COVID Rehab & Recovery Series: OPEN DISCUSSION AND Q&A SESSION!: Sunday, 7/19/2020


A lot of the lingering questions that you guys have vitals testing. What do I tell my doctor to get them to believe me? So to dive right into that, a lot of the questions we get are about heart rate, heart rate drops, heart rate spikes, and heart rhythms that we’re seeing post COVID. So for Noah, my question is many people are experiencing heart rates that are abnormal and new for them. Some are experiencing tackle cardia and some bradycardia. Can you walk us through what a normal heart rate should be and explain what bradycardia and Taka cardia is and why they may be occurring as an effect of COVID.


I will try, but the answer to why they are occurring as an effective covert I could start off with right now. No, I don’t know for sure. But let me just talk a little bit about heart rate controls. So we have the autonomic nervous system, right? And we talk about this pretty frequently. The autonomic nervous system essentially is, you know, the parasympathetic nervous system and the sympathetic nervous system. So sympathetic nervous system is fight or flight. It’s mediated by adrenaline. And the parasympathetic nervous system is what we call rest digest. So sympathetic is fight or flight. Meaning if you have to get into a fight, your body’s going to increase your heart rate, raise your blood pressure, get you ready to fight or run away or to freeze. So freeze is like a free fall down play. Dead hope that whoever’s running after you moves on.


And parasympathetic is is basically rest, digest and heal. So we know that one of the hallmarks of COVID is what we call dysautonomia. Anytime we have something called dis, that means whatever comes after that, God dissed, okay. That means it’s not working properly. So that means there’s a dysautonomia though can mean many different things because the autonomic nervous system is responsible for heart rate and rhythm. It’s responsible for, you know, gut Paracelsus. It’s responsible for blood pressure control. It’s responsible for pH control and things like that. So when we say dysautonomia, that’s like saying something’s wrong. We know the system, but how it goes wrong can take many different forms. So normally heart rate is between 60 and a hundred. Okay. So that’s the normal range of heart rate. So anything below 60 is a slow heart rate. We call that bradycardia, anything above 100 is a fast heart rate and we call it tachycardia cause it’s tacky.


But a lot of these things can happen from normal reasons. So why would somebody have a low heart rate? Like if you just think about everyday life, it could be that person is a conditioned athlete, right? It could be, you know, somebody like a marathon or then, and their heart, rate’s only 55. Well, we wouldn’t consider that pathologic. In fact, you could consider that very healthy medication. So many people take what we call beta blockers that lower your heart rate or other medications that lower your heart rate. And likewise, what can raise your heart rates? Things like caffeine, things like anxiety things like activity. So when we become more active or less active, the body is going to act upon supply and demand. And it’s going to raise your heart rate, raise your blood pressure is put up, put that’s my dog beating the drum.


But but it’s going to put out activity. That’s going to allow you to meet the demands of whatever it is you’re doing. So we have something called the essay node. The essay node is the pacemaker of the heart, and that will normally you know, control rate. And it’ll normally keep the heart rate between 60 and a hundred. And then we have something called the Vegas nerve, which is one of the parasympathetic stimulators, right? And so the Vegas nerve will generally slow things down a little bit. So that’s why we say textbook heart rate. Like if we take the textbook heart rate, it’s 80. So normal is 60 to a hundred. We get a little Vegas nerve activity on it. And that slows it down a little bit more. There’s a lot of thought going on now that the Vegas nerve is affected by inflammation and or cytokine storm or things of that nature, things that go on with COVID.


So if you would draw that sympathetic activity I’m sorry, if you withdraw that parasympathetic activity, then you don’t even have to add sympathetic activity, but just withdrawing back control is enough to make your heart rate go faster. We do see people who have lower heart rates, although it’s less common. The majority of people post COVID have faster heart rates. And sometimes we’ll see people who start rates go up and go down for no apparent reason. One thing I just want to say before I go on is the things that I’m going to tell you tonight are things I think, okay. There’s a lot of stuff that’s still unknown. I’m a cardiopulmonary physical therapist. I’ve been doing that for almost 30 years. I’ve been at EMT for almost 20 years. I’m going to tell you things based on my experience, some of them, I don’t have proof of some of them. Nobody has proof of. So don’t take what I say as the gospel, but just take it with a grain of salt as things you can ask your doctor.


So let me, let me just do it.


Let me, but let me just stick with heart rate and rhythm again for one second. Heart rate is one thing. Heart rhythm is another thing, right? So we can talk about, let’s say a heart rate of 110. We could look at 10 different people, all who have a heart rate of 110 and they can all have a different heart rhythm. So that’s important too. So one of the things we talk about is what tests should people get? The most basic test is an EKG, but keep in mind that an EKG is a snapshot in time. So you go there, you lay down on the table, they do it, they press the button, right? You could walk out of the room and your heart could go bananas. So at a bare minimum and EKG, but a lot of times people get kind of overconfident with an EKG because they say, you know what? My EKG was normal. Well, it was normal when we took it, it’s like the photograph, right? So you could smile for the photograph. The second, you know, it’s like, you’re smiling in the photograph. Everyone looks happy. The photograph is taken. The photographer turns around you and dad smacks you in the head. You know, something like that. Or you get, you give somebody, you know, the horns or you stick your tongue out. So an EKG is useful, but it’s only going to tell you what’s happening at that moment.


And just to add to that in the fields down here in South Florida, we’re very lucky. We have a hospital within five to 10 minutes of wherever we are. In that transport time I’ve seen hospital patients go through three or four different heart rhythms by the time we get to the hospital. So your heart rhythm is not something that necessarily takes time to change any thing or any event can cause that to change. So like no saying don’t be complacent just because your EKG at the doctor’s office said you were fine. And you can experience palpitations at any time, which your EKG might not capture at that time. If you’re anything like me, I’m having palpitations maybe twice a day. There’s no guarantee that while I lay there for that 30 seconds, while they capture this image that it’s going to capture the moment I’m having palpitations. So it’s one of the most basic tests that you can get. But again, it’s capturing something over actually really six seconds. So


Yeah, and that’s a great point. And, and, and another thing to keep in mind is that, you know, these things are dynamic. The body is dynamic. It’s not static. It’s like if you could get an EKG and that would keep you, you know, we know, we know your EKG is going to be that way for the next year. Well, that would be great, but these things change. And a lot of times when it comes to vital signs, the vital sign itself is just one piece of information, but we’re looking at trends. So in other words, if you, if I said to you, Hey we find a patient that their blood pressure is 200 over 80, right? That sounds horrible. It sounds like a really high blood pressure. And it is, but for all we know, maybe 10 minutes ago, they were two 50 over one 20.


So that’s why we take kind of serial blood pressures and serial rhythms and serial rates. You know, because trending is very important. And the reason why we bring this up, I know for sure that one of the complaints that a lot of long haulers have is that their doctors don’t believe them or my EKG was normal. So they said, I don’t have to see a cardiologist or my chest X Ray was clear. So I don’t have to see a pulmonologist. You know, I talked to a lot of really smart doctors and everybody says the same thing. We’ve never seen anything like this before. And and there’s like pre COVID and then there’s now, right? So everything we thought pretty COVID was one thing, everything that’s happening now has to be evaluated. And in particular, when things are unknown or when a clinical scenario is less clear, then you do more testing.


You don’t do less testing. So my I’m with you in that I want to test, I want people to test, test, test. I want people to see specialists. I want people to, you know, more information is always going to shed light, especially on a disease that is so complex and where so many of the signs and symptoms and characteristics can mimic other systems. So we’re seeing some general trends and the trends are respiratory, cardiovascular and neurologic to a lesser extent GI, but to, you know, liver. And that’s why over the next two weeks, we’re going to have a cardiologist here. Who’s been treating COVID patients. We’re going to have a gastro year, has been treating COVID patients can have a neurologist. And I am, they’re going to be surprised because I’m going to be like the most annoying kid in the class, because I’m going to ask all the questions I’ve seen for the last six months, because I want to know what other people think too. But don’t take no for an answer. This is not the time where no news is good news. You know, this is the time where we got to find out all the news and make sure we know what’s happening.


So feeding off that question, let’s explore the heart palpitations and different heart rates we’re seeing. Why, why are people experiencing heart palpitations? And let’s, let’s take anxiety out of the question. We know a lot of us are being totally have anxiety. If you guys are anything like me, your anxiety is likely stemming from the fact that you can’t get medical care. But let’s take anxiety out of the picture. What can cause the heart palpitations or changes in heart rhythms?


Okay. So let’s, first of all, how many people have palpitations? Keep your hand up? How many people know what palpitations are? What, what are you, what are you going? I’m going to get a, I’m going to get a headstart, unmute yourself, Don. What, what, when you say you’re getting palpitations, what are you feeling?


A change in my heart rhythm. And it feels like it’s beating out of my chest. It’s a rapid heart rate that, that I can see. I can actually look down and I can see my heart beating.


You can see your heart coming out. You can see a point where your heart is coming out of your chest. Okay. Very thin chest wall. So you, your, yeah. So you can see that you’re going to say you should preface


That it’s better. When I, earlier on it was, was very problematic and very scary. At this point it’s a lot better.


Okay. Who are you talking to over there? Bring that kid over here. I got to tell him something. Okay. So, okay. So let’s start with this. So palpitations, right? So palpitations can mean different things to different people. What I think of it is okay, I’m normal. Everything’s fine. And then all of a sudden I’m suddenly aware of my heart. Okay. For some people that means it’s feeling like it’s going very fast. Right. So it could be like, for some people, it could be like very strong for some people, it feels like it’s eating out of their chest for Dawn, because she has x-ray vision. She can actually look down. But for some people, it may also feel like a skip beat. Right. So skip beats. So does anyone have a sensation other than what I just said, any of those choices that they’d like to throw out there? So racing heart, beating heart, pounding, heart beating out of my chest, skip beats.


Those are the basic description of flutter. Okay. So like a flutter flutter or a stutter. So some people would say it’s like a flutter or it’s like a stutter. So the stutter is like, like, it feels like it’s not going to be smooth. Right. So everybody just for a second, repeat, repeat, just go like this, repeat after me for one second. So just be like, Oh no, I’m just, I’m just kidding. It’s my favorite part of Wolf of wall street. So listen. So we have normally what we call normal sinus rhythm and normal sinus rhythm has five characteristics. I’m not gonna tell you all five, cause some aren’t gonna make sense, but first and foremost, it’s regular. Okay. So what regular means is it’s, it’s just, it’s evenly timed. So if we looked at an EKG, all the spikes would be equal distance apart because spikes and distance on an EKG indicates time. So the longer distance in between means the slower, the heart rate. So it should be regular and it should be between 60 and 100 beats per minute. Okay. Now there’s a lot of things that can cause palpitations. So let me address the, each description of them. So the racing heart. Okay. So racing heart is this. So we got Mmm, Mmm, Mmm, Mmm, Mmm. Mmm. Then it goes,


Blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah, blah.


Some people it could be sustained. Okay. It could be sustained for hours for some people for some people you’ll have just a short run of it. It could be a ten second run or something like that. And there are multiple rhythms that can be responsible for that. So one could just be what we call it. S V T supraventricular tachycardia. So the reason why we call it that super means above ventricular has to do with the ventricles and tachycardia means fast heart rates. So there is something called V tap, ventricular tachycardia, and that’s a lethal a Rhythmia okay. It’s a potentially lethal arrhythmia. It’s like a cardiac arrest, but anything above the ventricles. And it doesn’t matter where it’s kind of circus, it’s called supraventricular tachycardia. So it could be atrial tachycardia. It could happen from the atria or it could be sinus tax. Now under certain circumstances, it’s normal to have that.


