While World Lung Day on 25 September has come and gone, lung health is still something which needs to be considered.

Taking care of your lungs is now more important than ever. If the past few years have shown us anything, it’s how we take breathing for granted.

Breathing is a function we need to survive but because it is involuntary, it is easily overlooked. To know if you have healthy lungs, the best thing to do is to consult your doctor or pulmonary specialist.

However, most people who have lung problems will already know that they get short of breath very quickly, have tight chests or battle with breathing in general.

Poor lungs or bad breathing habits lead to low energy, slower metabolism and poor sleep. Steven Sadie, managing director at Airofit SA, gave some pointers on better lung health and breathing.

“The best way to increase lung health is to stop bad habits and immediately start breathing exercises and RMT [respiratory muscle training],” he said.

The World Health Organisation (WHO) said the following about RMT: “Increasing exercise and fitness can be aided by RMT. RMT can improve breathing through reducing the effort required by the body as it breathes.

Inspiratory muscle training (IMT) is facilitated through the loading of inspiration, normally by using a breathing device.”

Sadie added: “We have had post-Covid patients down and out for months not able to recover who, once they start training their lungs, are able get back to normal in no time.”

Lung capacity can be measured as the full amount of gas in the lungs after a full inspiration – but normally measured on your expiratory amount.

Over time, our lung capacity and lung function typically decrease slowly as we age after our mid-20s. “There are many exercises such as diaphragmatic breathing – or “belly breathing” – to engage the diaphragm, and pursed lips breathing, said Sadie.

There are other options for breath training such as making use of the PEP flute, he added. You can live three weeks without food, four to five days without water but most people can’t live for more than a few minutes without breathing.

“So putting some time and effort into lung health makes sense,” said Sadie.

“By just spending five to 10 minutes a day exercising, you will have all you need to make a huge difference in your life. The biggest bonus is that you do not do this while running, at the gym or under duress, you do this calmly in your own home sitting on the couch.”

ALSO READ: Cleaning products can affect lung health in women but not men

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Richard Dick D. Brandes

Richard (Dick) D. Brandes, 83 years old, of Jefferson Township, passed away on Sept. 27, 2022.
Dick was born in Wellsville, N.Y., to Walter A. and Medora Rose (Lish) Brandes.
Dick attended Cornell University, before working for Agway Energy Products for 43 years.
On Jan. 28, 1961, Dick married Patricia Ann Mills, and during his career they moved to a dozen locations.
During that time Dick enjoyed volunteering and a life of service.
He volunteered for the Boy Scouts; was Explorer Advisor, and President of the PTA while in Vestal, N.Y. He was a baseball coach for the Boys Club in Endicott, NY. He also served on the Executive Board of the Boy Scouts in Honesdale, PA.
Dick was a past member of the Kiwanis and Lions Clubs in multiple locations. He was active in local and Mercer County politics, serving as treasurer and chair of the election committee; and served as the Chair of Jefferson Township Supervisors for 20 years. Richard also served on the Council of Government for 20 years, many years as President. He also served as President of Mercer Co. Assoc. Of Township Officials, and on the Storage Tank Advisory Comm. for DEP in Harrisburg, PA. He also volunteered at Sharon Regional in the pulmonary rehabilitation to help others that went through lung reduction surgery.
No matter where he lived, he cheered for his much-loved Buffalo Bills and always enjoyed playing cards with family and friends.
Dick is survived by 2 children, Jeff (Stacy) Brandes, Mercer, and Jamie Brandes of Gansevoort, NY; 5 grandchildren, Gen Brandes, Culpeper, VA; Gillian Brandes, Stuart's Draft, VA; Morgan (Matt) Varney, Philadelphia, PA; Paige Rosenberger, Philadelphia, PA; Mitchell Rosenberger, Gansevoort, NY; and one great-grandson, Hudson Varney.
Dick is also survived by 2 sisters, Betty Gallman, Bradford, PA; and Judy (Richard)Reuning, Columbus, OH; sister-in-law Connie Brandes, Wellsville, NY; and many nieces and nephews. Richard was preceded in death by his wife "Trish", parents, his brothers, Joseph and Robert and brother in-law Al.
Memorial contributions made to the Jefferson Township Fire Department would be appreciated.

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For those who aren’t familiar, respiratory therapy is a discipline that involves caring for patients with breathing problems. They assess, diagnose, treat and manage patients with respiratory conditions, such as asthma and cystic fibrosis. Respiratory therapists also work with patients who have sleep apnea, lung cancer, and other respiratory diseases. They work in many settings, including the critical care unit of a hospital, assisting patients who are on a ventilator. Respiratory therapy is a growing field that offers the opportunity for a meaningful career where you can earn a good living. If you want to learn more, read on to find out about the benefits of a respiratory therapy degree.

What are the benefits of a respiratory therapy degree?

There are many benefits to earning a degree in respiratory therapy, but you should also consider online respiratory therapy programs. Online programs offer students the flexibility to complete their coursework on their own schedule, which is ideal for working professionals. Online degree programs also typically have accreditation from the Commission on Accreditation for Respiratory Care (CoARC), which is the gold standard in respiratory care education. While an on-campus education may be preferable for some students, there are real advantages to online learning.

Perhaps the most obvious benefit of earning your degree in respiratory therapy is that it will offer you a wealth of opportunities for career advancement. With a respiratory therapy degree, you can work in a variety of settings, including hospitals, clinics, and home health care. You can also pursue specialized roles within the field such as critical care respiratory therapist or pulmonary rehabilitation therapist. Additionally, respiratory therapy degrees are in high demand, so you are likely to find plenty of employment opportunities once you graduate.

Respiratory therapists enjoy above-average salaries and excellent job security. The median respiratory therapist’s salary is $61,830, but top earners can make significantly more. The industry is also projected to experience 14 percent job growth over the next decade, which is much faster than the average for all occupations. This is explained by the fact that our aging population is increasingly in need of respiratory care. In addition, the rise in asthma and other respiratory illnesses h.as led to a greater demand for respiratory therapists.

How can you prepare for your degree program?

Whether you choose an online program or not, you will need to have a quiet place to study when you have work to do. Pick a room in your house that is quiet and free from distractions. This could be a bedroom, home office, or even the living room. Make sure you have everything you need in your study zone, including a desk lamp, textbooks, a computer, and a notepad and pen. You could also invest in decor so you feel comfortable in the space. Plants make a perfect addition to any study spot or home office, as research has shown that can improve your mood, boost focus, and alleviate stress.

Time management is one of the most valuable skills that students can learn. One of the best ways to improve your time management skills is to create a schedule and stick to it. This means setting specific times for studying, homework, socializing, and relaxing, and then making a concerted effort to stick to that schedule. Of course, life can sometimes get in the way and you may have to adjust your schedule accordingly, but you will see improvement if you’re consistent. If there are big tasks that seem overwhelming, try breaking them down into smaller, more manageable tasks. This will make the task seem less daunting.

As you can see, becoming a respiratory therapist can be a smart and deeply fulfilling career choice. Respiratory therapists play a vital role in assisting patients who are struggling with breathing problems. They work with patients of all ages, from newborns to the elderly, and can help treat many respiratory conditions. What’s more, respiratory therapists are in high demand, and can typically find employment in a number of settings, including hospitals, clinics, and long-term care facilities. Earning your degree in respiratory therapy is more accessible than ever, you can even look into online degree programs that allow you to work from home. Follow this advice and you’ll be well on your way to a successful career as a respiratory therapist.

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Global Airway Clearance Devices System Size is anticipated to be valued at US$ 589.3 Million in 2022, forecast to grow at a CAGR of 6.2% to be valued at US$ 1,137.8 Million from 2022 to 2032. Airway clearance devices systems are used to remove excess mucus from lungs. The excess production of mucus is a common feature in the COPD (chronic obstructive pulmonary disease) and it leads to accumulation of mucus in the air way. It results in the coughing, wheezing, chronic bronchitis, emphysema and shortness of breath.

There are few types of airway clearance devices system, namely: positive expiratory pressure devices, intrapulmonary percussive ventilation, oral high-frequency oscillation, high-frequency chest wall oscillation, flutter devices, and incentive spirometry. Positive expiratory pressure devices is an alternative to conventional physiotherapy, and it consists of the one-way valve to which expiratory resistance is applied.

Intrapulmonary percussive ventilation devices combine internal thoracic percussion and aerosol inhalations. Oral high-frequency oscillation is worked on the principle of high frequency and low volume of oscillations, and it is developed from the technique of jet ventilation with high frequency.

High-frequency chest wall oscillation devices is a mechanical device which works on the principle of positive pressure air pulse on the lungs by means of air pulse generator and inflatable chest. Flutter devices is a combination of high-frequency oscillations with positives expiratory pressure therapy. Incentive spirometry is used to measure inspiratory effort by using air volume and air flow.

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Airway Clearance Devices System Market: Drivers and Restraints

Conventional methods like chest physiotherapy used for bronchial drainage in different types of respiratory dysfunction. However traditional chest physiotherapy is time-consuming and labour intensive both for non-hospitalized and hospitalized patients. On the counterpart, airway clearance devices systems increasing the compliance with patients and is the less time-consuming process.

Reduced cost and independent application are other reason for changing the preference of patient population from conventional chest physiotherapy to airway clearances devices system market. All these factors influencing the burgeoning growth of the airway clearances devices system.

Others factors like decreased respiratory complications and demand for devices over conventional methods drives the growth of the airway clearance devices system market. Limited availability of evidence based data for effectiveness of devices act as a restraint on the growth of the airway clearance devices system market

Airway Clearance Devices System Market: Market Overview

Global Airway Clearance Devices System market has witnessed a robust growth due to increasing demand due to improving respiratory drainage and reduced infections. Airway Clearance Devices System market has a presence of many regional players which have a huge market share in emerging countries operating at regional or country level.

The future of Airway Clearance Devices System market anticipated with double CAGR during forecasting period.

Airway Clearance Devices System Market: Region-Wise Overview

Global Airway Clearance Devices System market segmented into following regions North America, Latin America, Western Europe, Eastern Europe, Asia-Pacific, Japan and the Middle East and Africa. North America is dominant in the Global Airway Clearance Devices System market mainly due to increased acceptances by patient population.

In North America, particularly the USA is dominating due to the high penetration. Economic conditions in the APAC region are set to drive the Airway Clearance Devices System market to new heights. European and APAC are fastest growing region due to rising awareness of Airway Clearance Devices System Market.

Growth in the Middle East and African region is considerably less when compared to the other regions. However, North America would maintain its position in the Airway Clearance Devices System market, though, we are anticipating emerging economies such India, China, Brazil, to have the highest growth rate in Airway Clearance Devices System market.

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Airway Clearance Devices System Market: Key Participants

The key participants in the Airway Clearance Devices System market mainly include Monaghan Medical Corporation, Koninklijke Philips N.V., Vortran Medical Technology and others. Companies are mainly focused on R&D to strengthen core competencies of the company’s product portfolio.

The research report presents a comprehensive assessment of the market and contains thoughtful insights, facts, historical data, and statistically supported and industry-validated market data. It also includes projections using a suitable set of assumptions and methodologies. The research report provides analysis and information according to market segments such as geographies, application, and industry.

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DALY CITY – San Mateo County Supervisor David Canepa announced that he has sent a letter to California Attorney General Rob Bonta urging him to investigate Sutter Health’s use of federal CARES Act dollars. The not-for-profit health care giant received $853 million in CARES Act funding, yet closed the Mack E. Mickelson therapy pool, the only warm water rehabilitation facility of its kind on the Peninsula.

