Tag Archives: Swim coach

Seniors and Patients Buff Up, Reduce Muscular Atrophy

Seniors – patients – buff up or lose it. My swim coach is transitioning me to the eleven-pound weights in our water workouts and I’m FEELING GOOD.

Feeling good includes decreased blood pressure and increased flexibility to bend over and pick up something from the floor, reaching up to an overhead cupboard and angling a heavy pan down from the shelf, and, gasp! – feeling formally loose fitting underwear snug tight around my thighs.

Why is tight underwear important? Because it means – to me – that muscle is building around my hip joints to protect my bone on bone left hip from injury and enabling me to have a more mobile life. … From a patient point of view. Ask your doctor what strength and aerobic exercising will do for you as a senior or as a patient.

Feeling good means my left leg and joints aren’t frozen in place and my left ankle flexes again to help walk and balance.

Does that mean I threw the walking sticks away? No – not yet, maybe never…they are tools to assist in a more secure balance and living. They tie on to a recumbent trike so I can ride and have them to assist getting out of the seat.

“…If people lose 30% of their muscle strength between the ages of 50 and 70 years according to “Deutsches Arzteblatt International, Frank Mayer and colleagues from the University of Potsdam conclude that progressive strength (resistance) training counteracts muscular atrophy in old age (Dtsch Arztebl Int 2011; 108(21): 359-64).”

“Study Of Strength Training For Seniors Finds Increased Muscle Strength, Reduced Muscular Atrophy

….

The authors investigated the extent of the effects that can be achieved by strength (resistance) training in elderly persons and which intensities of exercise are useful and possible in persons older than 60 years. They found that regular strength (resistance) training increased muscle strength, reduced muscular atrophy, and that tendons and bones adapt too. These successes in turn had a preventive effect in terms of avoiding falls and injuries. Greater intensities of training yielded greater effects than moderate and low intensities. In order to increase muscle mass, an intensity of 60-85% of the one-repetition-maximum is required. In order to increase rapidly available muscle force, higher intensities (>85%) are required. The optimum amount of exercise for healthy elderly persons is 3 to 4 training units per week.

In the coming decades, the importance of maintaining the ability to work and to make a living will increase, as will the need for independence in everyday life and leisure activities. The increase in the retirement age to 67 years from 2012 means that one in three adults of working age will be older than 50 by 2020, and by 2050, the proportion of people older than 60 in Germany’s population will rise to an estimated 40%. Currently, the proportion of elderly persons who practice strength (resistance) training is about 10-15%.”

Dr. Frank Mayer

Deutsches Aerzteblatt International

http://www.medicalnewstoday.com/releases/228254.php

Thanks for reading… Sharon O’Hara

Tweet This Post

COPDers One Legged Bike Training Study in Chest

Sharon O'Hara

YES, COPDers CAN improve aerobic capacity with one-legged exercise training compared with two-legged training in stable patients with COPD. However – how practical is it for the COPDer riding out in traffic for fun and exercise perched upon one of those crotch-numbing seats on an upright bicycle with one pedal?

Studies are great and as a COPDer, some studies are cause for great excitement learning how we can add more to our daily lives to help ourselves. The big question here is – how do the study results transfer over to using it in a practical way?

Thanks to Chris Wigley a COPD friend and fellow EFFORTS member in Canada for the following study. Published in Chest – results on one-legged exercise training.

My question is how can a COPDer get the same results riding a recumbent trike using pendulum pedals? http://pugetsoundblogs.com/copd-and-other-stuff/2011/07/10/severe-copd-and-eccentric-cycling-protocol-study/

Additionally, how do water workouts help the COPDer gain FEV1 if they are strenuous air exchanges?

My swim coach, Marilyn Grindrod cranked up our workouts yesterday and I feel it for the first time – excited and pleased to feel muscles I have not felt in years and my endurance has increased…far fewer slowdowns to breathe. It seems to me that oxygen must be moving more getting to the rest of the body.

The water workouts will build up the muscling around my left hip so – hopefully – I can get back on my regular recumbent trikes.

Currently we are working harder on my upper body conditioning and muscle building for my arm pedal recumbent trike. One way or another, I have a cycling trip to take.

