Inhale the GOOD…, Exhale the Bull… with Marion Mackles, PT, LMT!


Good evening, ladies and gentlemen,


My name is Noah Greenspan. I am the director of the pulmonary wellness and rehabilitation center and the pulmonary wellness foundation. My guest this evening is Marian Machlis who I will tell you about later. I want to build suspense. So one thing I wanted to just talk about for a few moments is the fact that every week that we see more and more patients, we’re learning more and more about COVID, we’re learning more and more about post COVID. We’re learning more and more about long haulers et cetera, et cetera. And at this moment, you know, I would say I’m seeing somewhere between 12 and 15 new patients in a week, and that is anywhere from, let’s say 18 to 24 hours of talking to COVID patients a week, which is a lot cause I get a lot of information. So, you know, I kinda like to each week starting this week update you as to like new thoughts and like new kind of paradigms as to where I think we are.


And this week, a lot of things came clear to me. And I just want to try to clarify these for you guys. So we all know that COVID presents itself with many, many different types of symptoms, affecting many different systems. And in many cases it seems kind of random as to who gets what, and it almost seems at times as if you can sort of reach into a hat and pull out a symptom or a system and that’s going to be what you’ve got today or, you know, like you can reach into, you know, you get your fortune cookie and your fortune cookie is going to tell you, Hey this is what it’s going to be. There’s a paradigm that I’m working on that I want to just kind of put in perspective for you guys in terms of how I think and how we think about how to get the best care for people dealing with COVID and particularly post COVID and particularly the long haulers, but it really applies to anybody who goes to any medical professional with a problem.


We really want to first find out like when it comes to COVID, I see it as kind of past present, future past present future. So you come with symptoms and what are the most common symptoms that we hear? We hear things like shortness of breath. We hear things like rapid heart rates. We hear things like extreme fatigue. We hear things like chest pain and pressure. We hear things like my heart rate goes up and down. We hear things like my oxygen goes up down, et cetera, et cetera, et cetera, you know what they are. And the thing about that is we always want to err on the side of caution and we want to make sure that anything that we do with you or anything that we tell you or anything that happens to you is going to err on the side of caution safety, do no harm, take baby steps until we know.


So it’s almost as if like we’re walking through a mine field and we’re not just going to jog across the minefield. We want to take steps and figure out what’s going on little by little. And when we take a good step, we’re going to take another step. Because as many of you know, the times when you actually can take a, you can overstep it. And we hear from patients. Sometimes you can do two minutes, no problem. You can do three minutes, no problem. You could do four minutes, no problem. But when you got to four minutes and 15 seconds, something happened and it was like a cutoff valve and that’s when kind of everything hit the fan. So first premium no-no Sara, which means first do no harm. When I talk about past the ghost of COVID past the ghost of COVID present and the ghost of COVID future, we want to ask ourselves, was there an incident caused by COVID?


So in other words, was there damage caused by Kobe? Was there an injury caused by COVID and that would fall, like, for example, for the, for the neurologic system that would fall under the category of a stroke, a bleed, a clot, something of that nature in the heart or the cardiovascular system that would fall in the category of a heart attack, or again, it could also be a clot. In the, in the, in the respiratory system, it could be something in the form of a PE, a pulmonary embolism, which is a combination of pulmonary and cardiovascular in nature. But could it be a pneumonia? Could it be a scarring or pulmonary fibrosis? And then we have the GI system and we have the other systems. And so that’s, was there an injury? Did you have something occur? Was there damage to an Oregon that is now causing you difficulty ghost of COVID past goes to culvert, present is, do you have something going on at this moment, even though we know you’re past the acute COVID phase, but do you have something going on in this moment that needs to be addressed?


Do you have an infection? Do you have an active pneumonia? Do you have an active PE? Do you have you know, something going on that if it’s not addressed is a situation for you and then we have future, okay. COVID future is, do you have something going on right now that is predicting to us that you may have a problem in the future? Okay. So that would be signs of a potential heart attack signs of a potential stroke signs of potential respiratory problem. And we want to number one, make sure that nothing’s going to happen to you at this moment. And we also want to protect you going forward and we can’t move forward until we make sure that you’re going to be safe. When it comes to COVID also because of the wide variety of symptoms. And because the fact that many of these symptoms are what we call nonspecific symptoms.


And when we talk about nonspecific symptoms, we don’t mean that you can’t put your finger on what the symptom is. It’s easy to describe profound fatigue. It’s easy to describe chest pain or pressure. It’s easy to describe you know, brain fog or high heart rate, but some of these things are nonspecific in the sense that they don’t point to one specific system or Oregon or actual conditions. So it’s really important that we get worked up. And as far as being worked up, you know, I always want to think of things in terms of highest priority first and work our way down and in terms of highest priority, the way I see, see this is cardiac is always going to take the highest priority. Neuro is always going to take the second highest priority. Respiratory is going to take the third highest priority and everything else is going to be after that because the heart, the brain, the lungs, if those are not functioning properly, that puts you at a great risk.


So if you’re having chest pain or shortness of breath or palpitations, et cetera, et cetera that could be any of those things. The basic rule of thumb, if you like patients and you want to help them is that you assume the worst until proven otherwise. So when it comes to cardiac system, okay there’s three things that I typically worry about from a risk stratification perspective. Number one is coronary insufficiency, meaning that your heart is not getting enough oxygen because of blockages in the coronary arteries. Number two is heart failure or pump failure. And number three is a arrhythmia. Now the majority of people that I’ve seen so far with any type of cardiac injury or I’m sorry, not injury, but any type of cardiac symptoms really far more so under the arrhythmia issue, but not in the classic sense of a Rhythmia.


Okay. It’s, it’s more that we’re seeing a lot of people with either Tackett cardia, which means you have a high heart rate above a hundred and some people are way above a hundred, or you have a low heart rate. Okay. A bradycardia and bradycardia is considered under 60. So 60 to 100 is a normal heart rate or people who have these various tacky Brady syndromes, where they kind of will cycle up to one 50. Then they’ll come back down to one 20, then there’ll be in the sixties and they’ll go back up. But none of those necessarily point to a cardiac problem that you might, that you would have had regardless. Okay. Some of the things that we talk about once we rule out the individual systems, we have to chalk it up to what many people are talking about as dysautonomia. And we’ll talk about that as we go future when it comes to the brain, okay, we really worry about stroke.


And so there are things that you can do to test for this so far. Let me just go back up to cardiac for a second. So there are two tests that I love for cardiac patients to have, or if we’re concerned about your heart, there’s two tests that I love for people to have, because as I said, we have mechanical issues. I told you what I worry about. I told you about a Rhythmia and arrhythmia has to do with the electrical system of the heart. I told you about heart failure, which has to do with the mechanics and the circulatory system of the heart, which has to do with coronary insufficiency. So how do we look at that? Okay. Everyone’s had an EKG, right? If you’ve had an EKG during this time, period, raise your hand. Okay. If you’ve had a 24 or more hour monitor, raise your hand much less.


If you’ve had an echocardiogram, raise your hand even less. Oh, well, a little more. Okay. But I also am seeing a lot of you who I know didn’t have COVID okay. So you ran, you had a, an, an echocardiogram, but the EKG is a, and the reason why an EKG is not adequate is because an EKG is a snapshot, right? So it’s a photograph in time. So I could be looking at you and I could be smiling and you take the photo and you have a nice smiling photograph and you turn around and I give you the horns. Okay. Or something like that, whatever it is you do when you’re mad. Okay. and any EKG is that second in time. And unless you’re actually having the symptom, that racing heart rate that we’re talking about at that second, then it’s completely missed. Okay. That’s where a 24 hour 48 hour, a 72 hour, a 144 hour, a 288 hour, a 576 hour, a 1000.


