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Texas Association of Cardiovascular and Pulmonary Rehabilitation
A Message From
Your President
Welcome to Fall! The weather has cooled somewhat and I’m starting
to see some color changes in the leaves. I love this time of year. I hope everyone
made it through Hurricane Ike safely and that you’re able to be back in your home if
you were forced to evacuate.
This newsletter is filled with information that will hopefully be useful to you in your
day-to-day work. Enjoy all the articles!
The annual AACVPR conference was held September 18th – 21st in Indianapolis, Indiana.
Four of our board members were able to attend. Barbara Flato, Julie Hartman, Erika
Abmas and Danielle Strauss all had a great time networking with others and gleaning
ideas from other states. Jenny Adams and Laura Raymond also attended. Julie and
Laura received their Fellow awards at the conference. Congratulations!! Barbara
lectured on Outcomes and how this applies to the certification/recertification process.
She plans to present this same material at the state meeting for those of you who may
be looking at certifying or recertifying your program. Jenny, Julie and Danielle
submitted a poster presentation. Several of these ladies are also on AACVPR
committees and attended committee meeting while there: Julie attended the
Education Committee meeting, Danielle attended the Research Committee meeting,
Barbara went to the Certification Committee meeting, Laura Raymond attended the
State Certification Committee Chair Luncheon. Julie and Erika also attended the
Reimbursement Meeting.
We appreciate all the hard work done at both state and national levels by these
individuals.
We currently have 197 members and are looking forward to seeing each and every one
of you at the Crowne Plaza Houston North Greenspoint for the 19th annual TACVPR
conference to be held April 3rd and 4th. I’ve checked with the hotel and they sustained
almost no damage from the hurricane. In fact, they were only without electricity for
one day. Good news for us! We are continuing to confirm speakers and hope to have
another very successful conference.
Enjoy the changing of the season as we head into cooler and shorter days. Be careful
not to load yourself with too many stress-inducing projects as the holiday season
approaches.
Have a Happy Fall!
Marilyn Burwitz, RN
TACVPR President
Do You Know Anyone Interested in Joining TACVPR?
To join or renew your TACVPR membership you may sign up online or download
a printable membership application at www.tacvpr.org
Fall 2008 Newsletter
Annual dues are $40/person
(membership is good January-December yearly)
www.tacvpr.org
Save the Date - 2009 TACVPR Conference
We Struck It Big: (Cardiac & Pulmonary
Act of 2008) It’s Now Law!
April 3rd & 4th,2009
Houston, TX
Plans are underway for the TACVPR 2009 conference. The conference will be held at the
Crowne Plaza in the Houston North Greenspoint area on April 3rd & 4th, 2009. The hotel has
recently completed a $13 million renovation. Hope you’re planning to attend!
Speaker Topics
We have confirmed a number of speakers who will talk on a variety of topics for both the
cardiac and pulmonary professional. Some of the speakers include:
►Dr. Marjorie King, FAACVPR, Past President of AACVPR
►Dr. Nicola A Hanania, MD, FRCP©, FACP, FCCP, Ben Taub General Hospital, Director, Adult
Asthma Clinic /Pulmonary Diagnostic Laboratory, Houston, Baylor Professor of Medicine
Pulmonary / Critical Care Medicine Director, Asthma Clinical Research Center
►Douglas Paddon-Jones, PhD, Associate Professor at the Department of Physical Therapy,
Allied Health Sciences and Department of Internal Medicine, Division of Endocrinology at the
University of Texas Medical Branch in Galveston
►Jenny Adams, PhD, Research Associate, Baylor Jack & Jane Hamilton Heart & Vascular
Hospital
Friday Social
Once again we will be hosting a Friday night social. It has continued to be one of the
highlights of the conference and we hope it will be again at this year’s conference. It is a
great opportunity for those who are looking for some additional networking time, or if you
just want to relax and enjoy the evening with your rehab friends!
AACVPR
Conference
2008
Jenny Adams, Danielle Strauss & Julie Hartman
with their Poster Presentation
Fall 2008 Newsletter
Laura Raymond & Julie Hartman
received fellow awards
www.tacvpr.org
What’s New on the
Reimbursement Front
By: Twyla Selvidge, MS
East Texas Medical Center Regional HealthCare System
The best news EVER for Cardiac & Pulmonary Rehabilitation! On July 15, 2008 Congress
passed H.R. 6331: the Medicare Improvements for Patients and Providers Act of 2008,
now Public Law 110-275. This law creates a specific benefit category under XVIII and XIX
of the Social Security Act. The new law addresses Cardiac and Pulmonary Rehabilitation
and takes effect on January 1, 2010.
