Healthier You | Summer 2017 by Prince George Citizen

Healthier You Summer

2017

HEALTHY LUNGS Pulmonary rehabilitation helps

northerners breathe a little easier SMOKESTACK SANDRA: PODCASTING FROM TAKLA LANDING WHAT IS A RESPIRATORY THERAPIST? PROTECTING WILDFIRE FIGHTERSâ&#x20AC;&#x2122; LUNGS

Volume 6, Issue 2

Summer

PULMONARY REHABILITATION IN PRINCE GEORGE

featurestory

A unique partnership in Prince George helps people with chronic pulmonary diseases cope with shortness of breath, develop activity tolerance, and improve quality of life.

2017

{REGULAR FEATURES} 4 CEO WELCOME

10 AUXILIARY UPDATE

p.19

PROVINCIAL RESPIRATORY OUTREACH PROGRAM

A non-profit program supports independence and self-determination.

CRUNCHING THE NUMBERS �� PAGE 5

WILDFIRE FIGHTERS’ LUNG HEALTH �� PAGE 11

SMOKESTACK SANDRA’S QUITTING JOURNEY �� PAGE 7

STAFF PROFILE: RESPIRATORY THERAPIST �� PAGE 12

Air quality meteorologists monitor pollutants and keep us in the know!

Sandra Teegee’s podcast project has helped her, and others, start to quit, bit by bit.

MAKING A DIFFERENCE FOR LUNG HEALTH IN NORTHERN B.C. �� PAGE 9 Spirit of the North Healthcare Foundation brings new respiratory equipment to the north.

Research at UNBC develops new tools and looks to better understand wildfire fighters’ respiratory health.

For Richelle Maser, “respiratory therapist” is a big misnomer!

A NORTHERN QUIT STORY �� PAGE 18 Quitting smoking is hard. Get inspired by others!

SUMMER 2017

Healthier You

welcomemessage

Respiratory health in northern B.C. One of our goals at Northern Health is to better understand the health needs of each community and to use this information to improve health. As we do this, we see that respiratory health often comes to the forefront.

Cathy Ulrich President and Chief Executive Officer, Northern Health

Why is this? There are many factors that impact respiratory health in northern B.C.: •

Where can you find Healthier You?

•

• Doctors’ offices • Walk-in clinics • Pharmacies • Other community settings

•

Smoking rates are higher here than in the rest of the province. Chronic obstructive pulmonary disease (COPD) is a leading cause of hospitalization. Our aging population – and an aging population of current and exsmokers – contributes to this concern. Environmental factors impact the quality of the air we breathe.

As we enter another wildfire season and mark Asthma and Allergy Awareness Month (May), the timing is ideal for an issue of Healthier You looking at respiratory health. What I hope you’ll see in this issue is that respiratory health brings together so many different programs, people, and community partners. Northern Health, the YMCA of Northern BC, and the Department of Physical Therapy at UBC coming together to reduce hospital readmissions through pulmonary rehabilitation (page 14) is one great example of this. When we looked for the diverse people and programs impacting respiratory health, we found generous northerners who, through foundations and auxiliaries, are bringing state-of-the-art equipment to local hospitals across our region (page 9). We also found podcasters (page 7), meteorologists (page 5), respiratory therapists (page 12), and UNBC researchers (page 11) all working to promote health, protect healthy environments, and prevent lung disease. I hope that you enjoy learning about the many fascinating ways that we can have an impact on respiratory health. As always, we would love to hear what you think about the magazine. If you have any comments about the magazine, please contact our health promotions team at healthpromotions@northernhealth.ca. Thank you for reading. 4

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SUMMER 2017

Healthier You Volume 6, Issue 2 – Summer 2017

Published by:

the northern way of caring

www.glaciermedia.ca

PUBLISHED BY NORTHERN HEALTH & THE PRINCE GEORGE CITIZEN

Contributors / Healthier You is produced by the Northern Health health promotions team with contributions from Northern Health staff and partner organizations, in partnership with The Prince George Citizen.

