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Spring
2004 Editor & Chair Mary Hart, RRT, RCP Baylor Asthma and Pulmonary Rehab Center 4004 Worth St., Suite 300 Dallas, TX 75246 FAX (214) 841-9799 maryhar@baylorhealth.edu Chair-elect |
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Notes from the Chairby Mary Hart, RRT, RCPAs I sit down to write this column, it is springtime. Flowers are popping out of the ground almost before my eyes, trees are renewing their leaves, and everything is turning green. It's that time of year when you either want to start fresh new projects or just play! Please don't ask me which I feel like doing at the moment! The latest information from the section on pulmonary rehabilitation concerns coverage for pulmonary rehab with lung volume reduction surgery (LVRS) and the long awaited "national coverage policy." According to the major pulmonary medicine societies, the Centers for Medicare and Medicaid Services (CMS) is still wrestling with the question of which benefit category authorizes pulmonary rehabilitation. Ironically, CMS has not been able to identify any benefit category that authorizes its coverage of pulmonary rehab as an integral part of LVRS. In response to the CMS stance, the AARC joined with the American Association of Cardiovascular and Pulmonary Rehabilitation, the American College of Chest Physicians, and the American Thoracic Society to set an arbitrary deadline of March 15 to hear back from CMS. All of these organizations are currently asking their leadership to write to their senators and congressmen, strongly urging them to contact CMS to suggest that they act on the year-old formal request for a coverage decision related to pulmonary rehabilitation. I hope that by the time you receive this Bulletin a national coverage policy for pulmonary rehab will be closer to reality so that we can all rest easy knowing our patients will continue to receive the care they deserve. In the meantime, we all need to continue to support our programs and our patients by working together and sharing information on what works and what doesn't when it comes to reimbursement and other key issues. One of the best ways to accomplish that goal is through this Bulletin. If you have information to contribute, please consider writing a short article and submitting it to Mary Hart. Your ideas and articles are always welcome. |
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Intimacy and Lung Diseaseby Nita Pack, RRT, Cardiopulmonary Rehab Specialist, Methodist Dallas Medical Center, Dallas, TXSexuality is an important part of life from the time we are born until the time we die. Concerns about sexuality are common and perplexing for seniors and for all people with lung disease. It is natural for our patients to have questions, and it is important for us as respiratory therapists to help them find answers. Unfortunately, both health care professionals and lung disease patients tend to overlook sexual needs. Neither will broach the topic. Possible reasons for this are: Health care professionals:
Persons with lung disease:
Definitions Before continuing, let's define a few terms that are associated with sexuality: Intimate or Intimacy:
Sex:
Sexuality
The effects of aging While the frequency of sexual activity and the ability to perform sexually generally decline with the normal physiological changes that accompany aging, reports show that the majority of men and women between the ages of 50 and 80 are still enthusiastic about sex and intimacy. The vast majority of older people maintain some sexual interest and, at times, intense sexual desire. Aging results in a number of predictable changes in sexual response that can lead to psychological distress if the individual is not aware of them. Changes as men age: Older men tend to need a longer arousal time and more direct penile stimulation to achieve an erection. Erections are also less firm, and a decrease in swelling occurs more readily and rapidly. Although it is easier for older men to delay ejaculation, the force of semen expulsion and the number of muscular contractions during ejaculation are decreased. Older men generally exhibit an increase in their refractory period, such that they may need several days between orgasms. Medications such as antihypertensives, tranquilizers, and antidepressants can affect erectile functioning and libido (the sexual urge). Changes as women age: The physiologic effects of aging on sexual function are primarily caused by decreased amounts of circulating estrogen after menopause. Post-menopausal women experience genital changes, including a reduction in the size of the clitoral, vulvar, and labial tissue; decreased size of the cervix, uterus, and ovaries and some loss of elasticity and thinning of the vaginal wall. Hormone replacement can restore normal vaginal function. Women require prolonged stimulation to produce vaginal lubrication, as the amount of lubrication is decreased. With orgasm, the woman's sensations are the same, but fewer and weaker pelvic muscle contractions occur. Although changes in sexual response occur in both sexes with age, under normal circumstances, they should not interfere with sexual activity. Unfortunately, when individuals lack knowledge of these age-related changes, they may become distressed. Changes due to lung disease Sexual function in a person with lung disease depends on a number of variables. These include age, personal health, sexual history, the nature and severity of the illness, the effects of medications and surgery, social circumstances, the partner's reaction to the illness, and the person's coping ability. Obstacles to sexual health in people with lung disease can be classified as follows:
Probably the most damaging factors leading to the avoidance or failure of sexual expression by persons with lung disease are poor self-image, fear of rejection, and fear of failure to perform and satisfy. However, the greatest fear of the person with lung disease regarding sexual activity is shortness of breath. Despite the absence of data on how often sexual dysfunction is due to the disease process itself versus how often it is due to psychological factors experienced by the person with lung disease, it is usually attributed to the shortness of breath and fatigue associated with the disease. Sexual dysfunction associated with lung disease can be divided into four categories:
Inhibited sexual desire People with lung disease expend a lot of energy just performing daily activities.