“The federal CARES Act of 2020 was passed for the express purpose of keeping vital medical and community resources like the Mickelson therapy pool open during the COVID pandemic,” Canepa said. “Yet despite receiving nearly a billion dollars in funding, Sutter closed the pool. For many, the therapy pool was the only way to ease their pain and have a decent quality of life. Losing that facility has caused untold suffering for the very people the CARES Act was passed to protect.”

The Mack E. Mickelson Arthritis and Rehabilitation Center in San Mateo was built to serve the health needs of the San Francisco Bay Area Peninsula community. Opened in 1996, the Mickelson Center was financed in its entirety by $4 million in community donations ($7.2 million in today’s dollars.) The Mickelson Center’s warm water therapy pool was—and remains—the only such facility in San Mateo County that meets ADA requirements. For 25 years—until Sutter needlessly closed it—the pool was a unique, vital resource for community members facing the loss of their physical mobility.

Supervisor Canepa was joined in his announcement by Warm Water Wellness Inc, a nonprofit advocacy group for warm water therapy pools on the Peninsula. “The Mickelson therapy pool is an invaluable resource for chronic pain management and rehabilitation for seniors, disabled individuals, patients recovering from surgeries, children with special needs, and pregnant women,” said Lindsay Raike, CEO of Warm Water Wellness. “By closing the pool, not-for-profit Sutter Health sends a strong message that it is not interested in the quality of life of the most vulnerable members of our community.”

Government agencies throughout San Mateo County have joined Canepa and Warm Water Wellness in advocating for the reopening of the Mickelson pool. “The San Mateo Board of Supervisors, the Sequoia Healthcare District, and a dozen city councils up and down the Peninsula have passed resolutions or written letters to Sutter in support of reopening the Mickelson therapy pool,” said Raike. “They understand that availability of warm water therapy as a core service is necessary to support the health and well-being of the community.”

Sutter has offered varying excuses for closing the pool, including “continued uncertainty surrounding COVID,” a ‘focus on … acute care services,” and efforts to be “good stewards of resources.”

“None of Sutter’s excuses holds water,” said Canepa. “For starters, therapeutic pools in San Mateo County were explicitly exempt from restrictions during COVID, so there was no reason to close the pool. Also, as of year-end 2020, Sutter had accumulated a nest egg of ‘resources’ that included $7.967 billion in cash, cash equivalents and short-term investments. And that’s not even counting the federal CARES act funds Sutter received that were specifically allocated to save services imperiled by COVID. Frankly, I question whether Sutter Health is, in fact, meeting the obligation of its not-for-profit status.”

Despite strenuous efforts to open a dialogue with Sutter regarding the therapy pool—including petitions, protests, and even a multi-million dollar offer from the Peninsula Health Care District to fully fund repairs, retrofitting and operational costs of the pool until a replacement facility can be built—local community members have been unable to gain any traction with the healthcare giant. “I personally tried to broker a meeting between Sutter Health and local stakeholders, but Sutter refused,” said Canepa.

Sutter’s community neglect is not limited to the closure of the Mickelson Center and its therapy pool. Over the past decade, Sutter has cut at least 22 vital programs, a significant number of which — such as the Senior Focus Adult Day Program, Phase 3 Cardiac Rehab/Phase 3 Pulmonary Rehab, and the Post Stroke Program — benefited seniors and the disabled. “Closing programs that CARES Act dollars are designed to save is a betrayal of both the local community and the federal taxpayer,” said Canepa. “We hope the Attorney General will conduct a thorough investigation.”

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Editor's note: Find the latest long COVID news and guidance in Medscape's Long COVID Resource Center.

Long COVID: The name says it all. It's an illness that, for many people, has not yet stopped.

Eric Roach became ill with COVID-19 in November 2020, and he's still sick. "I have brain fog, memory loss," says the 67-year-old Navy veteran from Spearfish, SD. "The fatigue has just been insane."

Long COVID, more formally known as post-acute sequelae of COVID (PASC), is the lay term to describe when people start to recover, or seem to recover, from a bout of COVID-19 but then continue to suffer from symptoms. For some, it's gone on for 2 years or longer. While the governments of the U.S. and several other countries formally recognize the existence of long COVID, the National Institutes of Health (NIH) has yet to formally define it. There's no approved treatment, and the causes are not understood.

Here's what is known: Long COVID is a post-viral condition affecting a large percentage of people who become infected with the coronavirus. It can be utterly debilitating or mildly annoying, and it is affecting enough people to cause concern for employers, health insurers, and governments.

First, the Many Symptoms

According to the CDC, long COVID symptoms may include:

  • Tiredness or fatigue that interferes with daily life

  • Symptoms that get worse after physical or mental effort (also known as "post-exertional malaise")

  • Fever

  • Difficulty breathing or shortness of breath

  • Cough

  • Chest pain

  • Fast-beating or pounding heart (heart palpitations)

  • Difficulty thinking or concentrating (sometimes referred to as "brain fog")

  • Headache

  • Sleep problems

  • Dizziness when standing

  • Pins-and-needles feelings

  • Change in smell or taste

  • Depression or anxiety

  • Diarrhea

  • Stomach pain

  • Joint or muscle pain

  • Rash

  • Changes in menstrual cycles

"People with post-COVID conditions may develop or continue to have symptoms that are hard to explain and manage," the CDC says on its website. "Clinical evaluations and results of routine blood tests, chest x-rays, and electrocardiograms may be normal. The symptoms are similar to those reported by people with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) and other poorly understood chronic illnesses that may occur after other infections."

Doctors may not fully appreciate the subtle nature of some of the symptoms.

"People with these unexplained symptoms may be misunderstood by their health care providers, which can result in a long time for them to get a diagnosis and receive appropriate care or treatment," the CDC says.

Health professionals should recognize that long COVID can be disabling,the U.S. Department of Health and Human Services says. "Long COVID can substantially limit a major life activity," HHS says in civil rights guidance. One possible example: "A person with long COVID who has lung damage that causes shortness of breath, fatigue, and related effects is substantially limited in respiratory function, among other major life activities," HHS says.

How Many People Are Affected?

This has been difficult to judge because not everyone who has had COVID-19 gets tested for it and there are no formal diagnostic criteria yet for long COVID. The CDC estimates that 19% of patients in the U.S. who have ever had COVID-19 have long COVID symptoms.


Some estimates go higher. A University of Oxford study in September 2021 found more than a third of patients had symptoms of long COVID between 3 months and 6 months after a COVID-19 diagnosis. As many as 55% of COVID-19 patients in one Chinese study had one or more lingering symptoms 2 years later, Lixue Huang, MD, of the China-Japan Friendship Hospital in Beijing, and colleagues reported in the journal Lancet Respiratory Medicine in May.

According to the CDC, age is a factor. "Older adults are less likely to have long COVID than younger adults. Nearly three times as many adults ages 50-59 currently have long COVID than those age 80 and older," the CDC says. Women and racial and ethnic minorities are more likely to be affected.

Many people are experiencing neurological effects, such as the so-called brain fog, according to Ziyad Al-Aly, MD, of the Washington University School of Medicine and the VA St. Louis Health Care System, writing in the journal Nature Medicine in September. They estimated that 6.6 million Americans have brain impairments associated with COVID infection.

"Some of the neurologic disorders reported here are serious chronic conditions that will impact some people for a lifetime," they wrote. "Given the colossal scale of the pandemic, and even though the absolute numbers reported in this work are small, these may translate into a large number of affected individuals around the world — and this will likely contribute to a rise in the burden of neurologic diseases."

Causes

It's not clear what the underlying causes are, but most research points to a combination of factors.Suspects include ongoing inflammation, tiny blood clots, and reactivation of what are known as latent viruses, or those that linger quietly in your body without causing damage. In May, Brent Palmer, PhD, of the University of Colorado School of Medicine, and colleagues found people with long COVID had persistent activation of immune cells known as T-cells that were specific for SARS-CoV-2, the virus that causes COVID-19.

COVID-19 itself can damage organs, and long COVID might be caused by ongoing damage. In August, Alexandros Rovas, MD, of University Hospital Munster in Germany, and colleagues found patients with long COVID had evidence of damage to their capillaries. "Whether, to what extent, and when the observed damage might be reversible remains unclear," they wrote in the journal Angiogenesis.

People with long COVID have immune responses to other viruses, such as Epstein-Barr -- evidence that COVID-19 might reactivate latent viruses. "Our data suggest the involvement of persistent antigen, reactivation of latent herpesviruses, and chronic inflammation," immunobiologist Akiko Iwasaki, PhD, of the Yale University School of Medicine, and colleagues wrote in a study posted in August that had not yet been peer-reviewed for publication.

This might be causing an autoimmune response. "The infection may cause the immune system to start making autoantibodies that attack a person's own organs and tissues," the NIH says.

There could be other factors. A study by Harvard researchers found that people who felt stressed, depressed, or lonely before catching COVID-19 were more likely to develop long COVID afterward. "Distress was more strongly associated with developing long COVID than physical health risk factors such as obesity, asthma, and hypertension," Siwen Wang, MD, a research fellow with Harvard University'sT.H. Chan School of Public Health, said in a statement. Plus, nearly 44% of those in the study developed COVID-19 infections after having been assessed for stress, Wang and colleagues reported in the journal JAMA Psychiatry.

Vaccine Protection

There's evidence that vaccination protects against long COVID, both by preventing infection in the first place, but also even for people who have breakthrough infections.

A meta-analysis covering studies involving 17 million people found evidence vaccination might reduce the severity of COVID-19 or might help the body clear any lingering virus after an infection.

"Overall, vaccination was associated with reduced risks or odds of long COVID, with preliminary evidence suggesting that two doses are more effective than one dose," Cesar Fernandez de las Penas, PhD, of King Juan Carlos University in Madrid, Spain, and colleagues wrote.

A team in Milan, Italy, found unvaccinated people in their study were nearly three times as likely to have serious symptoms for longer than 4 weeks compared to vaccinated volunteers. Writing in July in The Journal of the American Medical Association, Elena Azzolini, MD, PhD, an assistant professor atthe Humanitas Research Hospital, said the team found two or three doses of vaccine reduced the risk of hospitalization from COVID to 16% or 17% compared to 42% for the unvaccinated.

Treatments

With no diagnostic criteria and no understanding of the causes, it's hard for doctors to determine treatments.

Most experts dealing with long COVID, even those at the specialty centers that have been set up at hospitals and health systems in the U.S.,recommend that patients start with their primary care doctor before moving on to specialists.

"The mainstay of management is supportive, holistic care, symptom control, and detection of treatable complications," Trish Greenhalgh, MD, professor of primary care health sciences at the University of Oxford, and colleagues wrote in the journal The BMJ in September. "Patients with long COVID greatly value input from their primary care clinician. Generalist clinicians can help patients considerably by hearing the patient's story and validating their experience … (and) making the diagnosis of long COVID (which does not have to be by exclusion) and excluding alternative diagnoses."

Evidence is building that long COVID closely resembles other post-viral conditions -- something that can provide clues for treatment. For example, several studies indicate that exercise doesn't help most patients.

But there are approaches that can work. Treatments may include pulmonary rehabilitation; autonomic conditioning therapy, which includes breathing therapy; and cognitive rehabilitation to relieve brain fog. Doctors are also trying the antidepressant amitriptyline to help with sleep disturbances and headaches; the antiseizure medication gabapentin to help pain, numbness, and other neurological symptoms; and drugs to relieve low blood pressure in patients experiencing postural orthostatic tachycardia syndrome (POTS).