Advertising Sales Prince George Citizen

Advertisements in this magazine are coordinated by The Prince George Citizen. Northern Health does not endorse products or services. Any errors, omissions or opinions found in this magazine should not be attributed to the publisher. The authors, the publisher and the collaborating organizations will not assume any responsibility for commercial loss due to business decisions made based on the information contained in this magazine. Speak with your doctor before acting on any health information contained in this magazine. No part of this publication may be reproduced or transmitted without crediting Northern Health and The Prince George Citizen. Printed in Canada. Please recycle.

airquality

CRUNCHING

THE NUMBERS

TO PROTECT OUR HEALTH

ASSESSING A NON-STOP FLOW OF DATA ABOUT THE AIR WE BREATHE IS ALL IN A DAY’S WORK FOR AIR QUALITY METEOROLOGISTS. Vince Terstappen, health promotions, Northern Health

To shed some light on a topic that is so often out of view, occurring at the level of tiny particles, I spoke with air quality meteorologist Gail Roth. She took me through a day in the life of someone who spends a lot of time amidst tiny particles with big health impacts! How do we measure air quality? The Ministry of Environment has two types of monitors, continuous and non-continuous, that are set up in communities all over B.C. We monitor all sorts of pollutants, including sulphur dioxide, nitrogen oxides, and more. Because it’s the air pollutant that most often exceeds provincial objectives, a primary area of concern is particulate matter pollution – the tiniest of particles in the air that can get stuck deep in our lungs. These are called PM2.5 – particulate matter (PM) that is 2.5 micrometres or smaller in diameter. For comparison, a human hair is approximately 60 micrometres in diameter. PM2.5 is largely generated from combustion sources (e.g., vehicles, residential wood burning, industrial processes).

We also monitor PM10 (particulate matter that is smaller than 10 micrometres). These larger particles are mostly caused by big particles like road dust, wood dust, or pollen being broken down. In both cases, we measure how many of these particles there are in one cubic metre of air. You’ll see this reported as micrograms per metre cubed: µg/m3. What is an air quality advisory? The provincial objective for PM2.5 levels in a 24-hour period is 25 µg/m3. When a community gets above or close to this level, we issue an air quality advisory. This lets people know that their breathing may be affected and that they should be taking action to protect their health (see page 6) and reduce their emissions. The annual objective, which we use to monitor long term PM2.5 levels, is 8 µg/m3. The provincial objective for PM10 levels in a 24-hour period is 50 µg/m3. When a community gets above or close to this level, we issue a dust advisory. If there’s a forest fire in your area, you may also see a smoky skies advisory. Although specific smoke conditions might change because of wind, fire behaviour, and temperature, a smoky skies advisory in your area means you can expect higher levels of particulate matter pollution. Continued on page 6 SUMMER 2017

Healthier You

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Continued from page 5

What actions can I take to protect myself during these advisories? We include these actions right in the advisories, so they can be a helpful tool in protecting your health. The overarching goal of these actions is to reduce your exposure to the poor air. Some specific actions include: • Avoid roads with heavy traffic and areas with wood smoke. • Reduce or stop physical activity if breathing becomes difficult.

Further actions, including staying indoors and running air cleaners, may be needed for those who are more sensitive, like seniors, children, and people with underlying medical conditions. What else do air quality meteorologists do? In addition to monitoring air quality and issuing public reports and advisories, there are two other main parts to our work: 1. Technical reviews: As an example, when an industry applies for a permit for a project that might have air pollution emissions, we review the application and evaluate its potential impact on air quality in the local community and surrounding area. 2. Supporting local airshed management groups: We help to start these groups and translate technical air quality information for them. Local members drive the groups and we’re a resource for them, providing support on the science side. Where can I learn about advisories in my community? I’d encourage everyone to visit bcairquality.ca. Whenever an advisory is in place, it will appear as a link on the homepage. Even if there’s no advisory, you can still find current air quality conditions for where you live as well as great resources.

MORE INFORMATION DID YOU KNOW? Do you have respiratory sensitivities or want to take extra precautions during wildfire smoke events? There is a growing body of evidence to suggest that portable air cleaners (equipped with HEPA filters or electrostatic precipitators) are effective at reducing indoor particulate matter concentrations and the associated health effects during short smoke events. Be sure to research products before purchasing a portable air cleaner! Learn about the type of unit you’re purchasing and the proper sizing for your space. On these devices, you’ll notice a number called the clean air delivery rate (CADR) - if you’re concerned about wildfire smoke, the CADR rating for tobacco smoke is the most relevant to look at. When using a portable air cleaner, limit the entry of outdoor air. Keep in mind when you’re indoors and using a portable air cleaner, however, that there can be risks from increased heat and indoor-generated air pollutants. 6

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aboriginalhealth

SMOKESTACK

Sandra Teegee in the studio recording the “Smokestack Sandra” podcast with the First Nations Health Authority.