I would like to know why these bike studies use the upright bike when – for most COPDers, we are better off on the more stable and comfortable recumbent trikes – many due to mobility issues.

Most seniors can ride a recumbent trike – fewer can ride the crotch killing upright bike.

Effects of One-Legged Exercise Training of Patients With COPD*

Thomas E. Dolmage, MSc and

Roger S. Goldstein, MD, FCCP

+ Author Affiliations

*From Respiratory Diagnostic and Evaluation Services (Mr. Dolmage), West Park Healthcare Centre Toronto; and Department of Medicine (Dr. Goldstein), University of Toronto, Toronto, ON, Canada.

Correspondence to: Thomas E. Dolmage, MSc, West Park Healthcare Centre, 82 Buttonwood Ave, Toronto, ON, M6M 2J5, Canada; e-mail: RGoldstein@westpark.org

Abstract

Background: Most patients with severe COPD are limited by dyspnea and are obliged to exercise at low intensity. Even those undergoing training do not usually have increased peak oxygen uptake (V̇o2). One-legged exercise, at half the load of two-legged exercise, places the same metabolic demands on the targeted muscles but reduces the ventilatory load, enabling patients to increase work capacity. The purpose of this study was to determine whether one-legged exercise training would improve aerobic capacity compared with two-legged training in stable patients with COPD.

Methods: Eighteen patients with COPD (mean FEV1, 38 ± 17% of predicted [± SD]) were randomized to two groups after completing an incremental exercise test. Both trained on a stationary cycle for 30 min, 3 d/wk, for 7 weeks. Two-legged trainers (n = 9) cycled continuously for 30 min, whereas one-legged trainers (n = 9) switched legs after 15 min. Intensity was set at the highest tolerated and increased with training.

Results: Both groups increased their training intensity (p < 0.001) and total work (p < 0.001). After training, the change in peak V̇o2 of the one-legged group (0.189 L/min; confidence interval [CI], 0.089 to 0.290 L/min; p < 0.001) was greater than that of the two-legged group (0.006 L/min; CI, − 0.095 to 0.106 L/min; p = 0.91). This was accompanied by greater peak ventilation (4.4 L/min; CI, 1.8 to 7.1 L/min; p < 0.01) and lower submaximal heart rate (p < 0.05) and ventilation (p < 0.05) in the one-legged trained group.

Conclusion: Reducing the total metabolic demand by using one-legged training improved aerobic capacity compared with conventional two-legged training in patients with stable COPD.

lung diseases, obstructive

muscle, skeletal

oxygen consumption

physical conditioning, human

rehabilitation, pulmonary

The cornerstone of pulmonary rehabilitation is exercise training, based on the premise that altering physiologic processes will result in improved outcomes.12 Intensity and duration are important determinants of the physiologic adaptations that occur in response to exercise training.3456 However, most patients with COPD are so limited by dyspnea, even at modest levels of ventilation, that their training is restricted to low-intensity exercise.7 As a result, when undergoing exercise training they are usually unable to increase their peak oxygen uptake (V̇o2),8 although this measure is the recognized standard for confirming the physiologic effects of aerobic exercise training.

One approach that might allow training at a higher intensity, addressing the peripheral muscle deconditioning, is to partition the exercise to a smaller muscle mass while maintaining the same muscle-specific load. We have reported that patients with COPD achieved more work when cycling with one leg.9 Despite the same load being applied to the muscle, one-legged exercise placed the same metabolic and functional demands on the targeted muscle, at a lower total metabolic load, and hence a lower ventilatory load. The next logical step is to test the hypothesis that training using a one-legged technique, thereby increasing the muscle-specific stimulus, would induce physiologic changes sufficient to increase peak V̇o2. We report the influence of one-legged training on peak V̇o2 during incremental exercise compared with conventional two-legged training under identical conditions of training frequency and session duration.