So for example, you just had a triple espresso, right? So that it would be normal that you’d feel your heart racing, you know, but you’d have that high heart rate. So SPT may or may not be problematic. Okay. atrial tachycardia may or may not be problematic. It can depend on how fast the rate is. That’s one thing it could depend. Number one, what rhythm is it? And what is the rate? So let’s say for argument’s sake, your rate is how many people here have seen a rate above a hundred, one 20. Anyone seen above one 40. Anyone’s seen above one 60. Keep in mind that each bead is $10. So the auction is almost over one 70 anyone, one 70. Let me look on page. Okay. So far one anyone on page one, C and above one 70, all right, Christine, send me the seven $170.


You’re the winner. You’re the, the high heart rate manner. So here’s the thing under normal circumstances. Okay. Your heart is good. Your current arteries are clean. You have good circulation to the heart muscle. You can tolerate that for a short time, but it gets tricky because the problem with a heart rate of one 70, a lot of people think, Oh, the heart’s beating too fast. And the problem is that the heart is beating too fast. The problem is that there’s no filling time, right? So cardiac output, which is how much heart, how much blood, your heart pumps every minute is based on two things. It’s based on heart rate times stroke volume. So that means how many times does it beat per minute and how much does each stroke have? So for example, if you have you know, like something like this, a small, and then you have something like this, which is a lard. So if your heart pumps out this much blood per minute, then you can be more slowly. And that’s what athletes are like. But if your heart only goes like this


Just a tiny bit, then it has to be very, very quickly. And that the other tricky part of all, this is that every, every one kind of situation affects other situations with vital signs. So for example, your heart rate goes up to one 70. We don’t know why it went up to no one 70. There’s no filling time. Think of that. Like your toilet, you keep pressing, keep pressing, keep pressing. It’s depressing, but nothing’s happening because you didn’t allow to bowl to fill up or, you know, you’re trying to start your car. [inaudible] All of a sudden you flood the engine. And the problem with that is that can drop your blood pressure. Okay. And one of the other things that we’re seeing with Kobe is one of the other characteristics of, of, of dysautonomia is that people’s blood pressures also fluctuate a lot. So people can stand up and particularly in position changes.


So going from lying down to sitting at the side of the bed, that causes gravity to bring blood down into your legs. So under normal circumstances, the second that happened or the millisecond, even that that happened, your body would sense a change in pressure. And it would cause the blood vessels to construct and bring that blood back up. That’s doesn’t always happen in dysautonomia. Okay? But then you go from sitting down on the side of the bed to standing up, and now there’s no hips and knees blocking that blood. And you can drop your pressure even more, which is why. When people go from sit, you know, lying to sitting or from sitting to standing, they often feel dizzy. And the question is, well, are they, you know, you can feel dizzy because your heart rate is feeling is going fast and you’re dropping your blood pressure.


Or when you get up, you can have what we call orthostatic hypotension, which is a hallmark of, of a dysautonomia. And then your, your body says, Hey, our blood pressure just plummeted 60 points. We’ve been beat this hard, very fast to get that up. That’s a racing heart. Okay. So one thing that we’ve been recommending to people are compression compression, stockings, or compression leggings, because what that is, it’ll help tighten it up. And when I said that the other night I got slapped down by dr. Caner, but we talked about it after we had to talk about it because he said, listen, you know, he said, the other thing is, and obviously if you feel like you’re going to pass out, this is not always simple. So when in doubt, check it out. Okay. And we’re going to talk about what doctors should you be seeing.


But compression, stockings and compression leggings are very helpful because they prevent that blood from dropping down. And if one of the reasons why you can’t be active is because you get up and you start moving and all the blood pools and you learn and you feel dizzy and you have to go back and sit down. That’s very taxing on the body. And one of the other things that we hear, and I’m sorry, that’s like the knee bone is connected to the hip hip bone. And it’s like, you gotta, you got to swallow a spider to catch the fly. Then you got to swallow a bird to catch the spider. That’s what Cobra it is. It’s literally where we’re like chasing a storm here. And it’s like, one thing affects the other thing affects the other thing. So I’m throwing these things out there to you.


So you can start tracking what’s going on, start tracking vital signs and show these to your, your doctors. And, and let them start picking apart the pieces of these other forms of palpitations. You could have something called premature beats, right? So the heart has a certain characteristic, which is that cardiac muscle. Okay. Has the ability, every single cell of the myocardium can start the wave, right? It can start the wave and cause the heart to contract. Now, sometimes even in a healthy, normal heart, sometimes an area of the heart will become irritable. Can the parts I’m talking about? So normally the essay node starts, the electrical activity. It depolarizes the, to atrium, it gets slowed down a little bit at what we call the AAV node, which is in between the atrium and the ventricle. And then it goes, and depolarizes the ventricles in the ventricles contract.


Please understand. I like to be complete. I don’t expect you to memorize this stuff, but I feel like perspective is helpful. And this will be recorded. Now. I said, the essay note is the pacemaker of the heart, but if there’s something wrong with the essay node, the atria can come in and pace. So any area of the of the atrium, any part of that muscle tissue can kick in early. And we have, what’s called a premature atrial contraction. So it’s like teacher is the essay node teachers trying to get the class to, you know, kind of behave in an orderly manner. But an irritable area of the atria keeps making noise and beating early. You can feel that sometimes you can have, that’s the stip, that’s the stutter that you go. That’s the flutter that, so that might just be one beat and it’ll just be like, so you’ll feel, and then you’ll hear, and then it’ll go away. Now you can have more than one premature beat in a row. So you could have,


And then go back to


The normal. So the atria can kick in the AB node can kick in the ventricles, can kick in and they can have premature beats. So if they have just a premature beat, we call it a PAC premature atrial contraction, or a PVC premature ventricular contraction, or you could have every other beat. So if you have every other atrial beat, we call it atrial by Gemini. If you have every other ventricular beat, we call it ventricular by Gemini or just by Gemini. If you have two in a row, we call it a couplet. If you have three in a row, we call it a triplet. If you have four in a row, we call it ventricular tachycardia. And that’s the lethal way. Rhythmia so a lot of things here. So now what do you do about this? So we talked about an EKG and the limitations of an EKG.


I don’t want to bring up a negative topic or be a downer at the party, but we all hear stories of this guy walked out of the doctor’s office and dropped dead. Right? We’ve heard that before, right? He just had an EKG. What happened? So if you are having any type of cardiac symptoms, any of these premature beats, any of these palpitations, any of these fluttering, stuttering, beading, racing, anything like that? In my opinion, my opinion I think, I think at a bare minimum, you should have a halter monitor. And what a halter monitor is, is a 24 or more hour 12 lead EKG. And you gotta figure for most of the people I’m seeing 24 hours should catch it. Okay. If it doesn’t catch it 48 hours, 72 hours, you could go as long as you want, but that will ensure that we know your heart rate through the night, through the day.


We know your rhythm through the night that we know how many premature beats we have. You have. We know if you had any arrhythmias lethal or non-lethal right. And that can be ordered by any doctor. So your GP can order a halter. So I don’t like to tell people what to do. Actually, I take that back. I do like telling people what to do, but but the idea is you don’t want to go to your doctor and be like, Hey, I saw this guy from New York and he said, I should know, be nice about it. Trust me. First of all, I get enough hate now, as it is, I don’t need anymore. I’ve stopped reading my emails. But the idea is that you say, can I ask you a question? Like when I, when I want something, when I want somebody to help me with something, I played dumb.


So some people think I’m not playing, but the idea is I say, could I ask you a question? I heard a lecture about cardiac you know, cardiac associations or cardiac associated manifestations of COVID. And one of the things they said was a Rhythmia’s do you think it would be helpful if I had a 24 hour monitor? Because I feel like something’s racing in my heart where I feel like when I get short of breath, that my heart also raised, or I feel this pounding in my chest, or I feel as squeezing in my chest or a pressure in my chest. So with, with with an EKG or a halter monitor, we get, this is the information we get. We get your heart rate and we get your heart rhythm. And what that is is that’s a measure of what the electrical activity of the heart.


So the heart has three things we want to know about. We want to know about the electrical activity of the heart. We want to know about the vascular or circulation activity of the heart. And we want to know about the mechanical activity of the heart so we could get some, we definitely get the electrical from that. We get some information about the vascular, because there is something, there are certain signals that could show that the heart muscle is not getting enough blood. And then the only thing we’re missing is the mechanical information and the mechanical information we get from an echocardiogram. Okay. So to me, if it were me in an ideal world and I were writing the cartoon, I would have the CR I would have ultra monitor. Let’s see what your heart does for 72 hours, right. And an echocardiogram. And ideally, although I know then people are hesitant to do this.


Now, if this were real times, not Colby times, I would say a stress echo. And the reason why I say a stress echo is because then you have a stress test and you see the heart both at rest on, and also under stress. But there it’s up in the air as to how far we can push people post COVID right now. So I would say at a minimum 24 to 70 Atmos, 72 hour halter monitor echocardiogram. And we just got a lot of data there. And even if you doc, I hear a lot of people say, I can’t get a referral to a cardiologist, or I can’t get a referral to a pulmonologist. Anyone had that experience.


Well, you’re who I heard it from the one person raising them. And that’s what I heard it. No, I’m just, I’ve heard it from a lot of people. But the idea is I’ve seen a lot of doctors who go like this, they get the results and they’re like, wow, well, that’s strange. Okay. So at a minimum, if you go to your intern, you don’t want to refer me to a cardiologist. Okay. Can you re, can you order a Holter monitor for me please? Can you order an echocardiogram for me please? Humor me. I don’t know why adopter would not want to order these tests. I don’t know why a doctor would be resistant to these. The more information you have, the better it’s going to be. And then if something shows up on those, then you have your case, both with your doctor, with the insurance company, with anybody else, there’s your case to see a cardiologist. Does that make sense?




I like to make a short answer. Some people would like to make a long story short. I like to make a short story alone. Okay.


So again, off of, off of feeding, what you just talked about with heart rhythms what about these people that are actually getting into doctors and they’re getting a diagnosis of new onset of a fib or heart blocks, which you, you can have four different kinds of heart blocks. So I guess what could be leading up to those? What are some possible signs or indicators that people should look for?


All right. So again, big answer. We probably don’t know. Okay. These are questions that we’re going to ask the cardiologist in a week, but let me just talk a little bit about that. I personally haven’t heard of any, I haven’t seen a patient who is, has a new onset of atrial fibrillation. But atrial fibrillation is common in the, you know, it’s common in the population. So my feeling is anything that is a potentially weak link before or anything that you might’ve been predisposed to before. You’re going to have a greater chance of when COVID kind of, you know, do stabilizes the whole system. Atrial fibrillation is a little bit different than what we talked about before. It’s a different kind of arrhythmia and under normal circumstances, we have atrial depolarization ventricular depolarization. So we have to, to, to, to, to, to, to, to give and take, right?


