Texas Association of Cardiovascular and Pulmonary Rehabilitation A

Texas Association of Cardiovascular and Pulmonary Rehabilitation A Message From Your President Welcome to Fall! The weather has cooled somewhat and I’m starting to see some color changes in the leaves. I love this time of year. I hope everyone made it through Hurricane Ike safely and that you’re able to be back in your home if you were forced to evacuate. This newsletter is filled with information that will hopefully be useful to you in your day-to-day work. Enjoy all the articles! The annual AACVPR conference was held September 18 th – 21 st in Indianapolis, Indiana. Four of our board members were able to attend. Barbara Flato, Julie Hartman, Erika Abmas and Danielle Strauss all had a great time networking with others and gleaning ideas from other states. Jenny Adams and Laura Raymond also attended. Julie and Laura received their Fellow awards at the conference. Congratulations!! Barbara lectured on Outcomes and how this applies to the certification/recertification process. She plans to present this same material at the state meeting for those of you who may be looking at certifying or recertifying your program. Jenny, Julie and Danielle submitted a poster presentation. Several of these ladies are also on AACVPR committees and attended committee meeting while there: Julie attended the Education Committee meeting, Danielle attended the Research Committee meeting, Barbara went to the Certification Committee meeting, Laura Raymond attended the State Certification Committee Chair Luncheon. Julie and Erika also attended the Reimbursement Meeting. We appreciate all the hard work done at both state and national levels by these individuals. We currently have 197 members and are looking forward to seeing each and every one of you at the Crowne Plaza Houston North Greenspoint for the 19 th annual TACVPR conference to be held April 3 rd and 4 th. I’ve checked with the hotel and they sustained almost no damage from the hurricane. In fact, they were only without electricity for one day. Good news for us! We are continuing to confirm speakers and hope to have another very successful conference. Enjoy the changing of the season as we head into cooler and shorter days. Be careful not to load yourself with too many stress-inducing projects as the holiday season approaches. Have a Happy Fall! Marilyn Burwitz, RN TACVPR President Do You Know Anyone Interested in Joining TACVPR? To join or renew your TACVPR membership you may sign up online or download a printable membership application at www. tacvpr. org Fall 2008 Newsletter Annual dues are $40/person (membership is good January-December yearly) www. tacvpr. org

Save the Date - 2009 TACVPR Conference We Struck It Big: (Cardiac & Pulmonary Act of 2008) It’s Now Law! April 3 rd & 4 th, 2009 Houston, TX Plans are underway for the TACVPR 2009 conference. The conference will be held at the Crowne Plaza in the Houston North Greenspoint area on April 3 rd & 4 th, 2009. The hotel has recently completed a $13 million renovation. Hope you’re planning to attend! Speaker Topics We have confirmed a number of speakers who will talk on a variety of topics for both the cardiac and pulmonary professional. Some of the speakers include: ►Dr. Marjorie King, FAACVPR, Past President of AACVPR ►Dr. Nicola A Hanania, MD, FRCP©, FACP, FCCP, Ben Taub General Hospital, Director, Adult Asthma Clinic /Pulmonary Diagnostic Laboratory, Houston, Baylor Professor of Medicine Pulmonary / Critical Care Medicine Director, Asthma Clinical Research Center ►Douglas Paddon-Jones, Ph. D, Associate Professor at the Department of Physical Therapy, Allied Health Sciences and Department of Internal Medicine, Division of Endocrinology at the University of Texas Medical Branch in Galveston ►Jenny Adams, Ph. D, Research Associate, Baylor Jack & Jane Hamilton Heart & Vascular Hospital Friday Social Once again we will be hosting a Friday night social. It has continued to be one of the highlights of the conference and we hope it will be again at this year’s conference. It is a great opportunity for those who are looking for some additional networking time, or if you just want to relax and enjoy the evening with your rehab friends! AACVPR Conference 2008 Jenny Adams, Danielle Strauss & Julie Hartman with their Poster Presentation Fall 2008 Newsletter Laura Raymond & Julie Hartman received fellow awards www. tacvpr. org

