Four & Ten Whenever You Can
I just spent six days visiting wing 4C of the Thoracic ICU at the University of Michigan Hospital. This is the recovery floor for heart and lung transplant patients as well as those who’ve had THE (Trans-Hiatal Esophagectomy – a procedure where they remove the esophagus and replace it with the stomach).
The lead surgeon on the wing, internationally renowned Dr. Mark Orringer, who invented the THE procedure, had just returned from speaking at a conference in Washington DC where he’d been asked to explain his unbelievably high success rate with patients in recovery. Thoracic transplants and THEs are considered the most difficult of all surgeries in terms of recovery. He told us his single slide had a mere two bullets: Walking and Deep Breaths.
“Nothing Erudite,” he said. “No complicated glitz or glamour. Breathe deeply 10 times every hour on the hour. Then walk four times a day. End of story. In the old days you’d be bed ridden in high critical status for four days and in the hospital for weeks. We’d lose so many people to pneumonia and you name it. The single best thing we do for them now is to get them walking the day after surgery and deep breaths all the while. We lose less than 1% now.”
Of course, he has a highly trained crew of docs, nurses, and techs to support recovery overall but they are all committed to his breathe/walk mantra. There are hand drawn magic-marker check boxes on the nurse’s white board to inspire patients to reach their goal each day.
I watched a whole group of people, anywhere from age 50 to 87, roam the halls each day – in an ICU for goodness sakes! I watched my mom muster the courage to inhale and exhale into a spirometer every hour, in spite of her incisions. Gracious. If they can do it 24 hours post-op, what the heck are we waiting for? It saves lives! Walk, walk anywhere, but for crying out loud waaaaalk!
It doesn’t have to be far at first. Every step counts and every bit of progress mounts. Once these patients are walking and working their lungs, the physical therapists come along and give them the following, GENTLE exercises to add:
- Turn your head left, then back to center (pause here) then to the right.
- Tilt your right ear to your shoulder, back to center (pause) then left ear to left shoulder.
- Pinch your shoulder blades back, shrug up, then make shoulder circles.
- Reach one arm up to the sky as you exhale, inhale and relax the arm, then do the other side (in tai-chi class we call this “picking apples”)
- For the ankles, do toe raises (seated first, then standing when balance is good) – rock from heel to toes.
- For the knees, lift your lower leg up and slowly down.
- For the hips, lift your thigh as if you are marching in place.
These are the basics, by golly! How many of us are doing at least this much? Not enough. Get off your chair! Roam the halls for no reason other than to live strong. In China, everyone does this sort of exercise twice daily. It’s right in front of us. It is wholly prescriptive and yet we put it off until we have no choice. Again, if we can do it as post-op senior citizens, we can do it anytime, anywhere. And if you’re thinking, of course they have all the time in the world to do their walks, think again. Spend one 24-hr period with a patient on this floor and you’ll find they barely have time to sleep.
So I walked, too. I pushed my father in a wheelchair six times a day down the long hospital corridors; I “picked apples” with my mom; I cheered on the shuffling soldiers on 4C; I used a lot of hand sanitizer (another story in itself); I got stronger with and because of them. Breathe, walk, reach, give. And the good doctor will smile.
What can you do to get back to the basics for your health? Breathe (10 times an hour)? Walk four times a day (short but sweet)? Pick apples (stretch, reach, open up)? Give (cheer on others trying to live strong)? Can you choose one small effort to add?
Let us know how Dr. Orringer’s 4 x 10 mantra might fit into your life or work.