Case Studies

Respiratory Stories

Patients share their experiences with home respiratory and sleep therapy, expressing appreciation for the support from their therapists.

• By Russell Jackson
• May 01, 2010

Kathleen Adonia Gatewood

AGE 62

DIAGNOSIS Difficulty breathing

EQUIPMENT Invacare Platinum 5-Liter Oxygen Concentrator, Philips Respironics REMStar CPAP Unit and SeQual Technologies Eclipse Portable Oxygen Concentrator

SUPPLIER GoodCare by CPCI, Logan, Ohio

HISTORY A few years ago, Gatewood, a diabetic who describes herself as “very heavy,” was having so much trouble catching her breath that she went to her doctor’s office for advice. “I almost passed out on the way,” she remembers. “They took my pulse oxygen, and it was 80. It should be in the high 90s, so my doctor wouldn’t even let me drive from his office to the hospital. He made me take an ambulance — and the EMTs hooked me up to oxygen on the spot.”

After a few days in the hospital, Gatewood was discharged with instructions to use oxygen at night, but not necessarily during the day. On her way home, she stopped at a home medical equipment company to get set up. “[That company] gave me a unit and all of these little bottles,” she says. “But because I only used oxygen at night, it wasn’t that hard to do.”

Continuing to teach school, though, started to take a toll, and soon Gatewood’s physician recommended around-the-clock oxygen. “Every time I went out, I had to carry the bottles,” she says. “They were really heavy, and I started to develop shoulder problems.” Her chiropractor eventually told her she had to stop toting tanks everywhere, which led her to GoodCare by CPCI for an equipment upgrade.

BIGGEST CHALLENGE Gatewood laid out a challenge for the HME company: Help her travel and stay active. Her sister lives a couple hours away by car, and her son and grandchildren live in Seattle. In the past, if Gatewood wanted to visit them, she had to have tanks of oxygen delivered in advance. “That was limiting,” she says. Her new therapist, company owner Tim Good, CRT, AE-C, RPFT, introduced her to SeQual Technologies’ Eclipse, a portable oxygen concentrator approved for air travel.

The Eclipse is great for traveling around town as well, Gatewood says. “It is wonderful,” she says. “My car recharges the battery, so whenever I drive to a restaurant or store, I start recharging so it’s ready.”

HOW EQUIPMENT HELPED Now retired, Gatewood says she can go anywhere she wants — meaning the little ones in the Emerald City get to see grandma more often. Good adds that Gatewood is “a very independent and brave patient.”

HME INSPIRATION Good says the Eclipse has been reliable, but still doesn’t recommend Gatewood use it as her sole source of oxygen 24/7. “We feel that a stationary concentrator in the home as a backup or alternative is cheap insurance for a POC,” he says. That’s why Gatewood has the Invacare Platinum 5-Liter at home as well.

Still, Gatewood can’t say enough positive things about the portable technology and the company that led her to it. “Other oxygen patients stop me and ask me about the machine because they’re tired of wheeling bottles around,” she says. “I feel like I can contribute a little by setting an example.” And about GoodCare, she says: “They bend over backwards to help me out. It’s a good company.”

Cody Ellison

Cody Ellison uses a nebulizer at home. "It has reduced the number of doctor visits we've had to make," says his mother, Elaine.

AGE 10

DIAGNOSIS Reactive airway

EQUIPMENT PARI ProNeb Ultra II with Jet Nebulizer Kit and Omron MircoAir

SUPPLIER Active Healthcare Inc., Raleigh, N.C.

HISTORY Cody started life as a prime candidate for respiratory management — and he’s lived life as an example of how well respiratory therapy can work. He was born six weeks early, reports his mother, Elaine Ellison, and was on a respirator in the neonatal intensive care unit at the hospital for the first few days. It would not be the last time he came into contact with medical equipment designed to help him breathe better.

