Texas Association of Cardiovascular and Pulmonary Rehabilitation

1. A Message From Your President Welcome to the Fall edition of the TACVPR newsletter. I hope everyone had a fun and relaxing summer and is ready to get back into the swing of things now that the kids are back to school and the holidays are fast approaching. There is a lot to look forward to with the upcoming AACVPR conference and planning of the 2008 TACVPR conference. This newsletter is filled with informative articles addressing a variety of topics including an update on the latest reimbursement news, the upcoming TACVPR Conference and other events, Texas program certification update, as well as articles on Mindful Eating, Smoking Cessation, NHLBI Breathe Better Campaign and Childhood Obesity. The Texas state affiliate (TACVPR) continues to work closely with the AACVPR on leadership and legislative initiatives. Several board members, including myself, will be representing TACVPR at the 22nd Annual AACVPR conference in Salt Lake City, UT this October 17-21st. We will be attending many important meetings including the Health Policy & Reimbursement Workshop where we will get the latest update on legislative issues so we can bring that information back to you. There will also be many networking opportunities with other affiliates that will give us ideas of how to help us improve our association. I will also be representing Texas at the 2nd Annual AACVPR Leadership Conference in Chicago on November 15-16th. The purpose of this workshop is to provide Affiliate leaders with tools to help them succeed in their roles as state leaders and to provide networking opportunities to strengthen the local organizations. I hope you enjoy the enclosed newsletter and find the information helpful in your daily practice. If you are interested in writing an article for the next newsletter, please email Dean Diersing at mdiersing@teamumc.com. Happy Fall everyone! Julie Hartman, MS TACVPR President Texas Association of Cardiovascular and Pulmonary Rehabilitation 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 Annual dues are $40/person (membership is good January-December yearly)

2. Save the Date - 2008 TACVPR Conference Rodeo, Ropin’ & Rehab: Deep in the Heart of Texas April 25-26th,2008 Dallas, TX Plans are underway for the 2008 TACVPR conference to be held at the Doubletree Hotel Campbell Centre in Dallas on April 25-26, 2008. 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 topics include: ► Obesity and Metabolic Syndrome by Dr. John Foreyt ► Getting the Most Out of Your Healthcare Team by Kathy Oppenheim ► Oxygen Prescription with Exercise by Dr. Richard Casaburi ► Therapeutic Benefits of Laughter by Mark Iberg ► Certification & Recertification by Barbara Flato ► Broken Heart Syndrome by Danielle Strauss ► and many, many more Friday Social As we have seen over the last few years, the Friday night social has continued to be one of the highlights of the conference and we will continue with it again at the next 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!

3. What’s New on the Reimbursement Front By: Twyla Selvidge, MS East Texas Medical Center Regional HealthCare System August 2, 2007: CMS, awarded TrailBlazer Health Enterprises the contract for the combined administration of Part A and Part B Medicare fee-for-service claims in Jurisdiction 4 (J4), called MAC, Medicare Administrative Contractor, which includes Texas, Oklahoma, New Mexico, and Colorado. The TACVPR is pleased with this announcement. Since TrailBlazer has been the Texas Medicare claims administrator and given the fact that TrailBlazer issued a LCD for Cardiac Rehab on 5/17/07 AND Issued a LCD for Pulmonary Rehab on 5/30/07, we have hope that TrailBlazer will not change either of these LCDs. One specific quote from the announcement stated “ Neither the providers, physicians, nor the beneficiaries who receive service from the current fiscal intermediaries and carriers in this jurisdiction will be adversely affected by the transition of their work to the J4 A/B MAC. September 20, 2007: The ACC put out a news release on Cardiac Rehabilitation. The gist of the news release was to announce that new standards should contribute to increasing the number of patient referrals. You may view this release at www.acc.org/media/rleases/highlights/2007/sept07 See the information below that further explains the new standards. October 2, 2007: The AACVPR/ACC/AHA has revised a new set of performance standards for Cardiac Rehabilitation. The full document is published in the October 2, 2007 issues of Journal of the American College of Cardiology and Circulation. It is also available on theAACVPR and AHA websites. In addition, the AHA/AACVPR has issued a revised scientific statement: Core Components of Cardiac Rehabilitation/Secondary Prevention Programs:2007 Update. This can viewed at www.circ.ahajournals.orgIf your program is currently certified by the AACVPR or you are re-certifying or you are considering certifying your program, these standard performances and core components will help. What’s That? CMS: Centers for Medicare and Medicaid Services LCD: Local coverage Determination NCD: National Coverage Determination MAC: Medicare Administrative Contractor ACC: American College of Cardiology AHA: American Heart Association AACVPR: American Association of Cardiovascular & Pulmonary Rehabilitation

