Ottawa – Respiratory Rehabilitation Services at The Ottawa Hospital

Monday 26 May 2008


The wonderful Marcia offered to collect me in the morning (via Starbucks for a cappuccino) and drove me to my appointment with Dr Douglas (Doug) McKim, Medical
Director, Respiratory Rehabilitation Services at The Ottawa Hospital Rehabilitation Centre (www.ottawahospital.on.ca/rehabcentre). Respiratory treatment was not actually
something I had considered as part of my original itinerary but when Joan Headley at Post-Polio Health International (PHI) pointed out this gap, it made sense to include
such a service provider. One arm of PHI also deals specifically with ventilator users, and is called International Ventilator Users Network (IVUN) (www.post-polio.org).

The percentage of people who experience respiratory and swallowing problems as a result of post polio syndrome (the two often go together due to the region of muscles
affected by the initial polio infection) has been quoted at something like 12-15%. This number is not insignificant and may even be higher as many people may be
undiagnosed. Symptoms of a respiratory condition may include sleep apnea, shallow breathing and shortness of breath, chronic headaches, dizziness or lightheadedness,
and ‘brain fog’ due to a lack of oxygen.

Therefore, it is a very important area to cover and I was pleased to be provided with Dr Doug McKim as a contact by Joan. The Respiratory Rehabilitation Services at The
Ottawa Hospital are reputed to be at the cutting edge of respiratory therapy and work with a number of Chronic Obstructive Pulmonary Disease (COPD) conditions such as
ALS, Multiple Sclerosis, Muscular Dystrophy, and Post Polio Syndrome (PPS). The clinic was very busy in the morning when I arrived, and Doug introduced me to Carole
LeBlanc, a Registered Respiratory Therapist (RRT) and COPD Educator. I advised both Doug and Carole that I was an absolute novice in the area and they took that on
board when explaining the work they did. They even have a step-by-step education program for patients and their practitioners: http://www.irrd.ca/education/slide.asp?
RefName=e2r4&slideid=1

The key point they wanted to make was that it is just as important to keep the airway supple as with other muscles and one of the best ways to do this is what they call
“lung volume recruitment” (LVR). The two best ways to achieve this for a person with PPS is by the tried and true ‘frog breathing’ that many will recall from their childhood,
or with a ‘volume augmentation bag’. The bag is a simple device that incorporates a: resuscitation bag; 50cc tube; one way valve; one way valve with silicone valve
removed; mouth piece; and a noise clip. There are various levels of this equipment available, but for PPS patients, the clinic recommends the best quality for daily use at a
cost of something like $260.00 Canadian dollars. When assembled, it the user would simply squeeze the bag 3 or 4 times to ‘layer’ the breath before breathing out and
repeating this four times a day. The purpose of this is to: improve chest movement; prevent small areas of the lung from collapsing; improve cough; and increase speaking
volume. The LVR method can be used by itself if the respiratory condition is not too problematic, or as an adjunct to a bi-level respirator if further intervention was
required. For a full step-by-step explanation of this and other methods used, visit the Respiratory Rehabilitation Services at The Ottawa Hospital Rehabilitation Centre’s Respiratory Care Protocols: Interventions webpage: http://www.irrd.ca/education/presentation.asp?refname=e2r4

During the afternoon, I was introduced to three polio survivors who were using the volume augmentation bag and most of the tests performed indicated that lung capacity
had improved. Prior to being referred to Doug and the team, one woman had had a real problem recovering from a surgical procedure due to the treating hospital’s lack of
understanding of how her chest and abdominal muscle weakness would impact on her capacity to breath unassisted immediately following the operation. Another man
said he had never experienced breathing problems until he had a car accident which left him with whiplash and triggered off his PPS symptoms, respiratory difficulty being
part of the package.

This same man told me that, unfortunately, there are no polio support groups operating in Ottawa. Although the clinic is excellent at assisting polio survivors with their
respiratory problems, there is no connection to services that can deal with other PPS problems. Discussion was also had regarding the general lack of doctors available in
Ontario, with many people not having their own doctor – or at least a GP they could see as required. That would indicate to me that polio survivors in this Provence at
least (don’t know enough about the rest of Canada) would have a tough time getting any information or adequate service provision for PPS.

I was certainly glad that I visited the Respiratory Rehabilitation Services and was stepped through the benefits of LVR. I’m sure this simple technique will be of great
benefit to many people because it can be done quite independently and has proven results for polio survivors with respiratory conditions.

Doug was even kind enough to drive me to the train station where I will be catching a train to Montreal to spend time with my family over the next week. Official activities I
will be doing whilst in Montreal include dining with Members of the Association Polio Quebec Board on Thursday evening; visiting the Montreal Neurological Institute and
Hospital on Friday; and attending/speaking at the Association Polio Quebec’s AGM on Saturday, just before I fly back to Australia. This means the next report may not
appear for a few days. But I’ll have plenty of time on the plane to catch up, I imagine . . .