Previous SectionNext Section

Materials and Methods

Patients

Inclusion required a diagnosis of COPD10 based on standardized spirometry,11 clinical stability, smoking abstinence, and willingness to enroll in an inpatient or outpatient pulmonary rehabilitation program that included supervised exercise, education, and psychosocial support. Patients were excluded if they were hypoxemic at rest (Pao2 < 55 mm Hg), had comorbidities that limited their exercise tolerance, or were unable to provide informed consent. After baseline assessments, patients were allocated to one of the two exercise training methods (one-legged or two-legged training) according to an unrestricted computer-generated randomization list. The study was approved by the West Park Healthcare Centre Research Ethics Committee.

Exercise Training

Both the one-legged and the two-legged groups followed the same training regimen, except that one-legged trainers used the first half of the session to train one leg, followed immediately by completing the session using the other leg. Patients allocated to the one-legged group cycled while resting their inactive foot on a crossbar located midway on the ergometer head tube (Fig 1 ). Two-legged trainers cycled continuously throughout the session. Training was performed on an electromechanically braked cycle (Collins CPX Bike model 0070; Warren E. Collins; Braintree, MA) while breathing room air. Supervised training sessions were scheduled for three times per week for 7 weeks. The intensity was intended to allow 30 min of continuous exercise excluding warm-up and cool-down periods. The intensity was set at 50% and 70% of the peak power (Ppk) attained on the baseline incremental test for the one-legged and two-legged trainers, respectively, and reduced as necessary to obtain at least 30 min of continuous cycling; therefore, during the first week of the program, patients trained at a mean of 40% Ppk for one-legged and 56% Ppk for two-legged training, respectively. When the exercise duration reached 30 min for three consecutive sessions the training workload was increased by 5 W. The goal was to train at the highest power that the patient could maintain for at least 20 min. If, at any time, the patient found the workload intolerable, it was reduced to its previous setting. All other rehabilitation modalities were similar.

…

One-legged cycling. The subject is shown (having given informed consent) pedaling with his right leg while resting his left leg on the crossbar, midway on the head tube.

Outcome Measures

… The load was set at 80% of the Ppk achieved on the baseline incremental test. Patients breathed ambient air during all tests.

…

Eighteen patients, 9 randomly allocated to each group, completed the study. Two patients withdrew: one allocated to the one-legged group, following an acute exacerbation; and the other patient, allocated to the two-legged group, was uncomfortable cycling. The baseline characteristics of each group are presented in Table 1 ; there were no significant differences between study groups. All of the nine patients allocated to the one-legged group could easily manage this technique after simple instruction from the trainer.

Patients Who Completed Training*

Exercise Training

Both groups significantly increased their training intensity (p < 0.001) over the duration of the training program (Fig 2 ), with no significant difference between groups in the progression of training intensity. Three of the nine subjects in the two-legged group progressed to a training intensity of > 80% Ppk; one of the nine subjects in the one-legged group progressed to a training intensity of 86% Ppk. Both groups significantly increased their total work per session (p < 0.001) over the duration of the program (Fig 3 ). The slope of absolute work vs training time was greater in the one-legged group than in the two-legged group (p < 0.05).

…..

One-legged cycle training required no specific learning, and patients found it at least as comfortable as two-legged training, likely because leg fatigue is better tolerated than dyspnea. One-legged training does not preclude other strategies to improve exercise tolerance, such as supplemental oxygen,202223 mechanical ventilatory assistance,24252627 or heliox.242829

Models suggest that a limitation in the exercising muscle contributes to the low peak V̇o2 in COPD patients.3031 In our study, peak V̇o2 during incremental exercise increased among the one-legged training group, and V̇e at submaximal exercise decreased.71932 Some of the observed differences between groups, such as the lower submaximal HR and the increased posttraining peak V̇e in the one-legged group, were unexpected.

…

Although the effect of one-legged cycling on constant power endurance time was large, it also increased in the two-legged trainers, which almost certainly prevented there being a significant between-group difference. Had one-legged cycling been compared to a control group who did not exercise, there would undoubtedly have been statistically significant differences in constant power endurance. The latter measure is quite variable36 and therefore requires a larger sample size than was included in this study.

To minimize any small bias that might be associated with the absence of blinding,8 we used standardized instruction and encouragement during the exercise tests and included a comparison group of two-legged trainers, who expected to experience a positive training effect. The changes in effort independent submaximal responses, such as HR, also supported the differences being attributable to a treatment effect. Within the spectrum of COPD patients, this training modality may be most effective among the more severely ventilatory-limited patients.