4. Certification Corner By Barbara Flato MSN, RN-BC, FAACVPR The 2006-2007 AACVPR Certification and Recertification application process has ended. All results were recently mailed to the applicants. Programs are recommended to the AACVPR Board of Directors for Certification or Denial. As the process for Certification and Recertification evolves, there is now an opportunity for a program to be placed into a provisional status. This permits the applicant to remediate the areas that do not meet essential requirements allowing an opportunity for programs to make improvements in order to reach minimal standards for certification or recertification. This year the Program Certification Committee received 92 applications and the Program Recertification Committee received 416 applications across the country. Texas successfully submitted sixteen applications bringing the total number of certified program in Texas to 43. Currently approximately 25% of Texas programs are certified. I know we can do better than that! Congratulations to the following programs: Initial Certification CHRISTUS Spohn Alice Hospital Cardiac Rehab Alice Doctors Hospital Cardiopulmonary Rehab Dallas East Texas Medical Center Fairfield Cardiac Rehab Fairfield Hill Country Memorial Hospital Cardiac Rehab Fredericksburg Memorial Hermann Hospital Cardiac Rehab and Wellness Houston San Jacinto Methodist Hospital Cardiac Rehab Baytown Sierra-Providence Physical Rehab Hospital Cardiac Rehab El Paso Programs Successfully Recertified Baylor All Saints Medical Center/Ft. Worth cardiac Rehab Fort Worth Citizens Medical Center Cardiac Rehab Victoria Denton Regional Medical Center Cardiac Rehab Denton Medical Center Hospital Ann Roden Deaderick Cardiac Rehab Odessa Medical Center of Lewisville Cardiac Rehab Lewisville Medical City Dallas Health and Rehabilitation Dallas Medical City Dallas Pulmonary Rehab Dallas Mother Francis Hospital Cardiac Rehab Jacksonville Sid Peterson Memorial Hospital Pulmonary Rehab Kerrville New applications for the 2007-2008 year are available on the AACVPR Web site. Certification and Recertification committee members will be presenting a breakout session and a workshop session at the AACVPR Annual Meeting in October in Salt Lake. If you are submitting your program for certification or recertification this coming year, it is highly recommended that you attend these sessions. Feel free to contact the committee members at the state or national level when preparing your application. These volunteers are happy to work with you to help you achieve AACVPR program certification or recertification. Contact information can be found at www.tacvpr.org or www.aacvpr.org. We are here to help!! Check out these websites! Cardiac Rehab is getting good publicity from a paper released September 20th: http://www.acc.org/media/releases/highlights/2007/sept07/rehab.htm http://www.acc.org/qualityandscience/clinical/pdfs/CardiacRehab_PM_sept20.pdf