I’m going to stop there cause I can’t add anymore. But the idea of that is in that time period, there’s a high likelihood that what you’re experiencing is going to be caught on film. And when it’s caught on film, you are taking notes and saying, well, I was lying in bed and I was awakened by this gasp of air and my heart was pounding and they can look at that and correlate what was happening at that time, with what they’re seeing on the EKG and EKG will give us a lot of electrical activity, some indirect circulatory activity and some indirect mechanical activity. Okay. When you get an, you’re looking at very, very strong mechanics of the heart, and we’re looking at the pump and we’re looking at the valves and we’re looking at a lot of different things. But when we talk about circulatory and electrical and mechanical, it’s like a triangle and a problem with any one of those can cause problems with any of the other ones.


Okay. So if you’re having a cardiac issue, you’re having this racing heart rate, you’re having chest pain or pressure or squeezing or anything like that. I will say to people, and I say it probably a dozen times a week. I would love for you to have a cardiac monitor that monitors you for several days. And I would love for you to have an echo, but let’s see what the first thing says now, incidentally, okay. People are frustrated that they can’t see doctors. The majority of people are seeing GPS and their GPS are trying to muddle through this. Now anyone can order those tests. So if you have, in any case, if you have a GP and that’s, who’s kind of managing your COVID, you could say, Hey, listen, I was listening to this clown in New York city. And he said that we should you know, we should be thinking about this.


What about a halter monitor? What about a 24 hour halter monitor? And then depending on what that shows, because that’s going to be interpreted by a cardiologist anyway, right? They’re not going to send it back to your GP. Who’s going to be like, Hmm, no. So a cardiologist is going to look at it. They’re going to interpret it based upon that you can decide, do we need an echo? And based upon that, or based upon either one of those, do you need a cardiologist? Decision-Maker right there. Who’s with me, you with me so far. All right. Respiratory system. Okay. Okay. Respiratory system. How many people have had a chest X? Right?


How many? People’s had a chest X. Right? Okay. Raise your hand. If you’ve had a chest X right during this time and keep your hand up. If your chest X Ray was clear. Okay. Majority. Right. So what does this tell us? It tells us that you can have shortness of breath. You can have breathing problems. You can have a cough off, even with a cha a clear chest X. Right? Right. So that tells us that a chest X Ray doesn’t actually tell them everything that we need. And unless something is really significant enough to be what we call radio opaque, meaning that no light gets through it. Okay. And it’s going to show up as white on an X Ray machine. Well, then it’s going to be missed. So things like pleural effusion, it’s gotta be big to be seen on a chest X Ray at elect assist can sometimes be seen on an X Ray.


Pulmonary fibrosis can sometimes be seen on an X Ray, but not always. And so the chest X Ray is clear, but you’re, if the chest X Ray is clear and you’ve already ruled out cardiac problems, then we need to go further in terms of a closer look and a more intimate, which is the colonoscopy. Just kidding. Just making sure if you’re paying attention, it’s not the colonoscopy. It’s the cat scan. Okay. so it’s the cat scan. Okay. And the cat scan is going to tell us a lot of things that I’m a chest X Ray is not. But the reason why a cat scan is very valuable is because one of the things that we worry about pneumonia, people didn’t have pneumonia. They get over pneumonia. They go on to live normal lung lives. Okay. Fibrosis is a different story. And we want to be able to prevent things like pulmonary fibrosis.


And we want to make sure that if you do have anything that indicates that you’re getting pulmonary fibrosis, there are some things out there that are used in the pulmonary fibrosis community that may be of consideration to you. So that’s the respiratory system. And then in terms of, you know, the, the brain and the neurologic issues, okay. Then we talk about a cat scan of the brain or a head CT, what they call. Okay. And that’s going to tell you, have you had a stroke? Do you have any blockages, et cetera, et cetera, et cetera. And once we’ve got those three things worked out and we find out, Hey, guess what? No brain issue, no heart issue, no respiratory issue. That’s causing this. And it’s inexplicable. Why do I feel so bad? Then we go to our fourth and often most prominent enemy, which is dysautonomia.


Okay. And the thing about this Autonomia is that as dysfunction of the autonomic nervous system, and what that means is that imagine your autonomic nervous system and the autonomic nervous system is responsible for things like heart rate, blood pressure, oxygen, saturation, squeezing your guts so that you have Paris. Dosses you know, the, the, the kidneys making you go to the bathroom the liver. And the thing is that what dysautonomia is, and the way that dysautonomia is showing itself in a lot of postcode, long haulers, is that it’s almost like your autonomic nervous system, which usually sends out signals to the body. And the body sends back signals to the autonomic nervous system. And it’s constantly like, it’s like sonar, right? It’s like a whale sends out a signal depending on what the whale gets back at, knows the shape of things. But when you have dysautonomia, it’s like either something’s wrong with the signal being sent out, something’s wrong with the way the SIM SIM, the way that the signal is being received, something with the way the signal is being sent back to the brain and the autonomic nervous system or something wrong with the way that the brain is interpreting it.


Now here’s the good news. Dysautonomia is not going to kill you. Okay, it’s going to make you uncomfortable, but we can work with dysautonomia. And that’s why our protocol, which we are developing as we speak every day. And it could be modified, you know, hour by hour is rule out the things that are dangerous. Okay. Once we rule out the things that are dangerous, then we can start working on the things that are uncomfortable. And one of the things that’s really a hallmark of COVID and post COVID is this in increase in sympathetic nervous system activity. It’s an inflammatory process. It’s a very high energy process. It’s a process where it’s like, go, go, go, go, go, go, go. And your heart rate is high. And your blood pressure is all over the place, et cetera, et cetera, et cetera. So what do we do about this?


We must quiet the sympathetic nervous system. And, you know, I’ve told you this before about COVID bootcamp is based upon our original pulmonary bootcamp, which original pulmonary wellness bootcamp was designed to be a very, you know, kind of easy going, but progressive program that anybody can start. And what we found is that even though it was supposed to be in very easy, grow, easy going progressive program, that anybody could start, it’s still too much for certain patients who are post COVID. So if you’re in the boat where you just have so much sympathetic activity, then we need to quiet that first we’ve made bootcamp a lot simpler. We’ve cut it back a little bit, so that it’s much more digestible for you. And we’re going at a slower pace because what we don’t want is we don’t want to overstep the bounds. We want to know setback approach, even if it means we scale it back and go more slowly.


Okay. Just about every physician that I’ve spoken to in the last three or four months believes that this is going to get better. And at some point your symptoms will go away, but there are things that you can do to make them hang on and continue to exacerbate your body. And there are things that we can do to hopefully quiet the parasympathetic nervous system. And until we shake some of that inflammation, there’s no way to start stepping forward. So the beginning of everything that we’re doing is to get us up to the starting line, right? Because we’ve been knocked backwards. So we’re trying to dig out of this hole of sympathetic outflow, calm it down to get us to neutral. And once we get to neutral, then we’re ready to move forward. The overlap between being in the hole and moving forward is breathing. Okay.


