Author: amyspeed

The year 2020 was difficult for most people, but particularly so for Richard Guyer.      Richard….struggled….to….breathe. He needed a lung transplant. That decision was reached after a lengthy period of seeing multiple doctors and undergoing many diagnostic tests. During that time, Richard’s lungs were quickly getting progressively worse, and his breathing was only helped some by the oxygen tank he was carting around. Richard suffered a great deal of stress that went along with having no diagnosis or treatment in the near future, especially when he couldn’t breathe.

Richard was admitted to GMHC as an inpatient in late 2020. His symptoms were shortness of breath, a dry cough, and an increase in oxygen needs. Richard’s primary doctor, Dr. Smith, gave him a second referral to the University of Iowa because no diagnosis had yet been reached. Finally, it was determined that he had Idiopathic Interstitial Lung Disease, a rare disease that affects less than 200,000 people a year in the United States. The diagnosis is so difficult because so many disorders fall into this category, the signs and symptoms of many conditions can mimic this disease, and doctors must rule those conditions out before making a definitive diagnosis.

The cause of Idiopathic (unknown or undetermined cause) Interstitial (occurring between the air sacs) Lung Disease, or ILD for short, is unclear. The reality is a shortness of breath that gets worse as the disease progresses. This disease belongs to a group of lung conditions that cause progressive scarring (or fibrosis) of lung tissues, affecting your ability to breathe and to get enough oxygen into your bloodstream. By the time symptoms appear, irreversible lung damage has often already occurred. Medications may slow the damage of this disease, but most never regain full use of their lungs, and the end stage is respiratory failure. Treatment is not always effective in stopping the ultimate progression. A lung transplant is a viable option, as it was for Richard. 

Dr. Eberlein (University of Iowa Hospital) put Richard on the transplant list in mid-January of 2021. In December of 2020 Richard went from requiring low flow oxygen to being dependent on high flow oxygen 24/7. Due to the severity of his lung condition, Richard remained as an in-patient at the University of Iowa Hospital until he received his new lungs on March 1, 2021.

Post-operative therapy following a lung transplant is intense and requires close monitoring, so patients remain in the hospital during this first phase of recovery. There were also some setbacks with blood clotting during this period. This proved to be the most difficult time for Richard, as it occurred during the COVID-19 pandemic, which meant that he could have no visitors when he really wanted and needed them. “The pain was really bad, and I just wanted to see my family,” he explained. Richard remained very determined to take care of himself and said, “I had to put the lungs before everybody.” During this phase of recovery, he kept telling the nurses that he was going to walk by the second week… and he did! He replied, “I just convinced myself that I’m going to do it.” Richard also expressed great thanks to Dr. Smith and Dr. Eberlein for the great care they gave him.

After he was able to leave the U of I hospital, he stayed in a nearby hotel during the next level of treatment. Finally, Richard was with his father and received some of the support and family time he had been missing. “It helped a lot to be able to see my dad and stay with him,” Richard commented.

Next came the really good news, Richard could return to his home in Hawkeye, IA! In June of 2021, Richard began pulmonary rehab at GMHC, and although it was a distance to drive, he preferred to continue working with the people who he already knew, and who knew him. When he first arrived, he could only walk for 10 to 12 minutes without needing to stop. Gradually, he kept improving and was then able to walk for 30 minutes without a break. Currently, he is walking on a treadmill during therapy for 25 – 30 minutes… at an incline! He also lifts weights during his therapy sessions, and once a month does a spirometry lung function test along with a nebulized medication. The therapists also monitor his blood pressure and his oxygen saturation during his workouts. Richard said, “I am very grateful for the people who take me to my appointments; I like coming to GMHC for my rehab work, because it is close to home, I am familiar with the therapists I work with and I am comfortable with everyone here. The long struggle with Richard’s lung condition and eventual transplant left him with a fair amount of stress, and he commented, “It is very important for me to have a regular, comfortable place to go for rehab work. It was hard at first, but the therapists here know how to help me stay calm and in my comfort zone.” 

Richard visits the University of Iowa every two months for follow-up testing. He enjoys telling others about his journey through his lung-transplant experience, and adamantly relays the importance of becoming organ donors to others. “Without a transplant, I wouldn’t be here!” he concludes. Richard’s goal is to walk in the German Fest 5K and show everyone just how far he has come! 

Commented GMHC Respiratory Therapist, Catie Dean, “We started doing pulmonary function tests (determines lung volume) on Richard about a year before his lung transplant. We could see the gradual decline in his lung volume until he was to the point he had to be admitted to the hospital. It is so nice to continue to work with Richard and see the improvements in his health and his attitude since his lung transplant.” 

Living with a lung disease was restricting and defining Donna Simon’s way of life. Although she had just renewed her license, she stopped driving (for fear of causing an accident), stopped shopping for groceries, going to sporting events, even taking care of her grandkids. She was basically staying at home and only going out to go to doctor appointments. As a mother who raised seven children, four of whom participated in the Dubuque Colt’s Drum and Bugle Corp, it was a sad day when she couldn’t go see a local performance with her daughter. Donna had been oxygen-dependent for over three years, and it was robbing her of the life she knew.

