Cardiopulmonary Rehabilitation

A Winning Combination

Between emergency room visits and her 12 years in the pulmonary rehabilitation program, retired school librarian Maryclare Burke, 78, of Bellingham, estimates that Milford Regional has saved her life three times. One such instance occurred when respiratory therapist Cheryl McSweeny, AS, RRT, noticed that Maryclare’s treadmill time decreased and that her blood pressure and oxygen levels seemed off during a pulmonary rehabilitation session. “Cheryl said to me, ‘There’s something amiss,’” recalls Maryclare, who has a form of chronic obstructive pulmonary disease (COPD). “I’ll never forget her saying that.”

At Cheryl’s insistence, Maryclare visited the emergency department and followed up with her doctor. A cardiac catheterization revealed blockages, which led to double bypass surgery in Boston. Afterwards, Maryclare developed pneumonia and ended up back in the emergency department. Once she was discharged, Maryclare began cardiac rehabilitation, which takes place in the same room as pulmonary rehab but with a few key differences, including heart monitoring.

“Cardiac rehab has been wonderful and it’s like going home, but I had to laugh as the patients talk a lot in the cardiac program,” Maryclare chuckles. “Because of difficulty breathing, we can’t talk while we’re exercising in pulmonary rehab, and we go slower. I was on oxygen and needed my walker with me the first time I went to cardiac rehab...I probably looked like walking death. I’m feeling so much better now. I feel very lucky that I’m part of the program.”

Maryclare is the first blended patient of the newly created cardio-pulmonary department. In the past, the programs maintained individual staffs, but shared the same rehab room containing treadmills, exercise bikes, arm ergometers and free weights. Although pulmonary and cardiac patients typically exercise during different sessions, the staff now works together as one unit.

“With the new department, it’s a team focus,” explains Program Director Joan LeBlanc, RN, BS. “We’re cross-trained to work with both sets of patients and we can draw on each other’s knowledge and experience. Most pulmonary patients have cardiac disease and a good number of cardiac patients have respiratory disease. It’s shared knowledge all the way around and the goal is to take better care of the patient.”

The new cardio-pulmonary rehabilitation team includes medical directors, a program director, a pulmonary rehabilitation coordinator, cardiologists, pulmonologists, registered nurses, exercise specialists, respiratory therapists, dietitians, diabetic specialists, a social worker and a secretary.

Joan explains that cardiac rehabilitation helps patients to improve their quality of life after a heart attack, coronary artery angioplasty, stents, open heart surgery, heart failure, or heart transplantation. Pulmonary rehabilitation caters to individuals with a lung disease or other medical disease that causes difficult or uncomfortable breathing. Common conditions include COPD, pre-and-post lung transplantation, and Interstitial Pulmonary Fibrosis.

Milford Regional boasts the first cardiac rehabilitation program in Massachusetts to be certified by AACVPR (American Association of Cardiovascular and Pulmonary Rehabilitation). “A lot of cardiac rehab programs in the Worcester area have closed due to funding, so for us to have such a successful program in the hospital is great,” notes Joan. “The goal over the next couple years is to have the pulmonary rehabilitation program become AACVPR certified.”

Based upon your insurance, most generally provide full or partial coverage for up to 36 monitored exercise sessions. Upon completion, many patients continue their exercise routine in the maintenance programs for a small monthly fee.

Exercise Specialist and Registered Nurse Kerri Costa, CES-RN, stresses that even though the two programs work together, they offer distinct services. “A pulmonary patient has had a chronic, crippling, and serious disease for many years,” she says. “A cardiac patient is living their life normally until one day everything changes at the drop of a pin. I can exercise my cardiac patients a little bit harder as heart function can be improved. They can return to their baseline functioning level and even improve upon that.”

Kerri explains that cardiac patients receive a personalized exercise plan, along with education on heart healthy eating, reducing or maintaining weight, and smoking cessation. The staff also makes referrals to a dietitian and social worker. To date, the maintenance program has more than 150 participants. Kerri explains that close friendships often develop. “It’s such an invaluable aspect of this program, especially for seniors,” she says. “Just the social support alone is enough to keep them going. They’re all here for each other.”

Pulmonary Rehabilitation Coordinator Cheryl McSweeny, AS, RRT, has observed the same camaraderie with pulmonary patients over the years. Participants in both programs can join a support group for further peer interaction. “A lot of these people have seen each other around Shaw’s or know someone’s cousin, so it’s a very neighborhood type atmosphere,” says Cheryl. “We’ve had patients bring in their second grade picture, and they were classmates in second grade and now they’re here.”

Pulmonary rehabilitation patients are monitored with finger pulse oximetry after every exercise. Cheryl explains that pulmonary rehabilitation patients use the same equipment as the cardiac rehabilitation patients, and also do breathing exercises. “The patients run out of breath quickly,” she says. “It’s a huge effort just for them to get here. A lot of patients have oxygen to carry with them and that itself is a burden. Unlike a lot of other facilities, we supply all the oxygen here at the center. It’s a continuous-flow oxygen and we have some patients who have to be administered eight liters or more of oxygen, which they can’t do at home. We exercise with the goal of endurance rather than speed – to go very slow and stay on as long as they can.”

The pulmonary rehabilitation program also offers a lecture series which features topics such as the role of exercise, pulmonary medication and spacer devices, oxygen therapy, nutrition, and tips for staying healthy. Cheryl teaches a thirty-minute chair yoga class once a week to assist with stress reduction and breathing techniques. “Our goal is to prevent exacerbation and have people be aware of their breathing,” she notes. “It’s like a brush fire. If you go to treat it right away, it goes away. If you wait, it gets bigger and turns into a forest fire. We’re always answering questions. A lot of times we’re the bridge between them and their doctors.”

After seven weeks of cardiac rehabilitation, Maryclare built enough stamina for twenty minutes of exercise, and has returned to driving and going out with friends. She looks forward to getting off oxygen, resuming her volunteer work at the food pantry, and easing back into a longer exercise routine. After cardiac rehabilitation, she will transition back into her pulmonary rehabilitation time slot. Maryclare says that over the past 12 years, the cardio-pulmonary rehabilitation department has made a huge impact on her life. “I noticed a difference the weeks I didn’t go,” she says. “It got me exercising and it kept me mobile. It’s allowed me to lead a normal life. Without rehab, I’d probably be sitting in a chair not moving and I’m almost positive I would be on oxygen all the time. I couldn’t ask for nicer, more caring people. The staff have become like family to me.”

Read more about our cardiopulmonary rehabilitation program

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