SANDRA’S

QUITTING JOURNEY SANDRA TEEGEE’S PODCAST PROJECT HAS HELPED HER, AND OTHERS, START TO QUIT, BIT BY BIT. Cate Korinth, First Nations Health Authority

Adapted and reprinted with permission from Spirit Magazine (fnha.ca/wellness/spirit-magazine) Sandra Teegee is passionate, determined, and candid. And let’s not forget funny - she’s very funny. Sandra is also down to one pack of smokes a week from a pack and a half a day. And contrary to the norm, she’s even lost a few pounds along her journey to quit smoking. Her sense of humour and willingness to be candid triggered a request to keep an audio record of her personal health and wellness, specifically her daily life as a smoker. Now, Sandra’s daily audio recordings have been produced into three 30-minute podcast episodes called Smokestack Sandra, which you can listen to at fnha.ca/respectingtobacco. Sandra grew up off-reserve in Fort St. James and embarked on the adventure of a lifetime when she returned to her parents’ reserve of Takla Landing at 23 years old. She went there to work on a 10-week project to teach administrator training; it was always understood in her family that she’d give back to her community, her Nation. When she got to Takla Landing, the community touched her heart, and there was no turning back. Decades later, she has made her life in Takla, is Deputy Chief, and has become a leader in health and wellness. She’s an advocate for healing and dealing with the hard issues. What were you like when you moved to Takla Landing? Well, I was 23 years old and I was a health fanatic, real “granola,” and I’d been a deadly basketball player in

high school. I was optimistic, spiritual, and grounded. I was also alcohol and nicotine free. Why did you start smoking? I started in Takla. Everybody there smoked. It was all around me – coffee breaks, smoke breaks. I just wanted to be around all the fun. When you’re young, you think you are bulletproof. I thought this would be a short thing. What do you hope to accomplish with the podcast? “You’re not alone” is the message I wanted to convey most in the podcast. Quitting is easier said than done, and lots of people care. The three episodes are just the tip of the iceberg in terms of the people I talked to. What was the most difficult aspect of doing the podcast? Facing the fact that this was not supposed to be my story! These unhealthy habits were not supposed to be part of my life. What was the biggest surprise? The biggest surprise was my personal growth through this process. It’s been my gift from the Creator. I really mean it. Sure, it was very frustrating at times – when you are quitting smoking, you are dealing with core issues, the “should haves” of one’s own choices. Something else that resonated with me through the process of making the podcast is that we have the obligation to shine our light and share our gifts.

Continued on page 8 SUMMER 2017

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Continued from page 7

What is your advice to young people about smoking? I was young once, too, and I understand where they are. Please be wise enough not to take things lightly. I want them to know that it’s extra cool to be athletic, active, and healthy. If you are standing alone to be a leader in wellness, so be it. Bask in it. Know that you are doing a good thing. I can’t emphasize enough to youth that everything I was taught back then about health and wellness is in style now.

What has your quitting journey done for you? It has given me back to me. It has reawakened my spirit – who I am, who I am supposed to become. I went out of my comfort zone and it opened up other doors and reawakened my dreams. We can all do this. This journey has liberated me and taken me away from all the things that were hindering my potential. I’ve come back to where I used to be: that optimistic 23-year-old – but wiser.

What is your advice to others on their quitting journeys? Invest in your kids and grandchildren, because the message of quitting will impact your whole family. Seek out all the supports you can find – QuitNow.ca. The cigarette takes away from your life, from your time. It really isn’t a grounding method to cope with feelings at all, although that’s the illusion: that it helps us de-stress. Try your best to be able to stand in front of the challenges without cigarettes. Start little. Do your core work. Embrace who you are. Possibilities are limitless once you quit smoking. You’ll be able to quit other things, too. At first it’s hard, but after a while, it becomes a habit to make healthy choices. It’s never too late!

CONTEST ENTER TO WIN First Nations teens got together to do something about commercial tobacco, because smoking isn’t cool. Aboriginal teens smoke at a rate 2-3 times higher than other teens in B.C. “We made some videos because someone had to stand up to big tobacco and fight for our health.” Want to win $1,000? Enter the FNHA’s Youth Video Contest and check out the videos at fnha.ca/youth. Three $1,000 monthly prizes available until June 19.

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foundations&auxiliaries

MAKING A DIFFERENCE FOR LUNG HEALTH IN

NORTHERN B.C. SPIRIT OF THE NORTH HEALTHCARE FOUNDATION BRINGS NEW RESPIRATORY EQUIPMENT TO THE NORTH. Annette Stevens, donor relations manager, Spirit of the North Healthcare Foundation