The NIH is sponsoring studies that have recruited just over 8,200 adults. And more than two dozen researchers from Harvard; Stanford; the University of California, San Francisco; the J. Craig Venter Institute; Johns Hopkins University; the University of Pennsylvania; Mount Sinai Hospitals; Cardiff University; and Yale announced in September they were forming the Long COVID Research Initiative to speed up studies.

The group, with funding from private enterprise, plans to conduct tissue biopsy, imaging studies, and autopsies and will search for potential biomarkers in the blood of patients.

Sources

CDC: "Long COVID or Post-COVID Conditions."

CDC National Center for Health Statistics: "Nearly One in Five American Adults Who Have Had COVID-19 Still Have 'Long COVID.'"

National Institutes of Health: "Long COVID," "Long COVID symptoms linked to inflammation."

PLoS Medicine: "Incidence, co-occurrence, and evolution of long-COVID features: A 6-month retrospective cohort study of 273,618 survivors of COVID-19."

The Lancet Respiratory Medicine: "Health outcomes in people 2 years after surviving hospitalisation with COVID-19: a longitudinal cohort study."

Angiogenesis: "Persistent capillary rarefication in long COVID syndrome."

PLoS Pathogens: "SARS-CoV-2-specific T cells associate with inflammation and reduced lung function in pulmonary post-acute sequalae of SARS-CoV-2."

Lancet eClinical Medicine: "Impact of COVID-19 vaccination on the risk of developing long-COVID and on existing long-COVID symptoms: A systematic review."

JAMA Psychiatry: "Associations of Depression, Anxiety, Worry, Perceived Stress, and Loneliness Prior to Infection With Risk of Post–COVID-19 Conditions."

U.S. Department of Health and Human Services: "Guidance on 'Long COVID' as a Disability Under the ADA, Section 504, and Section 1557."

Long COVID Research Initiative:"Introducing LCRI."

Nature Medicine: "Long-term Neurologic Outcomes of COVID-19."

The BMJ: "Long covid—an update for primary care."



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Newswise — Westwood, NJ - (September 26, 2022) – Pascack Valley Medical Group today announced that cardiologist Mindy Markowitz, M.D. has joined the practice.

Dr. Markowitz has extensive inpatient and outpatient cardiac care experience, treating a variety of conditions. She strives to build strong patient-physician relationships to help guide patients in preventing heart disease and obtaining a better quality of life. Her special interests include echocardiography, coronary artery disease, valvular heart disease, prevention and cardiomyopathies. 

“I chose to practice cardiology because the specialty allows me to have a significant positive impact on patient lives through the prevention and treatment of a variety of diseases,” said Dr. Markowitz. “The broad innovations in cardiac care truly help patients to achieve a better quality of life, and I enjoy being a part of the journey to a longer, healthier life.”

Dr. Markowitz received her medical degree from Boston University School of Medicine and completed her internal medicine residency and cardiology fellowship at Lenox Hill Hospital in New York City. She is board certified by the American Board of Internal Medicine in internal medicine and cardiovascular disease, and maintains certification by the National Board of Echocardiography, Board of Cardiovascular Computed Tomography, and Board of Nuclear Cardiology.

“We are pleased to welcome Dr. Markowitz to Pascack Valley Medical Group,” said Emily Holliman, chief executive officer at Pascack Valley Medical Center. “Her patient-focused approach is key to personalizing care and ensuring a positive experience for those we serve. It is important that we expand our physician network with those who have a well-rounded approach to medicine and aim to care for patients by personalizing their options.”

Dr. Markowitz sees patients at 452 Old Hook Road in Emerson, NJ. New patients are welcome and may visit www.pascackmedicalgroup.com to make an appointment or call 201-666-3900. Virtual care and in-person visits are available.

About Hackensack Meridian Pascack Valley Medical Group

Pascack Valley Medical Group provides patients with exceptional care with the support of Pascack Valley Medical Center, part of the Hackensack Meridian Health network. With more than 80 providers already in our ranks, Pascack Valley Medical Group continues to grow, adding new providers practicing in a wide range of specialties from primary care, surgery and beyond.  We believe that an established relationship with your care providers improves health and quality of life.  Convenient locations can be found across the Pascack Valley Region of Bergen County. For more information visit www.pascackvalleymedicalgroup.com.

About Hackensack Meridian Pascack Valley Medical Center Pascack Valley Medical Center is a 128-bed, full-service, acute-care community hospital, located in Westwood, NJ providing the same nationally recognized quality care for which Hackensack Meridian Health is known. The hospital features, a brand-new Emergency Department, state-of-the-art maternity center, a women’s imaging center, cardiac and pulmonary rehabilitation, center for joint replacement, wound care center, and an intensive/critical care unit.

Pascack Valley Medical Center is also the only hospital in Bergen County with all private rooms at no additional cost to the patient. This inpatient hospital acts as an anchor to many outpatient services such as radiology, women’s health, and same day surgery. Find the kind of care you’ve been looking for at Pascack Valley Medical Center. For more, please visit www.PascackMedicalCenter.com 

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Obesity constitutes an important threat to national and global public health in terms of its prevalence and rising incidence, quality of life, life expectancy, and economic burden [1,2]. In severe obesity, bariatric surgery is the most effective therapeutic option to achieve long-term weight loss and improve the associated comorbidities [3]. This has made Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), and adjustable gastric banding the most popular and commonly performed bariatric surgeries [4]. However, a small proportion of patients have also been reported to not reach their optimum goal for weight loss two years after the procedure and very few can fail or regain the weight. While anatomical factors can play a part, behavioural and psychosocial optimizations are regarded as equally important. This includes eating patterns, depression, nutritional factors, and exercise [5,6].

Virtual reality (VR) development and applications have gained wide recognition in medical services by providing solutions to improve patients’ outcomes. This is through patients’ education, improving mental health, and post-operative care, including pain management, physical therapy, and rehabilitation [7,8]. VR is a computer-generated simulation of a real or imagined environment. It can be immersive or non-immersive according to its ability to involve the users [9]. The former has been the focus of many medical applications due to its ability to give the user control of the reproduced environment. Immersive virtual reality (IVR) is usually delivered in a variety of ways and the most popular being head-mounted displays or simply a headset [8].

We aim to provide insight on some of these immersive applications and how they can be included to enhance the patient pathway to optimize outcomes both in the pre- and post-operative period for patients undergoing bariatric surgery.

Methods

A systematic search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) research criteria was conducted from January 2015 to December 2021. PubMed was searched using the following keywords: virtual reality, patient education, anxiety and pain, physical rehabilitation, behavioural support, obesity, eating disorders, body image, and substance cessation.

Thirty-four studies were identified and included in the final manuscript (Figure 1) supporting VR technology across applications that can be applied to bariatric patients’ surgical pathways. The applications were subcategorized into eight different areas of interest, which can help to shape the concept of the virtual ecosystem of bariatric patients (Figure 2).

Results

VR applications have been described in the eight domains mentioned below, which can be applied in relation to patients undergoing bariatric surgery.

Virtual Reality Patient Education (VR PE)

VR education has been introduced to make the information more meaningful and patient-centred by enabling its users to be fully immersed in an interactive simulated and self-controllable visual and auditory experience [10]. In a study by Pandrangi et al. [11], VR was found to be a useful informative tool in educating patients about their aneurysmal disease through interactive reconstructed three-dimensional (3D) images of their aortic anatomy. The majority of the patients in this study agreed that VR 3D anatomy helped to improve their understanding and therefore felt more engaged in their healthcare decisions [11].

VR PE has also played a role in improving the stress levels of patients undergoing radiotherapy (RT) by improving clarity and levels of education about their treatment. A randomized study on 60 patients with chest malignancy showed that patients who received VR PE showed significant improvement in comprehension and reduction in stress and anxiety levels when compared to standard education [12]. Another study on 43 patients utilized VR PE by creating 3D images of patients in RT sessions and what to expect during the treatment. After the VR PE, 95% of patients agreed that they had a clear understanding of how they would feel when lying on the treatment table. Also, patients’ understanding of the location and the size of their cancer had significantly improved from around 50% to 95% with an increase in the orientation of side effects of the treatment by 30% post-VR PE [13].

In bariatric surgery, there is no currently reported data on the applications of VR education. However, the potential impact of VR PE can be numerous across the weight management pathway. Preoperatively, bariatric patients could potentially utilize VR to be virtually educated about different surgical options versus conservative treatment through enhanced 3D interactive images. This could be seen to help in better understanding of their options including surgery and thereby enhancing informed consent and overall education.

Post-operatively, VR-enhanced education could provide an option for daily or weekly updates on lifestyle changes, which could help in improving compliance. Importantly, this can be done from the comfort of the patient’s home with the added advantage of reducing costs and time for travelling to attend appointments.

Anxiety Related to Surgery

A significant amount of anxiety related to surgery is due to the fear and uncertainty of the outcomes. Its psychological and physical effects are associated with longer recovery, an increase in the need for analgesia, anaesthetic requirement, and unfavourable behavioural and emotional outcomes [14]. Conventional methods of mitigation of preoperative anxiety are pharmacological and non-pharmacological strategies [15].

Recently, with promising results in the management of anxiety and other psychiatric disorders, VR has been successfully applied to reduce anxiety related to surgery in different surgical settings [16]. Chan et al. [17] tested the effect of VR relaxing meditation and breathing exercises on 108 women undergoing hysteroscopy. This showed that anxiety scores were significantly reduced after the 10 minutes of VR content, which helped in reducing pain and stress related to surgery. Also, around 85% of patients reported the VR experience as good or excellent [17].

In minimally invasive abdominal surgery, Haisley et al. [18] used VR meditation as a perioperative tool with favourable results in reducing pain, anxiety, and nausea and around 75% of patients stated that they would use the VR again [18]. Similarly, VR meditation showed favourable results in reducing pain and anxiety in burns and complex pain [19,20].

The rationale for using VR to improve anxiety preoperatively is by immersing patients in a fully simulated relaxing environment with the objective of placing them in a more empowered state to deal with the triggers of their anxiety [21]. This could be applied to the bariatric population before surgery. It is to be seen from future studies whether these expected results can be validated in bariatric patients. There is therefore the potential for obtaining better evidence for patient satisfaction and reducing stress related to bariatric surgery.

Pain Management

Successful pain management is a key element of the post-operative course as it shortens recovery and reduces risks of cardiovascular and pulmonary complications. In bariatric surgery, pain management is essential to enhance recovery and prompt early mobilization, which helps to decrease venous thromboembolism, prevent other events, and reduce hospitalization [22]. Therefore, a multimodal approach through regional and systematic analgesia is considered the most effective method as it minimizes opiate use, which can induce obstructive sleep apnoea, which is more liable due to the co-morbidities of obesity [23].

Applications of VR in pain management in other surgical patients have been reported to have numerous benefits. This includes a reduction in pain scores after cardiac, knee, abdominal, and spinal surgery with overall patients reporting the use of VR as a pleasant experience and stating that they would use it again on further occasions [18,24,25]. VR pain management follows a similar concept to VR and anxiety meditation by immersing patients in a simulated relaxing environment, which can help to divert the patient's feelings from their pain. This could be playing a major role in bariatric patients' management of pain and anxiety related to surgery with proper application integration in their peri-operative pathway.

Optimizing Pulmonary Function for Surgery

Respiratory function in morbidly obese patients follows a restrictive pattern with up to 77% suffering from obstructive sleep apnoea [26]. This increases the risk of impaired post-operative oxygenation and other respiratory complications in the form of atelectasis. Optimization of pulmonary function for surgery includes smoking cessation, breathing exercises, including inspiratory muscle training, incentive spirometry, and optimization of chronic disease, for example, asthma and chronic obstructive pulmonary disease (CPOD) [27].

