Tuesday, November 20, 2012

The Ineffective Vest Treatment

inCourage System by RespirTech
If there's one thing I'm guilty of, it's not getting the most out of my Vest each and every time I strap it on.

Here's what an ineffective Vest treatment looks like:

I sit down at my computer desk and load my nebulizer cups with whatever medicine is due. After loading the cups up I place them on my desk in the order of which I take them. After my inhaled medications are all set to go, I reach over the back of my office chair and grab my Vest jacket (For those that are wondering, I happen to use the inCourage system by RespirTech). After my Vest jacket has been buckled on and the tubes coming from the machine are attached, I'm ready to rock!

The next order of business is to decide which pre-programmed set I will use. Depending on how long that particular session will be, between 30 minutes and 1 hour, I select program 1, 2, or 3. There is also a "quick start" option, but I tend not to use that very often. After selecting the program, I start shaking and then stick a neb into my mouth.

This is where the ineffective Vest treatment begins...

As soon as the Vest starts shaking and the neb starts puffing, I immediately get on to the tasks of the day. Whether it's e-mail, bills, social media, CysticLife, surfing the web, or more e-mail -  the one thing I'm usually not as engaged in is my treatment.

My breaths tend to be shallow in nature. I barely cough the entire time that I'm shaking. I never inflate my lungs fully. I allow the Vest to continue whether or not I feel that it's effective. Then, after 30 minutes or an hour, my Vest will stop shaking and I will move on to the rest of my day.

As I alluded to earlier, there are many times that I do not cough once in a Vest session. Now, the question has to be - is that the Vest's fault or my fault? If you know me at all you know how I will answer that question.

Ineffective Vest sessions are my fault. If and when I start doing engaged Vest treatments every time I put the thing on and then continue to receive an ineffective treatment, we can talk about what role the Vest can play in not making me cough.

Until then, I need to change the way I approach a Vest treatment if I would like a different outcome.

Hers's where you come in. Have any tip or tricks that you use for a more effective Vest treatment?

Comments (25)

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I continue to learn from your example with an eye toward my daughter's future. She's almost 7, so most days we're just happy she puts on her vest without an argument. I'm very grateful for your example though, so that we can be watching for pitfalls as we move forward.
1 reply · active 645 weeks ago
That's one reason I'm here - to show you guys what NOT to do!! :)
Ronnie my man!!! I think we all are guilty of this from time to time. A suggestion that I have is try to set the timer to less minutes. If your session is 5 minute intervals and then you switch up the the pressure or frequency how about just setting the time to 3 min intervals but still get in 5 minutes or more at that setting. I assume your vest will automatically shut off?? So instead of not using the vest to its full potential for the 5 minutes you only miss used it for 3 minutes or whatever that number is. That way it will make you stop using the CPU or whatever it is that you are doing and allow you to refocus on the treatment. Plus you can use your flutter in between to help you move that junk out.

I use the flutter in between every pressure/frequency change. So that makes me cough.

If I do not talk to you before have a HAPPY THANKSGIVING my friend!!!
1 reply · active 645 weeks ago
Good suggestion John. I'll have to try something like that out!
You answered your own question: __(ineffective Vest sessionsare is my own fault) __So it's not a physical or mechanical problem you need to motavate yourself mentally to use it to it's full potential.__Look around , look at the 2 things you love so much and want to be your best for them.__Search inside you heart and head how much they mean to you and why you need to go the extra distance and get every bit of effective use out of it__Look at them and think of them and what they mean each time you use the vest and let the task of the day wait
1 reply · active 645 weeks ago
That's a great way to look at it Roger. Thanks!
Christian Reinhard's avatar

Christian Reinhard · 645 weeks ago

Hey Ronnie
The Vest is not used in Europe as far as I know. Here we have something called autogene drainage (invented by a Frenchman). You put two elastic bands around your chest. This helps to keep the breathing in the lower parts of the lung. Then breathing step wise into lower regions of the lungs helps to mobilize the mucus efficiently. It requires to lay on the floor (Back, side and belly). It takes full concentration and becomes almost like meditation. In my view it is really useful and specially you cannot get distracted by TV, internet and such. I usually inhale my medication for 30 min and then do 10 to 15 min of AD. Twice a day in combination with running is the most effective therapy I know. It requires a good physiotherapist to train the patient and takes a lot of training to master it
2 replies · active 645 weeks ago
I really do need to start doing AD again!
Christian Reinhard's avatar