And the reason for that is multiple, but breathing is the key to life. And breath is the key to providing our body with oxygen and helping us to remove carbon dioxide and waste products. And the thing is that if you’re still in that inflammatory phase, the breathing is going to help you to quiet that inflammation and to quiet the sympathetic nervous system. And if you’re at neutral and you’re ready to go, then the breathing is going to help us step forward and push forward. My guest this evening is Marian Machlis PT LMT, which means physical therapists, licensed massage therapist, Marianne and I have been working together since 1994, 26 years. We have been working together every single step of the way of pulmonary wellness since day one, August 27th, 1998, which is when we opened our doors in a room smaller than a room I’m sitting in right now. Marion is the chief of our airway clearance unit. She is knows everything probably about breathing and how to use it. She’s also a licensed massage therapist, which means she knows a lot about relaxation. And we’re going to talk tonight about breathing and COVID and for anybody who needs to relax, welcome to the show Marian,


I unmuted myself. Thank you. It’s good to be here. So I you know, it’s listening to what Noah said. It’s thank you for that introduction. It’s, it’s strange because you have to think about what I used to do post COVID. And when I’m doing now during this whole process and how it’s actually changed, changed my thinking or not so much my thinking, but how I work with people. So, you know, before this happened, and I think it’s, you know, if you look at parallels in your life, it probably is somewhat similar, which is before this pandemic, my specialty was with helping people clear their lungs, breathe a little better using all devices. And I was always very demanding. So, you know, I wanted the patients to do the best. So if I could get more was better, you know, but to work with always work with what the patient could do.


And and even when I, you know, it was a lot of hands on work now of course it’s not so much hands on work. And what I have learned is that I have to go back to actually that starting at the very beginning is more beneficial than starting somewhere else and trying to get the most out of it. What I found was if you back off and help the person find where, what they can get or help them relearn their body, then it’s a good thing. So having been a very rush rush, fast, fast type a type person especially when I exercised or worked with people I’ve gone back to a place that is much different. So I used to, we used to always joke. No, and I, cause I used to always say, you know, whenever I had to speak, I had to speak to people.


It was always Zen. And the art of, because I always did believe that you have to talk to your body and learn what your body is. But for me, it was talking to someone else’s body and hopefully conveying something to their body that would help them. Now, what I’m finding is I have to pull back and basically help you find your own Zen, which sounds a little like, Ooh, but you know what I’m finding it works. And the more I do it with people, the more I am learning, how to, how to help you learn a little bit more. So it’s a lot different than what it used to be, where I’d come on and say, Oh, well you have to do this and this and this and this. And here you use this and use this three times a day. It’s totally different. I have to throw that all out the window and just say, okay, let’s start from, here’s the starting line. Let’s start from getting ready, preparing for that starting line. And where do we go from there? Because you don’t want to take a false start and have somebody then say, ah, I’ll start back to the back to that starting line. You know, we want to get there and then make that entrance into the race.


And that’s sort of where I am.


So Marianne, when you’re seeing patients who are complaining of shortness of breath, okay, we know that shortness of breath can, can come from many different areas. What is your technique for kind of assessing their shortness of breath and helping them figure out what they need to be doing?


What I’m really finding is, you know it kind of goes back to school. I I’m finding that because the first of all, this whole group of people, who’ve never been short of breath who are now short of breath and that’s different from what I’ve been working with, where people gradually got short of breath. And then all of a sudden we’re very short of breath. So what I am finding is that when we are short of breath, you try very hard to suck that air in to get that deep breath and you overcome. And we, we tend to open overcompensate for it. So I’m trying to take a breath in, I can’t, I feel like I can’t breathe. What am I going to do? I’m going to try to stuff that air into my face. That’s, you know, and even if it’s into, out for I’m trying for that too, instead of letting it happen, I’m trying to, you know, I could do one, two or I could do, you know, and I find that people are truly trying hard to get the deep breath in.


And it’s almost like you’re trying too hard. So what I’m finding is I have to take people back when they’re short of breath and sort of help everybody discover what, what breathing is and become more aware of their breath because before we can really find out what is making you short of breath and how to help that short of breath is you sort of have to relearn what breath is to your body. But that said, I also will ask questions. When do you get short of breath? Is it when you do this is, and when you do that, another thing I’m finding is that a lot of people will be slightly short of breath, but once they start to be short of breath, trying to catch up with bad breath or what they, where they should be breathing, it, it triggers anxiety. And you know, I’m not saying that to make people feel like, Oh, you know, you’re all anxiety ridden. No, I do it myself. You know, I will catch myself every so often, you know, feeling rushed and like I can’t breathe. And that sense alone makes you feel like makes, prepares your body to me to read faster, get your heart going, et cetera, et cetera. So when people are short of breath now with especially working with long haulers, I find it’s, you know, let’s go back to just some place here and not finding how to become less short of breath. Let’s find out what breath is and start from there. So


Leads to my next question. Marian, what is breath? Okay,


Good question. Wow,


There you go. On Marian. Let me just say two things. Number one, everybody we’re recording this and it will be posted on our websites and don’t feel the need to furiously write notes. And there was something else that I wanted to say that completely escaped my mind. So I say you are not alone. My friends.


Okay. So what is breath? Well, breath can be a mechanical thing, you know, and ruled by the nervous system and breath is also can be something that your head, you can actually control a little bit through your diaphragm. You know, it’s the only thing that that is within the sympathetic parasympathetic system where you can actually, you know, it or the autonomic system where you actually have some control, you can hold your breath for a point until your body says, I’m making a pass out because I want you to breathe. You know? But I think the problem, I, how can I say this?


I think what most of us have forgotten and I’ve gotten very philosophical about this. Like, you know, it’s like discovering God or something. I’ve now discovered air room air is 21% oxygen. And this is the thing that we’re trying to breathe, get into our lungs. But what I’ve come to realize is, wait a minute, we are surrounded by air. We live in air like a fish lives in water. We live in air, but we forget that we live in this air and that is, it is around us. You know, we we forget that it is there and it’s just are here living in it. And we demand it. I need to breathe. I want, you know, I’m taking my air. Like it’s a can of food that you take off the, off the cabinet and, and, you know, open up and bring when you need it.


But the reality is we’re surrounded by it. We live in it. We have to partner with it. So my whole new concept of breathing is form a partnership with this thing that is around us. So what is breathing? I mean, do we want to go into, I mean, the mechanics, you know, is basically that your diaphragm is going to pull down and form a pressure system. You’re going to fill with air, your ribs are going to expand, and then everything’s going to relax and come back in. I mean, that’s the reality, it’s just like a bellow. And, but I think there is such a psychological component of breathing and that’s, that’s really what trips us up, not, I mean, yes, that isn’t to negate the fact that there can be scar tissue in your lungs or an infiltrate that blocks and blocks any gas exchange or blood that blocks gas exchange.


So, I mean, that is there, but how do we get beyond that through exercise through long clearance, but also just learning a breathing pattern. But even before that learning to relax into breathing, because if you’re like this, trying to get your air in, it’s going to be harder than if you had the same problem and you’re like this and trying to get into the front end, there’s a big difference. And I surprised myself often with people who are coughing can’t stop coughing, or, you know, are having their bronchials right now are very inflamed, incredibly inflamed from COVID or just now it’s like, Oh my God, if I had only known this, when I was working with that person who had bronchiolitis, you know, this, I would have started to do this instead of, you know, being a little bit more vigorous. So but what I’m finding is if everything slows down, we slow down the process of taking in the air and letting the air somewhat do a little bit of the job. And I know that sounds very esoteric and who, like I said, but, and if you, if I had heard a tape of me saying this about your even well, two years ago I just like rolled my eyes and said, Oh my God, who is this crazy woman? But


It’s true because she heard me saying it and she rolled her eyes and said, who is this crazy woman? I just want to add one thing to that. Marion, you know, you, you make some really great points and I, what I was gonna say before, and I better spit it out before I forget it again. You know, we talk about anxiety and we talk about the psychological and emotional components of breathing. Just to understand that when we say that we are not minimizing your actual problem, okay, we are not saying, Hey, guess what? There’s nothing wrong with you, snap out of it. It’s all in your head. You know, no, that’s not it. Okay. But think about it. There are very few you know, things in the world that are more terrifying than not being able to breathe. Right? I mean, it’s very few and far between, but there is a huge psychological component to it.