“When Cody was around 18 months old,” Ellison reports, “we noticed that he was having difficulty breathing.” Concerned, naturally, she took the toddler to visit his pediatrician, who “decided to prescribe a nebulizer for better treatment.” That’s when he became a patient of Active Healthcare Inc. as well, says company founder Lisa Feierstein, RN, BSN, MBA. “We received a referral from the physician’s office to train the patient’s parent on using a nebulizer for the pediatric patient,” she says.

It’s a good thing that the training came when it did. Some time later, on a camping trip to the Outer Banks — the scenic barrier islands that are a North Carolina summer vacation hotspot — Cody “became sick and was coughing and having problems breathing,” his mother recalls. “We made a mad dash back to Raleigh, where he was diagnosed with pneumonia.” Doctors used the nebulizer after Cody’s ER visit to treat the condition, she says, noting that “since then, we don’t go out of town without it.”

BIGGEST CHALLENGE Because Cody is too young to manage his condition on his own, Feierstein says her biggest challenge has been “making sure that his parents understand the proper use of maintenance inhalation vs. rescue inhalation.” That’s a critical issue for any child’s caregiver to understand.

Two additional challenges Feierstein cites are “empowering the parent to use the maintenance medication even when the child feels well” — it’s often difficult to be the grown-up and insist that unpleasant things are good for one’s kids — and “teaching the parent the proper time to use the rescue inhalation.” Elaine Ellison is Feierstein’s colleague at Active Healthcare, so she’s an especially good student.

HOW EQUIPMENT HELPED “[Cody’s nebulizer] has been wonderful,” his mother says. “It has reduced the number of doctor visits we’ve had to make. That has given us reassurance that we will be able to handle any breathing issues that may come up.”

HME INSPIRATION With the right combination of patient, parents and products, home care just clicks. “I know that Cody’s family has avoided urgent care visits and last-minute visits to the doctor’s office because they truly understand when and how to use inhalation treatment properly,” Feierstein says.

Lou Britton Jr.

Lou Britton Jr. smiles with his 7-year-old son, Christian. Oxygen therapy helps Lou stay active. "I want to go just a little bit more to do things with him."

AGE 54

DIAGNOSIS Severe COPD

EQUIPMENT Invacare Venture HomeFill II Oxygen System and Inspired Technologies SmartDose Oxygen Conserver

SUPPLIER Medical Service Co., Cleveland

HISTORY Britton used to play racquetball and tennis all the time. But about 10 years ago, his opponents started noticing how short of breath he became after even a little walking or running. “People were concerned,” he says now. “That’s when I went to the doctor.” He was diagnosed with COPD and started using albuterol and Serevent.

Shortly afterward, Britton began using oxygen during sleep only. “After a year, I felt I did not need the oxygen anymore and went off it,” he says. “Later, my doctor recommended I go back to it and that I carry a portable system for use as needed.” Britton wasn’t noticing much difference in his functional ability then, he adds, but over time came to rely on the portable oxygen more and more. “I don’t have to use it 24/7 yet,” he says. “That’s a good thing.”

In April 2008, Britton retired on disability from his job as manager of a huge commercial property — meaning he wasn’t getting nearly as much exercise as when he roamed the grounds. “I was getting shorter and shorter of breath,” he says, “but I thought I was getting out of shape because I wasn’t walking. I didn’t think the COPD was getting worse.” It was. In February, his doctor recommended pulmonary rehabilitation, which Britton figures will be a good foundation for using the fitness center at the condo complex where he lives.

BIGGEST CHALLENGE Britton says it’s difficult to stop moving before the COPD forces him to. Jodi Monn, RRT, RCP, the Medical Services therapist assigned to his case, attributes much of that desire to keep on truckin’ to his 7-year-old son, Christian. “I want to go just a little bit more to do things with him,” Britton says. “I’m learning that I can’t. That’s a hard thing.”

HOW EQUIPMENT HELPED Britton contacted Medical Services in February for advice on portable tanks and other oxygen issues related to working out at the fitness center. “I was introduced to the Inspired Technologies SmartDose oxygen conserver, which senses, through increased breathing patterns, a patient’s additional oxygen needs and supplies a dose up to two liters beyond the current setting,” he says. “It was a bit unnerving at first, but it offers a welcome burst of oxygen to say the least.”