There are very few of us living in the north who are not touched by friends or family members who suffer from respiratory-related illnesses. There are many reasons for this and, as a result, residents of northern B.C. have a higher demand for pulmonary testing and monitoring. In 2014, the University Hospital of Northern BC (UHNBC) in Prince George, which serves the entire Northern Health population when it comes to pulmonary testing, had one pulmonary function lab and the waitlist for testing was approximately eight months. Spirometry, a common test used to assess how well our lungs work by measuring how much air is inhaled, how much is exhaled, and how quickly it is exhaled, was a six month wait. An additional pulmonary function lab in the respiratory therapy department was identified as a need to provide quicker diagnostic information crucial for medical decisions regarding care and followup for patients. That’s when Spirit of the North Healthcare Foundation was approached to fundraise for this much-needed equipment. With most of the funds raised through Spirit’s 10th annual radiothon, Costco’s Children’s Miracle Network campaign, and the Punjabi Seniors Society’s annual bike-a-thon, the community as a whole stepped up and made a difference to help bring the best of care close to home in the north! Through the generosity of sponsors, volunteers, and valued donors, a second lab became a reality! Funding also allowed for updated software in the primary pulmonary function lab. With all of this in place, patients are now able to receive a quicker diagnosis, allowing them to develop treatment plans earlier, begin appropriate treatment, and improve their quality of life. Wait times have decreased significantly and are now in line with the provincial average of 4-6 weeks.

Coming up next! Spirit of the North’s radiothon has been rebranded as Spirit Day and will take place June 1, 2017. Fundraising this year has been designated for equipment in the regional cardiac centre at UHNBC. This will improve access to, and quality of, cardiac diagnostics by bringing state-of-the-art echo ultrasound equipment to UHNBC. This will provide better emergency response and, ultimately, better health outcomes. Giving is the difference that makes the difference If you would like to make a difference, contact the Spirit of the North office located in the atrium at UHNBC, call 250-565-2515, or visit spiritofthenorth.ca.

SUMMER 2017

Healthier You

foundations&auxiliaries

BREATHING EASIER IN THE NORTH: AUXILIARIES IMPROVING LUNG HEALTH

Quesnel The auxiliary to the GR Baker Hospital purchased a ventilator/BiPAP machine for the ICU in 2016. This machine is used for patients who cannot breathe on their own or who need help to breathe. The auxiliary in Quesnel is a small auxiliary with very hardworking, dedicated members. Want to support their work to buy equipment for the local hospital? Their gift shop is a major fundraiser, along with their snack cart, TV rentals, recycling, juice machine, hand-knit baby clothes, bake sales, tag days, and raffles! Fort St. John The Fort St. John Hospital Auxiliary recently responded to the need for two additional AIRVO 2 nasal high flow humidifiers in the respiratory department of the Fort St. John Hospital. This equipment administers humidified oxygen to enhance patient comfort. The new units also have battery packs for continuous oxygen flow for patients who are mobile. The previous three units provided by the auxiliary limited the transfer of patients because the units needed electrical outlets. The demand on all of these units is increasing with the level of respiratory illnesses. The need for the vital battery unit was recently demonstrated with the transfer of a baby from the Fort St. John Hospital to the hospital in Vancouver. Taking the baby off of the continuous flow of oxygen even for a very short time would not have been the best quality of care, which the auxiliary works to support.

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Auxiliary members with staff and donated equipment at GR Baker Hospital in Quesnel.

Auxiliary members with Joanne Rondeau, head of the respiratory department in Fort St. John, pictured with one of the donated AIRVO 2 machines.

research

RESPIRATORY HEALTH

OF NORTHERN B.C.

MORE INFORMATION

WILDFIRE FIGHTERS

More respiratory health research happening at UNBC!

UNBC RESEARCHERS TRY TO BETTER UNDERSTAND THE HAZARDS THAT SMOKE POSES TO WILDFIRE FIGHTERS.

Developing advanced respiratory health diagnostics Researchers at UNBC recently harnessed advances in medical imaging to develop a new non-invasive method of assessing the health of our respiratory muscles. The study was conducted by Tanya Grob, a 5-year veteran of the UNBC Timberwolves soccer team and a two-time Academic All-Canadian Athlete. Tanya graduated with her Bachelor of Health Sciences (Honours) in May 2016. The research took place in the Northern BC Near-Infrared Spectroscopy Research Laboratory at UNBC.