And as Marian said, breathing is one of the few systems that has both an autonomic component to it, as well as a voluntary or, or, you know, controllable component to it. So it’s not like you could say to your liver contract, squeeze some squeeze, squeeze, squeeze. You don’t say that to liver. You don’t say to your kidneys, alright, press that urine out. No, but you have voluntary control and autonomic control of breathing. But there is a huge emotional component to it. So it’s anxiety provoking that anxiety puts out more adrenaline fight or flight, and that makes you more short of breath and that’s the cycle we need to break into.


Right? Yeah, absolutely. And you know, I always, and I tell this story, but it it’s always made me remember when I was, when I was very pregnant and it was summer and it was like a 98 degree day and my daughter loved to move around. And one day she stuck her foot right in my diaphragm and I could not breathe. And I, as I was like gasping for air and bending over and getting into a total panic where my heart started racing all the way into my neck, you could probably see my brains going like this. And I was just, and people were coming around because they could see, I was like, you know, and my total fear and my head took over, Oh my God, what’s going, Oh my God, am I going to die? Oh my God, I can’t breathe. You forget that.


If you just, and it’s hard. I, I said, Oh wait, what do I teach people all the time? I teach people that you have control of this. You have the tool. So here I am, the person who has the tools freaking out. And I went back into my head and said, you have the tools for this. You have the tools for this. And I did what I needed to do to calm myself down, you know? And I went and I finally did get calmed down and was able to breathe again. I said to myself, I will never, this, this, this feeling is going to go into my library. So I always remember what my patients feel like when they say they can’t breathe, or when they’re going to a total panic attack because they can’t breathe. And because when you’re in that mode, it’s also hard to call upon your, your, your, your higher self to say, I know what I can do here.


Or at least I can try to, to, to use those tools that I’ve been given. Start with one, start with one thing, you know, don’t okay. I can do this, this, this, this talk with one thing. Let me get that one thing. Okay, let me hold on to that. Now I can add this and I can have that, but I’ve never forgotten that feeling. And so when patient tells me that they can’t breathe, anyone does believe me. I can’t know what it’s like, 24 seven, but I know what that feeling can be like. And there’s a huge, huge head component to, to it as well. Because as we get more frightened and that sympathetic fight or flight system goes into effect, doing what, making our heart pump even more and telling us to breathe even faster, we have to not only fight the fact that we, you know, that we can’t breathe.


We now have to fight another system in our body that is telling us, you know, we’re in trouble and in a very strong way. And I feel sometimes that that’s really what, you know, what the long haulers are going through right now and having to settle that part down because the body is like one big communication system. And, you know, it’s, they’ve got to work together. They’ve all got to work together. And if you think about the autonomic system, you’ve got one part of it that is, you know, fight or flight. It’s that stimulus the adrenaline, the, you know, the rush of the heart pounding. And, you know, and then there’s the other part, which is your rest or digest, which is like, okay, get totally like spaced out. And just, but your, you know, rest up, yes, let your food digest, but your blood sugar just, you know, but then there’s also that component of the, the, the, the brain in the gut that tells you, you know, that has some intuition that is either going to trigger your fight or flight or your, your chill, your rest or digest.


And these things all have to communicate. And they all get in the way of breathing, whether your lungs are affected or not, they all get in the way of breathing. You know, your blood pressure drops and you start to feel dizzy. You know, what’s going to happen. Oh my God, you’re back into that fight or flight fight or flight where all of a sudden you’re back into, Oh my God, what’s happening. What’s happening to me. What’s happening to me, the heart story, because it’s also realizing that your blood pressure is taking a dive and it wants to try to get that stuff back up. You’re breathing fast. You’re and now you don’t know what is happening to you because first you felt dizzy and now your heart is racing, a pounding in your chest. And now you’re thinking I’m going to die, but maybe you’re not, not today. As they say, as they say in game of Thrones, not today.


No, probably not. And that goes back to that, that goes back to why it’s important to have a good workup, right? Because if we worked up your heart and we know that your heart is good, and you know, then when you have something like this, you could say, well, this is very uncomfortable, but I know it’s not my heart. It’s my dysautonomia tricking me into, you know, and again, it’s, I’m comfortable, but it’s not dangerous. Marion, how do you explain the people who are short of breath? But their oxygen saturation is 96 or 97 or 98% because that’s something that we hear a lot.


Yeah. well, it could be part of the miscommunication from the dysautonomia. It could also be, you know, there could be some sort of gas mismatch, which I think you’ve spoken about before where, you know, the, the blood supply is there and the gas is there, but there’s, you know, it’s not getting into the system properly. There are all different reasons why, but when I’m finding is that a lot of it too, is a lot of people are very inflamed in their bronchial tubes. So it’s like this feeling of, or their throats. You know, a lot of long haulers are written with inflammation, vocal, chords, throat, bronchial tubes esophagus. So sometimes their lungs are actually getting enough oxygen, but it feels hard to breathe because they’re so tight here. So if I would just, just put here, it’s hard to get that air into the lungs. That air might be a hundred percent and your blood might be able to your, what your lungs are sending into your bloodstream. Is it not, has enough oxygen in it, but the feeling is that you’re not getting enough. And because you’re not being able to expand those lungs properly or enough. I, yeah, sorry,


What I was going to say is with the understanding that many people here are at different levels, physically, emotionally, intellectually good-looking anise. And I’m just kidding. You’re all good looking. But what I would love for you to do is to take us, give us three things right now in order that people can use. So like, let’s start with, you know, the essentials, the deeper cuts, and then, you know, something bigger so that people have something that when they leave tonight, when they start to get the shortness of breath, they say, wait a second, let me listen to it. Let me remember what Marian said, boom, let’s do that. And then let’s do a breathing exercise, like a quieting exercise, and then let’s take some questions from these good looking people.


Okay. So the first thing is an it’s, this is just, you know, what? We have always taught people what we teach people with asthma and different, different problems. So when you’re feeling short of breath, first thing is just try to just settle yourself down. Hopefully you’re somewhere where you can sit. If not, you can do the standing and I’m going to move my computer home. I have the laptop. Yay. I’m gonna move my computer down a little bit. So first thing you want to do is, and I think Noah has spoken about this in the past. You want to just quiet yourself down for a second and say, okay, I have this, I can do this. Lean yourself forward. You can put, I like using my knees, lean yourself forward. I like to put my used bulldog hands. Some people, you know, you can lean on your knees, but you’re putting pressure to open up that rib cage, little and dump your diet, your, your organs down a little out of the way so that your diaphragm can get better expansion. It also brings the heart a little bit forward. You’re now exposing the part of your back that ha gets a little bit more blood flow and putting it in a position where it doesn’t have to fight gravity as much. And you’re just going to take some breaths. Nice and easy. Then the pattern that no one has been working with when he talks, speaks with you in that in for two out for, for her slips blowing,


Like you have hot liquid on your spoon and you don’t want to blow it off. You don’t want it splashing all over the place. You just want to move that water just lightly. If you can’t do infer to add for four in, for two, out for three and for one app for two, and for three after six and for two out for six, whenever it is, that is your pattern. And even if you’re there and you’re just focusing on what is my pattern, it will take your mind off the fact that you are having trouble breathing and just fine. Let me try this pattern because while you’re trying to easily find that pattern, your breathing will slow down. You can also lean on a table. If you’re home leaning on the table this way, this way so long as you’re just dropping this part of your body.


