• Diabetes: Risk for Cardio-Pulmonary Disease

    By Ryan Squire
    Naushira Pandya, MD, CMDNaushira Pandya, MD, CMD

    Dr. Pandya outlined identified the objectives of her talk to review the goals of glycemic control: One size does not fit all, review the current guidelines from several national organizations for cardiovascular risk, and review best practices for diabetes management.

    Diabetes is a head to toe disease: Retinal disease, stroke, nephropathy, neuropathy, large and small vessel disease of the extremities and  this emphasizes the range of diabetes impact.

    There are many potential barriers to improved management of diabetes: Institutional challenges, staff/practitioner resistance, and complexity of medication regimens and all may negatively impact diabetic control. Yet, there are several basic principles that apply to diabetes management, and must involve an inter professional clinical team:

    Maintaining functional status is the over arching goal of all interventions applicable to diabetes management.

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  • Weakness: Polyneuromyopathy - the Role of Mobility

    By Ryan Squire
    Peter Morris, MDPeter Morris, MD

    The issue of chronic critical illness or Post Intensive Care Unit Syndrome (PICS) is of great importance in the management of patients in the ICU.   There are many additional synonyms for the problem, and the number of names for syndrome demonstrates lack of critical understanding of the syndrome.

    Why is this an important concern? Acute respiratory failure results in 1.1 million ICU admissions needing mechanical ventilation annually.   There are 400,000 ICU deaths/yr with resp failure; hospital mortality: 37%.  The cost of this care is substantial and rising; total health care costs total 17.6% of GDP in the US.

    The key questions to be answered about early rehab care in the ICU are:

    Morris points out fiscal considerations of ICU rehabilitation are a potential barrier and historically, the fear of early movement of ICU patients may also fuel reluctance to intervene.

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  • Lawrence Cahalin, PhD, PTLawrence Cahalin, PhD, PT

    Activities of physical therapy and rehabilitation are critical in improving outcomes for the patient with heart disease.  The areas to be focused on include aerobic exercise training, resistance/strength training, and inspiration muscle training. These may have important impacts on measures such as hospitalization, quality of life (QOL), and even survival. One of the first steps is understanding your risk for heart attack. Cahalin urged the audience to visit the American Heart Association's website for heart attack risk factor assessment and asked that we have our patients do the same and take the assessment.

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  • Daniel Forman, MD, FACC, FAHADaniel Forman, MD, FACC, FAHA

    Daniel Forman, MD, is Medical Director of the Cardiac Rehabilitation and Exercise Testing Laboratory at Brigham and Women's Hospital. Dr. Forman suggests that while most of focus of heart care is placed on diseases of the heart, there is an enormous opportunity to modify biology and lifestyle years before cardiopulmonary disease ever shows up. Lifestyle factors such as eating habits, exercise habits, tobacco use and sleep add up over time and lead to disease. Add biological factors like age, family history, and genetic predispositions and there are many factors that lead to disease.

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