But in this case, the atria is kind of doing its own thing. So the atrial kind of be like this, that this sometimes it’ll be a little one and the heart, then the ventricle is kind of left to its own devices, right? Everyone’s kind of doing its own thing. So first and foremost, if you take your pulse and the biggest mistake that most people make when they take their pulse, that they press too hard. But if you want to take your pulse, just go to your thumb, walk away, right down there, and you should feel a little beaten if you don’t feel anything. And you’re still awake. That means you’re probably pressing too hard. But generally we should see this. Boom, boom, boom, boom, boom, boom, boom, atrial fibrillation. Boom, boom, boom, boom, boom, boom, boom, boom, boom, boom, boom, boom, boom, boom, boom, boom.


So Asia fibrillation is what we call irregularly irregular, which means there’s no pattern to it. Now you can have an irregular heart rate, but it could also be premature atrial beats doing that. It could also be premature ventricular contractions doing that. It could be a fib. So don’t jump to the conclusion that it’s a fan, but people can also go in and out of a fair, right? So you could be normal now, normal sinus rhythm. And in 20 minutes from now, you could be in a fit. That’s why an EKG might not catch it. So that’s the other beautiful reason to have a 24 hour test in my opinion. And then you also get, you know, sleep information and there’s things that physiology changes during sleep. And, you know, heart rate and rhythm can change during sleep box. Gen can change during sleep again, to me in such a kind of unknown and you know, muddy water picture that COVID is in such a mixed bag. To me, the more information we have, the better it is. And you want to make sure you’re not missing something. You know what I mean? We don’t want, we don’t, we don’t know what’s going on. Okay. And especially the overwhelming majority of long haulers, the ironing of the long haulers is that you weren’t hospitalized. Right. So how many people here were hospitalized? Raise your hand.


So a lot of you weren’t hospitalized, right? So a lot of these long haul symptoms, I have to wonder in the back of my head, because you know, I talk about this all the time with my EMS friends. It’s like, we see these patients that are home, trying to get through the night. And then at any other time in history, these people would have been admitted to the hospital. Some of them would have been in the ICU, but it was like, no, you know what? Go home take a month, two months, three months. If you’re still alive, then come back and we’ll figure out what’s going on. And I’ve hold some patients who, God, we’ve had nights where I’m not a prayer, but I said, God, if you’re up there, please get this patient through the night. You know? And it was in a lot of these cases, it was like, it was like by the grace of God, these and some of my patients are young kids.


I’m talking about like 20 year old kids. And like, we didn’t know if they were going to make it through the night. So the idea is that if you had been hospitalized, let’s say, and your blood was being drawn every day. And you did have an EKG every day. And you did have a chest X Ray every other day or an echo every other day. Well guess what? I can’t help. But think that maybe you wouldn’t be long haulers. Cause maybe things would have been treated right off the bat. I could be wrong. Okay. But like, if you think about it, you know, people have pulmonary embolize people have had strokes. People have had myocardial infarctions, right. And if we see you after three months, anything could have happened. We don’t know what happened. Right. It’s like you see somebody that usually is clean shaving. You see them in three months, they have clean shave. And again, they could have grown out a you know, black beard in that time that could have been like a pie. You don’t know. So I always feel the earlier you get treated, the more information you get, the better it’s going to be.


I agree. Okay.


And I could be wrong. So don’t get the idea. Don’t go to your doctor say, Hey, why didn’t listen? You know, this was a catastrophe here. This was, you know, look how many people died. This, you know, nine 11. You know, I had the pleasure of that one too. And that was a catastrophe, but numbers wise, that was nothing compared to this, right? So in New York city, we treated it like this. If you weren’t imminent, if you, if you were going to make it through the next 12 or 24 hours, you weren’t admitted to the hospital. And these are people that at any other time in history, they probably would have been admitted. No questions asked, so I could be wrong. And it doesn’t matter. Now, you know, you know, it doesn’t matter if I’m right or wrong only if, if, if it can help people in the future. But hopefully this will resolve also for most of you or all of you.


So going back to the blood pressures, the high blood pressure, which is hypertension and low blood pressure, which is hypotension. We’re seeing people on both spectrums, either high or low, and we’re seeing people who are experiencing both. So what can you say to these people again, also some key signs that they should be looking out for? Can anything distinguish between either or if they don’t have a cuff at home and do you recommend that people do get a cuff to monitor this?


Okay. So the short answer is, I don’t know as always, okay. Because there’s so many unknowns with this, but here’s, here’s what I’m gonna tell you what I think. And I had a actually, coincidentally, I had a conversation with David Petrino from, from, from, from Sinai about this on Monday. And I was just playing back the conversation. Cause I’m weird. I like to record all my conversations with people, but no, I’m kidding. But but we were talking about blood pressure. Okay. I have said for the past 20 years that if I can only have one vital sign, like let’s say, you’re playing a game, your eyes are closed. We’re going to give you one vital sign to make a decision. It’s always going to be systolic blood pressure. And the reason why I say that is because systolic blood pressure can tell you about a hundred different things.


It could tell you about the heart rate, right? It can tell you about the heart rhythm. It could tell you about oxygen saturation, because if your oxygen saturation plummets, then your heart rate, your, you know, your, your blood pressure is going to plummet. But just to be clear, systolic blood pressure, the top number, the highest, the higher blood pressure. It’s the pressure in the arteries. When the ventricles are contracting, diastolic is the lower number. It’s the pressure in the artery is when the ventricles are relaxing and filling. I think a huge amount of the hypotension that we’re seeing is related to potentially dysautonomia. And so it makes sense that if your blood pressure plummets, because all the blood goes to your legs, that your heart’s going to be fast. So I expect


That blood pressure could be. So like, if all of a sudden you’re walking in the street and somebody tries to Rob you, you’re going to see a high heart rate. And you’re going to see a high blood pressure, right? Because all of a sudden your is going to put this huge amount of sympathetic adrenaline into your system. And it’s going to make you ready to fight or run away. Right? Like that’s what that’s going to do is it’s going to constrict all the blood vessels. It’s going to get it to the heart. It’s going to get it right to the muscles that you’re going to use. It’s going to get it to your arms. If you’re going to fight, it’s going to get it to your legs. If you’re going to run with dysautonomia, that whole system is messed up. So it’s possible that you’ll get, if there’s 10 things that happen.


So let’s say your pupils constrict your blood vessels, dilate your heart beats faster and stronger. There’s a whole, you know, there’s like an op post this somewhere, but there’s this chart. And it shows you what the impact of each system parasympathetic and sympathetic is on each party or body. With dysautonomia, it could be a wild card. Any one of them could be anything and there’s no consistency to it. But high blood crusher, how many people here are experiencing high blood pressure during the storm Dorn anybody else and anybody else. So how many people are experiencing low blood pressure?




How many people just don’t want to say anything? The non-participants all right. If you choose not to decide, you’ve still made a choice. It’s okay. So here’s the thing. High blood pressure can come from a lot of different things. It can come from your heart beating harder and faster. It can come from income, increased plasma volume. It could come from anxiety. It could come from stress. And you know, I know, I know people don’t want to hear the word anxiety and say, Oh, it’s, it’s normal to be anxious now. Okay. It’s normal to be anxious. And it’s not just cause, you know, no one is the state is hearing you, but it’s like, this is super stressful. I mean, even if you guys didn’t have, I didn’t have COVID, I’m stressed. It’s a stressful time in the world. It’s a global pandemic.


If you’re not stressed by this, then I worry more about you than if you’re stress, but stress has this kind of constant adrenaline flow. So it’s going to make your blood vessels constrict. It’s gonna make your you know, your heart beat, faster blood pressure, the equation for blood pressure, blood pressure equals cardiac output by total peripheral resistance. Resistance is how tight are your vessels squeezing? Right? So if your vessels are squeezing tight and your heart is putting out a lot of blood, because it’s either, you know, it’s either you know, beating fast, beating strong or both, that’s going to raise your blood pressure. If you have a lot of plasma volume, meaning let’s say some people are having kidney issues


At this time, right. Renal issues. So maybe you’re not eliminating fluid in the normal way. And if you had any type of renal issues before, well, that could be magnified. And let’s say you know, let’s say for argument’s sake you had a big salty dinner, right? So the body always wants to maintain the same amount of saltiness. So if I just had one of those street pretzels, that’s full assault will over the next couple of hours and days, my body is just going to hold fluid. And if you think of that as like a water balloon, the more fluid in the water balloon, the higher the pressure, right? If you let some of that fluid out, well, the pressure goes down and it’s the same thing. What I see more commonly as a, as compared to higher blood pressures is I’m seeing lower blood pressures or I’m seeing people whose blood pressures are fluctuating from high to low and high to low.


And a lot of it is positional. So for example, one of the things we were talking about doing, and over the next couple of days, I will tell you how you can get into and be evaluated by the post COVID center at Mount Sinai, but get a blood pressure cuff because that’s really important. And check your blood pressure in different positions. So let’s say for argument’s sake, let’s if you just think about it, you know, I just try not to get people to memorize things. I get trying to get people to think about it and understand it. Let’s say, this is you, and this is your face right here. Right? So when you’re standing up like this, it makes sense that blood naturally flowed downward, right? So if you think of it like a ketchup bottle, if you’re lying in bed, well, it makes sense that more of it would flow like this.


And this is called venous return. So this means we get more venous return from the lower body and that’s going to increase the pressure because the pressure is going to be essentially a representation of what’s in your core. Now you sit on the side of the bed. Some blood is going to flow down, but you also have here, your hips and your knees are bent. So this is going to prevent some of it from going down. But Jen, you stand up and now it’s the best position to blood for blood to flow down. So one of the tests that we do with people is we could do it manually, which means have you lie down for a few minutes? Okay. Or, you know, you can do this. You really can do this yourself. Listen, my feeling is, if you were sent home to do whatever you want, then you could try little things here and there, but check your blood pressure lying down, right?


So your blood pressure lying down. There’s a case to be made as to why it would be lower, which is that, you know, Hey, I’m here, relaxing, lying down. But in this scenario where we have dysautonomia and people have orthostatic hypotension, the case would be that there’s more venous return and you might see a higher blood pressure. So have somebody stand by, check your blood pressure, lying down it. Keep the cuff on your arm, sit at the side of the bed. And as soon as you sit up, start the cuff again. Okay. See what that is. Okay. See if it’s dropped. If it’s dropped, you may also see a rise in your heart rate because as your blood pressure drops, you may see your heart trying to accommodate for that. Once it settles in, stand up, close the cuff again. Okay. See if your blood pressure drops even further and see if your heart rate goes up even higher.


This is going to tell us about dysautonomia. Now under normal circumstances, it’s gonna tell us about dysautonomia. It’s going to tell us about orthostatic, hypertension, positional, hypertension, under normal circumstances. The body is going to get an instant signal and the brain is going to sense these things. And within seconds, it’s going to normalize blood pressure. That’s not happening when you have dysautonomia. And it also can be a secondary effect of spending. A lot of time in bed spending a lot of time, sitting in a chair, spending a lot of time, being less active, all these things contribute. So what I say about COVID patients and the reason why my consultations take two and a half hours is because you literally have to go inch by inch. And it’s like, we have this big tangled ball of yarn. And it’s like, we unwrapped one piece at a time.


And as you get more information, but that’s why I feel doctors should be referring people for tests because only with like, you shouldn’t have to be doing your own testing at home. You could, but you shouldn’t have to. Another way to test that is a test called the tilt table test. So a tilt table test is kind of how it sounds. You’re lying on a table. And then they upped the table a little bit of table, table up table. You have an EKG on blood pressure on checking your oxygen, et cetera, et cetera, et cetera, turn out if you have these problems. Okay. So again, the question would be, you know, when I first stand up, I get dizzy and dah, dah, dah. Do you think that a tilt table test might help me and he’d ask and be like, tilt table test. Where’d you, where’d you say, where do you tilt table?