If you’re on the street, you can lean against the wall. I mean, I have no wall that I can lean against right now. Like that leaning on themselves. I’ll do my make believe there’s a wall I’m sitting up, there’s a wall in back of me. I’m going to lean this way with the wall holding me up. So that’s one way, but it is, I mean, it is a head game. It’s a head game where you just really have to just stop. I know what to do. I have some tools. So you start with that. That’s one thing I would say in terms of your breath. The other thing that I would say is, you know, doing breathing every day, doing breathing exercises every day, but I hate it. This is the thing we used to always call them breathing exercises. And I hate that word because they’re really not exercises. They’re breathing, breathing movements, they’re cage movements. There are movement, their body movements that help you mobilize your lung, your rib cage, and feel your lungs and help you to get that help build your diaphragm a little bit. Cause people think that just built buildings. The diaphragm is playing there, you know, in a position, okay, make your stomach cough, blow it out. Walks. I need some more books. Let me put some more books on me, 10 minutes of this.


But there are a lot of ways to build your diaphragm just by using breath and movement at the same time, because let’s face it. When you are, when you are moving in life, you are not thinking about pop my stomach low. It, it breathe in it, you know, make it come in, make it go out, make it come in. You’re reaching for things and breathing. You’re pulling up pants and breathing. You’re standing up and breathing. So let’s train our bodies to do that and make, do movements that help us open up and utilize our bodies with the breath. So that’s one thing I would say very simply. Wait, I can’t hear you. Sorry.


Another thing that people think about is that


No, we can’t hear you can’t hear me. Well, we, we know you’re talking and you look like no better. Okay. That’s not what you want to do when you can’t breathe. Now it’s a little better.


I have to get it. Go ahead married.


So that’s one thing, another thing that I like is, you know, our position. So for instance, the rescue position that I taught you, which is rescue rescue breathing when you get like this or like this, or leaning on a table. Okay. So positioning. I as when I used to, when I did a lot of manual therapy, you know, we would get people on their stomachs as if they could tolerate it, to make sure that we could get a lot of their, their lungs exposed while we were doing cupping and things like that for different parts of the lungs. And what I found was that even when people are finished with any sort of lung involvement that, that laying on their stomach when they are having trouble breathing or getting on, a lot of people will get, you know, getting on, putting some pillows down on the floor and getting on all fours, you know, to help drop that diaphragm down a little bit, or get you in a different position for breathing actually has helped people breathe a little better. So that’s another thing positioning. I think that if every day everybody and it’s, it’s actually very easy, you know, I cause we don’t want to overdoing it. We, you know, I have this firm belief now that you do one thing, you know, or a few things, and then you give yourself some quiet breathing time and some inner thought time to refuel and get settled down your systems, your autonomic system, that sympathetic system settle it down and then you get up and do more things. So




In terms of multitasking to be nice to your body, you could be getting in the morning, laying in bed and put your hand and just put your hand up above your head and take some breaths in to make sure that that lung is getting some air and you’re moving that rib cage before you go to bed, you could do the other side, or you could roll over in the morning and do both sides before you get up. You could roll over on your back on your stomach and do some breathing on your stomach. So there are ways to even do before you get up in the morning. And then you could sit up and start your day where it becomes part of your normal day is take the time to breathe because we don’t do that. We don’t take the time to breathe. And especially right now, when you’re all want to get better and you want to get back to functioning the way, the way you are before this virus, there’s this rush to get to, okay, I need you to do this.


I need to do that. I used to do this. I used to do that and there’s this desire to get there, but we have to really slow down. So if you start the morning with some breaths in, in one position and then in the other position, and then you sit up slowly, you have taken breath in before you move, blowing out with the movement. Just like when you’re weightlifting take, you take a breath in to prime yourself and you blow out as that wave comes up. It’s the same thing you’re going to just, you know, every time you move, fuel your body and let it come out. So I guess those would be my takeaway. You know, it used to be other things I’m a big believer in in, in positive expository pressure devices for clearing lungs and things like that. But what I have found is that and I, I like using them for people who don’t have lung problems for singers, for other people, or just to keep your lungs clear if you have allergies. But what I’m finding is, again with post COVID things are so inflamed that sometimes that can be too much and start to irritate the bronchials or the vocal chords. So I paired back a lot on that.


Hear me now


It’s so low. I can hear you, but it’s very low.




Okay. Okay. There we go. Alright. So basically, if you were to say it like this, someone short of breath, first stop what they’re doing, right? Because we know that we have to put out the fire, right? We can’t add fuel to the fire. Stop what you’re doing. Assume the position. Right. So leaning forward, arms down and then the breath. Okay, awesome.


I’m going to turn off. I’m just going to take a moment to turn on a light, but watch this. I’m gonna, I’m gonna model, I’m gonna model for you something. Okay. I’m going to get up to turn off the light. So I do not want to exhaust my system and use up everything getting up and who knows. I might get dizzy. I’ve been sitting for awhile. I’m going to take a breath in. I’m going to stand up and blow out. I’m going to stop where I am. Ask my body. Okay. My feet on the floor, take a few breaths in and out in for two for four. Then I’m going to go using paced, breathing in to and out two, three, four to go turn on a light. I’m not rushing. That light will be there. There we go. Okay. I hope that doesn’t make me too dark. Oh, now I’m blue. Look at that.


We’ve got a new show called the blue woman group. I’m going to model that of what it looks like with dysautonomia. It didn’t work as planned. Hold on. So this is what it’s like with dysautonomia. Okay. Your body has been dropped off somewhere, but imagine has been put into total darkness. So we cannot move back in total darkness. Right? We have to feel around and say, okay, until we get the hang of things and it’s the same type of thing. So we are essentially retraining your brain and retraining your autonomic nervous system to interpret these. So the way we do it is we stimulate it. Right. See how it reacts. And as we get better and better at this, your brain will get smarter and smarter at knowing what’s okay. And how it should respond when your heart rate and blood pressure and oxygen saturation. Don’t I think she’s gone like today’s Marion’s birthday. So Mary, can you take us through, let’s say maybe like a three minute something that people can do starting today. That will be helpful to, to calm them down and help them create more freeway questions.


Could I take it? Could I take maybe five minutes?


Take up to 33 minutes married?


You don’t want to do that. Okay. What? I’ve been starting people with. Hold on. I’d love just me. Shut up.




So what I’ve been starting people with is like, as I was saying, you know, I used to go right into certain breathing techniques. Oh, what I want you to do is we need to relearn or reteach our body. How to be in an environment, how to be in the present, how to be, how to actually breathe. What we need to do is give our autonomic system time to process what is going on. So what do we know about air we’re in it? We breathe it, but we don’t think about that. It is there to just, it’s a thing that we breathe in and out, but it’s not. It is our environment. We’re surrounded by it. So what I want to start with is I don’t want you to think about, let me get a deep breath in, take a breath in load out, deep breath in, blow it out.


I don’t want you to do that, but I want you to do is just start with your hands. What does this have to do with breathing? It has a lot to do with breathing. Just breathe naturally. Right now we’re going to go into breathing in a minute, but just move your hands. Okay. You can close your eyes. Okay? What makes your hands lighter? What are they doing? Just move your hands. How does the air around you support that movement? It’s almost like being in water. You know, when you go into water and you sort of just let your hands float and move them around, it’s giving your body a message. What does that feel like? How heavy are your hands? How light are your hands? How much energy would it take to slightly move them up and bring them down. Okay. Just move your fingers.


