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IVUN

INTERNATIONAL VENTILATOR USERS NETWORK

 

an affiliate of Post-Polio Health International

CONNECTING

VENTILATOR USERS,

HEALTH PROFESSIONALS,

AND INDUSTRY

VENTILATOR-ASSISTED LIVING

VOLUME 37, NUMBER 3

JUNE 2023

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Life has a way of throwing unexpected challenges our way, testing our resilience and determination. As a polio survivor who relies on home mechanical ventilation, I have experienced firsthand the obstacles and triumphs that come with this unique situation. I’d like to share a bit of my personal journey, shedding light on the strength, adaptability, and unwavering spirit that have helped me navigate life with polio and the use of mechanical ventilation.

​

Polio, a disease that once cast a dark shadow over the world, became an undeniable part of my life. Its legacy for me has been paralysis, muscle weakness, and respiratory difficulties. Despite these challenges, my journey as a polio survivor has taught me to appreciate the value of resilience and perseverance.

​

I first contracted polio as a six-year-old living in the suburbs of Chicago. My younger sister (my only sibling) was the first to fall ill. Soon, it would come calling for me. My memories from that period are a bit hazy. Some things are etched indelibly in my mind. Other details were filled in by my parents later............................................................................................MORE​

Ventilator-Assisted Living

Vol. 37, No. 3, June 2023

Editor: Brian Tiburzi

Designer: Brian Tiburzi

ISSN 1066-534X

© 2023 Post-Polio Health International.

Permission to reprint must be obtained from Post-Polio Health International (PHI) at info@post-polio.org.

Ventilator users, health professionals, non-profits, company representatives – send comments and updates to info@ventusers.org.

Moore

A Breathtaking Journey:

From iron lung to home ventilator

Peter Moore

Life has a way of throwing unexpected challenges our way, testing our resilience and determination. As a polio survivor who relies on home mechanical ventilation, I have experienced firsthand the obstacles and triumphs that come with this unique situation. I’d like to share a bit of my personal journey, shedding light on the strength, adaptability, and unwavering spirit that have helped me navigate life with polio and the use of mechanical ventilation.

​

Polio, a disease that once cast a dark shadow over the world, became an undeniable part of my life. Its legacy for me has been paralysis, muscle weakness, and respiratory difficulties. Despite these challenges, my journey as a polio survivor has taught me to appreciate the value of resilience and perseverance.

​

I first contracted polio as a six-year-old living in the suburbs of Chicago. My younger sister (my only sibling) was the first to fall ill. Soon, it would come calling for me. My memories from that period are a bit hazy. Some things are etched indelibly in my mind. Other details were filled in by my parents later.

 

iron lungs.jpg

I remember the iron lung. The overwhelming feeling of isolation. Of separation from my family. I remember the fear that would sweep over me at night. This intimidating contraption of metal and machinery became both my savior and my captor. Within its claustrophobic confines, I discovered a strange dependence on a device that relentlessly pumped life-giving breaths into my lungs. The rhythmic hissing and the vibrations served as constant reminders of my precarious state, while the limited view of the outside world fostered a yearning for freedom.
 

Slowly, my situation began to improve. Moments of despair, frustration and loneliness were juxtaposed with flickers of hope, resilience and human connection. The fear of the unknown loomed large, but it was the unwavering support of family, friends and healthcare professionals that provided the emotional anchor to persevere.


Mundane tasks became monumental feats as I navigated a world where simple movements were no longer taken for granted. Every activity, from eating to bathing, required assistance, fostering a sense of vulnerability. Most people, kids especially, are particularly resilient when given time to adjust, though. And in time, I, too, learned to adapt. I found new ways of doing things. I learned how to ask others for help when I needed it.


And, eventually, I recovered enough to leave the iron lung behind. Each breath taken without the assistance of the iron lung became a small victory, an affirmation of the indomitable will to survive. The camaraderie formed with fellow patients created a support network, fostering hope and fostering a sense of belonging amidst the isolation. And, eventually, I recovered enough to leave the hospital and return home to my family.


It wasn’t quite as simple as that, of course. There were surgeries and a lot of rehabilitation. I learned later from my parents that there were other parents in the neighborhood who didn’t want their children playing with someone who had polio, incorrectly believing that I might still be contagious. But, in general, I went on to have a fairly well-adjusted childhood. I excelled at school, went to college, married, had children of my own, and put together a fulfilling career.

​

I wouldn’t say I never thought about polio in my early adult years. I had noticeable muscle atrophy on my right side. I was sometimes self-conscious about it when wearing summer attire or when swimming at the pool or beach. At the time, though, I viewed polio as part of my past, like a childhood accident. Yes, there were physical reminders, but I had successfully overcome those hurdles. I had “beaten” polio and didn’t need to worry about it anymore.


That was, as you probably have already guessed, not the case. I first got an inkling that something was wrong with my breathing when I was in my forties. I was lucky to have a good family physician who recognized all the hallmarks of respiratory insufficiency and referred me to a good pulmonologist. It was that pulmonologist who first recommended I start using a BiPAP to assist my breathing at night.


