Health

Exercising Critically Ill Patients May Help Speed Recovery

Published

10 years ago

March 31, 2015

In this photo provided by the Wake Forest Baptist Medical Center, taken March 11, 2015 in the intensive care unit at Wake Forest Baptist Medical Center, physical therapist Katie Kellner helps patient Terry Culler do some exercises and briefly stand despite being hooked to a ventilator. There’s increasing evidence that mild exercise may have its place even for the sickest ICU patients, and new animal research suggests it may target both muscles and lungs. (AP Photo/Warren Cameron Dennis III, Wake Forest Baptist Medical Center)

LAURAN NEERGAARD, AP Medical Writer

WASHINGTON (AP) — The intensive care unit is a last frontier for physical therapy: It’s hard to exercise patients hooked to ventilators.

Some hospitals do manage to help critically ill patients stand or walk even if they’re tethered to life support. Now research that put sick mice on tiny treadmills shows why even a little activity may help speed recovery.

“I think we can do a better job of implementing early mobility therapies,” said Dr. D. Clark Files of Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, who led the research and whose hospital is trying to get more critically ill patients up, ventilator and all.

Hospitals have long nudged less critical patients out of bed, to prevent their muscles from wasting away. But over the past several years, studies in ICUs have shown that some of the sickest of the sick also could benefit — getting out of intensive care sooner, with fewer complications — once it’s medically feasible for them to try.

This isn’t just passively changing a patient’s position. It could involve helping them sit on the side of the bed, do arm exercises with an elastic band or in-bed cycling, even walk a bit with nurses holding all the tubes and wires. It takes extra staff, and especially for patients breathing through tubes down their throats, it isn’t clear how often it’s attempted outside specialized centers.

At Wake Forest Baptist, a physical therapist helped Terry Culler, 54, do arm and leg exercises without dislodging his ventilator tubing, working up to the day he stood for the first time since developing respiratory failure about three weeks earlier. “I cheered, I was clapping,” his wife, Ruanne Culler of Lexington, North Carolina, said after two therapists and a nurse finally helped him to his feet.

Biologically, why could such mild activity help? Files focused on one especially deadly reason why people wind up on a ventilator: acute respiratory distress syndrome, or ARDS, the problem Terry Culler battled. It strikes about 200,000 Americans a year, usually after someone suffers serious injuries or another illness such as pneumonia; it can rapidly trigger respiratory failure. Survivors suffer profound muscle weakness.

Files’ team injured the lungs of laboratory mice in a way that triggered ARDS. The animals, sick but still breathing on their own, walked or ran on a treadmill for a few minutes at a time over two days.

That short amount of exercise did more than counter wasting of the animals’ limbs. It also slowed weakening of the diaphragm, used to breathe. And it tamped down a dangerous inflammatory process in the lungs that Files suspects fuels muscle damage on top of the wasting of enforced bed-rest.

“It’s not only putting a load on the legs,” Files explained. “It’s something systemic.”

When certain white blood cells stick inside ARDS-affected lungs too long, they slow healing. The lungs of the exercised mice contained fewer of those cells — and their blood contained less of the protein that activates them, Files reported in the journal Science Translational Medicine this month.

Examining blood frozen from ARDS patients who had participated in an earlier Wake Forest Baptist study comparing early mobility to standard ICU care, he found patients who had gotten a little exercise harbored less of that protein.

The new research adds to the biologic rationale, but there’s already enough evidence supporting early mobility that families should ask whether their loved one is a candidate, said ICU specialist Dr. Catherine Hough of the University of Washington, who wasn’t involved with Files’ study.

She’s surveying a sample of U.S. hospitals and finding variability in how often ICUs try, from those that help a majority of critically ill patients stand to others where no ventilated patients do. Obviously, key is whether the patient can tolerate movement. But so is whether hospitals keep ventilated patients sedated despite research showing many don’t need to be, Hough said.

Back at Wake Forest Baptist, Terry Culler began the exercises when he was medically stable, and he scribbled notes saying he wanted to participate.

“It’s given him something to look forward to,” his wife said a few weeks before he was released from the hospital.

“Ask about it every day,” University of Washington’s Hough advises families, given that critical illness changes frequently. “On Monday, the patient might have a good reason not to be moving forward with mobilization, but there’s a very good chance it’s different on Tuesday,” she said.

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Gov. Newsom Goes to Washington to Advocate for California Priorities

Gov. Gavin Newsom traveled to Washington, D.C., for meetings with senior Biden-Harris Administration officials and members of California’s congressional delegation. During the week, he pushed for increased resources to improve public safety and quality of life in California.

Published

1 week ago

November 26, 2024

Oakland Post

Gov. Newsom visits the White House on Nov. 14. Photo courtesy of Gov.Ca. Gov

By Bo Tefu, California Black Media

Gov. Gavin Newsom traveled to Washington, D.C., for meetings with senior Biden-Harris Administration officials and members of California’s congressional delegation.

During the week, he pushed for increased resources to improve public safety and quality of life in California.

“California is continuing our work to secure additional tools and resources to improve access to health care, clean air and water, and secure critical funding to support communities recovering from disasters,” said Newsom.