Don’t tell him it was me, but no, I’m just kidding. But but you know, that’s how you find this information out. And so to come up with any type of treatment plan or to come up with any type of remedy without knowing what it is, makes no sense. Number one, because it’s like saying, okay, you know, could you pick me up something for my friend’s birthday? Well, what is he, you know, what is he like? I don’t know. So it’s like, we need the information. And the other thing is you want to make sure that you’re not missing something dangerous. [inaudible]


So the next thing that we have to talk about is oxygen saturation and shortness of breath. One of the major symptoms COVID patients experience is shortness of breath. In prior sessions, we talked about oxygen levels dropping. Can you tell us what the typical normal oxygen level is for a person when it becomes a concern and how dangerous can the drops be?


So normal with normal healthy lungs is 95% or better. So 95 to a hundred. If you have any type of CLPD, emphysema, chronic bronchitis pulmonary fibrosis, there are a lot of different conditions that can cause a drop that would cause you to have a lower resting saturation. And then you can drop even more with exercise with COVID. So a lot of people in the very acute phases have extremely low oxygen because they, their, their respiratory system is failing. So we have a RDS, acute respiratory distress syndrome. And these people, you know, amongst many, many other things, there are there’s inflammation there there’s cytokine storm there’s pneumonia. So that’s been a lower your oxygen saturation, but I like my patients, even people with respiratory disease to be 93% or higher if you’re below 90, that’s a very, very significant thing because there’s something called the Oxy hemoglobin dissociation curve.


Don’t worry. You’re not going to be tested on that. But it’s what it is, is like oxygen saturation doesn’t go like this. So this is what we call linear. So if it’s a linear curve, that means that each percentage point is equal, but this is actually a sigmoidal curve. So it’s like a hundred to 90 is very is very flat. Right. But then what happens is once you go below 90, it’s like going over a cliff. So imagine a hundred to 90 is where at the grand Canyon. Okay. And you want me to take your picture with the Canyon behind you? There’s 10 feet in between us. You could go anywhere in those 10 feet and you’re pretty good. You go that 11 foot and then there’s a massive drop. And that 11 foot is a doozy, same with oxygen senators. And so if you’re dropping below 90, whether it be at rest, if you’re drunk coming below 90 at rest, that’s significant. And that’s something that I would consider at least a potential emergency, because that could be a PE that could be, you know, amount of cardio. And I mean, there’s a lot of things that can happen, but if you’re at rest where the demand is very low and you’re still below 90, I think that’s like an emergency visit, you know, because that we need to know what’s going on there. If it happens only when you’re exercising, then it’s a supply and demand issue, but then you should probably be on oxygen when


You exercise, at least for now, every time you go below 90, every time your body doesn’t get what it needs, then you’re stressing your body increasing inflammation. And in my opinion, there’s a lot of, you know, my opinion is I think that’s bad for your system. I think it can potentially be inflammatory. I’ve seen it with patients where it sets them back, but more and more, we’re starting to see research come out that says you can’t push a COVID patient in the same way that you would push a patient with heart disease or lung disease. Because sometimes even just a little extra, is it enough to set you back for days or weeks? So err, on the side of caution you’re going to get through this. Okay. And you’re going to get better. Okay. I believe if you do it right, but I think, and when I say that, I mean, you have to do things that are not going to set yourself back. So you have to go slow air on the side of doing less air on the side of getting more rest. You know, we’re going to push you at a certain point, but for now do not overdo it.


The other thing about that, and I just remember what the, what the original question was, but a lot of people can be short of breath, even though their oxygen is perfect. And that’s frustrating for people, right? Because you say, well, my oxygen is 99%. Why am I short of breath? I should be breathing like a, you know, like a whale this point. But there’s a lot of things that can make you short of breath. It could be that you had pneumonia and now you have, you know, inflammation there. It could be that you have scarring there. It could be that you haven’t taken a deep breath in, in a long time. And so now you’re starting to become more active. You’re starting to push yourself a little bit and your lungs are tight or your Clara is tight or, you know, it could be mechanical.


It could be physiologic. It could be something else all together, but that brings us to lung testing. So what kind of tests will be helpful to you? I would love for people to have a pulmonary function test. Okay. And initially nobody was getting pulmonary function tests because they were afraid of you know, they were afraid of contaminating the, the machines and still people aren’t necessarily doing it. But even if you’re not going to have a formal pulmonary function test in a hospital, there are handhelds barometers that you could get that you could have at home that connect to an app. Is it perfect? Does it tell you everything that a full test tells you? No, but it’s going to tell you more information. And again, we talked about heart tests and lung tests. A lot of times, heart symptoms are very similar to lung symptoms. So if you want to try to weed out, what was it? My heart is in my mind, the more information, the better, unless you have all the information, it’s like, it’s like, you know wheel of fortune, right? You gotta have some letters. The more letters you have, the greater chance you have of guessing the diagnosis.


So we talked about some of the pulmonary test the cardiac tests in the EKG, the Holter monitor, stress test and echo. What about some pulmonary testing? So when you say pulmonary testing, what do you,


Yeah, so number one, chest X, right? Most people have had chest X rays, right? There’s some things you can find out from a chest X Ray. There was a lot of things you can’t find out from a chest extra. I’ve heard from at least two dozen people. I was short of breath. I had a chest X Ray and my doctor said, it’s clear and there’s nothing wrong. Right? It could be clear right this minute. And maybe you’re starting to feel short of breath or maybe you’re spiking a fever because you have the beginning of pneumonia and it just hasn’t presented itself on a chest X Ray yet. The other thing is that, you know, as dr painter was talking about the other night, a chest X Ray is specific for some. So if you have a massive pneumonia or if you have a lot of inflammation, right, you have a lot of scarring, then it may show up, but there are more specific tests.


So for example, a chest X Ray can show a pneumonia, but a pneumonia can also hide from a chest X, right? If it’s small, right? A chest X Ray can show a nodule, but it can also hide from a, from a chest X Ray, because it’s small inflammation might be shown on an F a, a chest X, right. But instead of having one area of massive inflammation that would show up, you may have a lot of areas of very minuscule inflammation that might not show up. It might be subclinical in the testing, but not subclinical in how you feel. So the next step from that would be a cat scan and a cat scan is going to tell you a lot. And especially in a, in a disease where one of the hallmarks or one of the things that we hear about is scarring, right.


And scar tissue. I would want to at least have a baseline so that we could say, Hey, where are you right at this moment over time? Are you getting better or are you getting worse? So let’s say on a scale of one to 10, and I’m using this purely arbitrarily in six months from now, if you’ve got a test that’s right. Or a cat scan and it’s level five, again, remember what I said about trends before. So if you were an eight and now you’re a five, well, that’s good. You’re going in the right direction. Your inflammation is getting better, but if you were a two right now, but nobody saw it because nobody checked you and then you’re a five, well, that means you’re going in the wrong direction, but we have no idea. So to me, in an ideal world, chest X, Ray cat-scan pulmonary function test that’s the story. That’s where I would, I would want to start


A lot of COVID patients. Which I think is the huge surprise to whole COVID thing. Is that how involved it is in the neurological system. So a lot of us that are suffering from memory loss, sleep issues, visual impairment. What do you suggest to us for neurological testing?


So that’s a tough one. You know, neuro is not something that I spend a whole lot of time with over the years. I mean, again, you could say a cat scan of the head, you could say nerve conduction, velocity tests. I would say this, I’m not going to answer this question because this is not something that I I’m, we’re gonna pick the neurologist’s brain, no pun intended when they come here. But but there is, I mean, I have a stack of articles here. And just, just to give you an idea, like I could, I could show you, let me just read from this article. So this was an article from the Washington post and they, this was an article by a doctor at NYU who did these autopsies and, and on the brain, this is what she said of all the Corona viruses manifestations, its impact on the brain has been among the most vexing patients have reported a host of neurological impairments, including reduced ability to smell or taste altered, mental status, stroke seizures, even delirium and early study from China published in the British medical journals of neurology, neurosurgery and psychiatry found 22% of the 113 patients had experienced neurologic issues ranging from excessive sleepiness, Tacoma conditions, typically grouped together as disorders of consciousness in June.


Researchers reported that 84% of patients in intensive care had neurologic problems and a third were confused or disoriented at discharge. Also this non those in the UK found that 57 out of 125 patients with a new neurologic or psychiatric diagnosis had experienced a stroke due to a blood clot in the brain. And 39 had altered mental state based on such anecdotal, such data and anecdotal reports, Isaac Solomon, a neuropathologist Brigham, and women’s set out to investigate. So you get, you get the idea. It’s, it’s very unclear and there’s a lot of different things that they’re seeing. So I think it’s going to take time, but what would I say? I would, I would say I’m seeing horologists if you’re having neurologic symptoms demand to see a neurologist and hopefully a neurologist who specializes in COVID or who’s at least seen a lot of COVID patients, you know, Karen and I were talking to him, so why do you, why do I think that people are not being heard?


Or why do I think that doctors are not making referrals? And I think, I think it’s complex as to why that is, but I think there’s kind of like this group of doctors that are on the front lines that are seeing patients that are just severely sick in the intensive care units. And they either help that patient get out or the patient dies and then they go onto the next severely sick patient. So these people are super experts. They’ve been there, done that. They’ve seen the worst of the worst. And if you’re not one of those doctors, then, you know, your experience may vary to 75% of that understanding 50% of that understanding 0% of that understanding. But when I hear about doctors, you say things like you’re fine. Or, you know, this is going to go away or, you know, don’t worry, it’s going to be better in two weeks.


That’s a doctor. Who’s not up to date. That’s a doctor. Who’s not paying attention to what’s happening in the world. And that would scare me. I would, I would head for the Hills and sooner. And you know, now long haulers are getting a lot of attention. It’s, it’s becoming something that people are really paying attention to. You’re starting to see post COVID care centers opening up and we’re going to learn more and more. But I think a big part of it is I think early on a lot of people were oxygen deprived. I think that a lot of people were possibly having micro clots in their brains. And you know, when your brain is deprived of oxygen, the cells can die. And so I think there’s many, many different reasons. The brain is super complex, but I think time will tell, but I would ask to see a neurologist and particularly, you know, usually good doctors refer to other good doctors. So if you have somebody who’s great. Say who could I go to? Or who else knows COVID, you know, who knows COVID really well. And the guys that have come up for us in the next two weeks, those guys know Colby. So we’ll have an opportunity to ask these questions. I’m fascinated to know myself. I have a million questions that I want to know the answers to as well, because it’s super unclear. Sorry.


I know hematology and lab work is not exactly your field. I’m seeing a lot of people who via my survey are responding that they’d been sent for tests for it had findings in their lab work. A lot of these have to do with white and red blood cell counts. They’re getting tested for autoimmune diseases. They’re getting tested for inflammatory markers, so on and so forth. What role can some of these findings be playing in Colbert? Or why could Kobe be causing them? We know COVID is highly inflammatory, which is why searching for inflammatory markers is important, but what else should be we, should we be looking for, what could these things indicate? Is there anything


You could stop right there? Cause my answer is going to be, I don’t know. So I, I am going to, if I can find that I am going to read to you from a study that came out specifically and this, this is a study and this doctor will be here next week. But this is from a study that happened at Cornell and it’s called characterization and clinical course of 1000 patients with coronavirus disease in 2009, coronavirus 2019 in New York, retrospective States, fate case studies. So here is I’m going to talk about inflammatory markers and blood tests. So I’m reading the most common presenting symptoms were cough fever and shortness of breath, dyspnea as presenting symptom, which is shortness of breath was considerably more common in patients who were admitted to intensive care units while patients who did not need intensive care, had the highest rates of nausea and vomiting important lab findings on presentation.