The significance of the new provision is that Medicare beneficiaries who have a clinical
need for cardiac or pulmonary rehab services should have timely access to formal
rehabilitation programs. In the past, the Centers for Medicare and Medicaid Services
(CMS) have had discretionary authority on many of the key decisions regarding coverage of
these services. Because of this, there has been inconsistencies in patient access and
inconsistencies within the services covered by Medicare, more so with Pulmonary Rehab,
across the country.
CMS has long recognized Cardiac Rehabilitation programs as a covered service, but
according to the Centers for Disease Control and Prevention and numerous researchers
have repeatedly emphasized that the service is dramatically underutilized, resulting in
suboptimal clinical care for patients with CAD. As a result, costly, life-threatening
recurrent cardiovascular events that can be potentially reduced with the appropriate and
timely use of cardiac rehab services still cost patients with or without insurance benefits.
For Pulmonary Rehabilitation, the new law will require CMS to provide national coverage of
rehabilitation services when medically indicated by the patient’s physician.
As the TACVPR is updated by the AACVPR regarding the enactment of this law, we will
update you as well. This is truly exciting news for us. The efforts to improve the access for
Cardiac Rehab has been about a 10 year effort for those of us providing the service. Who
knows, with this law, more hospitals may have to provide these services for their patients.
CMS:
LCD:
NCD:
MAC:
ACC:
AHA:
AACVPR:
Fall 2008 Newsletter
What’s That?
Centers for Medicare and Medicaid Services
Local coverage Determination
National Coverage Determination
Medicare Administrative Contractor
American College of Cardiology
American Heart Association
American Association of Cardiovascular & Pulmonary
Rehabilitation
www.tacvpr.org
Whole Person Wellness
By Tresa Anderson, RT
Health is a state of complete physical, mental and social wellbeing, not merely the
absence of disease or infirmity. Many would add to this definition of health a spiritual
component that encompasses “self worth, morals, higher values and purpose.” This is
referred to as holistic medicine, since the concept of health includes the whole person:
physical, mental, social, and spiritual.
There are changing views of health care and health needs. Professionals in the field
have realized a growing need in the standard of Pulmonary Rehabilitation to include and
reflect a growing awareness of the interaction of the mind, body, and spirit. While the
focus of a Pulmonary Rehab program is to restore and promote better lung health. The
responsibility for it is shared between staff and patient. It is the interaction of the
physical, mental, and spiritual aspects of the patient that contribute to health or
disease. Fundamental to treatment is the medical care, technology, and medication that
a patient receives to manage their pulmonary disease. We recognize that these alone
cannot fulfill all of their needs as they learn to deal with changes that are a result of
their lung disease.
A patients' lifestyle can always be improved, much of our programs focus on lifestyle
modification techniques. These efforts are concentrated in the areas of physical
training, stress management, and nutrition. These are the aspects of a patients life that
they are in control of, and when positive changes are made it will greatly affect their
ability to cope and make changes that they might need to improve their overall level of
functioning.
It is true that all of us would like to be able to do what we want, when we want.
Unfortunately we all must learn that there are many factors that impose limitations.
How we deal with these limitations helps determine how happy, productive and pleasant
our lives are.
Fall 2008 Newsletter
www.tacvpr.org
Is it a Cold or is it the Flu?
Whichever it is…What Should I Do?
By Nita Pack, RRT
A common cold is an illness caused by a viral infection located in the nose. Colds involve the
sinuses, ears, and bronchial tubes. Colds last for an average of one week. Mild colds may
last only two or three days while more severe colds may last for up to two weeks. Adults
average two to three colds per year and children six to ten, depending on their age and
exposure. Children’s noses are the major source of cold viruses. There are over 100 cold
viruses. Rhinoviruses cause at least one half of colds. Cold symptoms usually develop
anywhere from one to three days after the virus enters your body.
Cold viruses infect only a relatively small proportion of the cells lining the nose and can only
multiply when they are inside a living cell. When on an environmental surface, cold viruses
cannot multiply. However, they are still infectious if they are transported from an
environmental site into the nose.
Cold symptoms are mainly due to the body’s response to the infection. A stuffy or runny
nose, sore or scratchy throat, sneezing and coughing are usually signs of a cold. More rare
symptoms associated with a cold are fever, headache, general aches and pains, fatigue and
weakness. Complications are sinus congestion or infection, or earache.
