everyone. Statistics have shown, if you look at American
Heart Association, there are huge advancements and outcomes are tremendous if they actually
have done the done the program versus if they tried to do it on their own. The reason being is because there’s nurses
there. There’s other people that I’ve experienced
the same things as them and it’s just an easier way to better yourself when you’re there having
a coach, a counselor, and nurse and if you have any concerns, you have other people there
that are able to talk to you about it. Ke’an:
Okay. Mike, when we’re talking about the pulmonary
rehab, are there breathing exercises? Are there different things that- Mike:
Yes, we have the different options. We kind of keep it light. We have where we teach them to breathe deeper
and well actually the therapist will have a windmill and have him blow on it and see
how long they keep it going. It kind of strengthen as they’re breathing. We also have different devices, this is called
a acapella or might be known as a flutter. If you take a deep breath and blow through
there, it’ll cause the vibration deep down and then help loosen up any secretions that
someone like a COPD or might have to help get that out and help them breathe a little
easier and then we do a lot of education. This is for the meter dose inhalers. When you use this you get most of the medicine
they say actually 55 times more than if you just squirt it in the back of your- Ke’an:
With an inhaler. Is that what you’re telling me? Okay. Mike:
So we do a lot of education with our patients. So they take their medicines right and they
also use the devices correctly because it really does it, it improves the breathing. Ke’an:
Okay. So you mentioned COPD. what are some other
things that people struggle with who would go through pulmonary rehab? Mike:
We also take on the cardiac side, we get a patient with chronic CHF, which is kind of
the pulmonary side of it, backing up into the lungs, a little bit of fluid after a while
that takes stress on the lungs. So we bring them in and there again we work
with them to help them regain the strength and the ability to breathe and go on and make
their life better. Asthma, longterm asthma, we also get patients
with any kind of lung disease that might… And they may have to take out part of the
lung or chronic bronchitis. Just any kind of disease that might affect
your breathing. We will take a look at what is going on and
how we can help improve. Ke’an:
Okay. Morgan, we’ve talked a little bit about the
monitoring and the nurses and the doctors being on hand. Is that the main difference on how cardiac
rehab differs in a facility versus going to the gym? Explained to me the differences there. So people at home can understand the safety
I guess involved and some different things that come into play. Morgan:
Right. So the monitor, especially on the cardiac
side that they’re monitored with telemetry. So they’re watching that cardiac rhythms and
then the education is very important as well. So for cardiac rehab they’re educating on
any modifiable risk factors. So that’s nutrition that is smoking cessation,
that is sodium intake, stroke symptoms, anything that we want to be monitoring, making lifestyle
changes. So we’re looking at the body as a whole. It’s more of an overall wellness program,
medications, monitoring and making sure that they have the right medications mixed together. And speaking with the doctors, if there’s
anything… Two different doctors are working together
on. They’re also as far as doing a gym membership
and the safety of it, we on the pulmonary side, there’s a physician that stops by every
30 days. So that’s a requirement by Medicare that a
physician will stop by and speak with the patients. So that’s a huge benefit to have a doctor
just readily available for those pulmonary patients to speak with because the pulmonary
patients are very sick. And that’s kind of the difference between
cardiac and pulmonary is like he said that it’s a much slower progression because those
patients usually are having difficulty breathing and those patients, it could be very scary. I can’t imagine, I know we had talked before
the show that you have a child with asthma and I do and I can’t imagine… I’ve seen them struggle to breathe and I can’t
imagine these patients if they went to a gym and sometimes the air conditioning isn’t as
controlled or it’s a warmer environment, which makes it more difficult for them to breathe. But that feeling of having a difficulty breathing. They know that the respiratory therapist is
there if they need it. I’ve seen the respiratory therapists give
nebulizer treatments onsite and during the pulmonary class if they need it. So that’s a great service that they can offer
and it puts them at ease. I think it’s the same thing with the cardiac
program is I just had a new surgery, I just had open heart surgery. That would be really intimidating to go to
a gym after having a surgery like that. Ke’an:
Yeah, definitely. Morgan:
So I think it really puts them at ease knowing that they have medical personnel there, that
if something were to happen that they would be readily available. We are attached to the hospital, we have an
AED right there. We have the ability to call a rapid response