With the increase of applications of VR in different rehabilitation programmes, VR has been aiding in pulmonary exercises in both healthy individuals and COPD patients [28,29]. VR pulmonary rehabilitation is designed to enable home-based exercises in the form of a 3D avatar instructor in an immersive relaxing environment to guide patients through breathing exercises based on traditional rehabilitation programmes [30]. In COPD patients, VR-based respiratory rehabilitation has shown to have similar outcomes when compared to a conventional programme with the additional benefit of performing the exercises from home. Moreover, VR showed enrichment of experience by also decreasing the levels of anxiety during exercise and therefore optimizing cardiorespiratory function [31].

Physical Fitness Applications

Pre- and post-operative physical activity (PA) is regarded as an important element in enhancing recovery after surgery as it improves physical state, responses to stress from surgery, and improvement of cardiovascular function, thereby reducing complications [32].

In the bariatric population, a structured exercise regime is considered a feasible and effective adjunct therapy that benefits cardiometabolic parameters when compared to those with bariatric surgery alone [33]. Exercise before surgery has shown to be beneficial in reducing body weight, improving blood pressure, general fitness, quality of life satisfaction, and decreasing fasting plasma insulin and blood lipid. Exercise after bariatric surgery has been shown to preserve dynamic muscle strength and contribute to maintaining weight loss after calorie restriction [34].

Although PA promotion is recognized as an important component of weight loss programmes, there are no current evidence-based or standardized bariatric surgery-specific PA guidelines [35]. Reported exercise regimes ranged from walking, aquatic, resistance, and supervised exercises. Also, adherence to exercise before and after surgery plays a big role in physical rehabilitation. As in the bariatric population, many can face barriers in the form of low confidence levels in their abilities and not feeling comfortable going to the gym due to real and perceived discrimination. Therefore, many come up with the belief of not having time to participate in sports [36].

VR rehabilitation has gained much recognition from dedicated platforms like treadmills, diving, cycling simulators, and medically oriented VR rehabilitation. These studies have demonstrated increased participation of users utilizing VR exercise programmes [37]. VR rehabilitation and exercise have shown to be effective in healthy individuals and different medical rehabilitations. It was reported to be equivalent and sometimes more superior to standard physiotherapy in cerebral palsy, spinal injury, and stroke [38]. In healthy individuals, VR exercise was demonstrated to increase adherence and enjoyment with positive physiological effects during exercise [39]. It was also reported that obese children performed better on treadmills while using VR than traditional walking, as VR allowed more distraction and less discomfort [40].

VR exercises during rehabilitation can therefore potentially play a major role in pre- and post-operative PA improvement in bariatric patients. Given the feasibility and the safety of these home-based devices, it can decrease the load on healthcare services, as most of the standard pre-operative programmes are resource intensive.

Virtual Reality and Enhanced Cognitive Behavioural Therapy

Eating and depressive disorders significantly affect the bariatric population with a prevalence of 24% and 17%, respectively. Both can lead to less post-operative weight loss, weight regains, impaired general psychology, and quality of life [41]. Cognitive behavioural therapy (CBT) is recommended for patients undergoing weight loss surgery (WLS). It has been shown to improve self-monitoring and control eating behaviours with significant improvement in depression and anxiety and therefore better results [42].

Over the last decades, VR-enhanced cognitive therapy (VRCBT) has been embraced for being a novel way to deliver CBT. The technique creates an interactive 3D environment to simulate successful goal achievement. This helps patients to overcome memories of previous real-life experiences through emotionally guided virtual exposure [43]. VRCBT has shown favourable results in anxiety, phobias, social anxiety disorders, and depression [21]. Moreover, randomized trials have shown VRCBT to be superior to conventional CBT in managing eating disorders and binge eating [44,45]. This helped in weight reduction therapy and adding adherence to programmes [46].

There is a paucity of evidence of the use of VR in the overweight and morbidly obese population. Phelan et al. [47] tested the use of a VR environment on 15 overweight adults for four weeks with the main hypothesis to evaluate the effect of the simulated scenes on behavioural skills related to eating habits. Although they showed no difference in weight loss among participants, VR intervention was more preferred by patients over traditional weight loss programmes [47]. Manzoni et al. [45] tested the efficacy of an enhanced VRCBT module aimed to unlock the negative memory of the body and modify its behavioural and emotional behaviour. A total of 163 female morbidly obese inpatients were randomly assigned to three CBT-based treatments: a standard behavioural inpatient programme (SBP), SBP plus standard CBT, and SBP plus VR-enhanced CBT. The study showed that patients in the VR group had a greater probability of maintaining or improving weight loss at one-year follow-up than SBP patients and, to a lesser extent, CBT patients. On the contrary, participants who received only a behavioural programme regained on average most of the weight they had lost [45].

VRCBT can therefore be a valuable tool in managing behavioural disorders related to obesity in patients undergoing WLS. This can help in maintaining weight loss and improving well-being and quality of life.

Virtual Reality and Body Image (VRBI)

Body image disorders (BIDs) are linked to various psychological and physical sequelae of impaired functions, for instance, depression, anxiety, eating disorders, and poor quality of life [48]. Among the bariatric population, body image dissatisfaction is associated with binge eating, depression, and lower self-esteem, with one in five bariatric patients identifying appearance as their main motive for surgery [49]. Improvement in body image perception after successful surgery has been linked to a decrease in compulsive eating syndromes, reduction in body mass index (BMI), and improvement in self-esteem and intimate relationships [50].

A contrary aspect of body image after surgery includes the issue of excess skin with massive weight reduction. This has been linked to poor body satisfaction, dermatitis and skin fold irritations, and impairment in daily activities and exercise. In turn, this leads 85% of bariatric patients to seek body-contouring surgery (BCS) to elevate this problem [51].

The application of VR has been used to improve BID. This is by creating a 3D simulation of their bodies in the form of avatars through an immersive environment that reproduces situations related to their body image concerns. Through multisensory simulations, it produces an empowered feeling of ownership of one’s body, which consequently promotes a healthier body image and behaviour [52]. A recent systematic review of six studies utilizing avatars and VR in weight loss programmes showed that avatar-based interventions were effective in both short- and mid-term weight loss. Also, the technology helped to improve exercise adherence in the long term [53]. VR was also used to assess the BID of 78 women with different BMIs by exposing the participants to different versions of avatars: slimmer, same weight, and overweight. The study showed that women with higher BMI reported more BID on their replicated avatar and showed satisfaction with their slimmer version. This finding indicated that VR may serve as a novel tool for measuring BID [54].

Potentially, VR avatars can also play a role in body image perception in bariatric patients. It can be integrated to improve BIDs by recreating slimmer avatars, which could promote adherence to weight loss and exercise programmes.

Smoking and Alcohol

While the increase in BMI is a risk factor for adverse outcomes related to surgical procedures, smoking's hazardous effects range from increased risks of pulmonary complications, wound infection, venous thromboembolism, and slower recovery. Similarly, alcohol consumption before surgery can lead to increased unfavourable outcomes [55]. Smoking and other substance abuse are recommended to be stopped four to six weeks pre-operatively [56]. VR has been tested as a potential solution to stop smoking and alcohol usage by inducing an advanced cue exposure therapy (CET), which was superior to static images or videos used in conventical settings [57]. Also, VR exposure therapy (VRET) has been reported to be more effective if combined with conventional cognitive behaviour therapy in relation to stopping smoking [58].

Although its applications are still under development and validation, VRET in smoking and alcohol cessation could play an important role in optimizing patients undergoing bariatric surgery as a part of a virtual reality surgical care package (VRSCP).

Discussion

Patients who are candidates for WLS usually undergo variable preparatory phase and post-operative optimization to improve both short- and long-term results. Standard care models usually involve education and follow-up through multidisciplinary teams with reflection on the patient's progress through educational sessions and follow-up plans.

While VR applications are being investigated in many surgical and medical specialities, their application to patients undergoing WLS is limited and not yet explored. The favourable applications of VR in patient education, anxiety and pain management, preoperative optimization, and behavioural and physiological treatment can be packaged as a surgical care bundle making bariatric patients' journey more satisfactory with the potential for improved outcomes.

Despite its promising applications, VR is still an emerging technology and has its own initial drawbacks to gaining traction in the healthcare system. There are several reasons for this. Firstly, the obvious cost of the systems and the absence of adequate clinical validation could play a major role in limiting widespread adoption. Further delays in adoption would likely be seen within the education of both healthcare providers and their patients, particularly on the application and utilization of the systems. The technology is still seen to be clumsy to wear and will need educational support to use [59].

With the increased investments and advancement in VR technology, education of healthcare professionals and further studies demonstrating evidence of improved outcomes, VR will play a major role in surgical patients and more specifically bariatric patients. This could be even refined as a personalized surgical care package. This will contribute to a fully virtual ecosystem in health care.



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Baptist Memorial Hospital-North Mississippi’s pulmonary rehabilitation program was recently certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, recognizing the hospital’s commitment to enhancing standards of patient care.

To earn accreditation, Baptist North Mississippi’s rehabilitation program participated in an application process that requires extensive documentation of the program’s practices.

“The certification from the American Association of Cardiovascular and Pulmonary Rehabilitation is a testament to the high-quality care of our pulmonary rehab program,” said Bill Henning, administrator and CEO of Baptist North Mississippi. “Our health care providers and colleagues at Baptist North Mississippi work diligently to provide advanced care for patients.”

AACVPR Program Certification is the only peer-reviewed accreditation process that assesses a program’s adherence to standards and guidelines developed and published by AACVPR and other related professional societies.

The certification is valid for three years. Pulmonary rehabilitation programs help people with pulmonary problems (e.g., chronic obstructive pulmonary disease, respiratory symptoms) recover faster and live healthier.

Programs include exercise, education, counseling and support for patients and their families.

For more information, call 662-636-1000 or visit northmiss.baptistonline.org.


Courtesy of BMH-NM

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Some health care providers in Arkansas are starting to offer services tailored to patients struggling to recover weeks or months after being diagnosed with covid-19.

An estimated one in five covid-19 survivors between 18 and 64 years old and one in four survivors 65 and older have a health condition related to their illness, according to a study released this year by the federal Centers for Disease Control and Prevention, which included 63.4 million individuals.

Another 2022 study published in the Journal of Infectious Diseases estimated millions of Americans -- about 1.7% to 3.8% of the U.S. population -- experienced new, long-term symptoms that limited daily activities one month or longer after covid-19 infection.

"Because the coronavirus can attack the lungs, heart, brain and other organs, there can be lasting internal damage," said Sheena CarlLee, director of the University of Arkansas for Medical Sciences' Long Covid Clinic, which opened Aug. 25 in Fayetteville.

Damage to vital organs can exacerbate long-term health problems such as heart disease, diabetes, kidney disease, blood disorders, neurological conditions and mental health disorders.

The new UAMS clinic brings together specialists in order to treat patients across the breadth of symptoms.

"We are seeing patients with a wide variety of symptoms that require a unique treatment regimen," CarlLee said. "Our long covid clinic offers extensive evaluation from a team of students and trained health care providers from the disciplines of medicine, pharmacy, nursing, physical therapy, occupational therapy and radiation sciences."

Some of the most successful long covid clinics in the country are team-based clinics, which can dive into a variety of symptoms and devise a detailed plan, according to CarlLee.

The clinic team also works closely with researchers at the UAMS campus in Little Rock, and patients may opt in to participate in that research, she said.

UAMS bills through insurance, and the cost for patients at the long covid clinic will be the same as a primary care clinic visit, according to CarlLee.

LONG COVID

CarlLee, a UAMS internal medicine doctor, and other doctors at various UAMS campuses have seen former covid-19 patients with prolonged symptoms related to the infection, she said.