Treatment is mainly temporary relief of the symptoms. Nasal decongestants to unclog a
stuffy nose. Cough suppressants to quiet a cough. Expectorants to loosen mucus so you can
cough it up. Antihistamines to stop a runny nose and sneezing. Pain relievers to ease fever,
headaches, minor aches and pains.
Influenza is commonly called “the flu”. It is caused by the influenza virus, which infects
the respiratory tract, (nose, throat, lungs). The flu is spread easily from person to person
when an infected person coughs, sneezes or talks and the virus is expelled into the air. The
virus is then inhaled by someone else, and the flu begins.
The influenza virus thrives during the winter months when most of the population is indoors
in close proximity. This allows for the virus to be easily spread. The incubation period
after exposure is one to four days with an average of two days. A person is considered
contagious from one day before the symptoms begin until approximately five days after
illness onset.
Flu symptoms are the same as a cold, however, there is also a characteristic high fever
that lasts three to four days, a prominent headache, usually often severe aches and pains,
early and prominent extreme exhaustion and usually chest discomfort. Flu can lead to
bronchitis and pneumonia which may be life threatening.
Continued on next page
Fall 2008 Newsletter
www.tacvpr.org
Is it a Cold or is it the Flu?
Whichever it is …What Should I Do?
(cont.)
Treatment is the same as for a cold with the exception of the availability of some
Antiviral medicines. One of the main things that can be done is to get the annual flu
vaccine. The vaccine protects against the projected types of virus causing the flu for the
current flu season. Any one over the age of 65, any one who has a decreased immune
system (or persons working with these people), and/or any one with a chronic disease
process (lung, kidney, heart, diabetes, etc.) should get a flu shot each year. Flu vaccines
cannot give you the flu. Most people have little or no reaction to the vaccine. One in four
might have a swollen, red, tender area at the injection site. A much smaller number of
people may develop a slight fever, chills or a headache within the first twenty four hours.
Adverse reactions are seen in people with allergies to eggs.
Whether it’s the flu or a cold, here are some general guidelines for keeping it away:
•
•
•
•
•
•
•
•
•
•
Wash your hands often. Remember, cold viruses are picked up from objects and can
be passed to the eyes or nose easily
Keep at least three feet away from coughers and sneezers. If you are in a closed in
space (like an elevator) with a cougher, turn your back or get off and on another
elevator
Beware of closed in spaces. Poor air circulation and low humidity in homes and office
buildings in the winter harbor viruses
Drink plenty of fluids
Eat a healthy diet
Keep active. Walking, dancing, or cycling three times a week is all it takes to enhance
your resistance to upper respiratory tract infections
Treat only the symptoms you have. (Cough – cough suppressant, congestion –
expectorant, etc.)
Be sure you are getting enough vitamins. A multivitamin daily is usually sufficient.
Eating plenty of fruits and vegetables also helps
Get plenty of sleep
Get your flu shot each year
Texas Members Serving on AACVPR National Committees
We want to recognize our TACVPR members who serve on national committees and thank them for
dedicating their time help Texas to become more involved with AACVPR.
Cheri Duncan, RRT – Reimbursement Committee
Barbara Flato, MSN, RN-BC, FAACVPR – Certification Committee
Julie Hartman, MS, FAACVPR – Education Committee
Poppy Patterson, RN, BBA – Certification Committee
Laura Raymond, RN, FAACVPR – Chair of State Certification Committee
Danielle Strauss, BSN, RN-BC – Research Committee
you are
interested in serving on an AACVPR committee, visit www.aacvpr.org for more
information.
FallIf2008
Newsletter
www.tacvpr.org
Commotio Cordis, What is it?
By Danielle Strauss, BSN-BC, RN
Many cardiovascular and pulmonary professionals are familiar with the term sudden
cardiac death (SCD). An unpredictable lethal arrhythmia in a middle or older aged
person, where the outcome is death is what presents to the mind. However, many
cardiovascular professionals may not have learned about commotio cordis (CC), a type of
SCD that affects sports participants younger than 16 years old. The purpose of this
article is to increase awareness of this type of rare SCD event.
“Commotio Cordis may be defined as blunt thoracic impact without any observable
thoracic or cardiac damage. CC is the second leading cause of death in youth sports,
taking the lives of 85% of those afflicted” (Dau et. al). This process occurs from a
chest wall impact that occurs in a 10-30 ms vulnerable window during cardiac
repolarization, corresponding to the upstroke of the T-wave on electrocardiogram.
Rapid rise of left ventricular pressure following impact directly over the heart results
in SCD due to induction of ventricular fibrillation mediated through resultant
myocardial stretch and activation of stretch-sensitive ion channels (Dau et. al). This
represents only 1% of the cardiac cycle.