Christian Reinhard · 645 weeks ago

I think it is amazing. I have been doing it since I am a kid. I had a really good physiotherapist. She learned it from Jean Chevaillier himself. I met him once in a seminar. Diaphragmatic breathing became natural to me. Now I have to force myself to not do it. I think it helps to stay relaxed in stressful situations.
I have NO idea how you don't cough when doing the vest.... When I did my treatments, I would cough up junk non stop for at least the first 20-30 min... so strange!
1 reply · active 645 weeks ago
I'd like to think it's because of my gigantic muscles. No? :)
My 4 year old has the Hill Rom vest. We programmed it with 6 program points varying in pressure and frequency. Each program point runs for 3-4 minutes. You can tell when the vest changes points because the frequency increases. Between each point, we pause the treatment and have him do 3-5 hard coughs.
The harder issue for us is to keep him doing deep breaths during his nebulizer treatments. We let him play ipad, do puzzles, etc. in order to make treatments fun (or at least as fun as they can be). Many times he gets focussed on the game or puzzle he's doing rather than his breathing.
1 reply · active 645 weeks ago
You have him doing it the right way. Great job!!
Instead of doing your nebs for the entire time you are using the vest---try singing---seriously. Your neighbors wont appreciate it but your lungs will. I never cough with the vest and nebs duo---I cough quite alot if I mix in karaoke. It varies your breathing, forces deep breaths from the diaphragm and is much less boring than focusing on your breath.
1 reply · active 645 weeks ago
I'll have to give that a try!!
I use the Minnesota protocol whih requires you to stop after every four minutes and do belly breathing and huff coughs. I have found it to be very effective. Have you ever tries the Minnesota protocol?

I have a love hate relationship with my Vest. I hate that I need to do it and makes me feel disabled but it does help me feel so much better.
1 reply · active 644 weeks ago
I use the MN protocol as well...minus stopping the Vest and doing huff coughs. I need that to change however!!
I follow a very similar routine as you described,Ronnie.
I experienced success in 5 minute intervals of squatting or running (I prefer squatting) every 10-15 minutes of vest therapy- it really opens me up and mobilizes things.
I just push my chair back and squat or jog in front of my computer desk while my vest cycles through its program. My desk and chair have been handy when I need to rest. Once my 5 minutes are up, I return to what I was doing on my computer....till the next 5 minute interval, usually 3-5 squat intervals per vest session (depending on how I feel and the length of my vest session.)
1 reply · active 643 weeks ago
That's a great idea Chris! I'll have to give that a try :)
Alex Guedes's avatar

Alex Guedes · 594 weeks ago

Hi Ronnie
Great blog! Congratulations!
Thanks for sharing all these information.
Alex (father of a 11 years old boy with CF).
1 reply · active 594 weeks ago
Thanks for stopping by and leaving a comment!
I think I do this a lot! I never thought about it. I never have had very productive vests/neb treatments. I do more in the hospital though...Probably because they make sure it is effective. Good to think about more often! Love this post!
Sorry to ressurect a dead post, but I found this and was curious if you were able to settle on a method to help? I too am guilty of the absent minded vesting. Until I get sick, then I blame the best for not working. :) Reading the vest manual it says to always have some mist to inhale, be it meds, hypersal or just simple saline (that might help?). I've heard we can interspace ACBT or Autogenic Drainage into our vest cycle, to help mobilize the stuff its jiggling loose. Also I read a study that suggested AD for morning and afternoon, then vest in the evening was most effective in terms of volume of clearance. Might be worthy of a consideration :)
1 reply · active 579 weeks ago
That's interesting. Do you by chance have a link to that study?

As for me, it's most effective if I remember to do some deep breaths with fast exhales and slow exhales while vesting.
You answered your own question: __(ineffective Vest sessionsare is my own fault) __So it's not a physical or mechanical problem you need to motavate yourself mentally to use it to it's full potential.__Look around , look at the 2 things you love so much and want to be your best for them.

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