Try to feel the air through your fingers. I’m going to be quiet for a few seconds. And I just want you to experience that and send a message to your body, not your brain to your entire body. Now stop moving your hands for a minute and just let them flop at the wrist. Just let your heads flop. And now just let your hands flop down slowly. Curl your elbow up and bring one hand up and bring it down again. How much energy did that take? How does he air around support you when you do that? And now try to bring it all back up again, both hands up near your chest and move it. How much energy did that take? How can you make your hands feel lighter? How can you use the air around you? Just support that.


Just move your hands and let your body tell your brain and your gut. Now I want you to go to your breath. Okay? What’d you just breathe in. Don’t try to get anything in your lungs. Just take a little air into your nose and breathe it out lightly through your mouth. Very lightly over that spoon. Don’t think about a breathing pattern. Just think about the air and how it felt in your hands and how it helped your hands and your arms. Move that area in. Ask yourself. Is it heavy? Is it light? Is it warm? Is it cool? Is it thick?


Is it thin? What does that feel like now? I want you to take a breath in through your hands. If your hands were breathing that in to make believe your mounts are in your hands, take a breath in and just blow it out. Nice and easy. Now, take it in again through your mouth. And now what does that feel like? What does it feel like as it comes out, what does it feel like? And look like as it disperse into the air around you and you breathe it back in and what does it look like as it comes out of your mouth and just helps your hands float around.


Now, we’re going to take a little bit deeper. Just picture it going into your nose. Don’t push it and just let it disperse into your rib cage. What does it look like as it’s going down? What does it feel like? Is it thin? Is it thick? Is it hot? Is it cold? Is it light? Is it heavy? Don’t try to attribute anything other than what you’ve you’re feeling. If it’s heavy, don’t try to make it light. Just acknowledge it for now. Let your body learn what it is and agree. Now, if you were here on Sunday, you can sort of think about what Eric did. What does it look like? Does it have a color? Does, is it just dismissed? Just feel it dispersed in your lungs as you breathe it in and just dispersed into the air. Just floating away as it comes out.


Now, I want you to travel to your feet for a minute. How heavy are your feet on the floor? What do they feel in terms of the air around them? Is the air holding them up? Is it heavy? Is it light? Is it Chile? Is it warm? Can you feel the air around your legs? Now? I want you to in the Skippy difficult, but make believe your mouth is on the bottom of your feet next to the floor. Or there’s some sort of opening there. I take the air into that opening and send it to your lungs. Don’t try to force it to your lungs. Just picture it, shooting to your lungs, that center of your body. It doesn’t even have to be your lungs, just the center of your body, and then let it out. Let it disperse. Now, take it in through your feet again. Break it up to your chest and let it out.


And then come back to your mouth and your nose. Put your hands on your chest. Don’t try to force it in the air. Just feel your chest for a minute and bring your hands down. What did it feel like to put your hands on your chest? How did your body feel while you were touching it? Now I’m going to have you open your eyes, take a breath in and just say disperse in front of you into the air and ask your body what it learned from that. And then when you’re ready, just come back to reality or if you’ve been to reality already and didn’t take the journey. That’s okay.


But what I find is after people do that, especially when they’re feeling anxious, it just takes it away. But also when you take a breath in, there’s a little bit more awareness. So that’s getting to the starting line as a race. So now you might be ready to do something else. And then later on maybe some movements, but not right away. Just let that sink into the body. Sort of like, you know, doing if you’re a ballet dancer, it’s your bar before your, your, your dance. If you’re a piano player, it’s your scales or singer. It’s your, you know, vocal warmup before you start anything else, it’s just reteaching the body. And then eventually you try doing it standing, not for as long, but eventually asking your body how it feels when you stand, how do you move? How does it move? How do you move in the air? And you’ll also start to notice different days. It will be different. And that’s meant that is knowledge for your entire body. So knows how to deal with it.


Anybody feel different after that? How do you feel different? Well, we’ll free people up to unmute and we’ll, we’ll take questions, comments, and anything else that you’d like to share for the next 22 minutes. And as my old friend used to say, I’m Frasier crane


To do that.


I mean, people found it calming. So think about how you can use that. That’s a tool that Marian just gave you. This is like apex tech each week. We give you a different tool. You put it in your box and it’s yours to use until you get the next tool. But when it feels like things are getting heavy and like things are getting out of hand remember this and do it again. And guess what? This was the first time. So it gets better. It gets, it becomes easier to elicit. But it’s when we need it. Most that we often forget that we, these things


Fingertips very good. Joe Graham, she answered a lot of questions. I haven’t gone through her in my mind, although I couldn’t draw it, you know, I need help. I mean, I always knew it was in my mind. Fear takes you in getting back.


It’s empowering, you know, it’s, first of all, it’s empowering in her person.


I said, I’ve been going through the stages on my own. You guys come up here and it’s like, you go a little step farther. So it’s been a really good learning tool.


Marianne, what I liked the best about it was that last thing you had a stew when we put our hands on our chest, that was such a warm feeling. And then when I was breathing in, I was allowing my mind to let the air go through my entire body, not just my lungs, you know, it’s, it was, you know, some of this was, I mean, it comes from a lot of different things that I studied over a period of time. And a lot of it, I will tell you when I first studied it, I just think, Oh my God, this is who hooey. Honestly. And I had a lot, I was the type of person who would like to, you know, would do all these meditations. And like everyone would like, you know, B be into the CA candles and somewhere else. And I’ve had my eye open on that candle going, what the hell?


You know, or I could blow it out. You know, I could never focus. And you know, sometimes things happen that draw, you know, draw you back to remember and say, Oh, that’s why I did all of that because now I get it. And when I, what, what really stuck with me was I was working with somebody who I started doing this with. Because every time she took a deep breath, she was getting more and more irritated and also things were just falling apart. And it’s how do you learn to control? What’s falling apart. Well, first you have to listen to it. We’re so busy trying to find out what it is, which is good. We need to do that. We need to find out, you know, go through our checklist and make sure all our systems are in check, you know? But then at the time we have to start to feel that plane and just put it on the runway because the system check is, is, you know, is in the process of happening.


But when I found was I could come this person when they were sitting because it was, but then when they started to move, it was going away. So, okay. Let’s start with small little movements sitting. What does it feel like, then bring it to standing. What does it feel like standing? But then I realized it never includes when you’re breathing. How often do you think about your legs or your feet and what they’re feeling? They need that breadth and that support too. It’s like a tree, you know, you have this strong trunk, but it still needs to get its messages and its food from, from somewhere, you know, and send it up to the branches and the branches tell the trunk what’s going on. And the body is very much like that. So how do we do this? So I started working with her, actually standing and using that method to breathe in through her legs, which also took away when she was out of breath. That feeling of, I got to get it in here. It gave it a path from the ground up and, and freed her breath because she was giving her body what she needs. And again, I say, it’s all very esoteric and this is not like, so unlike me, but I have really come to a different place because of many of you. So what I’m giving you is what I’ve learned from you. And it’s changed my way. My evil ways.


Another thing to keep in mind is that the airways have smooth muscle lining them. And if, if you were to, let’s say, go out on a cold day to exercise, your muscles would be tight, right? And if you move them too quickly or too vigorously, you could pull a muscle where that muscle could go into spasm. And it’s the same thing with your airways. So, as Mary had said before, like when a singer is saying all of a sudden my heartbreak and they all, you know, they warm up and they do their scales. That’s a way to kind of relax the airways. So if you get out and you start to quickly, well, that’s going to cause your airways to constrict. So if in, for two and out for four is too much for you, then I go in for one out for two, and then you build up. And then as the muscle in the same way that if we’re stretching our, our, our hamstrings or something, as the muscle starts to loosen, you can go a little bit further. But if you go too quick, that’s when we get that kind of swing back.