Mike Eadie (MSc), Luke Harris (PhD), Chelsea Pelletier (PhD), UNBC School of Health Sciences

Because of their long shifts, proximity to fire activity, and strenuous work, wildfire fighters experience higher respiratory health risks than the general population. Excess exposure to wildfire smoke puts these men and women at risk of reduced lung volume, respiratory irritation, and poorer breathing performance. Wildfire fighting in B.C. Managing wildfires in B.C. is no easy task. Wildfire fighters spend their summer months preventing and suppressing wildfires that might threaten public safety or property. The largest available provincial resources for the task are 20-person wildfire unit crews. They are typically sent to fight large fires in any corner of the province at a moment’s notice. These unit crews may fight large fires for up to two weeks before being relieved by another crew. Shifts vary with the intensity of the fire, but typically range from 8-16 hours. Wildfires can be unpredictable, so suppression efforts are physically demanding and mentally strenuous. Wildfire fighters work to control these fires by removing potential fuel sources and using portable water delivery equipment to extinguish the flames. Many of these suppression tasks require the wildfire fighters to be close to the flames, which exposes them to high levels of wildfire smoke, with potential impacts on their respiratory health. Some of the more harmful products in this smoke are carbon monoxide, nitrogen oxides, polyaromatic hydrocarbons, and fine particulate matter that can be inhaled into the smallest pathways of the respiratory system. Currently, wildfire fighters in the province do not actively use respiratory protection while suppressing wildfires. Most of the available protective devices are either too bulky or are not effective at filtering out fine particulate matter. Gaining a better understanding of hazards and wildfire fighters’ needs This summer, researchers from the School of Health Sciences at UNBC will examine respiratory health in northern B.C. wildfire fighters. This project is led by graduate student and former northern B.C. wildfire fighter Mike Eadie, along with his co-supervisors Dr. Chelsea Pelletier and Dr. Luke Harris.

Tanya used specialized lasers, lights, and light detectors – all in a wireless, handheld box – to measure changes in blood flow and oxygen levels in athletes’ respiratory muscles over four months. What she discovered is that this tool and these new measures can show improvements or declines in muscle metabolism due to changes in fitness. In January 2017, Tanya’s research supervisor, Dr. Luke Harris, presented this discovery in San Francisco at the annual conference of the International Society for Photonics and Optics. UNBC researchers will use these new tools in their work with B.C. wildfire fighters during the 2017 fire season. Their study will include assessments of wildfire fighters’ respiratory health across the entire wildfire season (May to August) and across shifts during a large wildfire event. The season-long assessment will look at chronic or long-term respiratory health effects due to smoke exposure. The cross-shift assessment will involve researchers spending up to two weeks with a unit crew at a fire, observing changes in respiratory health pre- and post-shifts. The researchers will be measuring lung capacity and lung function, physical fitness, respiratory muscle fatigue, and body composition. The UNBC researchers hope that this study will lead to a better understanding of the hazards that wildfire smoke poses to wildfire fighters. Although extensive research has been done on their counterparts who battle structural fires, wildfire fighters as a population have not been studied a lot. This research will be the first of its kind to be undertaken in B.C. Findings from this study may help organizations responsible for responding to wildfire events make informed operational decisions regarding smoke exposure hazards when sending wildfire fighters out to a fire.

SUMMER 2017

Healthier You

staffprofile

STAFF PROFILE:

RICHELLE MASER, RESPIRATORY THERAPIST Where are you from:

I was born in Smithers and raised in Prince George.

Favourite food:

Ice cream (specifically: pumpkin pie blizzards)

Favourite thing about northern B.C.:

Everything! I love living here, I love our winters, and I love walking out of my door and right into nature.

Favourite activities:

I’m a bit of an adrenaline junkie (in life, like at work!) and I enjoy backcountry sledding and dirt biking. When I’m in the mood for quieter things, I like paddleboarding and yoga.

Motto:

Life is short, let’s rip!

What do respiratory therapists do? I often say that “respiratory therapist” is quite a misnomer. When people hear “therapist,” they usually think of some sort of optional care. Respiratory therapists are anything but optional! We’re considered essential to life care and most of our work is done in urgent or trauma environments like the Intensive Care Unit (ICU). We’re at the hospital in Prince George (UHNBC) 24 hours a day, 7 days a week. Many people are familiar with the ABCs (airway, breathing, and circulation) in first aid – respiratory therapists are the “A” and the “B”! When an emergency happens or when critical care is needed, respiratory therapists are there. Although my role is mostly ICU work, respiratory therapists can also be involved in outpatient education, home oxygen programs, and pulmonary function. Because of compassion fatigue (common among care providers), you actually see a lot of respiratory therapists shift out of urgent care and into these other roles later in their career. What does a typical day look like for a respiratory therapist? Work at UHNBC is broken up into 12-hour shifts. Any given day or night shift can be feast or famine. On any given shift, a respiratory therapist might be called as part of the critical care outreach team to the bed of a patient who is crashing and have to make split-second decisions on how to stabilize them to prevent a code blue (cardiac arrest). Then, they might need to test another patient’s arterial blood and use state-of-the-art technology to interpret their oxygen levels and recommend changes to treatment. That could be followed by a call to the delivery room to perform

Healthier You

SUMMER 2017

neonatal resuscitation on a baby born prematurely. That same day might end with supporting the extubation of a patient at the end of life so that they might die with dignity, in accordance with their wishes. On other days, I might end up spending most of my shift in the department, cleaning and restocking our equipment and ventilator machines, getting them ready for the next action-packed day! What type of technology do you work with?