5. Mindful Eating By Marilyn Burwitz, RN Have you ever driven down the highway for miles and then had no memory of how you got to your destination? Have you ever sat down to eat a meal, and when it was over, wondered how the food actually tasted? In both instances, you were practicing mindless “cruise control.” Often we go through our days completely unaware of what is going on around us. Our minds are so busy dwelling on the past or the future that we fail to really pay attention to the present moment. Mindfulness, on the other hand, is the moment-by-moment awareness of our experiences. With mindfulness, our actions become intentional, careful, slower and more thoughtful. When we practice mindfulness while eating we are aware of both our food and what our bodies are experiencing as we eat. We are blessed in this country to have a plentiful supply of food (sometimes too plentiful). Do we feel a sense of gratitude for this abundance or do we take it for granted? As we approach our food in a mindful manner, we should do so with gratefulness for what is available to us. We need to give ourselves time to experience thankfulness. Mindfulness also calls for us to use all of our senses as we eat. Some things to think about while eating: How does my food look? How does it smell? What is the texture and temperature of my food? How does my food taste--is it sweet, sour, bitter, or spicy? Where did this food come from and what effort was made to get it to my table? What kind of aftertaste does it leave in my mouth? Mindfulness while eating also calls for us to slow down and take our time. We need to give ourselves time to savor each bite, rather than just shoveling in the next bite as soon as we get one down. Take smaller bites, put down your fork, and chew slowly. Once that bite has been chewed, enjoyed completely, and swallowed, then and only then, do you reach for another bite. While you are eating, you also need to be mindful of how your body is feeling. We only need enough at each meal to get us to the next meal. Listen to your body. As soon as your body signals you that you’ve had enough, STOP! That signal should come long before you are “stuffed.” Oftentimes, instead of heeding this signal we keep right on eating to the point of misery (think Thanksgiving meal). Once we learn to heed our internal “satiety monitor” then we will find that we are actually satisfied with much less than we may have eaten previously. Mindfulness does not come naturally. We live very hectic lives and our minds tend to be working on many different levels throughout the day. It is not easy to focus on one thing at a time. It is worth trying. Practice taking smaller bites, focusing on what your food tastes like with each bite, eating slowly and listening to your body as you eat. Take time to stop and smell the roast!

6. Smoking is a personal decision, whether someone is starting or quitting, the choice is theirs and theirs alone. Although we would like a smoke free environment, it is at times difficult to approach the smoker, about cessation, that does not wish to quit. The effects of tobacco are addicting and when a person uses tobacco, the body thinks it needs nicotine and it becomes habit forming. When nicotine is taken into the body, the person gets a quick “kick” which is caused by the body releasing a hormone that causes a sudden release of sugar. The longer a person has used tobacco, usually the harder it is for them to “Kick the Habit.” The person should know that using tobacco can: - Cause breathing problems - Increase the risk for heart attacks or stroke - Lead to circulation problems - Shorten their life - Cause erectile dysfunction - Increase cholesterol levels - Cause insomnia - Cause infertility - Cause osteoporosis - Make them heal slower than normal - Lead to high blood pressure - Bring on menopause earlier - Narrow the arteries and make them less able to stretch - Increase the risk for certain types of cancer The person that has decided to quit may become anxious just thinking about it. The chances of stopping and staying quit will be better if they get ready to quit first. Following the START acronym may help in this process. S = Set a quit date T = Tell family, friends, and co-workers that they plan to quit. A = Anticipate and plan for the challenges they will face while quitting R = Remove cigarettes and other tobacco products from the home, car and work. T = Talk to the doctor about getting help to quit. While going through the quitting process, the person may experience the following withdrawal symptoms: - Strong cravings for tobacco - Depression - Anger - Irritability - Tension - Anxiety - Restless feelings - Sleeplessness - Trouble concentrating - Increased hunger Before beginning the quitting process, the person should determine why and when they smoke. Is it to get going in the morning, to deal with stress, to relax and feel good, or just because they like the feel of holding and smoking? Whatever the reasons, the person needs to be honest. The next step is the when, after meals, in the morning, while driving the car, while waiting for someone; after determining when, make conscious plans to change the routine so it is easier to break the habit. Continued on next page Helping our Patients with Smoking Cessation Nita Pack, RRT