In summary, we report the effects of one-legged cycle training on aerobic capacity in patients with COPD. Compared with conventional two-legged cycling, there is evidence that one-legged training enhances the adaptive response of peripheral muscle, resulting in increased peak V̇o2, Ppk, and peak V̇e. A large prospective clinical trial will better characterize the ideal candidate and provide a sample size sufficient for this method of training to be assessed using more variable outcomes such as constant power exercise and health-related quality of life. Muscle-specific training should be considered in conjunction with other approaches that improve exercise capacity in patients with chronic respiratory conditions.

.…

Acknowledgments

The authors thank the patients of West Park Healthcare Center as well as Mika Nonoyama and Stefania Costi for help supervising the training sessions.

http://chestjournal.chestpubs.org/content/133/2/370.full.html

Thanks for reading…. Sharon O’Hara

Tweet This Post

The Action is Hot Lungs, Harrison and Exercise – Part 3 of 3

Sharon O'Hara

The Heart & Vascular Center at Harrison, Cardiopulmonary Rehabilitation is Ready to Go!

Good! Many of us can use help meeting our goals! How, when, where?

Mai-Lin Gonzales is Harrison Medical Center’s Interim Manager of Cardiopulmonary Rehabilitation – the first for Harrison. Mai-Lin is working to establish cardiopulmonary rehabilitation centers throughout Kitsap County…beginning with the established Capri Cardiopulmonary I went through over a decade ago – a great program then.

Following is what patients have to look forward to …because an exercise program can make the difference between existing and quality life living for most of us. Many studies have proved a great shining star of preventative medicine is exercise.

1. Where, when, time, type of equipment

Mai-Lin – We will be remodeling the current suite (Capri) 111 in the Bridgeview building during July. The equipment will be the same type of treadmills, bikes, nusteps, arm ergometers, etc. We will be purchasing them from CAPRI and integrating a few new pieces to make a complete set for our needs.

Me – I hope they add the recumbent elliptical stationary bike. The recumbent elliptical stationary bike is expensive but allows those of use with hip problems to exercise. I could not pedal the regular recumbent bikes but was placed on the recumbent elliptical. I could use it and over time with Anna Marx; I had magical results on it. Anna is at Silverdale’s Kitsap Physical Therapy.

2. Will a workout pool be available?

Mai-Lin – The pool at the YMCA will not be part of the maintenance program. The pool is for Y members only. It would be difficult to watch participants in the pool and on the upper cardio deck at the same time. I would be happy to pursue asking the Y to consider creating a time that the pool could be open for a rehab population but it would be separate from the Harrison programs.

3. Will maintenance rehab be available

Mai-Lin – Maintenance will be available in Poulsbo and Port Orchard (through Ultimate Fitness) and Silverdale and Bremerton (through Harrison) and Kitsap Physical Therapy has a program in place in Kingston. We are encouraging other community facilities to start maintenance classes for the cardiopulmonary population – hoping to find a fit in Belfair and Bainbridge to start with…

4. Is Harrison is interested in a DASH Diet related Support Group? Even those who have had gastric bypass surgery must be vigilant about regaining the weight lost through the operation.

Mai-Lin: I will pursue this after I get Rehab up and running.

5. Is Harrison interested in and have a use for my excellent like new condition recumbent trikes?

Maui-Lin – We are restricted on space, I will not have an answer for this until we are in the space and have the equipment laid out.

********************************

I have had one goal for six or seven years.

http://www.cleanairadventures.org/big_ride_across_america/route_map.html

This year is the first time I set a set date, 5 June to leave on a self-tour following the same route as the Big Ride.

A long list of mishaps, bone on bone left hip, lymphedema and fat body brought ne to 1 February 2011 when Marilyn Grindrod and I began our first swim coach session. Over a two or three-month period of remarkable physical improvement, I KNEW I could pedal and ride again.

The day Marilyn and I went out to ride the trikes for the first time – my absolute confidence in being able to pedal due to the increasing physical shape, muscling and range of motion I was getting thanks to the swim sessions was knocked to the ground and stomped flat. I could not do it.