And I can send this to you Karen, to post on your page. Important laboratory findings on presentation include progressively higher inflammatory markers C reactive protein, which is CRP ESR, which is a wreath recite sedimentation rate. And those are basically general markers of inflammation. So they’re not going to point to any one specific area, but with COVID I believe inflammation is something that like the more you have the worse it is and the more it affects. So that’s, it sounds obvious, but I mean, like if you take the inflammation in your gut and the inflammation in your coronary artery and the inflammation in your, you know, gout, well, those things add up for, for, you know, a worst kind of situation. So inflammatory markers, C reactive protein ESR, E recur sites, sedimentation rate ferritin, a D dimer and lactate dehydrogenase for patients who would ultimately require intensive care as compared to those treated in the hospital, not in care units in the emergency department only. So those are things I would ask about. I would Def want, you know, CBC complete, you know, a full boot camp. Again, the more, you know, the better it is. And I’m working on getting a hematologist to come on as this guy. I know they call them the Gregory House of New York city. And I went to see him when I was really sick. And he’s, he’s like a genius. He’s like a crazy genius, but I will get it.


The hematologist who’s been doing it.


The key question, I think most important question, many of us want to know how do we get our doctors to listen to us? The horror stories of myself and that I’ve seen from any other long haulers are disheartening. It’s frustrating. It really lets us down. They either don’t take us seriously dismiss us. Or like you said, see one test day that we’re fine and kind of shoo us away. Many of us were not in the ICU. We were those people that stayed home or were told to stay home. And like you were talking about, we fear that not getting care for months and months is only going to prolong our illness or potentially create other serious conditions in us that are not being treated. So what can we do? What can we say to get our physicians to take our concerns seriously?


So, yeah, so that’s a complex question, but a great question. I agree with you, I agree that some of your concerns about not getting the right treatment now could lead to worse outcomes down the road. I absolutely believe in that. But you know, we’re in a kind of very challenging situation at the moment. Okay. First of all, it’s not like the war is over and now we can start picking up the pieces. Okay. So you guys are the soldiers that came home from the war, but on the battlefield, there’s still a raging war going on. And now I’ll preach for one moment and say that until our country acts in a United front and has some leadership and as a country, the supposedly United States of America apt and take a national position, then this is wireless is just going to be, you know, it’s going to be like quick silver.


It’s just going to keep going from place to place today. Someone takes out, she prays New York city, right? So I posted, I posted an article about New York city and patchy said, this is how it’s done. So of course, you know, Facebook, how it is. So like of course the, the haters or the, you know, have to say, Oh, I wouldn’t say that New York got it. Right. I would say, look at all those people in nursing homes who God said, listen, we’re mistakes made. Absolutely. Okay. It’s a brand new novel Corona virus. We’ve never seen it before. It hit like a bomb. And New York city was a great place to bomb because we have millions of people in a very small spot. Okay. We also have great Broadway shows and best restaurants now. But the other thing is that that’s why we got our assets tip. It came not a came out of nowhere. We knew something was coming. We had no idea what it was going to be like, but we live on top of each other and there’s tons of us. Right? Our hospital system was overwhelmed, but guess what? We got it under control. We got it under control. And if you look at sat in New York, the majority


Of people are wearing matters. Okay. The people who were sick are staying home. My practice has been closed since March 10th because I see the oldest sickest patients in the world. And when they describe who’s at most risk, that’s a picture of the pulmonary wellness and rehabilitation center. We closed our practice. So if people who are really sick are home, but the majority of people on the street are wearing masks and social distances. Okay. Now Monday is phase four of reopening. Does it mean it’s not going to come back? No, it might come back, but learn from what we learned. Okay. We had an excuse at that time. It was novel this time. It’s no longer, so novel. Okay. We know what it is. We know what spreads it. We know what, what brings it around. So the point is, as long as Florida and Texas and Georgia are still showing record numbers of new cases every single day, then you guys, aren’t going to get the care you need because the focus will always be on life, over limb.


And I’m sorry to say that, but it’s, you know, for the people that believe that, Hey, you either die or you just get better and then you’re done with it. They have no idea. Okay. But it’s that kind of thinking. And it’s the thinking that, Hey, you know, it’ll be fun to have a party and see which one of my friends gets COVID first. They’re preventing you from getting the care you want, because as long as you know, and Karen is a firefighter and a paramedic, right? Like, Hey, you know what, until the fire is out, you don’t start salvaging your stump. The fire’s not out. The fire is raging. So, you know, how do you get your doctors to listen? Hopefully good doctors, but you have to, you know, one way I think is helpful. Bring an article, not, not like a newspaper article or a magazine, bring a journal article and I’m putting together a list.


I’ll start posting articles. I’ll create a file and I’ll, I’ll give them, share them with Karen. And you know, we gotta disseminate these articles and, you know, we want, we don’t want to hand 37 articles to your doctor that they’re probably not going to have time to read. We want one good article. We want like a JAMA article, or we want a new England journal article. I want a British medical article and they’re coming out, but you got to say, listen, this is it. And I’m going to give you some suggestions. Number one, doc, you know, I was listening to this thing and they said that, you know, a halter, MITRE monitor might give you some information. What do you think about that? Let them think of it on their own. After you tell them what it is, that’ll help, but I don’t want to make it all about the doctor’s not doing their job.


But you know, the doctors kicked ass here, okay? The doctors and nurses and therapists and first responders, thank the Lord for people like that, who are willing to get up every day and lead that, leave their families and risk their own lives to help other people who they don’t even know. But I think start with your internist, recognize that, you know, a lot of times people will say, I want to see a neurologist, a cardiologist, and a pulmonologist. You have less chance of your doctor saying we’re giving you a referral to those three doctors than saying, Hey Don, can I have a halter monitor? Because all he has to do is say, Hey Kathy, can you or Steven, can you, I don’t want to be sexist, Steven. Can you set ms. Smith up for a vaulter monitor? Don’t you go to the halter lab?


They do haul up monitors all day. You get the results. He, someone interprets them and a cardiologist will interpret it. He’s going to tell your doctor if there’s a reason to go forward. Okay, now you see a cardiologist or Hey doc, do you think it would be worthwhile for me to have an overnight oxygen study? And that was something I forgot to mention before, but that’s also another great test to have, because by the time you wake up and put that postdoc seminar on your fender, even if it’s just two seconds, your, your body has already changed enough. So there’s an overnight oxygen study that could tell you a lot about sleep. And you’ve got a level with doctors. And another thing that’s really important is keep a journal and correlate, you know, your symptoms and your signs with your vital signs. So in other words, if you feel dizzy and your heart rate like today, my accountant told me his heart is op his blood pressure was 76, over 60.


I was like 76. And he’s my accountant’s crazy annually. He’s always got these odd ball things, but I said, you know, you might want to drink some water. But correlate these things in the morning, get up, check your heart rate, check your oxygen, saturation, check your blood pressure, write it down. If you’re active, take those numbers again. You want to be able to compare rest versus activity. You want to be able to compare lying down versus sitting up or standing up. You want to be able to compare when you have a splitting headache. Well, what’s my blood pressure. If you have a splitting headache and your, your, your blood pressure is one 95 over Andre, we better go to the hospital. You might be having a stroke. And I’m not saying that to scare you. I’m just saying that there are real things out there. Okay. There are legitimate things that can happen as a result of COVID and it doesn’t seem like anybody is screening for them. And I don’t know why I don’t understand it either.


Can I say something? I just had, I had them on mute me because Hey guys, no, I just want to speak because I am caring for a friend who is 20, who is a long hauler. She’s four months post. And I took her to the doctor and these are people who we know. And she was sent home from the hospital and had to make it at home by herself with no, and I on the telephone at three o’clock in the morning and four in the morning with her. But when I went to the doctor, you know, it’s sort of like, well, you have this, you have that. We finally, we get, you get a D dimer and she does have clots. And, but then along with that, it’s sort of like, okay, and we’re riding along, we’re riding along. And I finally said the last visit, you know, it’s been a while since that last cat scan her D dimer, isn’t changing anymore.


Should we see maybe what’s going on? And the doctor said sure. Okay. Is that okay? And I said, yeah. And then the, I said, exactly what Noah did. You know, I read this study and I happened to see this hospital’s name on that study. What can this child be in that study? Don’t you think you’d get pertinent information from her blood? And what she said was so you all of, you know that yes we would. And we would love to, but the problem is they are only taking empirical information from the people who were checked into the hospital and that they treated and were tested positive at the time. That’s basically the standard for a lot of these tests. So I said, well, you know, I happen to know there’s a group of long haulers out there, hundreds of them, and you are missing all this information, all of this information, there are people you could get so much from and find a cure faster.


And she said to me, you’re probably right. So you know what, I’m going to run it by the person who happens to be we’ll be looking at your cat scan. She’s doing a study. Let’s see. And sure enough, a week later we got a email to get her into a study, but it was all done. Like, Hey, I’m dumb. And I just happened. And I mean, and this person knows I’m not stupid, but, but you sort of do have to play it that way and go loaded with information. But part of it is that they are not looking at you people right now. And I think the louder you are in saying, Hey, maybe, you know, and keep pushing that and don’t give up. I really do believe I do not give up when someone stops you on the street, you know, and says, Oh, what’s wrong with you? Just, you tell them you’re a long haul. Or, you know, people see her at the, at going out on the street with the oxygen tank and go, Oh, well, do you have PD? And she goes, no, I had COVID and it’s four months later. And people like, what do you mean? The more you get your voice out, the more you educate and the more you just gently talk to those doctors, because they’re just as scared and in the dark as you are, which is scary for a doctor.


Yeah. That’s good points. So you know, like I’m going to, I’m going to make a sexist comment because I enjoy being inappropriate and I don’t work for anybody else. So I have that class. If you’re a man, it’ll help. If you start your sentences with something


And if you’re a women, if you start with something like T he you might get more. No, no, I’m just kidding. But here’s another thing. Keep a record.


Okay. Keep a record. And we’ll make, we’re going to do this now. And, and I’ll share it with Karen. So you can either reach out to her, but we’ll start to put together and we’ve already started, but we’ll make available all of these studies


And we’ll group them by category. And you know what? I find a lot of times


With my own doctors or with doctors of my patients. Cause we get patients sometimes who we see stuff. Cause you know, we, we run a rehab center where we see patients anywhere from three hours to four and a half hours a week and we have them fully monitored. So we’re seeing things that nobody else has seen. And a lot of times we get, even before COVID we have, we have doctors who are resistant. They don’t want to run this. They don’t, that’s just, this it’s just like, so I find if you a email or write a letter or a fax, a letter, okay. That helps why paper trail evidence. And I’m not looking to entrap somebody. Okay. But it sets a record. And then, you know, if you were to email your doctor and say, Hey, you know what, these are my questions. Like if you go into the, into the doctor’s office, you don’t know, they may just have 20 patients in a row.