Other questions I’m going to, I’m going to bring some questions from the chat was awesome, man. The chat open that it was awesome. Man makes me, someone else said it’s totally radical, dude. When, one thing, when, when it says like, you, you feel like you want to go to sleep, okay, this is what I think I say, don’t fight it. Okay. If you get to like, for me I was never a good meditator because it, I know you can’t tell, but I’m not that patient. Okay. But the thing is that the way that I learned to meditate was actually underwater when I was scuba diving, because what would happen is I would feel something coming over me and instead of fighting it, I decided to go with it. And I have this strange phenomenon when this happens to me, I hear the music from Ferris. Bueller’s day off. I headed a voice in my head says, Oh yeah. And then I just feel myself sink into it. And I’ve actually had people come up to me underwater and shake me to see if I’m okay. Now I can do it anytime I want, but that is parasympathetic activity. So if you feel like you have to yawn, if you feel like you have to sleep, if you feel like your eyes are getting heavy, don’t resist it, go with it. That’s the magic. That’s what we’re looking for. That’s the creamy center.


And actually, you know I know there were a lot of questions the other week when we were discussing, you know, do something and then take a rest break. And that doesn’t mean going on the tube, you know, the rest right. Can be, you don’t need to sleep, just get in touch with, just do some breathing, get in touch with one part of your body, rest your, your system, and then start something else because what I’ve found. And I know, and no it’s been fine. What we’ve been finding is that if you overdo it, you know, it sets you back. So how do you not overdo it? You need to just put these rest periods in your day and in between things, what do you do during those periods? You could sleep, but that might not be the, maybe you don’t feel like sleeping. It might not be the best thing to sleep. So you can go someplace and teach your body something, give it some, you know, start feeding it, different types of messages to rest so that it can then refuel for the next thing that’s going to happen in your day. Trying to keep that, that level, that sympathetic levels of, of, of stimulation here instead of there.


So another thing is that, you know, w we say, just be right. A lot of times people think they’re resting and they’re not really resting they’re on Facebook, or they’re on, you know, watching TV. I don’t know about you, but when I watch TV or I watched the news or I’m on Facebook, I don’t consider that relaxing. I consider that the opposite. And you know, one of the things we talk about, somebody asks what are long haulers, long haul, or is that people who’ve had COVID and their initial viruses gone their quote two weeks are over, but they’re still having symptoms weeks and months later. But the idea is that, you know, it’s really like long haulers. Like there was an initial push for people, you know, like COVID long haul survivors to be recognized. And, you know, we are recognized now you guys have done the job.


Okay. Everybody knows that long haulers exist. And I think we need to put that fight to bed and focus on healing and stepped forward. And that’s why last week, you know, we, we turn the corner to say, let the sunshine in or let you know, let’s, let’s let the light in, you know, there’s a sting song in which he says, you know you look different somehow. And he says, you know, everybody’s gotta leave the darkness sometime, you know? And so, you know, fight the fights you need, but we know you’re here. Okay. The medical community knows you’re here. I think it’s just now a matter of getting organized and, you know, trying to you know, take an organized pattern to getting you the care that you need. One of the things that Mary and and I do in our consultations is we really go through your history with you, help you figure out, did you have an injury?


Are you currently having an acute process going on? Are you at risk of an injury? And then how do we find out, is this something dangerous related to your heart or your brain or your lungs? Or is it just something uncomfortable? And if it’s something uncomfortable, it’s like when you’re nauseous or when you see sick, right? It’s like, it’s uncomfortable for you. It’s not going to kill you. It feels terrible. And dysautonomia is a lot like seasickness in many ways. It makes you feel terrible, but we can work with that. We can train you in that. We’re not going to work and train you or push you if you have a 90% occlusion of your coronary artery. So that’s, that’s the key. So at this moment, I say, you know, fight the fights that you need to, but right now we need peace and we need to step into the light. And we need to move forward and get back to living again. Somebody said, I, okay. So Marianne, I feel tension when I, when I, what about the people that feel tension when they try to do these relaxing things?


Have, so I will first say, I’d say where, how describe what tension mean? Tension tension means a lot to different people. Are you, is your chest getting tighter? Are you getting, are you getting a performance anxiety? Like you have to, do you have to do it? Or, or is it tightness in your, your, your muscles in your musculature? So when you say tension, be more specific,


The person that asked this question, G F if you would like to unmute, you can talk this out. If not, I will pretend I’m you and I will.


So, yeah, so it w you know, it would help. It would be a big help to know what pension means. Cause as I said, if it could be come in many different forms,


So let’s break it down into physical tension animals.


Oh, here it is. The anxiety of doing the breathing perfectly created anxiety, but it’s not perfect. You don’t have to breathe. Perfect fifth. That’s the thing. It’s not, you know, you’re not breathing perfectly. You’re breathing, it’s your breathing. And that’s what we’re trying to learn is what is your breathing? So, so yeah, so this isn’t a PR and that’s the thing. It’s not a performance thing. It’s, it’s learning to know. And you try it again in the quiet of your own space, without my voice, you know, where you’re just at one point, let me close my eyes and let me just see how I breathe. How do I breathe? What does it feel like when I breathe, not the mechanics of the breathing focus on just the air, you know, around you and just having go in your nostrils and out of your mouth. How does that feel?


But do it on your, because this should be a learning experience for your body. I mean, I can only talk you through five minutes of it, you know? So it’s sort of a plan of rushed type of, okay, now we’re doing this. Now we’re doing this, but when you’re alone, you could spend several days just feeling quiet in your breath, then just on how it comes in and how it goes out. But it’s, there’s no perfect breathing. Breathing is it’s yours. It’s nobody, else’s your breathing is not my breathing. My breathing is not no his breathing, you know? And that’s, that’s also, you know, part of the thing about treating any autonomic disease or any, or any problem, even with lungs, this person’s fibrosis is not that person’s fibrosis, their vital signs do not respond. We, you know, we’re taught textbook numbers in school, blah, blah, blah, blah, blah, for this blah, blah, blah, blah, blah, for that. And then when you start working with people, you realize those textbook numbers have to go out the window because each person has a different life story, different injuries, a different way of metabolizing they’re on different medications. They came across their disease differently. They deal with it emotionally differently. So that, that is how that person needs to be exercised as that person.


And don’t out yourself. It it’s, it’s already stressful enough with what you’re doing with and, you know, life is life. You know, things don’t go perfectly. My, my grandmother used to say man plans and God laughs you will never achieve perfection, never. Okay. What we can hope for is those moments where it feels perfect, those perfect moments in life that are few and far between, but you know, don’t let perfect get in the way of good, you know, and, and there’s, you know, one of my favorite sayings is, is, is don’t let the things that you can not do get in the way of the things that you can do. And everybody here can do much more things than they can do, right? Like we said, okay, well, what percentage could you do? Most people here are probably 75%, right? That’s 25. So let’s inch it along.


Let’s inch it along, but be kind to yourself, don’t pressure yourself, that pressure that you’re putting on yourself, you know what it’s doing, it’s stimulating your sympathetic nervous system. So those are the times that you have to say, screw it. This is what personally I’m from Brooklyn. So I would never say screw it. I would consider that too light. I would, I would say something different, but, but the point is that those, you know, you’re not going to achieve perfection by striving for perfection. Okay. And just certain times you have to just, you know, this is a condition and this is a time in the world for grace and humility and for peace. Ooh, I just got the chills. I’m inspiring myself as I say this, but it’s really true. I mean, it’s really true. This is a very it’s a very chaotic time and there’s this constant assault on our senses.