COPD as a big reason for intubation and life support. With asthma, many people, especially teenagers, underestimate just how deadly this disease can be. Asthma kills people and it can happen quickly. It can be hard to convince a young person to use their puffer or to get rid of the family cat but controlling these variables is key to managing symptoms. And the number one way not to see me is to quit smoking!

Many people don’t realize that as a teaching hospital, UHNBC in Prince George has state-of-the-art ventilators and treatment modalities available. This top-notch tech, along with the high level of responsibility and team we enjoy as respiratory therapists here is one of reasons we’ve been able to successfully recruit respiratory therapists. Spirit of the North Healthcare Foundation and the Firefighters Foundation are two big supporters of our pulmonary equipment. What types of patients do you see? I’m involved in literally the entire life cycle: from the delivery of a baby to complex end-of-life conversations and decisions. What type of person is drawn to a career as a respiratory therapist? Here again, I feel like “therapist” is a misnomer! The respiratory therapists I know, myself included, tend to be adrenaline junkies who are quick on their feet. But it’s so much more than that. Respiratory therapists are also extraordinarily compassionate. I feel so blessed to be so engaged in such intimate aspects of people’s lives from start to finish. How did you become a respiratory therapist? I had a friend who was a respiratory therapist. I had never heard of this career before but as they were talking about what they did, I was completely inspired! I wanted to do what they did! I had studied in a few different areas – I actually started out pursuing a law degree – and am so glad to have been told about respiratory therapy. It suits me so well.

MORE INFORMATION • Video on respiratory care education: bit.ly/respiratory-care-video • Respiratory Therapy diploma program at Thompson Rivers University: tru.ca/science/programs/rt.html • Canadian Society of Respiratory Therapists: csrt.com/respiratory-therapist

Respiratory therapy programs are notoriously difficult to get into and complete. There are just three programs in western Canada. I completed the program at NAIT in Edmonton. Then, like now, you basically graduate that program with a job! Respiratory therapists are in very high demand. What are the most significant respiratory issues you see? As a respiratory therapist, I’m called in to deal with all sorts of body systems and patients. That said, two big reasons that I end up seeing people are chronic obstructive pulmonary disease (COPD) and asthma. COPD is now recognized alongside heart disease and diabetes as one of the main causes of reduced quality of life and death. In the ICU, I often see SUMMER 2017

Healthier You

pulmonaryrehabilitation

PULMONARY REHABILITATION

IN PRINCE GEORGE What you need to know: Chronic Obstructive Pulmonary Disease (COPD) Although COPD is the most prevalent condition amongst pulmonary rehabilitation program participants, the program accepts people with any chronic pulmonary disease. Ask your doctor about pulmonary rehabilitation. From HealthLinkBC.ca: • COPD is a lung disease that makes it hard to breathe. • COPD is most often caused by smoking. Other possible causes include long-term exposure to lung irritants, neonatal lung disease, and genetic factors. • COPD gets worse over time. While you can’t undo the damage to your lungs, you can take steps to prevent more damage and to feel better. • The main symptoms are a long-lasting cough, mucus that comes up when you cough, and shortness of breath. • At times, symptoms can flare up and become much worse. This is called a COPD exacerbation and can range from mild to life-threatening. According to the Canadian Lung Association, “chronic lung disease accounts for more than 6% of annual health-care costs in Canada, and COPD is the leading cause of hospitalization.” COPD is the fourth leading cause of death in Canada. The Canadian Thoracic Society reports that a 2008 study “conservatively estimated the total cost of COPD hospitalizations at $1.5 billion a year.”

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AN INDIVIDUALIZED EXERCISE AND EDUCATION PROGRAM KEEPS PEOPLE OUT OF THE HOSPITAL. Vince Terstappen, health promotions, Northern Health

When Dianne Gagne first arrived to take part in the new pulmonary rehabilitation program in Prince George, she had to stop twice to catch her breath en route from the parking lot of the YMCA to the room inside where the program is run. “I couldn’t even shower without getting short of breath,” shared Gagne, whose shortness of breath is caused by chronic obstructive pulmonary disease (COPD) and other complications stemming from a fungal infection of her lungs that first appeared in her 20s. Robin Roots, a physiotherapist, has seen this before. “For many people with a diagnosis of chronic pulmonary disease,” said Roots, “simply going to Walmart is not an option because of the walking requirement. They are left winded, short of breath, and unable to function.” It is these challenges and more that the pulmonary rehabilitation program – a partnership between the YMCA of Northern BC, the UBC Department of Physical Therapy, and Northern Health – is working to address. And so far, as Dianne Gagne can attest, it seems to be working. “By the end, I could park and walk up to the room,” said Gagne. “I may never have my full lung function back – I was once an avid cross-country skier – but I’m noticing improvements. I can now do my daily chores without any issues and I’m walking for a full halfhour on the treadmill.”

