Sunday Service: Chest Discomfort, What It Is, What It Isn’t, What It May Be


Good morning, everybody welcome to Sunday service. So today’s topic is chest discomfort. And the reason why I chose to talk about chest discomfort today is because it is something that many, many, many people complain about many, many, many long haulers have some experience with, and the causes for it are often unexplained and often remain unexplained. And, and in my opinion are often not worked up in the same way that chest pain would be worked up, you know, prior to Cobin. So I wanted to give you some ideas and I wanted to just kind of explain sort of my thought process, as, you know, as I evaluate chest pain or chest pressure or chest discomfort, and especially in light of the fact that we’ve just signed, Hey Eva ICU. Especially in light of the fact that we’ve just signed a deal to open up a post COVID recovery recovery clinic in New York city.


So we will be starting to do exercise testing with people, but I want to start off by just doing a short breathing exercise, and then I’m going to talk about chest, chest pain and discomfort, and then we’re going to do a meditation at the end. I encourage those of you who don’t to turn on your cameras. If you are not in witness protection, it’s not forced, but it’s nice to see people’s face and know who we’re dealing with. But it’s not required. So I want you to just find a comfortable spot and keeping with our headache, neck, shoulder, back and chest pain. I’m going to just take you from the head down to the shoulders, more eventually wind up in the chest, but just close your eyes and take a nice, easy breath in through your nose and out gently through pursed lips.


Very often, it’s, you know, people ask what should my breathing pattern be? And with COPD patients or pulmonary fibrosis patients, we make more of an effort to tell you specifically a certain count. But what we really want to start with is we want to start by breathing in for two and then just sort of let the air come out very gently. And you can also make a noise with it. Like if you want to go like like just release what’s what’s in you at the moment that’s bothering you. So let’s just take a nice, easy


Breath in through your nose and then Nice deep breath in through your nose. Nice deep breath in through the nose.


And then one more, ah, and let’s let your head drop all the way back as you breathe in gently and then just nice and slowly bring it forward and let it fall down as you blow out gently. So let’s put our head back and forward and back as you breathe in and forward and back as you breathe in and forward, and now put your hands on the back of your head and just give a little bit of extra pressure forward and feel the muscles on the back of your neck, stretching and hold two, three, four arms down once, come back to the center and let’s look to the right as we breathe in and let’s blow it out. As we come back to the center, let’s look to the left. As we breathe in and come back to the center, as you blow up to the right and left at center, I’m sorry, and left and center, right, and center and left.


And now what I want you to do is if you can put your elbows down on something, if you have a desk or something you can lean on in front of you punch your hands with the palms of your hands, the bottom palms of your hands, underneath your cheekbones, and put your fingertips on the top of your head and just nice and easy move your kids up and down. You can close your eyes and pretend it’s someone else. If you like nice, easy breathing in through your nose, out through your mouth. Now, as you do this, you may feel the palms of your hands sliding up your cheekbones, and that’s okay because those muscles get very, very tight. So just nice and easy. Let your hands slide up as you breathe And move your fingertips up higher towards the top of your head as your palms, keep sliding. And when your palms get to the side of your eyes, just nice and easy down and up, down and up, And just scratch your head like this and bringing your head all the way up as you breathe in and down as you breathe out. And now I want you to take two fingers and put them right over here on the insides of your eyebrows and just apply a little bit of pressure here and worried.


You may feel tightness. You may feel pain, but that, that means that you need this actually. And you can just very gently massage this area right here. And now we’re going to come a little bit further down to the sides of our nostrils and just give that same pressure. And now we’re going to go underneath the nostrils,


Same pressure,


And now one finger right in the center. And now take your right hand and just nice and easy down and up your arm




And switch sides. And we’re going to go down and upper arm.




And to our chest and take your right hand, put it across and onto your shoulder and put your other hand on top and just massage your shoulder. Give it deep pressure. A lot of people get very, very tight there.