That was then, now is now and we have begun again – twice a week – and I have a recumbent delta hand cycle that does work for me – no hip pain… more later.

A Florida Trike Shop owned and operated by physically challenged recumbent trike riders told me about the pedal pendulum. I bought two – one from them and one set from Dave. They work great on my trikes, but it does not work for me. I cannot do more than a lower half pedal – too much pain to bring my leg up and over in a full pedal. I can hear and feel the left hipbones rub when my leg is crested to move up and over. We will keep working at it.

The hard lessons here sometimes- let go and move on.

**********************

Sitting and early death.

“Too much sitting leads to early death. In a recent study from the Cooper’s Institute. The cardiovascular mortality outcomes related to sedentary behaviors of men after 21 years of follow-up showed an 82% greater risk of dying among men who reported spending more than 10 hours per week sitting in automobiles compared with men sitting in automobiles less than 4 hours per week (7).”

http://journals.lww.com/acsm-healthfitness/Fulltext/2011/01000/The_Problem_With_Too_Much_Sitting__A_Workplace.14.aspx?WT.mc_id=EMxj00x20110627xL3

Thanks for reading… Sharon O’Hara

Tweet This Post

Lymphedema, Bone on Bone Arthritis, COPD – Prayer, Predisone, Water Workouts Help Heal this Patient

Sharon O'Hara

Regular rehab is fabulous. But? It doesn’t go far enough – long enough – it hurts and it isn’t challenging enough.

Years ago, before beginning a concentrated physical exercise routine I asked my pulmo how high I should allow my heart rate to go and he sincerely and thoughtfully said I probably shouldn’t let it get over 100 at the beginning. I laughed and told him it shoots to 100 just getting up from a chair! I’ve not asked anyone since.

I’ve had a few really outstanding rehab technicians and I’ve learned from them. They have to follow rules though and I don’t. I’m a patient and I’m through coddling myself when I feel sick because I have a goal and it has to happen this year.

Except for one day when I was in Harrison and couldn’t make my swim session…we haven’t missed one swim session since we began 1 February 2011. No matter what, my legs can ooze, my lungs labor and wheeze or burn with a fever – nothing stands in the way of a swim session.

Marilyn Grindrod is my swim coach and a miracle worker. The only thing she said when we met and she asked if my doctor approved of what we planned to do and I told her I believed they did but I would not ever ask my doctors to give me a written note guaranteeing my fitness to exercise. They couldn’t. Nobody could. Marilyn nodded and said, “get in the water, let’s get started.”

She doesn’t say I can’t do something. She leads the way and I follow as best I can. Gradually I’m improving to a physical fitness I haven’t had in years and is proving out what Anna Marx, PT, DPT at Kitsap Physical Therapy in Silverdale proved to me: the right machine/exercise WILL help my left hip get better and manageable.

Marilyn also, by changing my work-outs and her focus on breathing, must be getting oxygen to areas that have suffered without the oxygen they’ve needed…such as the Lymphedema in my lower legs.

Melissa will be surprised when I have to go in to be measured for another set of support stockings. Lower leg muscle will meet her measuring tape, not the flab of yesterday.

My legs (left leg mostly) occasionally still need and get the Old Guy’s expert spiral and padded wrapping when the skin gets too painful and I know if we don’t catch it, the skin will crack and lymphatic fluid will again ooze out. This is the longest stretch I’ve not needed to see a doc or Melissa at NW Orthopedic and Lymphoma rehab in Port Orchard for another outbreak! Melissa’s patient education works.

My ideal week is four, one hour or longer sessions in the warm pool water. The work-outs are nonstop, smooth and I can feel my locked body become more flexible, more agile and I’m beginning to feel muscle again.

A couple weeks ago working out close to the diving board I impulsively reached up and grabbed the end of the board and began doing ‘chin ups’- shooting myself up out of the water and above the board to my chest, lowered myself and repeated 15 times. That was a lot of weight I pulled up – the point is I did it easily – the first twelve anyway.