Pulmonary rehabilitation is a well-established, well-researched intervention to help people with chronic pulmonary diseases cope with shortness of breath, develop activity tolerance, and improve quality of life. Pulmonary rehabilitation includes both an exercise component and education relating to proper disease management delivered by a team of health professionals including physiotherapists, exercise physiologists, pharmacists, dietitians, respiratory therapists, and specialists. “Exercise is really the distinguishing feature of this specialized program,” said Roots. “Each participant is assessed and receives an individualized program which is fully supervised. Participants take part in high intensity lower limb aerobic training, strengthening, and balance exercises. Because most participants are on oxygen and many are quite deconditioned, this exercise needs to be very closely monitored. We’ve got some participants on bicycles, some on arm cycles, some on treadmills. It’s all about understanding how much their body can do and designing exercises that increase their ability to take on daily living activities.” For Gagne, the individualized program really stood out. “They scrutinize you very carefully,” said Gagne. “They would measure my oxygen levels, pulse, and blood pressure before and after exercises. If my oxygen saturation would fall below a certain level, the physiotherapists would stop me. They didn’t push me to do more than I could, but they did challenge me to do as much as I could! The exercise regimes they develop are specific to each individual. Some people were doing 2-3 minutes of activity, others were doing 45. The physiotherapists and students explain things at every step – they would tell me why I would be doing certain exercises.”

The pulmonary rehabilitation program in Prince George is an eight week program, with a cohort of 10-15 participants getting together twice weekly for exercises and education. Anyone with a diagnosis of chronic pulmonary disease can join the program, you just need to complete a pulmonary function test. You can access the rehabilitation program through your physician – ask them about it or tell them about it! Participants have come from as far as Smithers and work is underway to look at how the program can be made more accessible to people living outside of Prince George. Continued on page 16

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The pulmonary rehabilitation program has clearly had a positive impact on Gagne and the other participants. “Participants set their own goals,” said Roots, “and we try to get them there.” For many, the goal is simply to be able to better manage shortness of breath and to function day-to-day without getting short of breath – goals which can significantly improve quality of life. For Roots, however, the research points to an important system level benefit of the pulmonary rehabilitation program. “Research has shown that pulmonary rehabilitation can decrease emergency room visits for acute acerbations of COPD by 40 per cent. We know that there are approximately 300 hospitalizations for COPD per year in Prince George and that the average length of stay for someone with an acute exacerbation is nine days. There is also a readmission rate of 13 per cent. If we can reduce the number of ER visits and prevent hospitalizations, we can save the system a lot of resources.” Gagne agreed: “This program is a preventive measure. It keeps you out of the hospital and teaches you how to look after your condition on your own.” SUMMER 2017

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Continued from page 15

According to Roots, the pulmonary rehabilitation program in Prince George, which has received a lot of support from local respirologists Dr. Sharla Olsen and Dr. John Smith, is unique for a few reasons: • It represents a partnership between three organizations (a partnership that has also created a second program: cardiac rehabilitation). • UBC trains physiotherapy students in northern B.C. and the rehabilitation program offers a valuable site for clinical placements (“It’s winwin,” said Roots). The students provide a valuable service to the program participants while at the same time being trained under the supervision of a licensed physiotherapist. • While many pulmonary rehabilitation programs are run out of hospitals, this program is based in the community. This can help encourage participants to think about maintaining the gains they make in the program through active lifestyle opportunities right in the community. • The partnership has allowed for the program to be offered at very low cost to participants – just a $10 membership fee.

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Both Roots and Gagne have a similar goal: they want more people to know about the program! With one in four people likely to develop COPD in northern B.C., pulmonary rehabilitation programs have the potential to have a massive impact. “Without the program,” reflected Gagne, “I would be sitting at home, continually going downhill. And though these changes take time, I keep telling my doctors how fantastic the program was. I would like for more people to know about this program – it is available and is really helpful.”