They may have just lost a patient. They may have just lost a family member. You don’t know their situation. So don’t assume that everything that happened in that meeting is about you. Okay. But give them an opportunity to deal with it when they want and send them an email and say, you know what? I’ve been having palpitations, would you mind taking a peek at this study from the new England journal of medicine, about a arrhythmias and COVID and email them the study and they’ll look at it and they’ll see what they’re doing at Harvard. And they’ll see what they’re doing at Stanford. And they’ll see what they’re doing in Britain. And they’ll say, Hey, you know what? We better order this test. It’s new ground for everybody. And there’s too many people. We have more people than we have seats for at the table.


That’s the problem. It’s frustrating. It’s not fair. It sucks. This is why we started this series. Okay. Cause we want to at least help guide you a little bit and not have everybody make the same mistake, not have everybody reinvent the wheel. Another thing is and I can’t tell you this until next week when it’s a definite, but we are partnering with one of the big post COVID centers in New York city. And they have acknowledged that they will take patients from out of state and allow you to enroll and do telehealth. And you will be evaluated by a COVID rehab physician. So you can go in through their program or you could go in through our program, but we will be sharing data. We will be sharing patients. The first person that I will invite is you Karen. But you know, people are getting it together and eventually it’s going to be standard of care everywhere. But right now you guys are the ones in the wilderness and it’s your job to kind of cut down the grass and deal with the, you know do we want to just go to any, any questions in the chat that are


Well, let’s go to your pre-submitted questions first that people emailed you and then we’ll go to the chat. Yes. One of them were first of all, thank you so much for hosting the session. My CT scan shows post-inflammatory changes in my upper airways, but no active infection. However, I still four months later have shortness of breath. Is this something that typically clears up on its own or is this possible permanent damage? Do you have recommendations for healing? Rehabbing? The lungs is physical exercise recommended. I’m concerned I will relapse.


So that’s a lot of questions right there. But let me hit it one by one. So no active infection. Good. It’s always better not to have an active infection. Post-Inflammatory, you know, post inflammatory changes. That could be anything. Okay. It could be fibrosis. It could be a shortening of, you know, it could be a, a construction of the airways. It could be a kinking of the airways. Does it usually go away on its own? Sometimes? Yes. Sometimes. No. It depends what it’s from. Inflammation can cause many different things. We see a lot of patients who have had surgery for lung cancer. And what happens with these patients is that they’re told they don’t need any rehab. And they’re told go home and just walk. But because they have pain in their chest where the cut was, they don’t take a deep breath and they hold their arm like this.


And then the same way that a muscle that you hold in the same position for eight hours gets tight. The structures around the lung can get tight. So that could be the parenchyma that’s right. Linda Sullivan. That’s what I mean. But, but the thing is that could be, you know, the lung parenchyma could get tighter. Okay. The airways can get narrower. The plural can get tighter. There can be scar tissue in the interstitium of the lung. All these things can happen. So the answer is, will it get better? There’s no way to know, except time it depends what it is. It depends what caused it. Are there exercises? Absolutely. You should be doing everybody here should be doing deep breathing exercises. Okay. Every day. And that should have been happening from the time somebody goes to the hospital to the time they go home.


And even if they were discharged from the hospital, they should have been given a sheet or a video or something like that that says these are the exercises you need to do. So just as a general rule plays a big role and you lie on your left side and put your arm up. Well, then the bottom of your right lung is getting the most air. Marion is the chief of our airway clearance unit. And we’ll have her work on you know, we’ll, we’ll put together something for you. I did a breathing activity last week, but that was a little bit different because that was to quiet the nervous system. So should you be pushing it? Should you be exercising? I think you should exercise as much as you can without overdoing it. Right. So it’s like at a certain point, a lot of patients I’ve seen it’s like they could do a minute.


They could do two minutes, but if they do three minutes, then they’re in bed for a week. Okay. So it’s always err, on the side of caution and one of the things we’re going to be doing and it takes time. I I’m unfortunately, but it’s, it doesn’t take that much time. But within the next two weeks, we’re going to have a specific boot camp for COVID because we’re going to have to scale everything back. So for those of you that have joined bootcamp, I know a lot of you have air on the side of caution, err, on the side of going easy, if it means to do half of what you’re supposed to do that day, do it. Okay. I want you to do less rather than more, but every time you get to take one step forward, that’s a plus, but just do a little bit less than you feel like you could do because we don’t know how you’re going to feel later.


And sometimes we’ll feel good during the activity because then, you know, really warmed up and you’re taking nice deep breaths and your saturation is high and you may even feel good that night, but then the next day you may feel like you’ve gotten hit by a truck. So, you know, we’ll, we’re going to get it going again. We are working on it. So yes. Do as much as you can without overdoing it. But yeah, I think people need to be doing breathing exercises every day. A lot of people have these incentive spirometers. Right. So those are good. But we also like we like the positive expository pressure devices, things like the aerobic things like the acapella things like the flutter valve. And actually we just heard that there’s someone coming over here soon who’s who was able to figure out how to three D print these for about a dollar each.


So they should soon become very, very available to people. But I think next order of business is Marion should to do a a breathing, you know, teach, teach a breathing to open up the lungs type thing. And incidentally, you know, my, our team is doing consultations and Marion is available to do consultations, you know, for breathing and things like that. So we’re, you know, we’re, we’re not taking insurance for them. We’re doing them on a donation only basis. So don’t feel the pressure. It’s not inexpensive. We’re seeing anyone who wants it. And if, if that’s something that might interest you or we can discuss your individual case, then by all means, you know, contact me or reach out to, to us that, you know, and then, you know, if you went to set up a breathing technique, you know, a breathing session with Maryanne, but next week we’ll, we’ll do a session with Maryanne where she teaches the basics of breathing. But yeah, you should be doing these things. Next question. Sorry. You already answered question two that was submitted over to the chat. All right.


Do you want to tell everybody what email they can get?


You can get me at NOAA at pulmonary wellness dot or, or I can make it easy. Noah at COVID P T dot or a gift that’s easier. And then I’ll just forward it to my office manager who will contact you to set up a consultation. What, what a high SED rate influenced the blood pressure. So I would say this it’s probably not that related. Okay. Said rate is kind of general indicator of inflammation and it’s probably whatever it is that’s causing the sad rate that might potentially affect the blood pressure, but said, rate is just like kind of a marker for inflammation.


The reason I even checked blood pressure was because I had a feeling like the left side of my mouth was sagging, looked fine. I could smile ways. My arms, my nurse roommate took my blood pressure when I told her that. And it was high, went to the ER, had an EKG brain MRI, everything was fine. Anything to be concerned about. Blood pressure was fine after that. So again, that’s, that’s a scary question, right? So, you know, a lot of times when you have a neurologic insult like a stroke or something like that, what you feel is not what other people say, what you think or what you say is not necessarily what other people hear. Anytime you have a situation where either you feel like something’s drooping, you feel like something’s tight, your right side. Doesn’t feel like your left side to me or on the side of caution, go to the emergency room.


Why? Because if you are having a stroke, if you are having a clot, well, guess what, there are things that can be done about it. There are medications that can be given. There are procedures that can be gone, done that can prevent permanent damage. There’s something called the golden hour. So you had, you had an EKG, you had a brain MRI, so you had a brain MRI. Okay. So that is comforting. If the brain MRI was good, that’s comforting. And that means you didn’t have a stroke cause it would’ve shown up. And if there were plaque or if there was something else there, now that doesn’t mean that you didn’t have a Tia, a transient ischemic attack. If this were me and I were thinking out loud now that you know, they did this stuff to say, Hey, are you having a heart attack?


No. Hey, are you having a, Hey, no, but you know, a Tia is not going to necessarily leave evidence on a scan. Transient ischemic attack means that it’s a temporary loss of oxygen to the brain. One thing that a lot of people don’t do, I would have I would have a carotid. I would have your carotid arteries looked at. Okay. And the reason why is because the carotid arteries are often a source of plaque and a little piece of plaque can go up into your brain. And if it’s a little piece, it may be a transient ischemic attack, but it could be a big piece later on. So I would do, I would want a carotid ultrasound and something that’s less rarely, that’s more rarely done. There’s something called a carotid intimal thickening test. And that’s what that does is that shows is there.


So the carotid is like our, like to the brain and, and the cerebral arteries are to the brain with the coronary arteries are to the heart. Right? So don’t worry about the carotid intimal thickening, because your doctor is going to tell you to go screw yourself, but you could ask about a carotid ultrasound, okay. To say, is there a plaque in the carotids? And if there’s significant plaque in the carotids and you’re at risk of a stroke, then there’s medications that you can take that could minimize that risk. But it’s good that your brain MRI was good again. You know, when you go to the ER, think of it like this if you go to like the snake catcher and you say, listen, there’s a frog over there. He doesn’t care that there’s a frog, he’s waiting for a snake. So when you go to the emergency room, if it’s not an urgent emergency, they want to make sure that you’re going to make it out of there and make it to the next day. Now it’s time for the secondary assessment. So good. You didn’t have a stroke carotid, so let’s make sure you don’t have a stroke in three months.


Is inflammation of the Vegas nerve affect blood pressure? Yes, it definitely can. So again, Vegas nerve is going to give parasympathetic nervous activity is going to get parasympathetic stimulation. It’s going to lower your heart rate. If your heart rate is lower, it could lower your cardiac output. It could lower your blood pressure. So yeah, if you have an inflamed Vegas native, that would definitely not surprise me if you had dysautonomia.




That feeling happened during a wicked headache as well. Yeah. You were right to go to the ER, you were definitely right to go to the emergency room. All right. Then John, what do I think about the outlook for people who are experiencing dysautonomia? I think this is what you’re experiencing. So I’d say this, I’d say I’m not a despondent about it. I’m optimistic about it because you know, people have had dysautonomia from many different things. There are many different things can cause a at one of the more challenging ones is called pots. And we’ve been lucky enough to see seven pots patients over the years. And that doesn’t sound like a little hot, but in the world of pots, that’s like, that’s like 200, you know, people who like we think Brian Pitt is good-looking. But the idea is we’ve learned a lot by really kind of challenging people.


And when we had our meeting with the team at Sinai, we were finding very similar things and we do believe that you can train the autonomic nervous system. Again, we, we think it’s possible. Is it definite? No. Is it possible? Yes. if you do nothing, it’s going to take a long time to do it. If you get specific activities that will help to, you know, kind of, you know, part of this first, we’ve got to desensitize the system to the things that we don’t want it to be paying attention to and then to sensitize it to the things that we do. So it’s a retraining of the nervous system. I’m confident that I won’t say I’m competent. I’ll say I’m optimistic that there can be improvements in that. And I think if we can get that dysautonomia under control again, in my opinion, I think it’s like this, I think inflammation has to go away. I think dysautonomia has to go away and then we have to condition and I think people will get back. You know, I think in a year from now I don’t think you guys are still going to be in this boat. I don’t, that’s, that’s my, my hope and my prayer, but it’s also, I think I that’s what I, that’s my gut feeling. I think that we’re going to have success. I think it’s not going to be as fast as you want it to be. Nothing ever is.