7. Next, the person should decide on a quit method. These would include: - Quitting “cold turkey” – which means stopping all at once. Tapering off – using less and less tobacco each time. This can be done by decreasing the number of cigarettes or by cutting them down in length little by little. Nicotine Replacement Therapy is now available in many forms. The person can decide between the patch, gum, nasal spray, oral inhalers, lozenges, and pills. - Attending a Smoking Cessation Program may be helpful for some people while going through the quitting process. A list of programs in your area should be available through the American Cancer Society. - There are also telecounselling options available where the person speaks on the telephone with a counselor to help them with the quitting process. A couple of these are SmokeStoppers (1-800-697-7221) and 1 800 QUIT-NOW. - The internet offers websites which are interactive and educational. Some of these websites include: - SmokeStoppers.com - Quit-net.com - WebMD.com - Way2Quit.com - Cdc.gov - Smokefree.gov - Aha.com - Philipmorrisusa.com Other options are support groups, hypnosis therapy, and acupuncture. Recovery is getting past the withdrawal and its symptoms. No matter which method is used, the person should not become discouraged due to relapse. Statistics show that many who try to quit relapse. Most successful quitters try 2 to 6 times before they make it. If relapse occurs, talk to the person about not being hard on themselves and to work instead on the reason and weak links in the quit plan that led to the relapse. Addressing with a positive attitude and evaluating the reasons will help to set goals and put plans in place to keep relapse from recurring. Remember, stopping smoking is a personal decision, without the person making the decision to stop, the process will not work. For more information on teaching about smoking cessation, the 2008 TACVPR Conference will have a speaker on this topic. Helping our Patients with Smoking Cessation (cont.) 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, RN – Certification Committee Julie Hartman, MS – Education Committee Poppy Patterson, RN, BBA – Certification Committee Laura Raymond, RN – Chair of State Certification Committee If you are interested in serving on an AACVPR committee, visit www.aacvpr.org for more information.

8. Childhood Obesity on the Rise: Recess Will Not Help By Danielle Strauss, BSN-BC, RN Have you asked your children lately if they have recess anymore? Their response might surprise you, there is a chance they will tell you no. This may bother you because as a healthcare provider you think that physical activity is necessary for weight loss. Do you recall sunshine on your face, the smell of grass and kickball games? Time in the classroom for standardized test instruction has taken over the available time for recess. As a result, certain organizations and individuals are making recommendations for recess time. These organizations and individuals may be associating recess with calories burned. The math of this association is not plausible. Every day, literature crosses our desks and computers, stories are featured on the television and patients are seen in the emergency room because of the number one killer, cardiovascular disease. As healthcare professionals, we know that obesity is a risk factor of this disease. Some might think the risk factors for cardiac disease are limited to 50-70 year old patients. This is not the case in today’s children. Literature states that currently 16% of our nation’s children are overweight. The CDC reports that in children ages 6-11 the rate is as high as 18.8% and for children 12-19 years old the rate is 17.4%. Recess is important and beneficial for our young. The benefits include building bones, strengthening muscles, reducing stress and forming social skills. However, recess and physical education class are not the solution to the obesity rate in our children. Have you ever really considered the amount of calories burned during recess? A dodge ball game played during a 15-minute recess burns a total of 70 calories. Have you also considered the caloric content in a meal from McDonalds? One McDonald’s meal consisting of a cheeseburger, medium fries and coke is a whopping 905 calories. Do the math and you will find the answer. Have each child jog/walk 9 miles during a 15-minute period of recess, then one can assume the calories from that unhealthy meal will burn off. Recess is not going to make the slightest dent in the childhood obesity problem. The truth is that the type of food eaten and the amount of the food consumed has everything to do with obesity. In conclusion, parents have the most significant impact on their children’s health. Parents have the ability and knowledge to teach their children the truth and should be held accountable for the rising rates of obesity in their children. Recess is and should be fun, physical education is important for learning. Eating less is a guarantee for weight loss.

