April 10, 2017
It takes place at a very different kind of gym. It is a pulmonary rehab gym for people who have lung conditions and who need to be monitored (oxygen levels and heart rate) while exercising. Most of my fellow gym buddies have COPD or emphysema, and a few, like me, have pulmonary fibrosis.
August 01, 2016
By Russel Sison-Tojino, RRT-NPS, AE-C
They say everything happens for a reason and at the right time, and I believe that’s exactly what happened to me. I began a new career in respiratory therapy in the pulmonary rehabilitation specialty at a perfect time in my life personally and professionally. Now I cannot think of doing anything else!
The Pulmonary Rehabilitation Specialty Leap Of Faith
After 12 years working as an acute care respiratory therapist, I felt exhausted and in need of a change. I took a leap of faith leaving my hospital position, and fortunately another door opened for me in pulmonary rehabilitation. It was an unknown field for me but I am glad I took the chance of trying something new.
It was an exciting as well as a daunting transition. I thought that working in pulmonary rehabilitation (PR), wouldn’t be so different from being a hospital RT. I had worked in trauma, the ICU, NICU, and ER, and in general care areas in the hospital, but PR requires a very different skill set.
I didn’t learn about PR in respiratory school nor did I have a rotation in a PR clinic. I had not even heard much about it while working in several hospitals. My years in the respiratory field provided a good working knowledge of many different lung diseases. I was also able to utilize my assessment skills in recognizing clinical changes, communicating those changes, and making recommendations to physicians. Though these skills were helpful, most of my PR training I received on the job.
Dealing With Fear And Frustration
Pulmonary rehabilitation involves educating those with chronic lung disease, helping to improve physical function, and coordinating the best plan of care. Educating patients at this level was new to me. I had basic knowledge of inhalers and oxygen; however, topics such as exercise, travel, establishing an advance care directive, and giving guidance with nutritional needs were unfamiliar to me.
Performing a comprehensive initial evaluation is critical in assessing the needs of a patient prior to enrolling in the PR program and guides the course of therapy. Although our traditional program is in a group setting, our prescription for exercise and progress is individualized based on this initial evaluation.
Every patient has a different set of limitations to exercise, including dyspnea, muscle fatigue, and sometimes orthopedic pain. The one thing they have most in common is the fear and frustration of having lung disease. Part of my job is to provide support for patients coping with this fear and frustration, at times recommending further professional psychological evaluation. The depth of teaching and responsibility in PR differs vastly from the role of the inpatient therapist.
Poster Child For PR
In my six years thus far in PR, I have encountered multiple amazing people. One that stands out in my mind is a patient I had in the beginning of my PR career. He was in his early 60s, a well-educated business owner with GOLD stage III COPD.
He did not say so in so many words, but he had fears, sadness, and frustration related to the changes caused by his lung disease, which had greatly affected his quality of life. He ended up being the class motivator and a great support for his rehab group. By the end of his program, he was labeled by his pulmonologist as the “poster child for pulmonary rehab” and his family and friends were ecstatic with his vast improvement.
He had gained the confidence in knowing that, yes, he has COPD, but he can still live a happy and fulfilling life. He told me how life-changing our clinical team and PR program were to him. To this day, this patient regularly sends flowers, calls, and emails to tell me of his latest adventures and how grateful he is for the team at UCSD PR.
All respiratory schools should add PR to their didactic and clinical instruction. That said, I think it’s very valuable to gain clinical experience working in an inpatient setting before looking into PR, if it is of interest to you.
I am privileged and grateful to be a part of caring for people with chronic lung disease. It is awe-inspiring to see the unveiling of a person with newly learned knowledge and newly gained confidence in so little time. My job makes a difference to a person struggling with something they don’t fully understand. I help them overcome their fear of the unknown through education and exercise.
This why I know being a PR coordinator is the right fit for me!
Russel Sison-Tojino is the clinical coordinator for the UCSD pulmonary rehabilitation program in San Diego, CA.
July 16, 2015
Information provided by: http://academicdepartments.musc.edu/medicine/divisions/pulmonary/patient_care/pulmonary_rehab.htmPulmonary rehabilitation is a multidisciplinary approach to improve the quality of life of patients with chronic respiratory disorders, such as COPD, IPF, and post lung transplant. Treatment programs are individualized and tailored to the patient and includes disease education, exercise training, and psychosocial support. In addition to strength training, participants learn about oxygen therapy and their medication treatment plan. The pulmonary rehabilitation program at the Medical University of South Carolina has a devoted team of specialists to help patients improve their exercise capacity, reduce their symptoms and improve their lives. For more information please call 843-792-LUNG.
Affiliated Faculty:Assistant Professor
March 27, 2015
Written By: Dawn Brazell | MUSC News Center | Sept. 11, 2014
Photos by Sarah Pack
David Flurett walks on the treadmill as part of his physical therapy at MUSC 19 days after receiving a double lung transplant May 18. Photo Gallery
Just hours before midnight May 17, light blazes along a dark hallway from one lone operating room. Inside, nurses bustle about, prepping for what’s to come.