So, you can’t live a life in the water can you? No. What I can now do on land is lift my left leg about a foot and flex my left ankle. They’ve been – sort of – frozen. When something hurts we have a tendency to back off and it becomes a spiral into a body that doesn’t work and eventually gets dumped into a wheelchair.

My patient opinion is that physical rehab works best, is most effective in the water. The warm pool water resistance gets us further faster with less pain.

I believe in miracles.

In a Pulmonary Function Test two months ago, 16 February 2011 my FEV 1 (Gold Standard for COPD) sats had dropped across the board: 35% – 31% – 29%.

Last week 6 April 2011 across the board they were: 56% – 50% – 48%

Christopher Goss, MD at the University of Washington Medical Center was amazed and doesn’t need to see me again for five or six months.

What made the difference? The longer non-burst of Predisone he extended? A miracle? Prayers? Serious water work-out by a professional swim coach?

My sister lives in a small town in Kentucky and goes to a Revival church. She and her companion each stood up and asked the minister and congregation to “pray for Karen’s sister, Sharon in Washington” and Karen says they do!

Kristin Okinaka, a reporter at the weekly CK Reporter AND a runner recently came out and wrote an article and took a photo that shows some of my recumbent trikes… http://www.pnwlocalnews.com/kitsap/ckr/news/119501909.html

The following article is what prompted this post today: If Great Brittan can do it – we can too!

“Exercise pilot is successful for rheumatoid arthritis

People with rheumatoid arthritis (RA) in Portsmouth reaped the benefits from an exercise pilot, which was the first of its kind in the UK.

Volunteers took part in a 10-week programme to get exercising in the local area. They had tried various activities, including yoga, tai chi, walking and circuit-based exercises.

‘Appropriate, regular exercise is very important for people with rheumatoid arthritis, even when they are experiencing a flare of their symptoms,’ said Colin Beevor, matron and service manager of musculoskeletal outpatient department services at Queen Alexandra Hospital, where the pilot was launched. ‘Being more active helps to control joint swelling and ultimately can reduce the pain, stiffness and fatigue a patient may experience.’

Rather than hospital-based exercise, local facilities were used to encourage participants to become accustomed to working out in a familiar environment. By learning the basics of a variety of activities, participants were also able to discover which forms of exercise they enjoyed the most, with a view to continuing with the exercise after the pilot ended.

Around 700,000 people in the UK have RA, and while many recognise the importance and benefit of exercise for their condition, obstacles such as the prohibitive cost of classes or feeling stigmatised or embarrassed in group classes can stop people with RA regularly exercising.

Local firms such as private gyms and sports centres are now being encouraged to offer discounts to people with RA to enable the participants of the pilot to continue their exercise programme….”

The pilot, run by Portsmouth Hospitals NHS Trust, Solent Healthcare and UCB Pharma Ltd, received positive feedback from participants. http://www.arthritiscare.org.uk/NewsRoom/Latestnewsstories/Exercisepilotissuccessfulforrheumatoidarthritis

More later…thanks for listening… Sharon O’Hara

Tweet This Post

Meet a COPDers Guru and Lifesaver Mark W Mangus, Sr. BSRC, RRT, RPFT, FAARC

Sharon O'Hara

Meet Mark and daughter, Kim, the Cystic Fibrosis girl who started it all and has helped countless thousands of COPDers from a life of medical ignorance.

First…Today I walked upright across the shallow end of the pool. No walking sticks or the normal hunched over posture and limp. I walked upright, my bone on bone left hip locked in muscle tightening of my left bun.

Awed and surprised, I walked back and forth three or four times.

Saturday, 5 February 2011 I walked upright through the water without walking sticks or a walker or floating. It was the first time in two or three years.

Today was my third session with Marilyn, a real swimming coach and I didn’t intend to mention it until much later but I’m still jazzed about walking the end of the pool.

Another time on what we’re doing and why – but what I do today goes back to my online support and advocacy group, EFFORTS and Mark Mangus, Sr.

Baby steps as Marilyn says … and reach beyond shortness of breath to improve according to Mark. YES!

********************

A problem I developed that I discovered at a family Thanksgiving some six or seven years ago was laughing hard gives me a splitting headache at the base of my head and I have trouble breathing– this from a person who rarely gets a headache.