MORE INFORMATION COPD support Many participants in the pulmonary rehabilitation program see each other one more time each week through the Prince George COPD Support Group: “The Prince George COPD Support Group, also known as the SOBs (Short of Breaths) gives those diagnosed with COPD (and any other lung issues) a place to learn how to cope with an unforgiving disease. Our group gets exercise directions from a licensed physiotherapist, who also gives informative chats on various issues related to the lungs. As members are all living with the same issues, we have a wealth of lay knowledge to fall back on and share with each other. We have coffee days where we often bring in speakers on a variety of subjects, which goes a long way towards educating us all. We are a dedicated group of boomers helping others as they help us. We are a fun group and invite new members to join – bringing a friend or family member is always welcome!” –Nancy, treasurer, PG COPD Support Group. Meetings every Wednesday, 1 p.m. to 3 p.m. AiMHi Gymnasium 950 Kerry Street, Prince George

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Healthier You

tobaccoreduction

A NORTHERN QUIT STORY “FOR THE FIRST TIME IN FOREVER, FOOD TASTES FABULOUS.” Cindy Gjerde, tobacco reduction, Northern Health

Quitting smoking is hard and very few people manage to quit on their first try. Don’t get discouraged! Get inspired by others, like the successful quit story that a community member in Prince George shared with me. Make this story your story, or the story of someone you love: I quit. No really, I quit. Where to start? Smoking has been a part of my life for over 24 years. I started smoking at 14 years of age. My friends and family all smoked. I have tried to quit at least a dozen times before. I couldn’t do it. Until now. My friend who is a non-smoker is giving me the support to quit smoking. I wanted and needed the money I was spending on tobacco to go to other things and I want to be a good example for my kids. I don’t want them to have to deal with a 24-year nicotine addiction and poor health issues. Now, I am a quitter! 40 days tobacco-free on March 13, 2017!

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I accessed free nicotine replacement therapy through the BC Smoking Cessation Program. This program provided me with 12 weeks of patches. All I had to do was talk to a pharmacist! For the first time in forever, food tastes fabulous. I generally feel better all over. I did this. I am tobacco free and I couldn’t be more proud of myself.

MORE INFORMATION Want to make this your story? Contact QuitNow.ca or talk to a pharmacist today to obtain your 12 weeks of free nicotine replacement therapy. If you’ve tried before to quit, try again. It can take up to 30 quit attempts to remain smoke-free. Your next attempt may be your last! Help make your home and community a smoke-free, healthy place to live, work, and play.

independentliving

PROVINCIAL RESPIRATORY OUTREACH PROGRAM (PROP) A NON-PROFIT PROGRAM SUPPORTS INDEPENDENCE AND SELFDETERMINATION. Esther Khor, RRT, manager of respiratory therapy, BC Association for Individualized Technology and Supports for People with Disabilities (BCITS)

Take a deep breath in. Most of us don’t think about the effort it takes to fill our lungs with air. It’s an easy task for most. But this is not the case for the people with ALS, muscular dystrophy, spinal cord injuries, and other restrictive disorders that impede breathing. If you are living with these conditions, what’s the next step as you plan with your family and physician? In many cases, a breathing machine like a bilevel or a ventilator may be recommended by your physician. If you need ventilation support and want to live independently at home, one option in particular might come up: the Provincial Respiratory Outreach Program (PROP).

A ventilated PROP client enjoying his day on the water and in the sun.

PROP was created by those who needed the service specifically for independence and self-determination. The original users of the program advocated for funding over a decade ago and, as a result, to this day there is no user cost for PROP services. PROP provides services such as breathing equipment setup, annual assessments, 24-hour phone support, peer support, hospital discharge planning, equipment repairs from biomedical technicians, and education for caregivers. PROP is a non-profit program and currently supports over 550 clients throughout B.C. who need home ventilation because of a neuromuscular disorder or chest wall restriction. As I write this story, my fellow respiratory therapist Patrick is in Fort St. John seeing clients in -15 C temperatures! Fort Nelson is his next stop. Another respiratory therapist is in sunny Kelowna this week, seeing two new PROP clients. We are a small crew of four respiratory therapists and one registered nurse servicing B.C. for respiratory support. We are based in Vancouver but can be in northern B.C. within 3-5 business days to support newly accepted clients. All of this support is given so care can be managed in the comforts of home and with the support of your family and community. This client-direct model of care is simply another option in today’s health services. If you

ALS client living independently at home with mouth piece ventilation provided by PROP.

qualify for home ventilation and are someone who likes to drive their own care, PROP may be a fit for you! To find out if you are a PROP candidate, talk to your respirologist or simply reach out to us through our website at bcits.org. We’d love to hear from you! SUMMER 2017

Healthier You