In recognition of Respiratory Care Week Oct. 21-27, the Pulmonary Hypertension Association (PHA) interviewed a registered respiratory therapist and certified pulmonary function technician. Tonya Zeiger, R.R.T., CPFT, is the pulmonary hypertension (PH) coordinator and associate in pulmonary medicine at the Mayo Clinic’s Jacksonville, Fla. campus, a PHA-accredited Center of Comprehensive Care (CCC). In this interview, Ms. Zeiger discusses her journey as a PH-treating health care professional and tips and tools to optimize respiratory care for people with PH.
Why did you want to work in respiratory care and how did you transition into a role treating people with PH?
I’ve always had an interest in breathing issues and felt for anyone who had issues with shortness of breath. I, myself, developed asthma as an adult and it literally took me two hospitalizations to believe the doctors. Subsequently, I became very interested in the whys of shortness of breath.
I worked in a pulmonary function lab, then was recruited to develop a pulmonary rehabilitation program designed for post-lung transplant patients. During my time working with lung transplants, I became acquainted with pulmonary hypertension. At that time, pulmonary hypertension patients were followed, primarily by transplant, due to the high level of care that they required.
At that time, Charles D. Burger, M.D., was the primary intensive care physician who performed right heart catheterizations and pulmonary vasodilator studies. After he started the ongoing care of several PH patients, he asked if I’d be willing to help with their care in my spare time.
I continued my dual work in transplant/pulmonary rehabilitation and pulmonary hypertension for about a year. It soon became obvious that this was a position that required a full time (or more) effort. Between the two options, I chose pulmonary hypertension as my career path and had no idea how blessed I’d be by my decision.
Briefly explain your current role with your PH team.
I have to start off with my team believing that I am the keeper of all kinds of miscellaneous knowledge. I handle patients’ schedules, medication requests/dosing/titrations, prior authorizations, drug transfers, oxygen issues, disability and FMLA paperwork, clinical study management, labs, etc.
If it touches my patients, I’m usually involved, even if it’s in the background. I work both inpatient and outpatient, so my physical presence is not always visible but I’m usually available. Something as seemingly easy as having an MRI scheduled for an IV-medicated patient can result in hours of prep in which I’m directly involved.
I’m also the primary educator for pulmonary hypertension and all PH treatments in our hospital and clinics. In addition, I try to stay reasonably involved with our PH support groups.
Please list the top tips or tools people with PH can use in their everyday life.
Always, always, always keep your oxygen saturation at or above 90 percent*, even if it means the inconvenience of dragging around an oxygen tank. If your coordinator is a respiratory therapist, know that this is one piece of direction that will never change. You will hear me repeat it over and over again.
* This number may vary by clinic. Follow the recommendations of your PH care team.
A low oxygen level is the single most reversible issue our patients encounter.
All of the medications our patients take are to open up their blood vessels. When oxygen levels drop to <90 percent and patients don’t use their oxygen appropriately, their body’s response is to constrict those same blood vessels. Therefore, all medications are going to be less effective – regardless of their cost or how they are given – if the patient’s oxygen saturations are decreasing, even periodically, to less than 90 percent.
Pulse flow oxygen regulators, while convenient, may not be the appropriate oxygen supplement for you.
Pulse flow oxygen regulators do not provide the same liter flow as continuous flow oxygen regulators. In addition, they do not work with positive pressure devices that many of our patients use to sleep. If you are making a purchase outright of a portable oxygen concentrator, make sure there is a return policy. That way, if it doesn’t keep your oxygen levels up, you can return it.
Along that same line, if you have tanks that you fill from a large concentrator, make sure that your physician is aware of what you are using. When you fill your own tanks, you are not filling the tank with 100 percent oxygen like those that are delivered from the oxygen company. This may not be a big issue as long as you are monitoring your oxygen level with a home pulse oximeter, but it may be a useful piece of information if you are having problems maintaining appropriate oxygen saturations while using your portable oxygen system.
What would you like people with PH to know about the importance of respiratory care and respiratory therapists?
I feel respiratory therapists bring a new perspective to a patient’s care. In my day-to-day life, I get a lot of ongoing questions regarding the complexity of pulmonary hypertension and its treatments. I feel that being part of a pulmonary hypertension team is a true calling. It’s a calling for which you must have an ongoing curiosity and an insatiable thirst for knowledge. Unfortunately, I feel the respiratory therapist population is underrepresented in the pulmonary hypertension field.
Ms. Zeiger has been a member of the PH Professional Network (PHPN) for 12 years and is an active member of the PHPN Symposium Committee. Prior to her adoption of the pulmonary hypertension program at the Mayo Clinic, she helped build the clinic’s cardiopulmonary rehabilitation protocols and procedures. She is affiliated with numerous professional societies and is an advocate for patients, caregivers and medical community education.
More information about oxygen and respiratory care, including oxygen access rights, is available on the PHA website