I’ve never known why until I asked Mark recently. Following is my question and his answer. Additionally I asked him what made him stretch out so far beyond and disprove what medical sources ignored about COPDers. We CAN get better!

************************

“….You also just opened the door to something that bothers me whenever I laugh hard… the back of my head -occipital bone, I think- feels like its going to split wide open with the pain of a massive headache…something I rarely, ever, get. It is only in that spot and only when I laugh hard.

Why?

What can I do about it? Sometimes something tickles my funny bone so hard,

I can’t stop without great effort though pain is a great incentive to stop.

I used to laugh a lot, all the time…now I don’t want to.

What do you think?

COPD isn’t for sissies!”

*************************

“On 1/3/2011 8:59 PM, Mark Mangus wrote:

I would surmise that you are experiencing increased intracranial pressure
when you laugh and that it is backing up the blood in your brain. It could
be from a few different causes, not the least likely of which could be
attributable to increased right-heart pressures which would be transmitted
‘retrograde’ (backwards) through your jugular veins and to your brain,.
That slows drainage of blood from your head which is trying to make it back
to your heart and then your lungs. If you have increased pulmonary artery
pressure from long-standing hypoxia, that could easily cause such a
phenomenon.

In any case, it is most likely increased vascular pressure in your brain,
whatever the precipitating cause might be. Unfortunately, for you, laughing
seems NOT to be a ‘laughing matter’, in view of the unpleasant side-effects you suffer. Worse yet, there is likely nothing you can do about it, unless
you find oxygen use to be helpful in reducing or relieving the problem. It
is a tough problem, no doubt. I’m sorry you experience it! Laughing ‘can’
be so therapeutic under better circumstances!”

Mark W Mangus, Sr. BSRC, RRT, RPFT, FAARC

San Antonio, TX

mmangus52@gmail.com

*****************

This post is about an RRT extraordinary, Mark W. Mangus, Sr., BSRC, RRT, RPFT, FAARC individual. It was reading his posts in my online COPD support and advocacy group that helped me understand that we could help ourselves through exercise – going beyond what any doctor would prescribe for a COPDer.

His championship of patients going beyond – way beyond what they think they can do and the support of EFFORTS’ites are probably a key reason I’m still going today – start and stop though it’s been over these years of piling on medical conditions – since I was hospitalized at Harrison in 1997.

COPDers aren’t helpless – even though we’ve now progressed to the third leading cause of death in the United States and fifth leading cause of death in the world.

Meet an extraordinary dad, Mark and the girl who started it all, daughter, Kim.

*****************

“You asked me to speak to how and why I’ve become such an advocate for patient education – there are several reasons and influences.

First, when I became an RT, instead of pursuing medical school and an MD, I decided that my life’s quest would be to become the best RT I could and hopefully, with hard work and a bit of luck, along the way, to ultimately be considered one of the top RT’s of my era. Now that’s pretty ambitious and can be construed as a bit cocky. But, as with most all who enter the health care profession, I believe we all have a desire and even a calling to ‘help our fellow man’ and to try to be the best we can be. At least, we start out that way, for the most part In our particular positions, we choose to do that through delivery of health care and to foster better health.

Dr. Thomas L Petty is one of my great heroes and a source of greatest inspiration. As a pioneer in so many aspects of pulmonary medicine, he was not afraid to take on daunting projects and challenges, many of which resulted in our ground-level information on some of the most important lessons we’ve learned about pulmonary physiology and disease to date. I also decided that to become the best RT I could envision, I had to go beyond the simple boundaries of standard RT education. So I have studied extensively to include medical knowledge beyond the boundaries of RT. As a corpsman in the USAF, I was exposed to many non-respiratory aspects of disease and its treatment. Being assigned to Wilford Hall Medical Center, the Air force’s premier institution in the world, at the time, I also was given opportunities for training and experience that I would not have been afforded anywhere else.