Inhibited sexual arousal (refers to the inability of an individual to achieve erection or lubrication) For men:
For women:
Inhibited orgasms
Other problems with sexual functioning
Common myths about sex and lung disease Myth 1 - Disabled persons are asexual. On the contrary, disabled people have sexual needs. Although sexual activity may be absent or infrequent during acute exacerbations of lung disease, thoughts, fantasies, and feelings about sex do not disappear. Sex is an activity of daily living that affects the patient's self-concept and ability to cope with pulmonary disease. Myth 2 - The elderly are asexual. We often hear the following: "Impotence is a natural consequence of aging," "sexual activity can be dangerous for the elderly," and "the sex drive or libido diminishes with advancing years for both men and women." None are true. Older people not only have sexual needs, but aging is not a primary cause of sexual dysfunction. Satisfying sexual activity and, in the cases of some men, procreation, may occur into the seventh and eighth decades of life. The myths surrounding sexual intimacy in the later years are finally being put in their proper place - behind us. As a result of the pioneering work of Masters and Johnson, the subject of sex and the elderly has "come out of the closet." It is now a frequent topic of great concern to the more than 21 million American men and women who are over 65 years of age. Myth 3 - Sexual problems are due to lung disease. Most sexual problems experienced by lung disease patients are due to the person's adaptation to lung disease rather than the disease itself. The four most common situations associated with sexual dysfunction are:
A minority of persons with lung disease may have a physical reason for sexual dysfunction, although exact incidence is unknown because of sparse research on the topic. Some persons with lung disease claim sexual dysfunction, ranging from decreased sex drive to complete impotence, generally coinciding with the advancement of signs and symptoms associated with lung disease. At least some of the decline in sexual function may be related to a decreased level of oxygen. Correction of the decrease in the level of oxygen will allow otherwise impotent persons to become sexually active again. Myth 4 - Sexual problems are due to pulmonary medications. Pulmonary medications generally do not cause sexual dysfunction in those with lung disease. Tremors, a side effect of some medicines, may interfere with erection, but they may be avoided by appropriate medication adjustment. However, the person may be on other medicines that affect sexual functioning, such as antidepressants, sedatives, and antihypertensives. Myth 5 - Sexual activity will precipitate respiratory distress. Shortness of breath during sexual intercourse is a natural response that can almost always be tolerated by people with severe lung disease, provided they are on appropriate medications. Sexual intercourse itself requires expenditure of few calories and is relatively non-stressful. It is the associated anxiety and fear that causes respiratory distress. Myth 6 - Short of breath, disabled persons are fragile and need to be protected. Short of breath, disabled people can learn how to control their symptoms and lead relatively normal social and sexual lives. Myth 7 - A spontaneous and active role in lovemaking is essential. Any type of satisfying sexual behavior is acceptable. To adapt to lung disease, partners will need to communicate needs and experiment with new sexual patterns and a passive rather than an active lovemaking role for the partner with lung disease. Communication An unfortunate type of communication that couples frequently engage in is a game called, "I hope you can read my mind." That is, one partner wishes something would change in the relationship and hopes the spouse or significant other will comply with the unspoken wish. Communication between partners is a very important part of dealing with the effects of lung disease on their sexual relationship. It is common for people to find this difficult, but there are several things your patients can do to make it easier. Once they have "broken the ice" on the topic, they are likely to discover that it becomes more comfortable each time they try to talk about it. Suggest they try the following:
While patients may find it initially difficult to talk with their partners, opening up will help them rebuild intimacy in their relationship. Suggestions for enhancing sexual relationships Provide your patients with the following list:
Intimacy It's also important for patients to know that the sexual act is only one way to express their love and attraction for their partner. Physical closeness is tremendously important to feeling loved. So encourage them to be near their loved one - hold hands, hug frequently, snuggle - even if they haven't done this for a while. They can set the mood by putting other thoughts and cares out of their minds, concentrating only on their partner, or even taking a relaxing bath or shower together with dimmed lighting and soft music. Soft, gentle massages are another way of achieving an intimate atmosphere that can be relaxing and fulfilling. And they may lead to further activity. The important things to remember are that an intimate relationship:
Points for patients to remember
Lastly, help your patients realize that lung disease does not lessen the ability to hug, kiss, and caress. Each step along the way to intercourse - snuggling, hugging - can also be enjoyed as an end in itself. If these intermediary activities create a wonderful feeling of closeness and contentment, it is critical to discard any sense of pressure to go beyond them and consummate. Achieving intimacy and feeling loved are the ultimate goal of it all. |
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Section ConnectionRecruit a new member: Know an AARC member who could benefit from section membership? Direct them to section sign up. It's the easiest way to add section membership to their overall membership package. Specialty Practitioner of the Year: It's not too early to be thinking of worthwhile members to honor in 2004! Start brainstorming nominations and submit them online Section E-mail list: Start networking with your colleagues via the section e-mail list. Bulletin Deadlines: Winter Issue: December 10; Spring Issue: March 10; Summer Issue: June 10; Fall Issue: September 10. |