I was ambivalent at first. It felt like a step backward. I was fearful of how bad things might eventually get. I don’t remember the exact model I started with, but I remember it being heavy and clunky compared to what’s in use today (I currently use a Trilogy). However, my symptoms did improve. In some ways, it was comforting. Over time, I came to accept my new normal, knowing it was crucial to my well-being, even if being on home mechanical ventilation does come with its own set of daily challenges.


My emotional journey through these changes has been, perhaps, more significant than the physical. Coping with physical limitations and the constant reliance on technology can be overwhelming at times. However, through the support of my loved ones and the inspiring connections I have made with fellow polio survivors, I have discovered a wellspring of emotional resilience within myself. These connections have formed a community of understanding, encouragement, and shared experiences, reminding me that I am never alone in this journey.


My journey as a polio survivor on home mechanical ventilation has shown me the importance of advocacy and raising awareness about polio's long-term impact. By sharing my story, I aim to dispel misconceptions surrounding disabilities and create a more empathetic and inclusive society. It is through sharing our experiences that we can inspire change, promote accessibility in healthcare, and encourage further research and advancements to enhance the lives of not just polio survivors but all those who use home mechanical ventilation.


As I reflect on my personal journey as a polio survivor on home mechanical ventilation, I am filled with gratitude for the indomitable spirit that resides within me. I have learned to embrace life's challenges and refuse to let physical limitations define me. Through advancements in technology and the unwavering support of my community, I have discovered that no obstacle is insurmountable. My hope is that my story will inspire others to cultivate empathy, support inclusivity, and advocate for accessible healthcare, ensuring that every individual has the opportunity to live a life of dignity and fulfillment, regardless of their circumstances.

 

ADVOCACY

Advocacy

Concerns about Impact of Medicaid Cutoffs on Individuals with Disabilities Rise as Number Exceeds 1 Million

Since the end of the public health emergency related to COVID-19, states are reassessing Medicaid eligibility, resulting in over a million beneficiaries being disenrolled. Many individuals are being cut off from Medicaid due to procedural issues, such as failure to complete renewal paperwork. Concerns have been raised about vulnerable beneficiaries being affected without their knowledge.

 

U.S. Secretary of Health and Human Services Xavier Becerra has provided recommendations to states to prevent unnecessary coverage losses, including spreading out the renewal process, automatic renewals for qualifying individuals, and updating contact information. Becerra also stated that the agency may request states to pause procedural terminations if necessary. Individuals with disabilities are advised to stay informed about the renewal process, regularly check for correspondence from their state Medicaid office, ensure compliance with income and savings limits, and request a fair hearing if they believe their eligibility was determined incorrectly.

 

The Biden administration has sent a letter to governors urging them to prevent the wrongful termination of Medicaid beneficiaries. Secretary Becerra expressed concern about the high number of people losing coverage, particularly those with disabilities who rely on the program and called on states to utilize all available tools to ensure that eligible individuals do not lose their coverage due to avoidable reasons. He encouraged governors to review their state's existing flexibilities and consider adopting additional policy options provided by the administration to protect eligible individuals and families from procedural termination.

​

Supreme Court Hands Down Major Victory For Disability Rights

Disability advocates are celebrating a recent U.S. Supreme Court ruling in the case of Health and Hospital Corporation of Marion County v. Talevski. They had feared that the ruling could impose significant restrictions on the rights of individuals relying on Medicaid and other government programs. However, the 7-2 ruling maintains the ability of individuals receiving services through programs like Medicaid to sue state and local governments if their civil rights are violated. The case involved allegations of chemical restraint and inadequate treatment for dementia in a nursing home.

 

The Supreme Court rejected the argument that nursing home residents should not be able to sue in federal court, emphasizing the importance of holding governments accountable for violating rights under Medicaid law. Disability advocacy groups consider this decision a major victory, as it safeguards the rights of millions of beneficiaries of various safety net programs and establishes an important precedent for people with disabilities across multiple sectors.

Networking

NETWORKING

From the Mütter Museum: Interview of Audrey King

After contracting polio as a 9-year-old, Audrey King spent months in an iron lung and years in numerous English hospitals. Aside from the extreme difficulties of her physical paralysis, these experiences made it hard for her to build and maintain interpersonal relationships until adulthood. Audrey shares her moving account and how she has managed to overcome these challenges. The interview was conducted by Meredith Sellers and produced by Jonah Stern. 

Opportunity to Participate in Research

The NIDILRR-funded Research and Training Center on Home and Community-Based Services (HCBS) Outcome Measurement is conducting interviews with people with disabilities about their experiences with HCBS and the important areas of their lives (e.g., social connectedness, meaningful activities). Participants must be at least 18 years old, have a disability, and receive services or supports for their disability. Participants will meet with interviewers over videoconference or in person three times over one year and will receive a $10 gift card for each completed interview. For information or to volunteer, contact Matt Roberts at robe0290@umn.edu.