Sometimes long covid symptoms develop for people who had little or no symptoms upon their initial positive test, but long covid tends to affect those who had a more complicated initial infection, she said.

Based on recent research, people who stayed in the ICU, were put on a ventilator, are unvaccinated or have underlying medical conditions all seem more likely to develop long covid, according to CarlLee. Women also may be disproportionately affected, she said.

Long covid is still being defined by the scientific community, according to health officials, but it generally signifies new or lingering symptoms of the virus occurring at least three or four weeks after a positive covid-19 test.

Because the term has yet to be precisely defined, data varies on the condition's prevalence, said Jennifer Dillaha, director of the Arkansas Department of Health.

The symptoms and conditions associated with long covid, which will likely affect many people in the coming years, are consistent throughout the scientific literature, Rachel Levine, U.S. assistant secretary for health, wrote last month in the Journal of the American Medical Association.

Symptoms such as shortness of breath, muscle aches, cough, fatigue, loss of taste or smell and problems with memory and concentration are among the more common symptoms. Heart palpitations, dizziness, diarrhea, stomach pain, rashes and joint or muscle pain have also been experienced post-covid, according to the federal Centers for Disease Control and Prevention.

Long covid isn't a singular case of long-term symptoms developing from viral infections, according to Dr. Marti Sharkey, Fayetteville's city health officer. Epstein-Barr virus is the cause of infectious mononucleosis, more commonly known as mono, she noted.

"It's not unusual to see prolonged systems. It's not surprising with a virus that has infected so many people," she said.

PATIENTS YOUNG AND OLD

In Central Arkansas, the Strong Hearts Rehabilitation Center by Arkansas Heart Hospital offers a rehab program for long covid patients at facilities in Little Rock, Russellville, Conway and Bryant.

The center enrolled its first post-covid patients in January shortly after the U.S. Centers for Medicare and Medicaid Services issued guidance allowing programs to treat lingering symptoms of the disease, said Amanda Xaysuda, director of the center.

"We had all of that planned before then but once Medicare was paying for that and more research was coming out that it was beneficial in this patient population, that's when we decided to go for it," she said.

Strong Hearts Rehabilitation Center's program focuses on pulmonary rehabilitation. Health care providers with the center help patients build their exercise tolerance and work on breathing exercises.

"Everything else we do is focused around the patient and what symptoms they are coming in with," said Xaysuda.

The program has helped post-covid patients dealing with postural orthostatic tachycardia syndrome, an abnormal spike in heart rate that occurs after sitting up or standing.

While the program's oldest patients have been in their 90s, the youngest was 16. Many patients are in their 30s and 40s, a demographic the Strong Hearts Rehabilitation Center isn't used to seeing.

"What we've always done is traditional cardiac rehab. Typically, our patients are Medicare age. They're 65 and older," said Xaysuda. "This is a whole new population of people."

Although Medicare and some private insurance companies cover pulmonary rehab for post-covid diagnoses, Xaysuda said Arkansas Blue Cross Blue Shield does not.

Other large Arkansas health care providers do not offer specialized clinics like the ones provided by UAMS and Arkansas Heart Hospital.

In a statement Thursday, spokesman Joshua Cook said CHI St. Vincent does not have a clinic dedicated to long covid treatment.

At Baptist Health, the prevalence of long covid is not high enough to warrant a specialty clinic, said Dr. Amanda Novack, medical director of infectious diseases in a statement Friday. Primary care physicians with Baptist Health nevertheless work with long covid patients to create personal care plans.

"These treatments might include specialized treatments such as physical therapy, nutritional support, cardiac or pulmonary rehabilitation," said Novack in the statement.

COMMUNITY RESPONSE

Sharkey, the Fayetteville city health officer, said preventing transmission should still be a goal of the community.

"Every time we get infected with this virus, there's another risk for long covid. Just because you haven't had long covid doesn't mean you won't," she said. "We have people who got covid on the first wave in winter of 2020 that are still suffering.

"We're definitely a lot better than where we were a year ago, but we're not at the end yet," she said.

Sharkey recommends people experiencing long-term covid symptoms visit a clinic with a team-based multidisciplinary approach, like the UAMS clinic.

"You need a team approach to assess multiple organ systems and have a very tailored approach to the symptoms of the person," she said.

Getting vaccinated will help fight transmission of the virus, Dillaha said.

"I'd encourage people to get primary vaccination doses, followed by at least one booster dose. Take reasonable steps to avoid getting infected. Especially if you're at high risk for severe illness," Dillaha said.

Dillaha worries people, especially parents, are not informed about long covid and do not consider the risks of infection when deciding whether to get themselves or their children vaccinated.

Even with mild symptoms, people should still get tested for covid-19, because they may be eligible for treatment with Pfizer's anti-viral drug Paxlovid and be able to minimize the risks of infection, according to Dillaha.

Arkansas' death toll from covid-19 topped 12,000 Tuesday. Nationally, more than 1 million people have died as a result of covid-19 infection, according to the centers.

Appointments

Residents can schedule an appointment at the UAMS clinic at 1125 N. College Avenue in Fayetteville by calling (479) 713-8701.

Source: University of Arkansas for Medical Sciences

 

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Some health care providers in Arkansas are starting to offer services tailored to patients struggling to recover weeks or months after being diagnosed with covid-19.

An estimated one in five covid-19 survivors between 18 and 64 years old and one in four survivors 65 and older have a health condition related to their illness, according to a study released this year by the federal Centers for Disease Control and Prevention, which included 63.4 million individuals.

Another 2022 study published in the Journal of Infectious Diseases estimated millions of Americans -- about 1.7% to 3.8% of the U.S. population -- experienced new, long-term symptoms that limited daily activities one month or longer after covid-19 infection.

"Because the coronavirus can attack the lungs, heart, brain and other organs, there can be lasting internal damage," said Sheena CarlLee, director of the University of Arkansas for Medical Sciences' Long Covid Clinic, which opened Aug. 25 in Fayetteville.

Damage to vital organs can exacerbate long-term health problems such as heart disease, diabetes, kidney disease, blood disorders, neurological conditions and mental health disorders.

The new UAMS clinic brings together specialists in order to treat patients across the breadth of symptoms.

"We are seeing patients with a wide variety of symptoms that require a unique treatment regimen," CarlLee said. "Our long covid clinic offers extensive evaluation from a team of students and trained health care providers from the disciplines of medicine, pharmacy, nursing, physical therapy, occupational therapy and radiation sciences."

Some of the most successful long covid clinics in the country are team-based clinics, which can dive into a variety of symptoms and devise a detailed plan, according to CarlLee.

The clinic team also works closely with researchers at the UAMS campus in Little Rock, and patients may opt in to participate in that research, she said.

UAMS bills through insurance, and the cost for patients at the long covid clinic will be the same as a primary care clinic visit, according to CarlLee.

LONG COVID

CarlLee, a UAMS internal medicine doctor, and other doctors at various UAMS campuses have seen former covid-19 patients with prolonged symptoms related to the infection, she said.

Sometimes long covid symptoms develop for people who had little or no symptoms upon their initial positive test, but long covid tends to affect those who had a more complicated initial infection, she said.

Based on recent research, people who stayed in the ICU, were put on a ventilator, are unvaccinated or have underlying medical conditions all seem more likely to develop long covid, according to CarlLee. Women also may be disproportionately affected, she said.

Long covid is still being defined by the scientific community, according to health officials, but it generally signifies new or lingering symptoms of the virus occurring at least three or four weeks after a positive covid-19 test.

Because the term has yet to be precisely defined, data varies on the condition's prevalence, said Jennifer Dillaha, director of the Arkansas Department of Health.

The symptoms and conditions associated with long covid, which will likely affect many people in the coming years, are consistent throughout the scientific literature, Rachel Levine, U.S. assistant secretary for health, wrote last month in the Journal of the American Medical Association.

Symptoms such as shortness of breath, muscle aches, cough, fatigue, loss of taste or smell and problems with memory and concentration are among the more common symptoms. Heart palpitations, dizziness, diarrhea, stomach pain, rashes and joint or muscle pain have also been experienced post-covid, according to the federal Centers for Disease Control and Prevention.

Long covid isn't a singular case of long-term symptoms developing from viral infections, according to Dr. Marti Sharkey, Fayetteville's city health officer. Epstein-Barr virus is the cause of infectious mononucleosis, more commonly known as mono, she noted.

"It's not unusual to see prolonged systems. It's not surprising with a virus that has infected so many people," she said.

PATIENTS YOUNG AND OLD

In Central Arkansas, the Strong Hearts Rehabilitation Center by Arkansas Heart Hospital offers a rehab program for long covid patients at facilities in Little Rock, Russellville, Conway and Bryant.

The center enrolled its first post-covid patients in January shortly after the U.S. Centers for Medicare and Medicaid Services issued guidance allowing programs to treat lingering symptoms of the disease, said Amanda Xaysuda, director of the center.

"We had all of that planned before then but once Medicare was paying for that and more research was coming out that it was beneficial in this patient population, that's when we decided to go for it," she said.

Strong Hearts Rehabilitation Center's program focuses on pulmonary rehabilitation. Health care providers with the center help patients build their exercise tolerance and work on breathing exercises.

"Everything else we do is focused around the patient and what symptoms they are coming in with," said Xaysuda.

The program has helped post-covid patients dealing with postural orthostatic tachycardia syndrome, an abnormal spike in heart rate that occurs after sitting up or standing.

While the program's oldest patients have been in their 90s, the youngest was 16. Many patients are in their 30s and 40s, a demographic the Strong Hearts Rehabilitation Center isn't used to seeing.

"What we've always done is traditional cardiac rehab. Typically, our patients are Medicare age. They're 65 and older," said Xaysuda. "This is a whole new population of people."

Although Medicare and some private insurance companies cover pulmonary rehab for post-covid diagnoses, Xaysuda said Arkansas Blue Cross Blue Shield does not.

Other large Arkansas health care providers do not offer specialized clinics like the ones provided by UAMS and Arkansas Heart Hospital.

In a statement Thursday, spokesman Joshua Cook said CHI St. Vincent does not have a clinic dedicated to long covid treatment.

At Baptist Health, the prevalence of long covid is not high enough to warrant a specialty clinic, said Dr. Amanda Novack, medical director of infectious diseases in a statement Friday. Primary care physicians with Baptist Health nevertheless work with long covid patients to create personal care plans.

"These treatments might include specialized treatments such as physical therapy, nutritional support, cardiac or pulmonary rehabilitation," said Novack in the statement.

COMMUNITY RESPONSE

Sharkey, the Fayetteville city health officer, said preventing transmission should still be a goal of the community.

"Every time we get infected with this virus, there's another risk for long covid. Just because you haven't had long covid doesn't mean you won't," she said. "We have people who got covid on the first wave in winter of 2020 that are still suffering.

"We're definitely a lot better than where we were a year ago, but we're not at the end yet," she said.

Sharkey recommends people experiencing long-term covid symptoms visit a clinic with a team-based multidisciplinary approach, like the UAMS clinic.

"You need a team approach to assess multiple organ systems and have a very tailored approach to the symptoms of the person," she said.

Getting vaccinated will help fight transmission of the virus, Dillaha said.

"I'd encourage people to get primary vaccination doses, followed by at least one booster dose. Take reasonable steps to avoid getting infected. Especially if you're at high risk for severe illness," Dillaha said.

Dillaha worries people, especially parents, are not informed about long covid and do not consider the risks of infection when deciding whether to get themselves or their children vaccinated.