I’m 70 with asthma. I survived. COVID in may, by miracle though. I have many serious problems losing 60 pounds in two months, I would not survive. What are my chances of reinfection? You didn’t trust that I was going to keep your email apart. I got your email. I was getting to it. Alright. So what are your chances of reinfection again? Unknown. Okay. There are people who have had antibodies before and don’t have antibodies now, which is not the best dr. Kainer who was here the other night believes that he had COVID twice. So I don’t know. I mean, I think there might be a chance that you could be reinfected, you know, and I think all these people who have antibodies and now somehow feel like they have some kind of COVID force field around them. I think they’re making a bad decision for themselves and for others.


So I, I would advise you to be super careful and I would advise that to anybody. I mean, I’d advise that I had to take a ride the other day with somebody I was in full PPE in the backseat. It was someone I didn’t know, and somebody who’s out and about, and this was my driver and I was on a two hour ride. So mass shield headgear PBE you gotta take this seriously. You know, I don’t think there’s any, I don’t think anybody should be confident about any part of COVID at this moment. You know what I mean? It’s like, we just, like, if you’ve ever seen the movie, the perfect storm, it’s like, my favorite is my favorite movie, but it’s like, okay, we had a rogue wave. Okay. We had a shark that got on the boat. Okay. One of our guys fell over.


Nobody should be walking around, feeling confident at this moment. I think we should really be humble in the face of something. That’s much more powerful than any of us, and we need to take it seriously. And for the ones that aren’t, I, you know, I don’t want to sound like a demon or anything. I’ll, I’ll say that thought. But I mean, I just, I just think that, you know, people are, are making bad mistakes and they’re writing, you know, if I want it to sound like an action movie hero, I would say, you know, writing checks that their body can’t cash or, you know, something like that, but just be careful. I think if you’ve had COVID and you run down, I think your chances get cancers are only going to be, you know, more likely to get it if you come in contact with it again.


But you know, I think you’re probably more susceptible to the flu. I think you probably more susceptible to pneumonia. I think anytime your immune system is compromised, you know, you’re like the weak fish in the tank and everybody’s gonna come after you. So be careful. Thank you Karen, for all you do. I am very grateful. That was not for me. That was from Dawn. Although I am I live at 5,000 feet. Does that affect normal oxygen level yet? It does. 5,000 is significant. It’s not 10,000, but it’s not C level. I usually start to feel something at about 3000 feet. But I’ve also been as high as 15,000 feet and I didn’t feel anything, but my heart rate was one 60 for the first time in a really long time. So 5,000 feet. Yeah. It’s significant.


Is there a relationship to shortness of breath, increased heart rate with mild activity? Mild activity makes me lose my breath and can’t usually speak full sentences. And then my blood pressure’s then high. So then again, we go back to chicken and so we go to, is it that your heart rate went so high, dropped cardiac output. As a result, you didn’t get enough blood back to your lungs. Is it that you dropped your oxygen for some reason? And now your heart is beating fast. Again, these things are all connected. That’s why we have to do testing. That’s why the more evaluation you do that, otherwise it’s this, the answer to everything is maybe that’s the real legit answer. Only with information. Can, can you get answers to these questions and no more testing, doesn’t create more. Would shortness of breath be a symptom of dysautonomia when oxygen levels are normal?


It could. But again, dysautonomia is nonspecific. This oughta know Mia is like, Hey, we got, you know, 26 different types of bagels in the bag. You can reach in, you can pull out on everything. You could pull out in an egg. You don’t know it could be, but again, I’m not sure air hunger, I don’t know. Shortness of breath could be a lot of things. It could be a dysautonomia. It could be something else. Should it be above when sleeping too? Yes. Oxygen should always be above 90. Why do I lose my breath when I’m just talking? Maybe talk too much Rose. No, I’m kidding. But the idea is that I’m talking is exhale, right? Talking is exhaling. So people wonder how I could do a whole webinar like this and only take two breaths. It’s cause you know, I’m falling on here. But the thing is that you are exhaling, exhaling, exhaling, exhaling, exhaling.


Like this is like the foot is on the gas, but it’s on the gas, but it’s on the gas. We’re using gas, using gas, even gas, eventually run out of gas. You have to refill with a breath. Now I got four more hours in me when lips, when the lips and fingers turn blue. So that’s a sign of, you know, your body not getting enough oxygen. Are you seeing that Joel and yourself? No. Okay. So yeah, you’re not necessarily going to see that in every person who’s got low oxygen. People can be in the seventies. It doesn’t mean their lips are going to be both. What are low levels when you’re sleeping? Really? You should be above 90 all the time. So if you’re dropping below 90, when you’re sleeping, then I would, I would look at the possibility of sleep apnea, which for some reason, a lot of people with COVID or are winding up with sleep apnea.


Now, did they have it before? Maybe now it’s just more prominent. Did they have a mild case before? Maybe now it’s more it’s more significant. But again, that’s something else where it’s simple, overnight oxygen study is going to tell you. And that doesn’t mean, you know, going to a sleep lab is, is a big thing. You got to go to the hospital, you got to sleep over there, but overnight oxygen studies, just put this, watch on, put this thing on your finger results, go to the cloud and your doctor gets it. My oxygen saturation has been in normal range. The whole time had been short of breath for over four months. Definitely feel the air hunger like I’m bothering the breath. Yep. So Dawn, did you have did you have pneumonia? You did. So what’s possible. Were you hospitalized? So you were sent home with pneumonia.


So you were sent home with an infection, right? So anything that I talked about before inflammation scarring you know, kind of getting bound down because you weren’t able to take a deep breath, all that stuff. It can, it can lead the shortness of breath and the inactivity can also lead to that. So there’s stuff you can do. There’s stuff you could do. I could be wrong. I thought I saw your name on my calendar. Am I wrong? You don’t even have to say, but, but we’ll talk about it. And Marion can definitely help with that as well. My doc ordered a PST. I can’t get it. So the end of September, Oh God. You know what I would get, if you can’t get a spirometer, we, we will make a work. One of the things that we hope to do is make, you can buy spirometers, okay?


And there are, they’re not expensive. You can track your own stuff and it’s not going to tell you everything and PDOT rule. But if anything else, even if he can’t get a spirometer, just get a peak flow meter or an incentive spirometer. So get a peak flow meter that they use for asthma. And look for changes there. Because as we talked about the other day, you can either have obstructive disease, which means you have difficulty blowing air out. And that will be shown on a peak flow meter. Or you could have restrictive disease, which means you have difficulty taking a deep breath in. And then that will show up on an incentive spirometer. Yeah, I mean, it’s not even August. You gotta, you know, you gotta push that Sarah. And the reason I say that is because a lot could happen between now and then. So let’s say you do have a problem, right? You want to wait two months until you fix your problem. I don’t, and it could get worse and it could take something that’s benign. That’s workable right now and make it significantly. What’s that peak flow people, Marion likes to get in on the act. I nodded nominate, go ahead, man. Take it away.


No, it’s just showing what a peak flow meter looks like for those who don’t know I happen to have on here. Hold on.


She, she she’s a a breathing device nerd.


I do like I took one that was like not open. So just in case I had to send it to a patient, but yeah. So hold on. The trick is not using it. The trick is opening the frigging plastic. Okay. I don’t know if I can open it to show them. So it’s just gonna be a glare.


Do you have strong lungs? Do it through the plastic?


Yeah, really? Wait, I have strong teeth. Hold on just a second.




Don’t do that at home. Okay. Here you go. So it looks like, I don’t know if you could see it, but you might see better. It looks kinda like this and you’d like blow into it and take a deep breath in and blow hard, really hard, hard, hard, hard. And then you’ll, it will give you a, a number in of


Your expiration rate.


So you can give that number to your doctor. And,


And it’s also, again, same thing, not just the number itself, but trends. So you can tell, are you getting better? Are you getting worse? I just want to run through these questions in a speed round. Cause at nine I have a hard stop, but so should we use a spirometer to expand out long capabilities? If so, how often I’m going to ask management. What do you like? You like the spirometer or you like the positive excavate pressure devices? What do you think people should use now?


Well, if I say it depends, I think that there are some people where they’re not taking deep enough breaths, so that to do like a breath on an spirometer before they do a positive excretory pressure device. I like to actually do that, but otherwise I think, you know, if you’re doing really good breathing exercises, which are just simple movements of your arms and laying in certain positions and breathing in and then using the device, I actually find that more beneficial.


Why don’t we record that this week? Why doesn’t everybody order? What should they order if you’re rich?


Well, you know, I mean, I could be really geeky because there’s something now that I’m trying out, which is really great, which is an Inspirado butter that has a pep attached into it. So that after you’re done with it, you can take it out. It’s, you know, I don’t know. I just got the thing from the rep.


Alright. So we’ll find out what recommendations, but what, what you can do is we’ll record something this week. That will be a brief, you know what we’ll do this week, we’ll record something that you don’t need any equipment for. And we probably have that in bootcamp. We’ll post it, we’ll get the thing and we’ll post it. I know which one it is. It’s, it’s the one with popup up. That is that that’d be good.


Yeah. Well, there’s one for people who are, if you’re still, if you’re having a lot of trouble with speaking and, and, and supporting your breath as you speak there’s a, a an exercise for vocal, vocalization and breathing.


All right. So what we’re going to do is we’ll post we’ll post the two different things and we’ll tell you who should be using which one, but again, with the caveat that please clear this with your doctor and please go slower than you think you should be going. Just a few things. I had a CT done to check recurrence and PEs on Thursday, no PEs, but there were some strange things on my CT. I didn’t know if this was scarring it’s specifically said, depending on ground glass densities and lung parenchyma, mild thickening of distal esophagus. So again, this is inflammatory response. And if you remember what dr. Painter, the other night, he said,


Ground glass, it’s like, it’s over the lung tissue itself. So it’s possible that they’re scarring there, but it’s also possible that it’s inflammation. If it’s inflammation, it gets treated. It goes away, but that’s somebody who should see a pulmonologist. So was, was that a HANA? Did you did a pulmonologist do that for you? Or was that your GP? Well, anyway, if it was your GP, then that’s your indication that you need to see a pulmonologist. Other things keep a log of your symptoms daily, bring other long heart holler articles with you. Bring scientific journal studies, bring my survey, Karen survey results with you, even if it is just the key findings, go in armed with knowledge, write your questions and concerns down before you go. So do not blank out or feel nervous and also record the session, record the session so that when you get on, I record every consultation and then I send it to the person because there’s no way either of us are going to remember everything that’s there, but record your session on your, on your phone when you’re with your doctors.


So that you say, what was he saying again? I don’t know something. Faxes might be seen by more people. If you have a real fax machine, we just switched to electronic. But thank God we know what the center, what that center is. That’s amazing. I’m actually crying over that news. Same Martha Noah recommended a book last time. It’s called the healing power of the breath. It’s great. Yes. Dr. Richard Brown healing part of the breath. That’s my dude. That sounds good. Now I have to scale back at basics and bootcamp. Everything you’re saying is true. I feel so great when I’m doing the activity, but I’ve ended up yep. Err, on the side of doing less. Okay. And one thing I’ve come up with a kind of a scale of what I think I would say don’t do more than 5% more than your previous maximum at a time.


So in other words, if you’re the most, you’ve walked is a hundred feet. Don’t walk more than 105, maybe 10%, 105 and a half or 110 feet. Stop wait. Okay. And then after that it would be one 21. And then after that it would be one 33. I’m being called back on site to work at a clinic with recurring fevers. Am I safe to be in that environment if I’m able to sneak through the 10th Springs? No. And you shouldn’t and you shouldn’t. I mean, you know, I’ve had heard of people sneaking onto planes, you know, they know they’re sick. You shouldn’t be in a clinic, you have recurring fevers, you are not safe. We don’t know if the people you’re going to be taken care of are safe. I pray that you do the right thing. And the right thing is not going back to work.