The device makes Britton confident that his oxygen needs will be met as they change. “I worry less about stopping to rest before I completely fall into a breathing crisis — not that I’m careless about the warning signs.” The portable tanks can be filled on his home concentrator, he adds, and, while the system is relatively quiet, it still makes a characteristic “whoosh” sound when activated. Quips Britton: “I can’t sneak up on anybody.”

HME INSPIRATION Monn reports that Britton’s oxygen is primarily used for exertion because his SpO2 drops significantly when he’s ambulating. He started out using the Easy Pulse oxygen conserver with the Invacare product, but Monn recently evaluated him on the SmartDose conserver; it can be added to a HomeFill tank with a post valve. “I suspect that as his COPD progresses, he’ll need continuous flow on exertion,” Monn reports. “At that point, he will probably be switched to liquid oxygen for portability.”

Says Britton: “Medical Services has been invaluable to me. The staff there is always available for my questions and responsive to my needs. And they’re quick to fill my supply orders.”

Evan Mercer

DIAGNOSIS Severe obstructive sleep apnea

EQUIPMENT ResMed S8 Elite CPAP Unit with Heated Humidifier

SUPPLIER Active Healthcare Inc., Raleigh, N.C.

HISTORY Mercer thought he was suffering from depression. “I was taking two or three naps a day, and I didn’t understand why,” he remembers. “I thought it was something that was my fault. I kept asking myself, ‘Why can’t I get anything done at work?’ I wondered if I was just bored or something like that.” Turns out it was nothing like that.

In June 2009, Mercer’s girlfriend found the Berlin Questionnaire online. It is designed to test one’s risk of sleep disorders, and she suggested it because Mercer was snoring a great deal and tired all the time. The questionnaire indicated a severe risk for a sleep disorder, so Mercer asked his doctor at Duke University about a more formal overnight test. Julie Shannon, his customer service rep at Active Healthcare Inc., says, “The doctor ordered a sleep study after identifying further symptoms of sleep apnea — including drowsy driving, excessive daytime sleepiness, forgetfulness and napping during the day.” Mercer had heard of Active Healthcare, she adds, “and he came to us.”

BIGGEST CHALLENGE As with all CPAP patients, Shannon points out, Mercer’s initial challenge was getting used to the pressure and sleeping with the mask. “Finding the right mask is the key for making the patient successful,” she says. “This patient was lucky in that he felt the benefits from the CPAP therapy almost immediately, which gave him the incentive to persevere.”

Mercer agrees. “The biggest challenge was getting used to the machine in the beginning.” The mask, he says, is cumbersome and “not very comfortable, but it’s effective, so it’s worth the hassle.” It’s a good thing he feels that way, because it is unlikely there will be a day when he can say goodbye to it forever. “I assume it’s permanent,” he comments. “If I don’t wear the mask for a couple of nights, I notice a change immediately. I can’t imagine this setup not being permanent.”

HOW EQUIPMENT HELPED “The biggest way the equipment has helped me is I’m not sleepy during the day anymore,” he says, the wonder still evident in his voice. “That was a challenge I’d faced for years. But I noticed a difference driving to work in the morning the next day after the sleep test.”

These days, Mercer suffers only normal drowsiness at work — and really, can anyone claim to have never yawned during an extra-long staff meeting? “The home medical equipment has changed my productivity at work,” he says, enthusiastically. “It’s really amazing.”

HME INSPIRATION Mercer gets much of the credit for his respiratory turnaround, Shannon emphasizes. “This patient was committed from the beginning,” she says. “He viewed this as an amazing opportunity for him to take control of his sleep health and improve how he feels on a daily basis. And that’s something we can all appreciate.” Mercer, for his part, says the change the CPAP device brought has been nothing less than “transformational.” Overnight, he says, he improved so much that he can now concentrate at work again. And he is enjoying an even bigger benefit: “I’m happier,” he says.

This article originally appeared in the Respiratory & Sleep Management May 2010 issue of HME Business.