[Inaudible] Give yourself 10


Strong squeezes, and then we’re going to switch sides. And when you’re ready, right ear to right shoulder left ear to left shoulder, right ear to right shoulder left ear to left shoulder and raise your arms gently up as you breathe in and blow it out gently, nice deep breath in and blow it out gently. Nice deep breath in and blow it out gently. And just last thing where you’re going to put your hands out in front of you like this in squeeze your shoulder blades together, as you breathe in, and then just pretend like you’re hugging a big tree. Don’t worry. Anti environmentalist. I’m not referring to tree hug. I can specifically squeeze your shoulder blades all the way together in the back and forward. Squeeze your shoulder blades together and in the back, and just put your hands in your lap and close your eyes and just nice, easy breathing, nice, easy breathing. And if, and only when you’re ready, feel free to open your eyes and return to the room with calm. Anyone feel any different after that comments, anyone like to share Debra Shiraga you look happy. Do you want to say something? It’s a morning here? So that was a nice little follow up to my morning vest and nebulizing little bringing me in back into my body and remembering I have a head in the shoulders. There you go. And they’re not connected or they aren’t connected, but sometimes they become one. Yeah.


Anyone have any discomfort during that? Not at all. Thank you. It made me feel so much better, much more relaxed. Thank you.


You’re very welcome.


The chat says I needed that. Thank you. Feel good. I feel so much better. Thank you relaxed. Very nice. Feel more relaxed. Can breathe more easily through sinuses and neck tension to the lessons like the mini message burning breathing. Alright, so guys, one thing that I try to get you to realize each and every time I speak to you is that there are always things that you can do. Okay. What we just did, that was not rocket science. Okay. I didn’t go to a book. I didn’t go to the ancient teachings of the masters for that. Okay. but it’s really about you learning things that you can do to help yourself feel better. So if your hands are right, like, I mean, how many people here have hand pain or arthritis or something like that. Right. What do we do? We say, Oh, my hands hurt.


Well, did you do anything about it? No. But look, we can take our fingers and we can go one finger at a time and we can lose them them and stretch them if our chest hurts. And we’ll talk about the chest a little bit, but just remember, there are always things you can do. And sometimes even the little breathing techniques a few breaths, like I always ask people after the first breath you feel any different. And if you feel different after one breath, imagine how you feel after 10 breaths or 30 breaths or five minutes of breathing with 10 minutes of breathing. So there’s one of my favorite quotes of all time is by basketball coach, John wooden. And he says, don’t let the things that you cannot do interfere with the things that you can do. And one of my concerns as it relates to long haulers is that very often I can make a little, I can make a little you know, I almost feel like I’m going to say what happens when a group of long haulers gets together, you know, in an elevator or something like that.


But in, especially in like a lot of groups and a lot of the narrative that I see in the news in the papers is about the poor long hauler, right? The victim, the victim, long hauler, who’s suffering and miserable. And believe me, I’m not in any way, shape or form making light of the fight that you are all going through. But as long as we continue to buy into that victim mentality and long as we continue to allow others to determine who we are and how we’re going to get through this, we’re not going to step forward. And, and, you know, I said this a few months ago, when you know, the, the idea was that we’re trying to raise awareness of long haulers. Well, everybody’s aware now, okay. So if the fight is one, let’s not keep, keep fighting that light for the simple reason that we need all of our time, our energy, our physical energy, our emotional energy, our spiritual energy, our financial and energy certainly to heal.


Right. And I told you this last week, but I’m going to tell you again I am really starting to see people making progress. I am really starting to see a lot of people getting better. And for the majority of people you know, it’s, it’s not fast, okay. It’s not a fast process. Okay. This was a scorched earth, you know, condition that we were not ready for, but the earth is growing back and people are starting to get better. So please don’t give up. If it means finding different specialists, finding the right specialist, finding the right healthcare team you know, we will help you do that. But I, I do, I believe from the beginning and I still believe more than ever that people are going to get better from this. And that’s why now is the time for us to open a rehab center where we can actually test a lot of our theories that we’ve been, you know, that we’ve been working on online now in person.


I want to talk a little bit about chest pain and pressure. How many people here at some time or another have had some kind of chest discomfort, pretty much everybody. Okay. And it’s a very, very common it’s a very, very common complaint with long haulers or anybody with Kobe, even in the acute phase. And it’s a very scary complaint, right? It’s very scary. And one of the things that makes chest pain or chest discomfort really confusing is that between our neck and our BeltLine, we have a lot of systems. Okay. We have the cardiovascular system, we have the respiratory system, we have the GI system. And the thing is that a lot of these a lot of these systems and a lot of the symptoms of these systems can often seem very similar in nature. Okay. So let me tell you, my background is I am a cardiopulmonary physical therapist.