What’s New on the Reimbursement Front By: Twyla Selvidge, MS East Texas Medical Center Regional Health. Care System The best news EVER for Cardiac & Pulmonary Rehabilitation! On July 15, 2008 Congress passed H. R. 6331: the Medicare Improvements for Patients and Providers Act of 2008, now Public Law 110 -275. This law creates a specific benefit category under XVIII and XIX of the Social Security Act. The new law addresses Cardiac and Pulmonary Rehabilitation and takes effect on January 1, 2010. The significance of the new provision is that Medicare beneficiaries who have a clinical need for cardiac or pulmonary rehab services should have timely access to formal rehabilitation programs. In the past, the Centers for Medicare and Medicaid Services (CMS) have had discretionary authority on many of the key decisions regarding coverage of these services. Because of this, there has been inconsistencies in patient access and inconsistencies within the services covered by Medicare, more so with Pulmonary Rehab, across the country. CMS has long recognized Cardiac Rehabilitation programs as a covered service, but according to the Centers for Disease Control and Prevention and numerous researchers have repeatedly emphasized that the service is dramatically underutilized, resulting in suboptimal clinical care for patients with CAD. As a result, costly, life-threatening recurrent cardiovascular events that can be potentially reduced with the appropriate and timely use of cardiac rehab services still cost patients with or without insurance benefits. For Pulmonary Rehabilitation, the new law will require CMS to provide national coverage of rehabilitation services when medically indicated by the patient’s physician. As the TACVPR is updated by the AACVPR regarding the enactment of this law, we will update you as well. This is truly exciting news for us. The efforts to improve the access for Cardiac Rehab has been about a 10 year effort for those of us providing the service. Who knows, with this law, more hospitals may have to provide these services for their patients. CMS: LCD: NCD: MAC: ACC: AHA: AACVPR: Fall 2008 Newsletter What’s That? Centers for Medicare and Medicaid Services Local coverage Determination National Coverage Determination Medicare Administrative Contractor American College of Cardiology American Heart Association American Association of Cardiovascular & Pulmonary Rehabilitation www. tacvpr. org

Whole Person Wellness By Tresa Anderson, RT Health is a state of complete physical, mental and social wellbeing, not merely the absence of disease or infirmity. Many would add to this definition of health a spiritual component that encompasses “self worth, morals, higher values and purpose. ” This is referred to as holistic medicine, since the concept of health includes the whole person: physical, mental, social, and spiritual. There are changing views of health care and health needs. Professionals in the field have realized a growing need in the standard of Pulmonary Rehabilitation to include and reflect a growing awareness of the interaction of the mind, body, and spirit. While the focus of a Pulmonary Rehab program is to restore and promote better lung health. The responsibility for it is shared between staff and patient. It is the interaction of the physical, mental, and spiritual aspects of the patient that contribute to health or disease. Fundamental to treatment is the medical care, technology, and medication that a patient receives to manage their pulmonary disease. We recognize that these alone cannot fulfill all of their needs as they learn to deal with changes that are a result of their lung disease. A patients' lifestyle can always be improved, much of our programs focus on lifestyle modification techniques. These efforts are concentrated in the areas of physical training, stress management, and nutrition. These are the aspects of a patients life that they are in control of, and when positive changes are made it will greatly affect their ability to cope and make changes that they might need to improve their overall level of functioning. It is true that all of us would like to be able to do what we want, when we want. Unfortunately we all must learn that there are many factors that impose limitations. How we deal with these limitations helps determine how happy, productive and pleasant our lives are. Fall 2008 Newsletter www. tacvpr. org

Is it a Cold or is it the Flu? Whichever it is…What Should I Do? By Nita Pack, RRT A common cold is an illness caused by a viral infection located in the nose. Colds involve the sinuses, ears, and bronchial tubes. Colds last for an average of one week. Mild colds may last only two or three days while more severe colds may last for up to two weeks. Adults average two to three colds per year and children six to ten, depending on their age and exposure. Children’s noses are the major source of cold viruses. There are over 100 cold viruses. Rhinoviruses cause at least one half of colds. Cold symptoms usually develop anywhere from one to three days after the virus enters your body. Cold viruses infect only a relatively small proportion of the cells lining the nose and can only multiply when they are inside a living cell. When on an environmental surface, cold viruses cannot multiply. However, they are still infectious if they are transported from an environmental site into the nose. Cold symptoms are mainly due to the body’s response to the infection. A stuffy or runny nose, sore or scratchy throat, sneezing and coughing are usually signs of a cold. More rare symptoms associated with a cold are fever, headache, general aches and pains, fatigue and weakness. Complications are sinus congestion or infection, or earache. Treatment is mainly temporary relief of the symptoms. Nasal decongestants to unclog a stuffy nose. Cough suppressants to quiet a cough. Expectorants to loosen mucus so you can cough it up. Antihistamines to stop a runny nose and sneezing. Pain relievers to ease fever, headaches, minor aches and pains. Influenza is commonly called “the flu”. It is caused by the influenza virus, which infects the respiratory tract, (nose, throat, lungs). The flu is spread easily from person to person when an infected person coughs, sneezes or talks and the virus is expelled into the air. The virus is then inhaled by someone else, and the flu begins. The influenza virus thrives during the winter months when most of the population is indoors in close proximity. This allows for the virus to be easily spread. The incubation period after exposure is one to four days with an average of two days. A person is considered contagious from one day before the symptoms begin until approximately five days after illness onset. Flu symptoms are the same as a cold, however, there is also a characteristic high fever that lasts three to four days, a prominent headache, usually often severe aches and pains, early and prominent extreme exhaustion and usually chest discomfort. Flu can lead to bronchitis and pneumonia which may be life threatening. Continued on next page Fall 2008 Newsletter www. tacvpr. org