9. NHLBI’s LEARN MORE BREATHE BETTER Campaign By: Kitty Collins, RRT Anyone working in Pulmonary Rehabilitation is all too aware of the devastating effects of COPD. How many times have we heard “I stopped smoking 10 years ago” by someone who was in the moderate to severe range of COPD when you first met them? Over the last four years I have worked with American Lung Association to promote COPD awareness within the Austin community. The NLHEP (National Lung Health Education Program) has wonderful resources as well as the GOLD (Global Initiative for COPD) program for helping educate the public and health care community on early detection and treatment for those suffering from COPD. In spite of this there was not much media attention given to this disease, even though it was the fourth leading cause of death in the U.S. Finally with the launch of NHLBI’s (National Heart Lung Blood Institute) campaign, Learn More Breathe Better, on January 19th, 2007 there have been articles in Newsweek, The Wall Street Journal, and most recently Woman’s Day magazines. They are all centered around Ted Koppel’s wife, Grace Ann Dorney Koppel. She has become the national spokesperson for NHLBI for COPD. Her story is like many with COPD in that in spite of her history of heavy smoking in the past and her complaints of SOB, she had a difficult time finally being diagnosed with COPD. She openly talks about her frustration with this particularly after she discovered that it could have been detected with a simple spirometry test. She has also been interviewed on Good Morning America, The View and the CBS Evening News with Katie Couric. Grace and her husband are doing their part to help get S 329 passed and recently attended meetings on Capitol Hill with members and staff of the Senate Finance Committee on the need for national coverage for pulmonary rehabilitation. If you are not already involved in COPD Awareness, now is the perfect time to get started. World COPD Month is in November and World COPD Day is Nov. 14th. It may be something as simple as having a poster presentation in your facilities lobby or something on a grander scale. NHLBI has promotional materials that are free of charge to get your project going. They even have PSA’s for media presentations and suggestions for promoting COPD Awareness in your community. To read more about the campaign and to receive information go to www.learnaboutcopd.org. You can also get wonderful resources at www.nlhep.org and www.goldcopd.com. I would be happy to assist anyone that needs help starting their own community project and would encourage you to contact your local American Lung Association branch to find out what support they can give or you can email me at kcollins@seton.org. Congratulations to the RAP (Refer-A-Pal) Candidates & Winners: Kori Rich =  8 points = Free Conference Dues for 2008 Conference Dean Diersing = 8 points = Free Conference Dues for 2008 Conference Katy Kennedy = 6 points Anita Gaddis = 4 points Valerie Arizmendi = 4 points Marilyn Burwitz = 2 points Julie Hartman = 2 points Clint Rivers = 2 points

10. IN OTHER NEWS… ATTEND THE UPCOMING NTACVPR MEETING All cardiac & pulmonary rehab professionals are welcome to attend the next meeting which will be held on Tuesday, October 30th at Don Pablos Restaurant. Location: Don Pablos Restaurant 3911 W. Airport Freeway (Rt 183) Irving, TX 75062 Topic: Sammons Preston will be highlighting the new/updated equipment from Star Trac & Sci Fit NTACVPR Activities:  Election of Officers, sites to host next year’s meetings, HOT topics for 2008 meetings, ideas to increase participation, & CEU opportunities       Please RSVP to Ellen.Bracy@va.gov or Margaret.Auchter@va.gov or by phone at 214-857-0101 Congratulations to Joanne Garcia for winning the drawing for a free TACVPR membership for 2008 by visiting all the vendors and completing the vendor card.  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

11. UPCOMING SEMINARS CARDIAC YOGA TEACHER TRAINING COURSE Nov. 1-6, 2007 M. Mala Cunningham, Ph.D. Founder & Director - Cardiac Yoga Website: cardiacyoga.com GET CERTIFIED TO TEACH CARDIAC YOGA FOR HEART PATIENTS 6-DAY CONDENSED COURSE, NOVEMBER, 2007 Medical Personnel, Cardiac Rehab Staff, Yoga Teachers and others are eligible to apply Limited Enrollment - Register Early Charlottesville, Virginia 6-day condensed program, non-residential tuition: $1275.00 Held at the beautiful English Inn in Charlottesville, VA For an application or more information: Mala Cunningham, Ph.D., info@cardiacyoga.com

12. 2007-2008 TACVPR Board of Directors Board Officers President: Julie Hartman, MS Baylor Jack & Jane Hamilton Heart & Vascular Hospital President-Elect: Marilyn Burwitz, RN East Texas Medical Center Fairfield Past President: Lorri Lee, BS, RCEP McKenna Memorial Hospital Treasurer: Twyla Selvidge, MS East Texas Medical Center Secretary: Nita Pack, RRT Methodist Charlton Medical Center Board of Directors Poppy Patterson, RN, BBA Hillcrest Health System Kitty Collins, RRT Seton Medical Center Mary Hart, RRT Baylor University Medical Center Danielle Strauss, BSN, RN-BC, BS Baylor Jack & Jane Hamilton Heart & Vascular Hospital Barbara Flato, MSN, RN-BC, FAACVPR CHRISTUS Spohn Cardiac Rehab Dean Diersing, MS University Medical Center, Health Point Fitness & Cardiac Rehab Interested in serving on the TACVPR Board of Directors? Contact Lorri Lee at llee@mckenna.org for more information.