And we have to find the piece where we have to meet the piece where it is. We have to be grateful for every bit of it that we can get. So if in addition to all this, you’re striving for perfection. I hate to tell you this, but that ship has sailed a long time ago. I entered physical therapy school with almost a perfect GPA. My plan was to go to physical therapy school, get straight A’s be valedictorian and go work at Russ. Luckily my hopes were dashed in my first semester when I got a C minus in a seven credit class. And it was the greatest grade I ever got and I had a one nine. So I went from almost a four Oh two, a one nine. I was not the valedictorian. I was the lowest GPA in my class. And I still got my dream job at rust, but shit happens people.


Okay. And at this moment, a lot of shit is happening and be kind to yourself. You know, it’s okay if you don’t feel up to it today, that’s all right. Take the moment. And if you don’t feel up to it this second, it’s not all or nothing. It’s not black and white things in black and white. Right. And the idea is that, let it, let it be. It’s not all or nothing. If you don’t feel up to it this moment, give yourself five minutes, come back to it. And if you think about how you felt after that five minute breathing exercise, imagine how you’d feel. If you did it for 10 minutes or 20 minutes or an hour, that’s a tool right for you. And I don’t know if any of you noticed this in the same way that I do, but I noticed that at every zoom meeting, all the cats liked to put their butts to the camera. Why is that? It’s every cat tell them to turn around. That’s the time


I want to address something about also the perfection, if I could, which is, you know what you may do. You know, I always say, don’t give it up right away. Try it a few times. You’ve you’ve actually acknowledged what it does make you a bit that it makes you feel that way. So do it a few times and see if it always makes you feel that way. And if it does, you know, there’s one of my favorite songs in a chorus line is, you know, that there’s a song. I feel nothing. I’m feeling nothing. You know? So, you know, if you feel nothing, go find a better class. And when you find one, you’ll be an actress and that’s exactly what happened and came to Paris. So, you know, try it a few times. If it doesn’t work for you, it may not be the right thing for you. Not everything works for everybody. So then you know what? We throw that out and we try something new.




There’s no perfection. It’s nothing. It’s it’s you. So


A lot of tricks. We’ve got a lot of tricks. We’ve been doing this for a long time. So everybody repeat after me from a chorus line. I really hope I get no other questions, shoot them out. I have a question, go for it


On the, on the breathing. So last Thursday was a setback for me. I was having a lot of shortness of breath. Then Monday there was an emergency situation with my dog. And then last night I had a terrible headache in the middle of the night that I couldn’t even concentrate. And I was doing slow breathing in each situation to not become anxious and, and contribute to what was happening. Is there a different kind of breathing for each situation where, you know, I had shortness of breath and then another one was true anxiety with my dog. And then last night, just trying to think through this headache, that that was just overtaking me in the middle of the night. So when I, well, my feeling is when you’re


Feeling very short of breath, the first thing I would start with is the relaxed or rescue breathing, where you get down in a position and be, and bear down a little bit, open up your chest and just focus on the slow breathing and see if that will, if that will help. You know, and sometimes it very well might be that, you know, the air quality itself, which is that message that you can send to your head that helps calm things down. The air quality itself could make it difficult to breathe the humidity or something else. So, you know, so you can suck in as hard as you can and it’s just going to make it harder. So, you know, it’s those things that you notice that you work with and just try to slow it down. So I would start with this first and then once you’ve kept that under control that has, that has been set a response in your, into your system.


Okay. So now you have, you went through that, you had that pouring in of adrenaline of catacholamines and you’ve, and you’ve gotten that stimulation in your system that can cause that can then, you know, get you overwork your your sympathetic nervous system. So then after you get control of the shortness of breath or feel like you have a little bit more control over it, then you can go into a more relaxed breathing pattern. So I’ll give you an example. One of my long haulers cut their finger the other day and they’re on blood thinners. So the first part was stopping the, breathing, the blood, the blood, rather, but that whole, the whole thing, which would do it to anybody, you know, got them all worked up and frantic. And then all of a sudden what happens, they couldn’t breathe. They felt lightheaded. They couldn’t stand up. They sat down, had a major headache, that major, major headache. It was like, boom, boom, boom, boom. Okay. So first thing we did while they’re have ice in holding their finger tightly and whatever, let’s get down into that position and just catch it. Let’s let’s just relax our breathing. You know, the bleeding is under control. It’s being taken care of, just get your bathing together.


Okay. The breathing settled down out my head. I have a headache now I can’t sit up. My head is so bad now, fine thinking back, let’s do our relaxed breathing. Let’s do this type of let’s go into, let’s go into a place where we’re relaxing a little bit and letting that headache go. Now, the headache was already triggered. So, you know, she also took some Tylenol, but sometimes the Tylenol will not work. When’s that headache that, that really painful headache comes in after that type of event where the heat is here and the inflammation just starts in the boot and the pounding starts. But once we got her to a place where she could relax, it, it sort of made everything easier to cope with. And that’s part of it too. You know, there’s no magic wand to say, poof, you’re gonna, you know, you know, you’re going to be able, the headaches going to go away.


The brain, this is going to happen in this is going to happen. We have no magical wand, but we can, we can do what’s in our, our, our tool case. We can use the stuff that’s in our toolkits for our best interest so that we don’t go further down that rabbit hole. You know, if you can stop it here and just keep it here, instead of letting it go awry. Now, this is the person where a month ago would have never been, been in bed for four days after that, unable to move. But we were able to, we have now at the point where we can use those tools to sort of stop it there, maybe go to bed a little earlier, but wake up. Okay. It’s just, you know, it’s a spine line between rescue breathing, breathing for relaxation and also getting rest. And then, you know, getting to the point where, yeah, maybe I do have these symptoms, but I can keep them here instead of here. And every time you do that, you’re teaching your body. Something is it’s another good day in your book.


Somebody said most of the last I’ve been all day. That was wonderful. Evan said, I am one of those people who are short of breath, but had OTU in the nineties. I liked the breathing exercise, but leaning forward makes it harder to breathe. Is there an alternate breathing position? Yeah. You can do any breathing position that makes you feel comfortable. The reason why we recommend forward is because leaning forward does a couple of things. Number one, it allows the abdominal contents to drop forward, clearing the way for the diaphragm. But what if find a comfortable position there’s no right or wrong to this. Okay. We’re telling you things based on experiences we’ve had with thousands of patients over, you know, 56 total years between us. And you know, but it’s up to you to find your thing on Saturday at 12 noon Eastern time, I’m going to lead a, a 30 minute breathing session.


So feel free to come to that. And I will show you a lot more little things you could do. Other just quick announcements. Sunday nights at seven, we have a group that is now more transitioning towards more of a support group sharing type group than an educational group. And that was really nice. On Sunday night, we have a psychology psychologist who with us, we have a social worker who’s with us, but it’s really an opportunity for people to share their experiences with each other. Not for us to tell you anything, but just to sort of say, Hey, you’re not alone. We’re also doing consultations. They are strictly donation-based meeting that, you know, there’s, there’s not a specific charge for them. We want to be able to reach people who need it. And and that’s about it next week on Wednesday, we will have dr.


Dana McCarthy McCarthy from Mount Sinai medical center, who is a rehabilitation specialist and somebody that we will be collaborating with in the future to talk about rehab of COVID. And I think that’s a wrap Marion, thank you so much. That was brilliant. All the people who mentioned how young I look and clean shaven, let me tell you why I wrote four hours a day. I did shave, but I also wrote four hours in a convertible yesterday. So I’m a little burned and there’s a function on zoom where it says enhance your appearance. And apparently it really works. You guys can use it too. So have a great evening. Thank you so much, Marion, and feel good people, and you will get through this and your lives will get better. Promise you. Thank you. Thanks also. Thank you. Goodnight guys. Take care.