Even with mild symptoms, people should still get tested for covid-19, because they may be eligible for treatment with Pfizer's anti-viral drug Paxlovid and be able to minimize the risks of infection, according to Dillaha.

Arkansas' death toll from covid-19 topped 12,000 Tuesday. Nationally, more than 1 million people have died as a result of covid-19 infection, according to the centers.

 

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The lungs are two of the most important organs that are affected by the coronavirus, which leads to Covid infection in the respiratory system. It has been noticed that while most patients recover completely after the infection, at least 5 per cent to 10 per cent experience prolonged symptoms that last for several months or even years. This is known as ‘long Covid‘.

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Dr Vishal Sehgal, the president of Portea Medical says “pulmonary rehabilitation” can improve a person’s lung function, their exercise performance, quality of life, and even counter any anxiety associated with the condition.

“Pulmonary rehabilitation is symptom-based; it requires a multi-pronged approach to deal with the various related complications. It is a holistic plan that comprises preliminary patient assessment followed by medicinal treatment, lifestyle modifications, physical exercise, nutritional support, self-awareness and psychological counselling,” he says.

According to the expert, some major aspects of a rehabilitation programme are as follows:

1. Physical activity

Physical activity can significantly improve the quality of daily living. From low-impact training for the chest and back muscles, to more intense forms of exercise, there is a range of activities that can help. Under the guidance of a trained specialist, these are done depending on individual progress and capacity, says Dr Sehgal.

2. Breathing techniques

Breathing techniques can help alleviate the pressure on the lungs. There are different types of breathing techniques including those that are part of yoga that can help in case the patient experiences symptoms of breathlessness, he adds. “For instance, pranayama — the ancient practice of breath control — helps in improving multiple aspects of physical health, including lung function.”

3. Diet and lifestyle

A balanced diet helps in boosting immunity and overall wellness. It can also help in alleviating certain symptoms of long Covid, the doctor states. “Those who are put under a pulmonary rehab programme are given a diet rich in complex carbohydrates and fibres, as well as other micronutrients. In case a patient lacks access to a proper rehabilitation facility at hospitals, it is possible to do this process at home.”

“People who survive Covid-19 can experience long-term consequences: respiratory, neuropsychiatric, cardiovascular, hematologic, gastrointestinal, renal, and endocrine. There is a rapid increase in the burden of long Covid which calls for strategies that can help improve outcomes over time,” says Dr Sehgal, adding that on World Lung Day, it is important to understand and discuss these strategies as well as take precautions and prevent the spread of the virus further.

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Every year, World Lung Day is celebrated on September 25 to advocate lung health and spread awareness. Lung disease is any problem that arises in the lungs and prevents it from working properly. Lung disease is divided into three main types - airway diseases, lung tissue diseases and lung circulation diseases.

The lungs, just like any other part of your body, age with time and that's why they need extra attention and care. People don't understand the importance of healthy lungs until they experience a breathing problem. After the Covid-19 pandemic took over the world, millions across the globe showed signs of weak lungs and reported breathing issues.

In 2022, it's crucial that we look after the health of our lungs and take precaution against harmful diseases that can make our breathing difficult. After all, the lungs are a crucial part of the respiratory system as they carry oxygen from the air and pump it through the body's airways and air sacs. The oxygen is then absorbed into the bloodstream and carried to the heart via the blood vessels.

Understanding the three main types of lung disease:

Airway Diseases

These harmful diseases impact the tubes that carry oxygen, making it difficult for people to breathe.

Lung Tissue Diseases
These diseases affect the structure of the lung tissue, which then makes it difficult for the lungs to function properly and diffuse oxygen from the airways into the bloodstream.

Lung Circulation Diseases

This type of disease impacts the blood vessels in the lungs. These diseases affect the way blood flows from the heart to the rest of the body.

Most Common Lung Diseases:

Most common lung diseases emerge from one or more of these three main types. Here are the most common lung diseases:

Asthma

Millions of people across the country suffer from asthma and have difficult breathing. Though there's no cure for this disease, the person can lead a healthy and normal life with the help of right treatment and managing the asthma.

The disease can be managed by working with a healthcare provider to develop a plan to keep your asthma under control by understanding your trigger and learning of simple ways to limit your exposure, understanding your medication, learning self-management skills and more.

Chronic Obstructive Pulmonary Disease (COPD)
This disease includes Chronic Bronchitis and Emphysema and is a long-term lung disease that makes it hard to breathe but is often preventable and treatable.

Bronchitis

Most commonly referred to as bronchitis, acute bronchitis is a lower respiratory infection that impacts the air tubes of the lungs and usually comes on suddenly and can last for a week to 10 days.

Tips To Prevent Lung Diseases:

Stop smoking as it increases your risk of lung cancer. According to several reports, smokers are 12 to 13 times more likely to die from COPD than nonsmokers.

Exercise. Getting a regular workout will really help your health. It will not only make you fitter but also improve your overall health. When you workout, your heart beats faster and your lungs work harder.

Get some fresh air. It's no secret that we are exposed to pollutants on a daily basis. So give your lungs the much needed break and reduce the exposure to harmful air by making your home smoke-free zone, dusting your furniture, improving the indoor air ventilation by opening a window, avoid synthetic air fresheners, candles, and wear a good mask when you go outside.

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Neil Lydon jokes with program co-ordinators Lisa Curtis and Robyn Palk. (Megan Macalpine/CBC - image credit)

Neil Lydon jokes with program co-ordinators Lisa Curtis and Robyn Palk. (Megan Macalpine/CBC - image credit)

As Neil Lydon adjusts the seat on a recumbent stepper machine, he chuckles, looking back on his first days in the Saint John-based pulmonary rehabilitation program.

"I was never brought up with sports, and I see a machine and I think, 'Oooh … effort,'" he says.

After living with chronic obstructive pulmonary disease, or COPD, for more than a decade, a respirologist referred Lydon to the promising pilot initiative. There is no cure for COPD, but the program aims to build a patient's stamina and, ultimately, keep them out of the hospital.

"Blood oxygen is low, so you use up whatever energy you've got pretty quickly," he said.

"My doctor said, 'Maybe we'll try you on some meds,' and in the end I wound up on two different medications, and he thought it would be a good idea to get some physicality into the program.

"It sort of got me out of my inertia."

Megan Macalpine/CBC

Megan Macalpine/CBC

Lydon said the gym wasn't an environment he was familiar with, but then he found he could use the machines that best suited his fitness level at that time.

"I tried the treadmill, but I got very winded, very quickly on that … I did push my limits on the step machine," he says. "I increased that from three or four hundred steps up to 1,700-and-something by the time I'd finished. It took about half an hour."

The rehab program is a research project and is infused with students from the New Brunswick Community College and the University of New Brunswick. Students from a number of disciplines, such as respiratory therapy, nursing and pharmacy technology, work almost one-on-one with the seniors who take part.

To be eligible, participants have to be at least 60 years old and living with moderate to severe COPD with nothing to disqualify them, like a recent heart attack, uncontrolled blood pressure or being at risk for falls.

One in five seniors

Tammie Fournier, a respiratory therapist and chair of Allied Health programs for NBCC, says one in five New Brunswick seniors have COPD.

"People living with COPD experience shortness of breath and they have a chronic cough. The combination of those two symptoms would lead to inactivity which inevitably worsens with their condition," Fournier said.

"So the worsening shortness of breath and cough and decrease in activity really become this vicious cycle that robs people with COPD of their quality of life over time."

This program is meant to break that cycle, and Fournier says it's shown some exciting results.

Submitted by Robyn Palk

Submitted by Robyn Palk

"One person decided not to sell their home after completing the clinic reduced their shortness of breath while climbing their stairs," she said. "Two other participants both gained enough strength to travel to Toronto and receive life-saving lung transplantation."

In a computer lab-turned-gym at NBCC's Allied Health Education Centre on the UNB campus, the seniors in the program build their endurance using gym equipment, free weights and drumming exercises.

Besides helping participants increase their stamina, the program also teaches them how to properly take their medications to get the most out of them and what to do if symptoms suddenly get worse.

Robyn Palk, the co-ordinator of the program, says a participant told her that information helped her avoid calling an ambulance after accidentally inhaling fumes while she was cleaning her oven. The woman thought back to classes on breath techniques and was able to take control of her breathing, Palk said.

"The hospitals are full," Palk said. "You don't want to be short of breath and having to wait in an emergency room for an extended period of time. If there are steps you can take at home to keep yourself out of hospital, that's really important right now."

Big savings

New Brunswick spends $23 million annually on COPD, Fournier said, which equates to about 3,100 hospital admissions at $7,400 per admission.

"The program is decreasing the risk of lung attack in 80 men and women, or about 0.14 per cent of our New Brunswick COPD population," she said. "So by extension, if each one of those participants reduces their admission to hospital by only one, this could save almost $600,000 of health-care spending on those 80 people alone."

Funding for the program comes from the Healthy Seniors pilot project, a $75-million provincial and federal initiative to research ways to better support the aging population.

However, the funding ends in 2023, Fournier said, and they're now looking for a source of sustainable funding to ensure it can continue.

Megan Macalpine

Megan Macalpine

"I've been a respiratory therapist,and Robyn has as well, for over 20 years now," said program co-ordinator Lisa Curtis. "This is the most rewarding work we've ever done because we get to spend so much more time with people than you do in acute care."

Curtis says over the course of the program, they get to watch participants go from barely making it into the building to coming in with a smile, and getting on a treadmill and walking for 30 minutes.

What happens to the research?

Curtis and Palk say they've been in contact with other institutions across Canada hoping to set up their own programs, and they've developed a how-to manual or toolkit for getting a program started.

They've also been selected to present at an international conference on COPD.

Neil Lydon hopes more people hear about the program that's helped him.

"I think people who are out there who have COPD, they might not realize … there is a program that will assist them in dealing with it, getting some relief," Lydon said.

"It's important to get the word out."

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When we think of chest pain, we usually think about heart attacks.

According to the American Heart Association (AHA), a heart attack occurs when the blood flow that brings oxygen to the heart muscle is severely reduced or cut off completely, which can be fatal. Heart attack pain can last for hours if untreated.

A heart attack is the most serious symptom of coronary artery disease (CAD), the most common type of heart disease. CAD can produce a type of chest pain called angina.

Angina may feel like pressure or squeezing in your chest and typically happens when you are physically exerting yourself. The discomfort can also be felt in your:

  • Shoulders
  • Arms
  • Neck
  • Jaw
  • Abdomen
  • Back

Angina pain may even feel like heartburn, but it is short lived and typically doesn't last longer than 10 minutes.

If you're experiencing chest pain, it's important to get it checked out, ASAP. Don't hesitate to call 911, especially if it's a new symptom that you've never had before, the pain comes and goes, or the pain gets worse.

All chest pain should be checked out by a healthcare professional. They can determine if it's angina, heart attack pain, or something else.

Chest pain isn't always caused by a heart attach. Some causes can be mild, like heartburn, others can be dangerous, like pancreatitis.


You might be wondering how someone could mistake the symptoms of acid reflux for a heart attack, but there's a reason why it's called heartburn, after all.

Gastroesophageal reflux occurs when a person's stomach contents—including the gastric acids that help break down food—back up into the esophagus, the tube that connects the throat and stomach.

Stomach acid is highly acidic, hence, the burning sensation behind your breastbone; on the pH scale, it scores about a 1 according to the Environmental Protection Agency (EPA) falling somewhere between battery acid and vinegar.

Our stomachs are lined with protective membranes that shield it from the corrosive effects of acid, while our esophagus is not.

The occasional reflux is fairly common and probably nothing to worry about, but if you're experiencing it twice a week or more, you may have gastroesophageal reflux disease (GERD).