Donna came to GMHC for pulmonary rehab to see what breathing she could regain. Respiratory Therapist Amanda Miller, noted that during Donna’s therapy sessions her oxygen levels would drop immediately, causing severe shortness of breath and increasing her heart rate and blood pressure. This is typical for patients with lung disease, but the progress they had hoped to make just wasn’t happening. In fact, it was all they could do just to maintain her current level of breathing. Her lungs were in a serious condition. 

Donna had been a patient of Dr. Schope (now retired) in Dubuque, who had diagnosed her with COPD in 2012. Although she tried to quit smoking then, it took her until 2018 to stop for good. During a visit with her new pulmonologist, Dr. Powers, it was suggested that Donna might want to consider getting a lung transplant. She discussed it with her family and with the medical staff at GMHC, and everyone in both cases was supportive of that decision. It would not be an easy road, but she was willing to try it. 

To be placed on the transplant list, Donna would have to undergo almost 6 months of testing. Dr. Hoffmann and Dr. Powers sent her records to the University of Iowa, and the testing began. She had to have a colonoscopy, CT scans, MRIs, and even a checkup with dermatology, among other tests. All her immunizations had to be up to date. There had to be absolutely no signs of cancer, skin or otherwise, because the medications taken for cancers could cause scarring in the lung and could also cause any existing cancer to grow more rapidly. 

Saying that Donna was a trooper through all the testing and trips to Iowa City was probably an understatement, as she had to complete all of this while she still felt miserable and could hardly breathe. Finally, on August 10, 2020, she was put on the lung transplant list, and six months later, on February 25, 2021, she received her new lungs.

Immediately after surgery, a lung transplant patient is required to stay in Iowa City for intensive care and therapy before they can leave the hospital. Following this first round of therapy, she was transferred to St. Luke’s in-patient rehab department in Cedar Rapids. After a reaction to a medication, she had to return to UIHC for two weeks before completing her therapy at St. Luke’s, where she remained until they were able to get her up and walking. After this accomplishment, she was able to return home to Guttenberg with her husband and dog! She began pulmonary rehabilitative therapy here at GMHC. She commented, “That was huge for me, to be able to come home and go to therapy nearby. It made such a difference in my recovery.”

Donna still needed to make some trips to Iowa City for post-surgery tests and checkups, but her doctor allowed her to do the frequent and necessary lab work at GMHC and have the information forwarded to U of I. “That made it much easier for me and saved us a lot of travel,” she commented. During her therapy at GMHC and recovery at home, Donna was sure to celebrate the little milestones along the way. At first, her husband had to help her get up out of the chair by lifting her at the back side of her pants waistband. “I got tired of all the wedgies he was giving me!” she joked. When she was finally able to complete this task alone, she announced, “Look at me, I can to this without anyone here!” And “I couldn’t have done this without the great rehab I was receiving.” 

Donna had some work to do to regain her confidence in driving, as it had been 3 long years since she had been behind the wheel. But lately, she is taking full advantage of her newfound freedom. She is driving again, shopping for groceries, meeting friends for lunch and even driving herself to her appointments in Iowa City. Perhaps best of all, she recently was able to watch her grandkids again, and even made a trip to Redfield to celebrate birthdays for two of them. After seeing her for so long with an oxygen line attached, her grandson asked, “How are we going to be able to find you Grandma, without your cord?” When asked to describe how all of this makes her feel, she exclaimed, “It is great! It’s basically like having a new life!”

“We (Respiratory Therapy Staff) are very proud of Donna throughout her road to recovery. It was truly amazing to witness her reclaim her life and get back to being a busy grandma!” replied Amanda Miller, RT.

A surgery that occurred over seven years ago may have been the beginning of lymphedema, a condition that Ron now lives with.

Immediately after his surgery to repair a large abdominal aortic aneurism (a bulge in the aorta in the abdomen), Ron noticed a difference in the size of his legs, with some swelling in the right leg. It was not clear at that time, or even later, what the swelling was coming from. Gradually it got worse, and eventually Ron also noticed tightness in his legs. He was admitted briefly as an inpatient at GMHC in March of 2021 for cellulitis (a bacterial skin infection).

A few months later, in September, Ron developed cellulitis again, along with venous stasis ulcers on his legs, which are open wounds that “leak” excess protein-rich fluid from the body. After working to control the swelling and sores with Unna boots to promote healing of his venous stasis ulcers for several months, Ron’s primary care provider, Dr. McCaw, decided to refer him to a wound care specialist for more extensive treatment; however, there was a two month wait to be seen. Because GMHC’s Physical Therapist Kimberly Franzen, PT, DPT, CLT, had been recently certified to treat lymphedema, Dr. McCaw decided to refer Ron to her. That decision has been life-changing for Ron.