Is it a Cold or is it the Flu? Whichever it is …What Should I Do? (cont. ) Treatment is the same as for a cold with the exception of the availability of some Antiviral medicines. One of the main things that can be done is to get the annual flu vaccine. The vaccine protects against the projected types of virus causing the flu for the current flu season. Any one over the age of 65, any one who has a decreased immune system (or persons working with these people), and/or any one with a chronic disease process (lung, kidney, heart, diabetes, etc. ) should get a flu shot each year. Flu vaccines cannot give you the flu. Most people have little or no reaction to the vaccine. One in four might have a swollen, red, tender area at the injection site. A much smaller number of people may develop a slight fever, chills or a headache within the first twenty four hours. Adverse reactions are seen in people with allergies to eggs. Whether it’s the flu or a cold, here are some general guidelines for keeping it away: • • • Wash your hands often. Remember, cold viruses are picked up from objects and can be passed to the eyes or nose easily Keep at least three feet away from coughers and sneezers. If you are in a closed in space (like an elevator) with a cougher, turn your back or get off and on another elevator Beware of closed in spaces. Poor air circulation and low humidity in homes and office buildings in the winter harbor viruses Drink plenty of fluids Eat a healthy diet Keep active. Walking, dancing, or cycling three times a week is all it takes to enhance your resistance to upper respiratory tract infections Treat only the symptoms you have. (Cough – cough suppressant, congestion – expectorant, etc. ) Be sure you are getting enough vitamins. A multivitamin daily is usually sufficient. Eating plenty of fruits and vegetables also helps Get plenty of sleep Get your flu shot each year Texas Members Serving on AACVPR National Committees We want to recognize our TACVPR members who serve on national committees and thank them for dedicating their time help Texas to become more involved with AACVPR. Cheri Duncan, RRT – Reimbursement Committee Barbara Flato, MSN, RN-BC, FAACVPR – Certification Committee Julie Hartman, MS, FAACVPR – Education Committee Poppy Patterson, RN, BBA – Certification Committee Laura Raymond, RN, FAACVPR – Chair of State Certification Committee Danielle Strauss, BSN, RN-BC – Research Committee you are interested in serving on an AACVPR committee, visit www. aacvpr. org for more information. Fall. If 2008 Newsletter www. tacvpr. org

Commotio Cordis, What is it? By Danielle Strauss, BSN-BC, RN Many cardiovascular and pulmonary professionals are familiar with the term sudden cardiac death (SCD). An unpredictable lethal arrhythmia in a middle or older aged person, where the outcome is death is what presents to the mind. However, many cardiovascular professionals may not have learned about commotio cordis (CC), a type of SCD that affects sports participants younger than 16 years old. The purpose of this article is to increase awareness of this type of rare SCD event. “Commotio Cordis may be defined as blunt thoracic impact without any observable thoracic or cardiac damage. CC is the second leading cause of death in youth sports, taking the lives of 85% of those afflicted” (Dau et. al). This process occurs from a chest wall impact that occurs in a 10 -30 ms vulnerable window during cardiac repolarization, corresponding to the upstroke of the T-wave on electrocardiogram. Rapid rise of left ventricular pressure following impact directly over the heart results in SCD due to induction of ventricular fibrillation mediated through resultant myocardial stretch and activation of stretch-sensitive ion channels (Dau et. al). This represents only 1% of the cardiac cycle. There are potential dangers for young athletes during rigorous sport activities including karate, baseball catchers, lacrosse and hockey goalies. Parents and participants should take the necessary precautions to prevent such trauma. It is imperative to include chest padding as a barrier to projectiles. However, a recent study performed with animals showed that using chest protection was ineffective in protecting against ventricular fibrillation due to chest blows. Conclusions from this study recommend a change in material and improved design in such equipment. The survival rate is very low even with the performance of CPR and immediate external defibrillation. Young athletes affected by CC do not have a history of congenital or preexisting coronary heart disease (Pigozzi and Rizzo). If there are young sport enthusiasts in your family, please caution and educate the coach and team on this tragic element of SCD. References: Evaluation of Injury Criteria for Predicting Commotio Cordis, Dau et. al JAMA, Clinical Profile and Spectrum of Commotio Cordis, vol. 287 No. 9, March 6, 2002 Sudden Cardiac Death in Competitive Athletes, Pigozzi F. and Rizzo M. , Clinics in Sports Medicine, Vol. 27, issue 1, January 2008. Fall 2008 Newsletter www. tacvpr. org