Left untreated over time, GERD can cause asthma, chest congestion, and a condition called Barrett's esophagus, which may increase your chances of developing a rare type of cancer, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).




It's possible for someone to mistake a strained chest muscle for something more serious, like a heart attack, said Christine Jellis, MD, PhD, a Cardiology Specialist at Cleveland Clinic.

"I had a patient who came in with chest pain, and he was worried he was having a heart attack," said Dr. Jellis. "After taking his history, I learned he had moved [to a new house] and hadn't lifted heavy furniture in years. But he did the right thing, coming in."

Healthcare providers don't expect people to be able to tell the difference between a heart attack and a pulled chest muscle, said Dr. Jellis, but a good way to check is that if you can press on the wall of the chest and it feels even more painful, it's more likely to be a musculoskeletal injury than a problem with your heart.




Costochondritis is an inflammation of the tissue (cartilage) connecting your ribs to your breastbone, according to MedlinePlus.

It's a common and benign (or non-threatening) cause of chest wall pain. But if it's new to you, it's a good idea to get it checked out by a medical professional anyway.

Although healthcare providers can't always pinpoint what triggered the condition, the causes can range from viral infections to chest injuries.

Typically, people feel a type of pressure on their chest wall and—similar to a strained muscle—a tenderness when they press on the area.

In this case, a healthcare provider will probably start by taking your medical history and doing a physical exam. "A physician is going to want to rule out cardiac and other serious issues first," said Dr. Jellis. "It'll most likely be a diagnosis by exclusion."

If you do have costochondritis, the pain typically goes away in a few days or weeks; taking over-the-counter painkillers can help.




The virus that causes chickenpox lingers in your body long after the spots have faded. In fact, the varicella-zoster virus can reactivate in adulthood (usually in people older than 50) as a disease called shingles.

The first symptoms include itching and burning skin. If the area over the chest is affected, someone might mistake this new pain for a heart attack or other cardiac issue, said Salman Arain, MD, an interventional cardiologist at Houston and the Memorial Hermann Heart & Vascular Institute-Texas Medical Center.

A few days later, however, the telltale rash can appear, followed by blisters.

If you think you have shingles, call a healthcare provider ASAP. Antiviral medications can lessen the pain and shorten the duration of the symptoms, but only if you take them within 72 hours of the rash appearing.

If it's too late to take antivirals, a healthcare provider can prescribe a prescription painkiller.




Pericarditis is a condition where there is inflammation in the layers of tissue that surround the heart (called the pericardium).

In 80%–85% of cases, pericarditis is caused by a viral infection, as reported in a 2022 review published in Current Cardiology Reports.

Other causes include bacterial infections, which are less common, and fungal infections, which are rare, according to MedlinePlus. Although there can be other causes as well.

Pain is present in most cases and is described as sharp or stabbing. The pain is located on the left side or front part of the chest, but it can also occur in the neck, shoulder, back, or abdomen.

It's more intense with lying down, breathing deeply, coughing, or swallowing, and it improves with sitting up and leaning forward, which is unique to this condition.

Although pericarditis is usually harmless, according to Dr. Arain, it can really impact your quality of life.

A healthcare provider may diagnose your condition after ordering a CT scan, EKG, or chest X-ray.

Chances are, however, your pericarditis will clear up in a few days or weeks simply through resting or taking over-the-counter pain medicine like ibuprofen, which also helps quell inflammation.




Just because a person's chest pain isn't related to a heart attack doesn't mean that it isn't dangerous. One example: acute pancreatitis—the sudden inflammation of the pancreas, which is located just behind the stomach, says NIDDK.

"Intense abdominal pain can radiate up to the chest," said Dr. Arain. "And the pain from pancreatitis is usually a deep-seated, intense pain."

Oftentimes, pancreatitis occurs when gallstones (hard, pebble-like pieces of material usually made of hardened cholesterol, according to NIDDK) trigger inflammation in the pancreas—something that's more likely to occur in women than men.

If you think you have pancreatitis, get medical attention right away; you'll probably have to stay in the hospital for a few days to get antibiotics, IV fluids, and pain medication.

A healthcare provider will also want to do blood work and order other tests, like a CT scan or abdominal ultrasound.




Chest pain can have a number of pulmonary (lung) causes. Because the lungs and heart are both located in the chest, it can be easy to confuse the origin of the pain.

Pleuritic chest pain occurs when the lining of your lungs (the pleura) becomes inflamed. This can cause "sudden and intense sharp, stabbing, or burning pain in the chest when inhaling and exhaling," according to a 2017 article published in the American Family Physician.

While not related to a heart attack, this type of chest pain can also be serious and is another reason you'll want to get your symptoms checked out by a medical professional.

Pulmonary embolism is the most common serious cause of pleuritic chest pain and is life threatening.

Pulmonary embolism occurs when there is a blockage in a lung artery. This blockage can damage the lungs and cause low oxygen levels in your blood, which can damage other organs as well, according to MedlinePlus.

Pneumonia can also cause pleuritic chest pain. Pneumonia is an infection of the lungs and can range from mild to severe, depending on the cause, according to MedlinePlus. Chest pain from pneumonia will occur when you breathe or cough.

If you've had some type of injury or trauma to your chest, a broken or bruised rib can also cause chest pain. Breathing, coughing, and moving your upper body can be very painful if you've injured your rib.




Having a panic attack can certainly feel like a heart attack; people often believe they're dying when they are having one.

In addition to chest pain, symptoms can include a pounding heart, sweating, shaking, nausea, dizziness, and a feeling of going crazy. It's your body's fight-or-flight response kicking in, according to the American Psychological Association.

Panic attacks tend to crop up suddenly with no warning. People can experience them for a variety of reasons, including:

  • Having a family history of panic attacks
  • A history of childhood trauma
  • Dealing with major life changes and ongoing stress (such as a serious illness of a loved one)
  • Experiencing a traumatic event (such as a robbery or car accident)

If you think you've experienced a panic attack, it can be helpful to visit a healthcare provider. They can rule out any physical issues with your heart, which can help put you at ease.

A provider may also refer you to a mental health professional who can help you treat and manage your symptoms.



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Baptist North Mississippi’s pulmonary program certified by leading cardiovascular and pulmonary organization

Published 8:00 am Friday, September 23, 2022

Baptist Memorial Hospital-North Mississippi’s pulmonary rehabilitation program was recently certified by the American Association of Cardiovascular and Pulmonary Rehabilitation, in recognition of the hospital’s commitment to enhancing standards of patient care.

To earn accreditation, Baptist North Mississippi’s rehabilitation program participated in an application process that requires extensive documentation of the program’s practices.

“The certification from American Association of Cardiovascular and Pulmonary Rehabilitation is a testament to the high-quality care of our pulmonary rehab program,” said Bill Henning, administrator and CEO of Baptist North Mississippi. “Our health care providers and colleagues at Baptist North Mississippi work diligently to provide advanced care for patients.”

AACVPR Program Certification is the only peer-reviewed accreditation process that assesses a program’s adherence to standards and guidelines developed and published by AACVPR and other related professional societies. The certification is valid for three years.

Pulmonary rehabilitation programs are designed to help people with pulmonary problems (e.g., chronic obstructive pulmonary disease, respiratory symptoms) recover faster and live healthier. Programs include exercise, education, counseling and support for patients and their families.

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What does "Pulmonary Fibrosis" mean?  
The word “pulmonary” means lung and the word “fibrosis” means scar tissue— similar to scars that form on the skin from an old injury or surgery. So, in its simplest sense, pulmonary fibrosis (PF) means scarring in the lungs.

Pulmonary fibrosis is a lung disease that occurs when lung tissue becomes damaged and scarred. This thickened, stiff tissue makes it more difficult for your lungs to work properly. As pulmonary fibrosis worsens, people can become progressively more short of breath.

The scarring associated with pulmonary fibrosis can be caused by a multitude of factors. But in most cases, doctors can't pinpoint what's causing the problem. When a cause can't be found, the condition is termed idiopathic pulmonary fibrosis.

The lung damage caused by pulmonary fibrosis can't be repaired, but medications and therapies can help ease symptoms and improve quality of life. For some patients, a lung transplant might be appropriate.

Symptoms of Pulmonary Fibrosis:  
The most common symptoms of pulmonary fibrosis are dry, persistent cough and shortness of breath. Symptoms may be mild or even absent early in the disease process. As the lungs develop more scar tissue, symptoms worsen. Shortness of breath initially occurs with exercise, but as the disease progresses patients may become breathless while taking part in everyday activities, such as showering, getting dressed, speaking on the phone, or even eating.

Due to a lack of oxygen in the blood, some people with pulmonary fibrosis may also have “clubbing” of the fingertips. Clubbing is a thickening of the flesh under the fingernails, causing the nails to curve downward. It is not specific to pulmonary fibrosis or idiopathic pulmonary fibrosis and occurs in other diseases of the lungs, heart, and liver, and can also be present at birth.

How Do Doctors Recognize and Diagnose Pulmonary Fibrosis? 
There are three consequences of pulmonary fibrosis. Doctors use these consequences to recognize that someone has PF:

1. Stiff Lungs. Scar tissue and inflammation make your lungs stiff. Stiff lungs are hard to stretch, so your breathing muscles have to work extra hard just to pull air in with each breath. Your brain senses this extra work, and it lets you know there’s a problem by triggering a feeling of breathlessness (or “shortness” of breath) while exerting yourself.

Also, stiff lungs hold less air (they shrink a bit). Doctors take advantage of this “shrinking” to diagnose and track the disease using breathing tests (called Pulmonary Function Tests) that measure how much air your lungs can hold. The more scar tissue your lungs have, the less air they will hold.

2. Low blood oxygen. Scar tissue blocks the movement of oxygen from the inside of your air sacs into your bloodstream. For many people living with pulmonary fibrosis, oxygen levels are only reduced a little bit while resting, but their oxygen levels drop quite a bit during activity. The brain can sense these low oxygen levels, triggering breathlessness.

Doctors will check your oxygen levels to see if they drop after walking, which could be a clue that PF might be present. Doctors also often prescribe oxygen to be used through a nasal cannula or a facemask during activity and sleep for those with PF. As pulmonary fibrosis progresses, oxygen may be needed 24 hours a day and flow rates may increase.

3. “Crackles" lung sounds. Your doctor may have told you that “crackles” were heard in your lungs. Crackles (also called “rales”) sound like Velcro being pulled apart.

They are heard in many lung diseases because any type of problem affecting the air sacs (such as PF, pneumonia, or a buildup of fluid in the lungs from heart failure) can cause crackles. Some people with pulmonary fibrosis don’t have crackles, but most do.

Can pulmonary fibrosis be reversed? 
Unfortunately, lung damage due to pulmonary fibrosis is permanent (not reversible). Getting diagnosed and starting treatment as early as possible may help your lungs work better, longer.

How is pulmonary fibrosis treated? 
Most pulmonary fibrosis treatments focus on easing symptoms and improving your quality of life.

Your provider may recommend one or more treatments: 
• Medication: Two medications — pirfenidone (Esbriet®) and nintedanib (OFEV®) —may slow down lung scarring. These medications can help preserve lung function.

• Oxygen therapy: Giving your body extra oxygen helps you breathe more easily. It may also increase your energy and strength.

• Pulmonary rehabilitation: Staying active in this special exercise program may improve how much (or how easily) you can do everyday tasks or activities.

• Lung transplant: A lung transplant replaces one or both diseased lungs with a healthy lung (or lungs) from a donor. It offers the potential to improve your health and quality of life. A lung transplant is major surgery, and not everyone is a candidate. Ask your provider if you may be eligible for a lung transplant.