Recent Pubs

RECENT RELEVANT PUBLICATIONS

Practical Guide to Management of Long-Term Noninvasive Ventilation for Adults With Chronic Neuromuscular Disease

Hansen-Flaschen J, Ackrivo J.

“Recent technological advances in respiratory support and monitoring have dramatically enhanced the utility of long-term noninvasive ventilation (NIV). Improved quality of life and prolonged survival have been demonstrated for several common chronic neuromuscular diseases. Many adults with progressive neuromuscular respiratory disease can now comfortably maintain normal ventilation at home to near total respiratory muscle paralysis without needing a tracheostomy. However, current practice in many communities falls short of that potential. Mastery of the new technology calls for detailed awareness of the respiratory cycle; expert knowledge of mechanical devices, facial interfaces, and quantitative monitoring tools for home ventilation; and a willingness to stay current in a rapidly expanding body of clinical research. The depth and breadth of the expertise required to manage home assisted ventilation has given rise to a new focused medical subspecialty in chronic respiratory failure at the interface between pulmonology, critical care, and sleep medicine. For clinicians seeking pragmatic "how to" guidance, this primer presents a comprehensive, physician-directed management approach to long-term NIV of adults with chronic neuromuscular respiratory disease. Bi-level devices, portable ventilators, ventilation modalities, terminology, and monitoring strategies are reviewed in detail. Building on that knowledge base, we present a step-by-step guide to initiation, refinement, and maintenance of home NIV tailored to patient-centered goals of therapy. The quantitative approach recommended incorporates routine monitoring of home ventilation using technologies that have only recently become widely available including cloud-based device telemonitoring and noninvasive measurements of blood gases. Strategies for troubleshooting and problem solving are included.”

Respir Care. 2023 Mar 15:respcare.10349. doi: 10.4187/respcare.10349

Long-term mechanical ventilation and transitions in care: A narrative review

Xiao L, Amin R, Nonoyama ML.

“Transitions from hospital to home, pediatric to adult care, and to end-of-life for VAIs are complex and challenging processes. Although there are several LTMV clinical practice guidelines highlighting key components for successful transition, there still exists gaps and inconsistencies in care. Most of the literature and experiences reported to date have been in developed countries or geographic areas with funded healthcare systems.

​

“For successful transitions, the VAIs and their support network must be front-and-center. There should be a coordinated, systematic, and holistic plan (including a multi-disciplinary team), life-time follow-up, with bespoke consideration of jurisdiction and individual circumstances.”

Chron Respir Dis. 2023 Jan-Dec;20:14799731231176301. doi: 10.1177/14799731231176301.

Chronic Neuromuscular Respiratory Failure and Home Assisted Ventilation

Carmona H, Graustein AD, Benditt JO.

“Chronic respiratory failure is a common, important complication of many types of neuromuscular and chest wall disorders. While the pathophysiology of each disease may be different, these disorders can variably affect all muscles involved in breathing, including inspiratory, expiratory, and bulbar muscles, ultimately leading to chronic respiratory failure and hypoventilation. The use of home assisted ventilation through noninvasive interfaces aims to improve the symptoms of hypoventilation, improve sleep quality, and, when possible, improve mortality. An increasing variety of interfaces has allowed for improved comfort and compliance. In a minority of scenarios, noninvasive ventilation is either not appropriate or no longer effective due to disease progression, and a transition to tracheal ventilation should be considered.”

Annu Rev Med. 2023 Jan 27;74:443-455. doi: 10.1146/annurev-med-043021-013620

Ed Ops

EDUCATIONAL

OPPORTUNITIES

ERS International Congress 2023

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The European Respiratory Society (ERS) International Congress will take place in Milan, Italy, September 9-13, 2023. Find out more at www.ersnet.org/congress-and-events/congress/

CHEST 2023

October 8-11, 2023, Honolulu, Hawaii. The CHEST 2023 Annual Meeting will take place in person and will offer more than 300 educational sessions, including simulation and interactive learning opportunities. Sign up at the link above to receive the latest updates via email.

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INDUSTRY

Industry

Independent Tests Confirm No Health Risks in Some Recalled Philips Respiratory Devices

Independent tests have indicated that the use of respiratory devices involved in Philips' global recall did not pose health risks to patients, according to the company. Rigorous testing conducted by external parties on the DreamStation machines showed positive results, confirming preliminary findings released earlier. Philips CEO Roy Jakobs expressed satisfaction with the results, reassuring patients that the devices did not pose a health risk despite potential foam degradation.

 

The global recall was initiated in June 2021 due to concerns about potentially toxic foam in the machines. Philips stated that exposure to degraded foam was unlikely to cause significant harm to health. The company also noted that foam degradation resulting from the use of unauthorized ozone-based cleaning products was improbable to cause appreciable harm. The test results cover 95% of the recalled devices, and the remaining 5% results are expected to be available in Q3 2023. 

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