Are you Ready for Some Football Food? ? ? Enjoy These Recipes at Your Next Tail Gate Party Bourbon Grilled Chicken 4 boneless, skinless chicken breasts 2 T olive oil 2 T Dijon mustard ¼ cup bourbon whiskey 2 T red wine vinegar 2 T Worcestershire sauce 1 T light soy sauce ¼ cup brown sugar 2 garlic cloves, minced Black pepper Combine olive oil and next 8 ingredients. Add chicken, cover and refrigerate for at least 2 hours. Remove chicken from marinade. Grill over medium heat for 15 -20 minutes turning once. Grilled Mexican Corn on the Cob 4 cobs of corn 2 T of light butter or margarine 4 lime wedges ½ cup cotija cheese, crumbled Cayenne pepper to taste First, clean that corn! Cut off excess silk hanging from the end and remove loose husk. Completely submerse all of the corn you will be cooking under water. This will provide extra moisture for cooking. Let the ears of corn soak for at least 15 minutes prior to cooking. Remove the corn from the water and pour out any excess. Place the corn on the grill and cover. If you are using a gas grill, keep the heat on med-high and turn the ears every 5 minutes. If you don't turn them enough, the corn will char. Cook for about 15 minutes. When done remove the corn from the grill and remove the husk. Rinse to get rid of any excess ashes or husk. Squeeze one lime wedge on each ear of corn. Smear on butter. Lastly sprinkle the cheese and cayenne. Fall 2008 Newsletter www. tacvpr. org

IN OTHER NEWS… ATTEND THE UPCOMING NTACVPR MEETING Tuesday, November 11, 2008 Location & Speaker: TBA Looking for a job in Cardiac or Pulmonary Rehabilitation? Visit the “Job Opportunities in TX” tab on the TACVPR website at www. tacvpr. org Is Your AACVPR Membership Up to Date? AACVPR membership dues expired June 30 th – Don’t forget to renew! Membership fees: $185 Member/Associate Member; $75 Student Go to www. aacvpr. org to join or renew your membership Fall 2008 Newsletter www. tacvpr. org

NG I OM ARS C UP IN M SE Fall 2008 Newsletter www. tacvpr. org

2008 -2009 TACVPR Board of Directors Board Officers President: Marilyn Burwitz, RN East Texas Medical Center Fairfield President-Elect: Dean Diersing, MS University Medical Center, Health Point Fitness & Cardiac Rehab Past President: Julie Hartman, MS, FAACVPR THE HEART HOSPITAL Baylor Plano Treasurer: Twyla Selvidge, MS East Texas Medical Center Secretary: Nita Pack, RRT Methodist Charlton Medical Center Board of Directors Erika Abmas, RRT Baylor University Medical Center Tresa Anderson, RRT Shannon Medical Center Barbara Flato, MSN, RN-BC, FAACVPR CHRISTUS Spohn Cardiac Rehab Lorri Lee, BS, RCEP Mc. Kenna Memorial Hospital Poppy Patterson, RN, BBA Hillcrest Health System Danielle Strauss, BSN, RN-BC, BS Baylor Jack & Jane Hamilton Heart & Vascular Hospital Interested in serving on the TACVPR Board of Directors? Contact Julie Hartman at julie. hartman@baylorhealth. edu for more information. Fall 2008 Newsletter www. tacvpr. org