Can pulmonary fibrosis be cured? 
No cure for pulmonary fibrosis exists today. But researchers around the world are working to change that.



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When you're feeling stressed or having trouble sleeping, it can sometimes be difficult to get out of that headspace and calm down. But the solution may be as easy as taking deep breaths in and out in a specific rhythm.


A breathing technique—dubbed the 4-7-8 method—has been growing in popularity in recent years thanks to Andrew Weil, MD, who has been teaching the method since the 1980s.


As the name implies— the technique involves breathing in for four seconds, holding that breath for a count of seven, and then exhaling for eight seconds while making a whooshing sound by placing the tongue behind the front teeth. After four repetitions, a person should ideally feel a sense of calm.


"Over time…after you practice it for six weeks or eight weeks, there is a real shift in the balance between the parasympathetic and sympathetic nervous system, resulting in lower heart rate, lower blood pressure, improved digestion, better circulation," Dr. Weil, founder and director of the Andrew Weil Center for Integrative Medicine at the University of Arizona College of Medicine, told Health. " It's also the most effective anti-anxiety measure that I've ever come across."


Here's a closer look at how breathing affects our sense of relaxation, how the 4-7-8 method can promote better sleep, and the easiest ways to incorporate it into your daily routine.



The 4-7-8 technique actually comes from pranayama, or yogic, breathing, Dr. Weil explained. Under this umbrella, there are hundreds of other different techniques for controlling breath that promote health or mindfulness in various ways.


This specific type of breathing engages the diaphragm, explained Todd Arnedt, PhD, professor of psychiatry and neurology and director of the behavioral sleep medicine program at Michigan Medicine at the University of Michigan. This is the opposite of the kind of breathing we do when we're stressed.


"When we're anxious, we tend to do a lot of short, quick breaths, breathing from our chest," Arnedt told Health. "[4-7-8 breathing] sort of redirects you to breathe from your belly and from your diaphragm. And there are a whole host of positive physiological responses that go along with that breathing and help to put you in that relaxed state."


Some of these positive outcomes from diaphragmatic breathing may include improved cognitive function and lower cortisol, or stress, levels, as well as improved quality of life. For the 4-7-8 method more specifically, research found that the practice can help improve blood pressure and heart rate variability.


It may seem strange that something as simple as breathing can have such a big effect on our health, but the connection between breath and the parasympathetic nervous system is likely why we see so many health benefits from the practice.


"Our autonomic nervous system is made up of two main parts, the sympathetic and the parasympathetic," Raj Dasgupta, MD, pulmonary critical care and sleep medicine specialist at Keck Medicine of the University of Southern California, and spokesperson for the American Academy of Sleep Medicine, told Health. "The sympathetic is going to be our fight or flight per se, and in general, that may increase your heart rate, may increase your breathing. And when you activate the parasympathetic nervous system, we kind of refer to that as a rest and digest."


Breathing in this specific ratio—four seconds in, seven seconds of holding at the top, and eight seconds of exhaling—activates the parasympathetic nervous system and helps our body relax, slowing the heart rate, helping with digestion, and lowering stress hormones. Breathing in through your nose and then holding your breath also humidifies and filters the air, and opens up the lungs, Dr. Dasgupta added.





Because it can help relax the body, the 4-7-8 technique can be a good one to incorporate, especially if a person is dealing with stress or has any kind of insomnia.


"As it relates to sleep, we often encourage people to engage in these kinds of practices in the last hour or so before they go to bed, in concert with a good positive, wind down routine," Arnedt said. "This 4-7-8 breathing technique or other mindfulness and relaxation strategies can often be a good part of a good wind down routine—that again, sets the stage for sleep to happen."


Doing this breathing technique can also be useful to help lull a person back to sleep if they wake up in the middle of the night, he added.


Besides making sleeping easier, being able to make your body more relaxed and more ready for sleep should help with a host of other issues as well. Poor sleep quality and not getting enough sleep are linked to a number of health issues—everything from heart disease to depression. Having a simple tool to get you ready for sleep could be a great tool to stay on top of your health.


But the 4-7-8 breathing technique does more than promote sleep, and can be used by anyone at any point throughout the day, Dr. Weil said. It also increases in effectiveness the more that a person does it, so as long as you feel well, "you cannot do it too frequently," Dr. Weil wrote on his website.


"I do it in the morning when I first get up. I do it in the evening when I get into bed to fall asleep, and I do it anytime during the day that I may feel anxious or I want to relax more," he said.





The 4-7-8 breathing technique is fairly simple, Dr. Weil explained, which is in part why he recommends it so widely. You can do it standing, lying down or sitting, he explained, though if you're sitting, it's best to sit upright and have both feet on the floor.


"It's also totally simple, it's very time effective. The practice, it just takes a minute or two a day, no equipment," Dr. Weil added. "And it's an utterly simple technique."


Even though it's simple, for some it can take some getting used to.


"You can think of it as a skill. It's probably not something that you're going to be good at right away. It's likely something like practicing the piano or another instrument, or learning how to throw a baseball," Arnedt said. "It's something that's gonna take a little bit of time for you to master and be good at."


For people with underlying heart or lung issues, Dr. Dasgupta added, it can sometimes be challenging to hold their breath for a full 7 seconds. Breathing out for a longer period of time may also feel a bit strange—it expels a lot of CO2 from our lungs, he explained, which can sometimes make us feel lightheaded. The experience has to be tailored to the individual.


"The technique by itself per se, isn't the magic bullet. We definitely encourage people to use this breathing technique with other relaxation techniques," Dasgupta said. "But this is something that is safe for most people."


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CHI Memorial announces the certification of its cardiac rehabilitation program by the American Association of Cardiovascular and Pulmonary Rehabilitation.  This certification is recognition of CHI Memorial’s commitment to improving the patients’ quality of life by enhancing standards of care.

Cardiac rehabilitation programs are designed to help people with cardiovascular problems, like heart attacks and coronary artery bypass graft surgery, recover faster and live healthier.  The program includes exercise, education, counseling, and support for patients and their families.

“The AACVPR certification is a testament to our team's commitment and efforts in providing high-quality patient care and services,” shared Matt Thomas, manager, cardiopulmonary rehab. “Achieving this milestone was no easy task, but our patients deserve the highest level of care we can provide." 

To earn accreditation, CHI Memorial’s cardiac rehabilitation program participated in an application process that required extensive documentation of the program’s practices. AACVPR Program Certification is the only peer-review accreditation process designed to review individual programs for adherence to standards and guidelines developed and published by AACVPR and other related professional societies.  Each program’s application is reviewed by the AACVPR Program Certification Committee, and certification is awarded by the AACVPR Board of Directors.

In 2018, AACVPR moved to an outcomes-based process with performance measurements that represent more meaningful outcomes. Therefore, AACVPR-certified programs are leaders in the cardiovascular and pulmonary rehabilitation field because they offer the most advanced practices available and have proven track records of high-quality patient care. AACVPR Program Certification is valid for three years.

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Why rehabilitation post lung transplant is critical to ensure optimum success of procedure

Human lungs. Image courtesy Pearson Scott Foresman/Wikimedia Commons

Lung transplant is an established treatment for patients with end-stage lung disease. It is a surgical procedure to replace a diseased or failing lung with a healthy lung, usually from a deceased donor.

Several modifiable pre- and post-transplant factors contribute to a wide range of physiological and psychological changes which need to be addressed and effectively managed.

It is well established that rehabilitation plays a major role in the pre and post-operative management of patients. It involves working in partnership with the patient, their family and caregivers and a comprehensive multidimensional medical team- towards a common goal of maximising the potential and independence of the patient and to promote a holistic health. It is the process of helping an individual achieve the highest level of function, independence, and to enhance their overall quality of life.

Global review of literature depicts that with the involvement of a multidisciplinary team of experts contributes greatly to the well-being of the patient.

The rehabilitation team typically includes physical therapist, exercise physiologist, psychologist and nutritionist.

The transplant trajectory is complex and intensive, and patients usually experience this period as extremely stressful. Along with the functional impairment – the patients also undergo significant degree of emotional distress. With the prevalence rates of anxiety and depression being high in transplant candidates and recipients, there is a strong need for psychological rehabilitation along with physical rehabilitation for their overall holistic wellbeing. Pre- and Post-transplant psychological support is an important, but overlooked, element in optimising transplant outcomes, particularly in lung transplant recipients who have some of the highest rates of complications and distress following transplantation.

In order to evaluate exercise capacity and function in lung transplant candidates and recipients, a combination of aerobic testing, muscle function, mobility testing and assessment of physical activity is utilised. Along with this- a comprehensive psycho-social assessment is carried out where patient’s understanding regarding the medical illness, process of transplant, willingness/desire for treatment, compliance and care of lifestyle factors, along with the patient’s present emotional and mental state, past psychiatric history is elicited. Based on the test results, a comprehensive rehabilitation programme is planned.

Rehabilitation can be divided into two broad categories:

1. Pre-operative Rehabilitation or Prehabilitation
2. Post-operative rehabilitation

Prehabilitation

Participating in a supervised pulmonary rehabilitation programme is recommended to assist with prevention of further deterioration and improvement in symptoms, understanding of the condition and enhancing the quality of life. The goal is to promote a better functional recovery post-transplant. Most of the patients awaiting transplant are recommended to be subjected to prehabilitation as indicated.

The prehabilitation is feasible and improves the quality of life by:

• Effective chest clearance and lung expansion techniques
• Maintaining or improving physical activity levels
• Maintaining or improving cardiorespiratory fitness
• Preparing the patient for the transplant surgery
• Psychological interventions to enhance coping

Post-operative rehabilitation

Inpatient rehabilitation

Early post-operative rehabilitation

Post-operative rehabilitation starts immediately after surgery once the patients is stabilised, where the initial focus is on maintenance of bodily systems, as well as to assist the patient with the weaning of ventilator/supplemental oxygen and facilitate early mobility.

It typically begins in ICU and then continues in wards with the goal to improve:

• pulmonary hygiene and lung capacity
• General mobility
• Functional capacity
• Muscle strength and endurance
• Emotional coping
• Facilitate discharge from the hospital

Rehabilitation in wards can be further escalated to frequent walking, cycling, strengthening and stair climbing.

Outpatient rehabilitation

An outpatient rehabilitation programme may begin as soon as possible after hospital discharge. A tailor-made exercise programme is prescribed keeping in mind individual patient goals. The outpatient rehabilitation programme facilitates regaining the muscle mass and strength lost during prolonged illness and the disuse associated with prolonged illness along with adequate emotional coping to regain a sense of normalcy in their day to day lives.

The comprehensive programme typically includes:

• Aerobic exercises
• Resistance training
• Flexibility exercises
• Breathing retraining
• Psycho-social counselling
• Nutritional intervention which makes it an efficacious rehabilitation programme

Remotely monitored (tele-health) home based exercise, or pedometer based walking interventions might serve as alternatives to supervised outpatient rehabilitation interventions in the long-term post-transplant phase.
Both inpatient and outpatient rehabilitation have proven to be beneficial for patients before and after lung transplant by improving exercise capacity, promote adaptive coping and overall quality of life.

With recent research showing reduced risk of cumulative mortality in patients of lung transplant- which was attributable to Pre and Post-Transplant rehabilitation, and with other studies depicting greater survival rates among patients even after five years- Rehabilitation should be seen as an essential service offered across all levels of the health care system. We encourage patients to enrol in rehabilitation programme pre-operatively and continue the journey post operatively for an optimal gold standard of care.

The author is Consultant – Rehabilitation and Sports Medicine, Sir HN Reliance Foundation Hospital. Views are personal.

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