Lymphedema can occur as an abnormality at birth, primary lymphedema, or secondary lymphedema that develops after an injury, surgery or radiation treatment. Lymphedema is a protein-rich fluid buildup in the arm(s) or leg(s) that causes swelling, discomfort or achiness in the extremity and decreased mobility of the joints that can make it very hard to move your limbs to complete daily activities. Lymphedema symptoms include increased tightness and size of the arm or leg, skin changes including texture and color and increased difficulty with use of the arm or leg with daily cares such as dressing. Lymphedema increases the chances of recurring infection. At GMHC, we treat lymphedema to help reduce the size of the arm or leg, heal wounds, improve health of the skin and improve the patient’s quality of life. Because there is no cure for lymphedema, it is very important to treat it and learn to manage the symptoms.

Franzen began therapy with Ron in December of 2021 and treated both of his legs. She used all the techniques learned during her certification in Complete Decongestive Therapy for lymphedema, including manual lymph drainage, to aid in his healing. The results were amazing—the wounds were almost gone in three days! To maintain these results, and further decrease the lymphedema, intensive treatment began at 5 times per week for two weeks, and then tapered to 2-3 times per week for the remainder of his treatment. Franzen used multi-layer short stretch bandages to wrap Ron’s legs, which provided greater compression to reduce the lymphedema.

Each case of lymphedema is very different, and so is the individual treatment plan. Usually, the course of treatment is from 1-2 months. In Ron’s case, he experienced a few setbacks, and needed just over two months of intensive therapy. During this time, he also learned some valuable lessons in the precautions he needed to take to ensure his health. Franzen reported that during his therapy, Ron was mobile and doing all that he could to care for himself.

Franzen’s certification consisted of learning the full CDT (Complete Decongestive Therapy), which includes not only performing manual lymph drainage (MLD) to reduce the amount of fluid build-up, but teaching/ educating the patient how to apply compression bandages or garments, exercise, nail & skin care, and other self-cares to assist with overall management of their condition. The successful treatment of lymphedema includes a lifetime commitment to control and manage the symptoms.

Ron described the difference it made for him to have the swelling more controlled in his legs, “Before, when I was using the exercise bike, my legs could only go for about 7 minutes, but after my course of treatment, I was able to go for about 20 minutes,” and, “now when we are walking around while shopping, my legs don’t really get tired, just a little heavy—so I stop to rest my legs for a few minutes and I’m ready to go.”

Following the intensive therapy, Ron received instruction on transitioning to self-care, where he would monitor his own situation and only need to receive treatment if conditions would get worse again. Ron said that after living with this condition, he now knows what signs to watch for that would require a visit to his health care provider.

Franzen taught Ron and his wife how to bandage his legs on the days he didn’t have treatment. Because the course of treatment was effective in controlling the lymphedema, an accurate measurement was taken for custom compression socks, which he will regularly wear during the day, along with a custom-fit Velcro garment at night. 

When asked what he looks forward to being able to do again, Ron replied, “I hope to walk the course when I go golfing again. It will also be nice to wear dress pants instead of sweatpants, and regular shoes instead of extra-wide ones!”

Guttenberg Municipal Hospital & Clinics was recently named one of the top 20 critical access hospitals (CAHs) for Best Practice—Patient Satisfaction in the country. 

The top 20 CAHs, including GMHC, scored best among CAHs as determined by the Chartis Center for Rural Health for Patient Satisfaction. The rankings were recently announced by the National Rural Health Association (NRHA). An awards ceremony will be held during NRHA’s Critical Access Hospital Conference in September in Kansas City, MO. 

The top 20 CAHs have achieved success in overall performance based on a composite rating from eight indices of strength:  inpatient market share, outpatient market share, quality, outcomes, patient perspective, cost, charge and finance. This group was selected from the Chartis Center for Rural Health’s 2022 top 100 CAH list, which was released earlier this year. 

The top 20 CAH best practice recipients have achieved success in one of two key areas of performance:  

Quality index:  A rating of hospital performance based on the percentile rank across rural-relevant process of care measures.

Patient perspective index:  A rating of hospital performance based on the percentile rank across all 10 HCAHPS domains. 

“GMHC is proud of the efforts of the physicians and staff who have contributed to our hospital achieving this designation,” says Timothy Ahlers, CEO. “We are incredibly proud of our staff. We are blessed to have a team of professionals with high standards who care deeply about each and every patient and our entire community.”

“Our results as a top Best Practice Recipient in Patient Satisfaction means our community can count on us to deliver the services they need now and in the future,” said Ahlers.

About NRHA

NRHA is a nonprofit organization working to improve the health and well-being of rural Americans and provide leadership on rural health issues through advocacy, communications, education and research. NRHA’s membership is made up of diverse individuals and organizations from across the country, all of whom share the common bond of an interest in rural health. 

About the Chartis Group

The Chartis Group provides comprehensive advisory services and analytics to the health care industry. With unparalleled depth of expertise in strategic planning, performance excellence, health analytics, informatics and technology, digital and emerging technologies, clinical quality and operations, and strategic communications, Chartis helps leading academic medical centers, integrated delivery networks, children’s hospitals, and health care service organizations achieve transformative results and build a healthier world. For more information, visit www.chartis.com.

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