There are potential dangers for young athletes during rigorous sport activities including
karate, baseball catchers, lacrosse and hockey goalies. Parents and participants should
take the necessary precautions to prevent such trauma. It is imperative to include
chest padding as a barrier to projectiles. However, a recent study performed with
animals showed that using chest protection was ineffective in protecting against
ventricular fibrillation due to chest blows. Conclusions from this study recommend a
change in material and improved design in such equipment.
The survival rate is very low even with the performance of CPR and immediate external
defibrillation. Young athletes affected by CC do not have a history of congenital or preexisting coronary heart disease (Pigozzi and Rizzo). If there are young sport
enthusiasts in your family, please caution and educate the coach and team on this tragic
element of SCD.
References:
Evaluation of Injury Criteria for Predicting Commotio Cordis, Dau et. al
JAMA, Clinical Profile and Spectrum of Commotio Cordis, vol. 287
No. 9, March 6, 2002
Sudden Cardiac Death in Competitive Athletes, Pigozzi F. and Rizzo M.,
Clinics in Sports Medicine, Vol. 27, issue 1, January 2008.
Fall 2008 Newsletter
www.tacvpr.org
Are you Ready for Some Football Food???
Enjoy These Recipes at Your Next Tail Gate Party
Bourbon Grilled Chicken
4 boneless, skinless chicken breasts
2 T olive oil
2 T Dijon mustard
¼ cup bourbon whiskey
2 T red wine vinegar
2 T Worcestershire sauce
1 T light soy sauce
¼ cup brown sugar
2 garlic cloves, minced
Black pepper
Combine olive oil and next 8 ingredients. Add chicken, cover and refrigerate for at least
2 hours. Remove chicken from marinade.
Grill over medium heat for 15-20 minutes turning once.
Grilled Mexican Corn on the Cob
4 cobs of corn
2 T of light butter or margarine
4 lime wedges
½ cup cotija cheese, crumbled
Cayenne pepper to taste
First, clean that corn! Cut off excess silk hanging from the end and remove loose husk.
Completely submerse all of the corn you will be cooking under water. This will provide
extra moisture for cooking. Let the ears of corn soak for at least 15 minutes prior to
cooking. Remove the corn from the water and pour out any excess. Place the corn on the
grill and cover. If you are using a gas grill, keep the heat on med-high and turn the ears
every 5 minutes. If you don't turn them enough, the corn will char. Cook for about 15
minutes.
When done remove the corn from the grill and remove the husk. Rinse to get rid of any
excess ashes or husk.
Squeeze one lime wedge on each ear of corn. Smear on butter. Lastly sprinkle the cheese
and cayenne.
Fall 2008 Newsletter
www.tacvpr.org
IN OTHER NEWS…
ATTEND THE UPCOMING NTACVPR MEETING
Tuesday, November 11, 2008
Location & Speaker: TBA
Looking for a job in Cardiac or Pulmonary
Rehabilitation?
Visit the “Job Opportunities in TX” tab on the
TACVPR website at www.tacvpr.org
Is Your AACVPR Membership Up to Date?
AACVPR membership dues expired June 30th – Don’t forget to renew!
Membership fees: $185 Member/Associate Member; $75 Student
Go to www.aacvpr.org to join or renew your membership
Fall 2008 Newsletter
www.tacvpr.org
Fall 2008 Newsletter
www.tacvpr.org
2008-2009 TACVPR
Board of Directors
Board Officers
President: Marilyn Burwitz, RN
East Texas Medical Center Fairfield
President-Elect: Dean Diersing, MS
University Medical Center, Health Point Fitness & Cardiac Rehab
Past President: Julie Hartman, MS, FAACVPR
THE HEART HOSPITAL Baylor Plano
Treasurer: Twyla Selvidge, MS
East Texas Medical Center
Secretary: Nita Pack, RRT
Methodist Charlton Medical Center
Board of Directors
Erika Abmas, RRT
Baylor University Medical Center
Tresa Anderson, RRT
Shannon Medical Center
Barbara Flato, MSN, RN-BC, FAACVPR
CHRISTUS Spohn Cardiac Rehab
Lorri Lee, BS, RCEP
McKenna Memorial Hospital
Poppy Patterson, RN, BBA
Hillcrest Health System
Danielle Strauss, BSN, RN-BC, BS
Baylor Jack & Jane Hamilton Heart & Vascular Hospital
Interested in serving on the TACVPR Board of Directors?
Contact Julie Hartman at [email protected] for more information.
Fall 2008 Newsletter
www.tacvpr.org