David Flurett, 57, hopes it will be him.
Cuddled up against his wife who has crawled up into his hospital bed, Flurett seems oddly chipper amidst a chorusing beep of monitors. His wife, Debra, compares the wait for her husband’s double-lung transplant to having a baby. They didn’t know exactly when it would come or if tonight might be a false run.
Debra Flurett cuddles up with husband David Flurett, just hours before he is scheduled to get a double lung transplant.
All they know is that surgeon Chadrick E. Denlinger, M.D., is en route to pick up the donor lungs. All they can do at this point is wait.
In the corner of the room is Flurett’s 42-pound backpack, custom made for the three tanks of oxygen he has to carry. He specially designed it so he could remain mobile at home and at work, where he handles fire systems’ testing and maintenance at the Savannah River Nuclear Solutions site.
Rarely sick a day in his life, Flurett’s luck ran out a couple of years ago when an annual physical and X-ray revealed a spot on his lungs.
“They couldn’t figure out what it was. I had never had anything wrong with me ever, so I just passed it off. As the year went by, I noticed when I was doing stuff in the yard, I’d start coughing and just couldn’t quit.”
When he had his next physical, it showed up again and was worse. He was referred to a pulmonologist in Aiken, and had a CT scan and breathing test.
“We went back to get the results. My wife had ordered pizza. Pizza is our big celebration thing so she went to order pizza because she thought we were going to get really good news,” he said. “They sat us down and said, ‘I hate to tell anybody this, but what you have is terminal, and there’s nothing we can do for you. We’ll have to put you on the lung transplant list.’ My wife was devastated.”
Flurett was, too, but he wasn’t as surprised by the diagnosis based on how hard it had gotten for him to breathe.
On the continuum of diagnoses, Flurett got one of the worst – idiopathic pulmonary fibrosis or IPF, which is a chronic and incurable disease that causes tissues deep in the lungs to stiffen and scar. According to the Coalition for Pulmonary Fibrosis, more than 128,000 Americans suffer from IPF, with 40,000 dying from the disease each year.
Flurett pulls his wife in closer to his side as they talk of that day they got the news. A tight-knit crew, he and his wife love being home together with their two dogs and two cats, piddling around in the garden and house. With surgery looming, they reminisce about how they met.
Flurett grins. “I had to pursue her relentlessly,” he said. She was a control room supervisor in one of the reactors, and he was one of the subordinates, but that didn’t stop him. “I just happened to notice her in the control room and thought she was the prettiest thing there ever was.”
He kept calling her, staying on the radar. Debra said he finally wore her down and she agreed to go out once, just to show him how it wouldn’t work. “That was 29 years ago,” she said, adding that they married in 1985. His wife said he has applied that same drive in getting prepared for his transplant as he has in life. “He’s ‘Mr. Happy Go Lucky – Failure is not an option’ kind of guy. He’s the perfect person for a lung transplant. He will surprise everyone I think.”
Flurett’s calm demeanor cracks only once as he tears up talking of family. His son Orion is a Clemson engineer graduate bound for the Navy and his daughter Ariel, 22, loves horses and has an associate’s degree in business.
“I was thinking 20 years out, 30 years out with my life and planning. Now it’s just condensed to two years or five years. All my focus went to my family to make sure everything was squared away before I took this journey.”
His surgery a go, Flurett’s surgical team huddles around him. The clock reads 1:50 a.m., but it might as well be 8 in the morning. The air hums with energy. Flurett’s chest rests open. There’s a flash of pink as his lungs slip into view and then back out, like cycling surf that is in sync with his breath. They are lungs that in a few hours, will no longer be his.
Penny Mitchum, RN, clockwise from left, assists Dr. Chadrick Denlinger as he and Dr. Jeffrey Griffin transplant the donated lungs into David Flurett.
Surgeon John Kratz, M.D., and chief resident Jeffrey Griffin, M.D., prepare to remove Flurett’s lungs as they wait for news of Denlinger, who is expected to arrive shortly. The call finally comes at 2:15 a.m. that the donor lungs have arrived at the local airport, and Denlinger is en route. At 2:35 a.m., they go onto cardiopulmonary bypass, just as Denlinger and Danny Eads, M.D., roll the donor lungs down the hallway.
Lifted from their sterile nest inside an ice chest, the two lungs still are attached to the donor’s trachea and part of the left atrium, the back of the donor’s heart. Denlinger quickly separates the lungs, a marbled color like speckled birds’ eggs, into respective left and right sides, and they are gently placed into sterile basins.
Meanwhile, Penny Mitchum, R.N., anticipates what the surgeons need often before they ask for it as Kratz and Griffin remove the diseased lungs. Perfusionist Heidi Doffing uses her quick wit to keep the mood light, the team sharp. It’s far from her first case of the day, but she monitors all vitals diligently. Flurett’s blood flows through a maze of tubes, an artificial circulation system, an invention that’s the genius of other researchers from days past. Flurett’s heart still beats, but it’s mostly an empty beating heart now that he’s on bypass.