Can persistent fever and affect airway, constriction, breathing and or blood pressure. I would say that it’s not that the fever would necessarily cause those things fever in itself is kind of like a sign. It’s like the smoke to the fire. It’s not the fire. It’s telling you those situation there. Need sources for IPB support group. I want to talk to other patients on medication or ones with same condition and how they’re handling it. What is IPD? I’m sorry if anyone knows I’m drawing a blank right now. I don’t know if I’ve ever heard it before Linda. You’re on muted. You, you just muted yourself. All that. Don’t touch anything. You’re still touching. Okay. I’m gonna okay. You try to unmute yourself


Idiopathic pulmonary disease, basically pulmonary fibrosis, but they don’t know for sure.


Yeah. IPF. So idiopathic pulmonary fibrosis. Yes. email me. I will set you up with some groups. Number one, our Facebook group does it. There’s also a group called the PF warriors on Facebook. The person’s name is bill Vick. I’m going to be giving a talk for them next Thursday. But email me and I will send you the links and put you in touch. But before don’t threaten you into, don’t threaten me. Right. now we’ve been treating IPF patients since 1995. We love it. Like we don’t, we don’t love the disease. We are. We love that. We, you know, we’ve gotten, we understand it. Me too, Martha concerning bootcamp, the breath work too was a little too. Yeah, I know. It’s really, it’s really a lot. It’s really a lot. So you know what we’re gonna, like I said, we’re going to be redoing the new bootcamp and it’s going to be 32nd increments.


You know, it’s going to be today, your exercises, 30 seconds tomorrow, your exercise is 40 seconds. So the one thing I’ll say to you is that don’t expect this to be done with in a week or two weeks or a month. And I don’t say that to you to discourage you. I say that to you because this is one of those things that if you push it, it’s counterintuitive, you’re actually going to slow your progress. Can you forward breathing exercises for those of PF? Yes. For all of us recovering at home, can additional oxygen help either through a tank or an hyperbaric oxygen therapy. So the answer to that is oxygen and a time because only help you if your saturation is low. So in other words, if your oxygen, if your saturation is 95 or 96%, the oxygen is not going to help you. Hyperbaric chamber is an interesting one. Okay. Hyperbaric chamber. I I’ve been in a hyperbaric chamber. I had the beds and I was in a hyperbaric chamber for five days. I think there’s something to be said for that, but I think there’s something to be said for it very early. I don’t know if there’s anything to be said for it. The answer is, I don’t know. And I don’t think that anybody is doing it at this moment.


I don’t know.


Sorry. I’m very concerned about memory and cognitive issues, which I don’t feel doctors are addressing seriously enough. What’s the best approach to get that evaluated. So


I think you should ask


Or a referral to a psychologist or a psychiatrist. And that’s not because I’m saying you’re crazy. I’m saying those or a cognitive therapist or occupational therapist or a social worker or anybody who does those kinds of testing. But yeah, I think it’s worthwhile. I think we need to know, because the thing is, the question is why are you having memory issues? Right? So the first step would be a neurologist. And then I would, I would want to make sure, Hey, your brain is okay and that that’s not what’s causing the memory issues. And then you ask the neurologist, what kind of testing should we be doing? What do I think about schools reopening or giving parents the option of in person? You know, my own opinion, my personal personal opinion. If I were a parent, I wouldn’t be sending my kids to school. Me, that’s me. I’m not saying I’m right. I’m not saying I’m right. I could be wrong. Maybe it’s going to be safe. I don’t think it is my, I come from a family of teachers and I have nieces and nephews.


And what’s the point?


I mean, what’s the point? What are you going to say? If something goes wrong, we’re going to say, will this boat hold us? Is this well, it says a thousand pounds in this elevator. Well, we’re only 1500. We’ll probably make it. I mean, you know, what’s talking about children. I mean, how are you going to socially distanced? How are you going to make sure this is my opinion? I could be wrong. I pray I’m wrong. But I just heard something like, well, these infants, I think it was in Florida. Was it where all these infants tested? We don’t know enough everybody’s been inside. So to me, I would be, if I were a parent, I would be a crazy overprotective parent. When I was a kid, I used to walk to school when I was three months. Me and my sister used to walk to school like that. I would never, I would never let it happen. But to me, I don’t know. I don’t know enough about it. I haven’t made any mistakes so far since this began and we’ve been advising masks day one. But I just look at it and I see those kids and I’m like, I don’t know if I want to test, if a boat is sea worthy, I’m going to test it on grownups first. I’m not going to send all the kids out. I want to get on this one to Noah. Sure.


So I’m a single mom. I have an 11 year old right now. I’m in South Florida where things are really, really bad. We’ve had anywhere from 11 to 15,000 cases every day for almost the last two weeks. Our death rates are increasing study, just came out. I think yesterday showing that 33% of all the children being tested are testing positive. And no, it was just mentioning another test today that it was 70 infants tested positive. And that was just, I think in one County, I don’t think it was for a state. So there was a lot of talk out there about kids not being affected as much as an as much as adults,


One of those infants die of Colvin. Okay.


And I’m not necessarily sure that that’s entirely true. I posted to my page a couple of days ago. I’m a little boy. I think he was seven or eight. He’s a long holler. He got sick right at the same time as me and he’s dealing with all the same issues as well. And for me my number one job as a parent is to basically shade my child from everything that can possibly hurt them. I mean, our number one goal is to make sure that they are safe in all aspects. And I know what I’m going through as a long hauler, I’ve seen all of your stories. I would never want my child. I don’t even want to give him the chance to ever contract this. I don’t want to see him get all, any of these issues. And we don’t even know if this is lifelong.


So for me, I’m 30 years old. Lifelong for me is still a long time. Can you imagine something being lifelong for children? We’re regardless of their age, dealing with something that could have been prevented by just being as safe as possible. And it’s just, even if the kids don’t get sick, the influx of spread that we’re going to see kids carry viruses all over the place. They’re peachy dishes, right? They’re going to come home. They’re going to infect parents who are going to go to work and infect others. They’re going affect grandparents, who we know this virus has a bad effect on the elderly population. So even if it’s not affecting the kids per se, it’s going to be affecting a lot of people around us at this time. I really just don’t think that it’s smart. That it’s good. I think that we owe it to our kids to suck up whatever hardships that we’re going through. I’m a single mom. I’m not working. There’s bills piling up. There’s a lot of things, but in the long run for me my child’s safety is going to come first. I know this is my opinion. I know others don’t share that. I post this a lot in the mom’s groups and I get beat up for it. But if I can change one or two opinions and have a positive impact on their families and their outcomes, I’ll take it all day long. So Eric,


To me, it’s a simple formula before us is still on fire. The playground is in the forest, use your head, you know, and, and I hope I hope I’m wrong. I hope none of you have ever experienced what it’s like to lose a child, but trust me, if you do, your life is done. Nothing else matters after that. Okay. So to me, it’s a no brainer, but for those,


For those who want some more information, there’s a great there was a great article written by a woman. Who’s a PhD in education and also has a master’s in social work and she’s written two books. I can dig it up and it was how there are four different scenarios. And she goes through all four scenarios and the ifs ands or buts of each, she doesn’t come up with a conclusion, but she lays it out there for you to think about. And it’s a really wonderful article because, you know, there are, she does make some valid points for some kids who, you know, need some sort of help, but it’s basically, you know, she does look at the CDC guidelines. She talks about various educational problems, food problems, and how the government has to have certain things in place for it to happen and to help these people. But she lays out all these scenarios. And it’s really interesting because she looks at each one with clear eyes. Now I’m looking at this one. Now I’m looking at one and she takes everything into consideration. So it’s a good article to read it to, you know, and then make a choice from your head and from your heart, you know, that, but it is, it does give a lot of good valid information.


Yeah. I mean, when I hear people talk about the numbers or, Oh, the numbers there. So I just say, you know, my number is my number is 25. Okay. It doesn’t sound like a lot, but that’s how many people I know personally that died of COVID including my, my EMS partners, brother, and father, and cause life’s ever going to be the same again. So, you know, be smart. You know, it’s, it’s crazy and it’s crazy. But anyway does inflammation typ typically resolve itself over time? Sometimes it does. Sometimes it don’t doesn’t, you may need help. You can get one on Amazon for $15. I don’t know what they’re referring to, but someone else said, what is that called peak flow meter. Thank you now to get my PCP to believe that you guys are amazing. I he’ll believe it. Show my father.


No, I’m just kidding. The 10% rule is also what we use for endurance event training. So just think of yourself as awesome endurance athletes. Yeah. I mean again, and it might even be less than 10%. I don’t know. I mean, I’ve seen some people who like, I didn’t, you know, and I even said in the first breathing exercise, you may think we did nothing, but it’s okay. Cause you did some breathing and you got to see how you are the next day. I’ve got the same opinion as Noah about sending kids. I don’t even know what the opinions are going to be, but if you have the same one as me and no, one’s going to be very intelligent. I got the same opinion as Noah about sending kids back to an on campus school. And I’m a K-12 science specialist. Yeah. I mean, I dunno.


I just look at that my 15 year old is a long hauler. I’m so sorry to hear that. I started a group for parents of kids who are long haulers feel free to post it in my group or on my personal page or in parents group. And we’ll definitely distribute it 85 incent infants in Texas. We found in our group that anti-histamines are somewhat effective in symptom reduction is the mechanism of action against information. I’m sure it is. And you know, I had a thought a few months ago that I thought maybe I’m seeing you aware might work because Singulair has a leukotriene receptor and it’s anti-inflammatory, but it prevents the inflammation before it comes as opposed to treating it once you’re having this, I mean reaction, I’m an elementary school teacher, children that age will not recognize and be able to verbalize what I’m going through now.


Absolutely good point, Texas is where the infants tested positive. I feel a lot of elderly were affected because of living in care facilities that had to in their rooms. I feel like kids were not isolated. So kids were not isolated, so not exposed. Like they would be in a school to put them together in a kids. Jamie, please share your group with me. I will share it to my page. And that is all the questions. And it only took two hours and eight minutes. Well, maybe two hours in six minutes because we had to wait for parents to sign back in. But all right. My friends, I hope that was helpful to you. Hang in there. This is a tough one. I’m not gonna lie. It’s a tough one, but we’ll get through it. We’re learning more every day. I know it’s not going as fast as you want it to nothing ever does.


But just stick with it. We’ll, we’ll figure some stuff out. And this Wednesday is going to be Rheem Shariah talking about GI and liver manifestations of COVID. And I also want to talk to her about diet. What diet does she think will be the most helpful for people who are recovering from COVID. So hang in there guys, be safe, feel good, little at a time. And one thing I will ask, because I feel like I would be doing a disservice to the foundation, if not. So all the work we do is for the pulmonary, for and through the pulmonary wellness foundation we don’t get paid for it. We don’t take any money for it, but it does allow us to do more programs. So if you happen to have an extra million dollars, $2 million, $20 laying around pulmonary wellness, that or a backslash donate, it is greatly appreciated. Thank you so much. Have a great evening. My friend, see you on Wednesday. Thank you, Karen. Thank you back. Thank you, Maryanne and thank you to everyone else. Monkey knows the meeting’s over, so he wants to go outside. Have a great evening.


Bye guys.