So, I have to say I’ve been fortunate to have been in the right place at the right time many times in my career, with regard to training opportunities and those who have taught and mentored me along the way. I have had the opportunity to learn much that other RT’s never get a chance to experience. Having participated in what was the pilot program for physician’s assistants while I was in the Air Force, I was given training and opportunities that are simply not a part of RT training. That has given me an edge that others have not had opportunity for. I was one of a group who were present and part of studies in what was at the time, cutting edge respiratory research and received unique training and experience during that period, again, not available to RT’s then or in the same scope for years after those early days. That training and experience instilled in me the realization that I had been given a special gift; one which I was compelled to build upon and utilize to the best benefit of people I could.

With the birth of my daughter and the discovery of her affliction with Cystic Fibrosis, I both realized the extent of the blessing of knowledge I had gained, in being the one who, while others were pooh-poohing my suspicions, indeed diagnosed her as having the disease. That came through having had the good fortune to work with the disease for two years before she was born and to work to learn more and understand the disease sufficient to recognize and suspect it before any obvious signs had manifested. This was actually a bittersweet realization of the knowledge I possessed at the time, as it included both the angst and horror of learning of her problem and the gratitude for knowing enough to discern it before she suffered any serious effects of the disease. Treatment was started quickly and my wife and I set out on what has become a 29-year journey to give her the best care and advantage in life possible. That has, as you know, included two double lung transplants in addition to the many events over the years preceding her first transplant.

When I was asked to take on the task of formulating the first comprehensive pulmonary rehabilitation program, I felt like a fish out of water. To that point, my understanding of COPD was very mainstream; ‘you simply can’t do anything with folks whose lung function has gone south as it does when COPD advances’. Yet, I chose to look at it with an open mind in an effort to try to learn “why” their plight was so ‘dead-end’ and hopeless and to ‘maybe’ find a way to make the inevitable easier for them and even help them to find a better way to live within those conditions they could not change. Today, I am ecstatic to acknowledge how wrong I was back then, along with the majority of others in medicine, having been taught some of the greatest lessons of my career during these past 25 years of study and work in pulmonary rehabilitation and ‘disease management of lung diseases’.

The more I dug into COPD, the more I learned that most everything about the disease was “theoretical” knowledge that had not been supported by evidence-based study. As I learned more about what was empirically known, I increasingly saw the incongruities and contradictions in the real world to what was presumed gospel knowledge about lung disease. Then along came lung transplantation and then LVRS and the advances in medications and research into cause and effect. The undeniable truths and tragic fallacies about COPD and other lung diseases became glaringly apparent.

\Unfortunately, too many of those in health care, continued – and still continue – to hold to false ideas about what can and should be done about lung disease and how to improve life with these diseases. So, I joined Dr. Tom and the many others who ‘crusade’ for a better lot in life with COPD. And, because there is still such disparity and nilistic attitude toward COPD, in particular, added to the fact that as with several other kinds of chronic ailments, patient knowledge and ‘active’ participation in their own care have demonstrated improved living, longevity and reduced infirmity with chronic disease, I long ago decided that I had to play a leading role in my capacity to educate patients and bring them “into the loop” of their own care, even to the chagrin of many health care professionals – yes; including “doctors”!

So, for the last 20 years, I have become increasingly involved in the educational front on a widening scale to the international stage. I join a host of others in our effort to do our part, simply because it’s the ‘right thing to do’. It’s not for fame or financial gain, though that is always nice, if it comes with helping folks. Lord knows, I’ve not become a rich or even modestly wealthy man in my endeavors. That’s OK with me. I have what I need and can look back with satisfaction knowing what I have contributed. And I can look ahead to what still needs to be done. That’s my focus and my ongoing quest.

Would I like to see ALL RT’s hold the same outlook and attitude? SURE! But, I, too, have read Plato in my studies of many years ago. And I understand that there is no “Utopia” in the ‘real world’. Nevertheless, as I endeavored to explain and encourage in the chapter I contributed to Dr Tom’s last book: “Adventures of an Oxyphile2”; a chapter written for RT’s and about RT’s, I hope I can help at least some of my colleagues become better than they might otherwise have been, had they not encountered me in some way.

Photo taken at Kim’s graduation party when she finished her BSRC degree August 2010.

Thank you Mark and Kim!

More later… Sharon O’Hara

Tweet This Post