At the White House, Newsom met with President Joe Biden and key officials, advocating for disaster relief funding, healthcare expansion, and environmental protection. He also engaged in discussions with senior Biden-Harris officials, including Interior Secretary Deb Haaland, to address water quality improvements and the San Luis Dam project, which will support water supplies for two million Californians.

“Building on our strong partnership with the Biden-Harris Administration, California is working closely with the White House over the next two months to deliver the critical protections and resources our communities need,” Newsom said.

On Capitol Hill, Newsom met with California Senators Alex Padilla and Adam Schiff, along with other Congressional leaders, to emphasize the need to approve pending disaster funding, healthcare programs, and environmental protections. He also previewed California’s upcoming special session to proactively address potential federal challenges when President-elect Donald Trump is sworn into office.

Newsom’s discussions also focused on securing Medicaid waivers from the Center for Medicare & Medicaid Services (CMS) to enhance behavioral health services and reduce homelessness. The state seeks approval for the BH-CONNECT waiver, which would address behavioral health and homelessness, and the MCO Tax Waiver, which would provide over $20 billion for Medi-Cal to improve healthcare access.

Additionally, California is pushing for Clean Air Act waivers from the U.S. Environmental Protection Agency (EPA), which are crucial for enforcing air quality regulations. These measures are projected to prevent 11,000 premature deaths and provide $116 billion in health benefits over the next three decades, according to the Governor’s office.

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California Reports First Case of Mpox in the United States

On Nov. 16, the California Department of Public Health (CDPH), reported the first known case of clade 1 Mpox, previously known as Monkeypox, in the United States. However, the risk to the public remains low, according to the CDPH.

Published

1 week ago

November 26, 2024

Oakland Post

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By Bo Tefu, California Black Media

On Nov. 16, the California Department of Public Health (CDPH), reported the first known case of clade 1 Mpox, previously known as Monkeypox, in the United States.

However, the risk to the public remains low, according to the CDPH.

“This case was confirmed in an individual who recently traveled from Africa and is related to the ongoing outbreak of clade I mpox in Central and Eastern Africa,” reads a statement the CDPH released.

According to the DDPH, “The affected individual received health care in San Mateo County based on their travel history and symptoms. The individual is isolating at home and recovering.”

Public health workers are also conducting a contact tracing exercise and reaching out to people who have been in close proximity to the affected person.

“The mpox specimens from the traveler are being sent to the CDC for further laboratory testing,” the CDPH press release continues.

Californians can take a number of steps to prevent Mpox. Here’s more information:

Preventing Mpox Infection

It appears clade I mpox spreads in a similar manner as clade II mpox, through close (skin-skin), intimate and sexual contact. The identification of a potentially more severe mpox version in the United States is a good reminder for individuals who have certain risk factors to take preventive action, including:

Getting vaccinated if you may be at risk for mpox. For the greatest protection, make sure you get both doses of the vaccine. Find mpox vaccine (JYNNEOS) near you.
Taking precautions if you were exposed to mpox. Get the mpox vaccine before symptoms develop and consider avoiding intimate contact with others for 21 days. Watch yourself for symptoms and get tested if they develop.
Preventing spread if you have been told you have mpox. Avoid contact with others until the rash is healed, clean and disinfect shared areas in the home, and notify people who may have been exposed.
Talking to your sexual partner(s).
Avoiding skin-to-skin contact with those who have a rash or sores that look like mpox.
Not sharing items with someone who has mpox.
Washing your hands often.
Protecting yourself when caring for someone with mpox by using masks, gowns and gloves.

Visit the CDPH website to learn more about Mpox with Sexual Health Toolkits and a Campaign Materials Page.

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California Black Media

California Department of Aging Offers Free Resources for Family Caregivers in November

In honor of National Family Caregivers Month this November, the California Department of Aging (CDA) is spotlighting a range of free resources to support caregivers of older adults and individuals with disabilities. Through its extensive network of Caregiver Resource Centers (CRCs) and Area Agencies on Aging (AAAs), the state provides essential tools to help caregivers manage their responsibilities while prioritizing their own health and well-being.

Published

1 week ago

November 26, 2024

Oakland Post

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By Bo Tefu, California Black Media

“Caregiving is a great act of love, and this month — and every day — we uplift California’s caregivers as the under-recognized backbone of our families and communities,” said Susan DeMarois, director of the CDA. DeMarois emphasized the need for caregivers to access available support to better balance their roles without compromising their own health.

California is home to more than 4.5 million unpaid family caregivers, who contribute an estimated $81 billion annually in economic value through their care. Most caregivers are women who balance work, family, and caregiving responsibilities, often at the cost of their physical and emotional health. Given California’s aging population, the demand for caregiver support is rapidly growing, underscoring the importance of these free resources.

Thousands of caregivers accessed these services in the 2022-2023 fiscal year, benefiting from tools like professional care management and respite support. The Aging in California Resource Guide, available in six languages, offers additional information on caregiver support.

Caregivers can learn more about available resources by visiting the CDA website at aging.ca.gov and connecting with local CRCs or AAAs to discover personalized services to support them in their caregiving journey.