The team talks about how much they like Flurett, what “a good guy” he is. A mood of camaraderie settles in.
Denlinger switches out with Kratz, working quietly and methodically to sew in the donor lungs one at a time. Trained by the pioneers who developed the techniques for doing lung transplant, Denlinger is doing his favorite type of operation. He’s drawn to its complexity and technical challenges and the magic of that final moment that he hopes will happen soon.
Penny Mitchum, RN, clockwise from left, assists Dr. Chadrick Denlinger as he and Dr. Jeffrey Griffin are about to transplant the donated lungs into David Flurett as perfusionist Heidi Doffing monitors his vitals.
The bypass pump circulates approximately five liters of blood each minute, essentially replacing the normal function of both the heart and the lungs. After both lungs are completely sewn in, it is time for the moment of truth.
The lungs turn from a pale ashen white, from being on ice, to a flushed pink. Dr. George Guldan, M.D., the anesthesiologist, gently reinflates the lungs with the ventilator and the flow through the bypass pump is cut in half. After ensuring that there are no bleeding issues the bypass pump is turned off completely.
At 6:17 a.m. May 18, Flurett pulls in his first breaths with his new lungs. The room quiets as the entire surgical team stands captivated by the monitors. They watch the oxygen level hold steady at 100 percent and celebrate that his vital signs remain stable.
“The lungs turn pink and look alive and that’s awesome,” Denlinger comments. “The true test of the operation is once we wean off the cardiopulmonary bypass. The best part of the operation is when we turn down the (bypass) pump and prove that the lungs are capable of doing what they are supposed to be doing – they are oxygenating the body. That’s success. That’s really what I look forward to in the entire case. It’s like touchdown for the space shuttle.
Debra watches her husband pace the length of MUSC’s rehabilitation room June 6 doing his prescribed laps. “He wants to go back to work,” she said, smiling. She’s not surprised. “He’s an Energizer bunny. Failure is not an option. He just floors them. Most people just want to walk across the floor without oxygen, but he wants to go on and beyond that.”
Flurett specially designed a backpack to carry his oxygen tanks so he could remain mobile at work.
That’s not to say he’s not grateful for being off oxygen, constantly tethered to a cord.
“You could see his frustration. It’s great having my husband back – having the person I married and the person I remember instead of this frustrated person who was attached to this umbilical cord of oxygen – It’s nice having life return much more to normal. I can’t keep up with him now. What’s it going to be like with new lungs?”
It’s a problem she’s grateful to have.
There are challenges that come with transplants, such as the immune suppressant medications necessary to give the new lungs a chance to work. Life expectancy rates also are lower than for other transplants. The median survival for double-lung recipients is 5.5 years.
Debra said she’s grateful for their second chance at a better quality of life.
“It’s amazing. I’m still trying to wrap my mind around how they can take your lungs out and put someone else’s in.”
Flurett said he feels “tremendously better” and is grateful he no longer is attached to oxygen by long hoses that his wife accidently kept stepping on, trying to choke him. Debra rolls her eyes at the running joke.
Rehabilitation is challenging, but Flurett praised MUSC’s team approach. “Everyone seems to enjoy their job on that floor which makes it a lot better for the patient. I’m impressed with team that Dr. (Tim) Whelan has gathered together. Dr. Luca Paoletti, Dr. Whelan, Dr. Denlinger, a great surgeon, Clancy (Flounders), Jason (Ferro) – everyone works well together.”
His wife agrees. “You get the sense that they know each other very well, and they know us well. And they told us that. They said ‘we will know a lot about you and your family. You will become a part of us when you get this transplant,’ and she was absolutely right,” she said of Flounders, who is the lung transplant coordinator.
MUSC respiratory therapist, Jessica Gregorie shares a laugh with David Flurett while he rides a stationary bike during his physical therapy session at MUSC.
Flurett said it’s difficult to describe what it’s like being able to breathe again and focus on something normal, such as getting back into shape. He’s thankful for the gift of his donor. It’s a philosophy he shares. “I’m a donor. We’ve had time to think about it. If I die on the table, this is what I want done.”
Debra said it feels like a miracle to be three weeks out from the transplant and see her husband return to as normal as he was the day she met him. “When you first get diagnosed, you become very aware that you have a very limited time together left on this Earth and what are you going to do with that. Now this is a new lease on life, and you can look out five, 10, 15, 20 years and there is that to look for instead of ‘I have to get my ducks in a row in the next three to five years.’”
Flurett said it is a game changer. “Three weeks ago, I had maybe a year to live. Now everything is turning out great. Now I should be able to live another 20 or 30 years,” he said, pausing to smile at his wife, “as long as she keeps me healthy.”