and just that access to physicians if we needed it. They both have experienced that before. Shannon just had one last week that needed
additional attention. And it could be something as simple as… I don’t want to say it’s simple, but a patient
going into a AFib where okay, your rhythms… You’re not normally in AFib and today you
are, you need to have a conversation with your physician. Or it could be like last week where their
heart rate was very low and they needed more immediate medical attention. Ke’an:
When you mentioned the phase two and the phase three I’m curious why there isn’t a phase
one or if there is what it is and then also is the education portion included within that
36 weeks of cardiac rehab or is it extra? How does that work? Shannon:
Yeah. With the phase two the education is definitely
provided with the 36 sessions and phase three is actually… They’re still getting the education. Even though some of those patients have been
here for 13 years, they’re still… If they have questions or medications have
changed, then they’re still able to ask us those types of questions. The only difference really between the phase
two and the phase three is that the phase three, they don’t have to wear the cardiac
monitor, so they’re more independent. But the phase two, we’re watching them strictly
throughout the whole exercise session, but for both of them, we’re onsite at all times. Ke’an:
Okay. We’ve got about two or three minutes left
here. We talked about you want to improve a person’s
life, so you’ve got goals. Once they finish the rehab program and they’re
home doing some things, do you send them some things home in order to stay on task and do
they have further goals when they’re done with rehab? Let’s kind of wrap this up a little bit and
talk about what happens on how they continue to improve their life after they’ve worked
with all of you. Morgan:
We encourage them to stay phase three. So that phase three is so that they can continue… That we help them along their wellness journey
and we want them to continue that wellness journey. So, the phase three is $6 a session, so we
try to make it reasonable for most patients that they can continue to come and continue
to get that support. But if not, then we hope that we have given
them the tools to continue to improve their lifestyle and make healthier choices. Ke’an:
Okay. Would you like to add anything onto that? Shannon:
Ultimately, our goal is we want to not only… We want it to be a well rounded, so we want
to help improve them cardiac wise, but we also want to improve their lifestyle choices,
smoking cessations also education that they can further take with them on nutrition and
help prevent them from having frequent hospital stays and just to take things with them that
they can teach others. Ke’an:
All right. Thank you, Mike. Mike:
I have seen the pulmonary and the cardiac side of it for years and just watching these
patients when they come in, how they act and move and you could tell things, bring them
down and when they leave… A lot of them don’t leave. Most of them want to stay and continue the
phase three and for life. That’s great. But there’s so much better. There’s so much just happier. It’s so wonderful to see. Ke’an:
Yeah, I can imagine you’re helping improve people’s lives from situations that they’ve
had to deal with health scares and so on, and you’re improving their life and then you’re
giving them the independence to know that they can do it on their own. So how can folks find out about these programs? Morgan:
So, they both require a doctor’s referral, so they would just need to talk with their
provider and get a referral from them to be able to come and begin the program. And then we have a website at, is it, myhorizonhealth.org
to get into the Horizon Health program. There’s additional information on online as
well. Ke’an:
All right. Thank you all so much for joining me today. This has been really informative and I want
to thank all of you for tuning in today for this episode of being well, and we’ll see
you next week. Jeff:
At HSHS St. Anthony’s Memorial Hospital we are at work transforming heart care, rebuilding
knees and hips, delivering new generations, and focused on providing healthcare to you. We are HSHS St. Anthony’s Memorial Hospital. Rameen:
Meeting the ever changing in healthcare needs of our communities. Paris Community Hospital/Family Medical Center
is now Horizon Health, with the same ownership, management, providers and employees. Horizon Health provides patient care and promotes
wellness to the communities of East Central Illinois. Male Voice:Carle is redefining healthcare
around you. Innovating new solutions, and offering all
levels of care, when and where you need it. Investing in technology and research to optimize
healthcare, Carle with Health Alliance, is always at the forefront to help you thrive. Lori:They’re the ones who raise the bar. The ones dedicated to providing care in the
most demanding of circumstances. The ones that understand the healing benefits
of kindness and compassion. They’re the people of Sarah Bush Lincoln,
and they set the bar high. Sarah Bush Lincoln, trusted, compassionate
care, right here, close to home. [music playing]


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