I have been for almost 30 years. I’m also an EMT in New York city where I have been for almost 20 years. I’m a cardiovascular and pulmonary specialist. So this is what I, I do kind of day in, day out, but I kind of have this pre COVID life and this post COVID life, because everything that made sense pre COVID doesn’t make sense anymore in the context of COVID. And so, you know, people aren’t working them up in the same way, people aren’t working patients up in the same way, and it’s hard to find patterns in things. But let me tell you, you know, I’m going to talk a little bit about free COVID and then I want to tell you about current COVID and then I’m going to tell you about future COVID and how I, you know, and then I’ll take some questions, but when we hear the word chest pain or any type of condition from, from my perspective, my priority will always be life threats first.


Okay. So it makes sense. I worry about the things that could potentially kill you. So it’s always going to be a question of life over limb. And when we think about chest pain, there are many, many, many different potential causes of chest pain, but the ones that are potentially life threatening are as follows. So we worry about a coronary syndrome, right? Acute coronary syndrome, which is essentially coronary artery disease atherosclerosis. So when somebody has chest pain, or when we think about chest pain, we think about classic substernal chest pain with radiation down the left arm. But we know that not everybody who has chest pain, not everybody has coronary disease, not everybody who has a myocardial infarction or heart attack is going to have that classic chest pain. And we know that there are things that are called anginal equivalent. So some people will report some neck discomfort or throat discomfort.


Some people report some jaw discomfort, some people report some discomfort in their shoulder blades. Okay. But my philosophy always is err, on the side of caution and err, on the side of treating it as if it is your heart. Because as I always say, if we treat it like it’s your heart and it turns out to be that bean burrito that you ate for lunch, no harm, no done, no foul, but if we minimize it, okay, one of the number one, you know, one of the number one sin, number one, stems, symptoms or characteristics of people having a heart attack is denial, right? So if we say, ah, it’s probably just gas ads, probably just this and it is your heart. Then we have a situation. So to me, I’m always going to err, on the side of caution. So 31% of people who present to the emergency room with chest pain or having some type of acute coronary syndrome pre COVID, okay. 2% are having what’s called a pulmonary embolism. And pulmonary embolism gets a lot of attention in the context of COVID because we know that COVID can increase the


Clotting factors in, in the blood. And we know that there’s inflammation within the walls of the blood vessel. So that’s something we have to think about a lot. Pneumothorax pneumothorax is less than 1% and pneumothorax means some kind of leak or rupture or a collapse of one of your lungs. Pericardial, Tampa nod is something where that the pericardial SAC, which is the SAC around your heart, fills up with blood. And that is less than 1% aortic dissection, less than 1% or a stop at GL perforation, less than 1%. So 31% for people having chest pain free COVID we’re having some kind of coronary syndrome. So one in three, I’m going to the ER. Okay. That’s it definitely. Now let me tell you some other common causes. Okay. 30% of the people let anyone have any guesses of what some of the other ones are going to tell you.


There’s a 38%, there’s a 28% and there’s a 2% and a 1%. So what do you think the 30% is panic attacks? What is it? Attacks panic attacks, no reflux. Okay. Reflux 28% musculoskeletal causes and musculoskeletal causes could include anything related to your muscles, your bones, your tendons, your ligaments costochondritis is something that we hear over and over again. These days, pneumonia 2%. Okay. And peri carditis well pneumonia and pleuritis or what we call pleurisy, which is inflammation of the pleura, the pleura, or the air SA are not the air SACS that the casing around the lungs. So the pleura are to the lungs, what the pericardial SAC is to the heart. And then the last one is pericarditis. So that’s inflammation of the SAC. So the question is how do we know? Which is which, okay, so that’s all pre COVID post COVID, it’s a lot different.


But when we talk about you know, and the thing that we worry most about is that somebody would be having an acute coronary syndrome, but there are certain clues that we can get that will lead us in one direction versus the other. So let’s just start with, with a few of them. So there’s something that I use to kind of remember things which is called OPQ, our STI. Please don’t try to it. Remember this, please just go with what I’m about to tell you. So Oh. Has to do with the onset, right? So in other words, what were you doing or what was happening when you first experienced this discomfort? So if you’re just sitting on your couch watching TV, unless you’re watching something like the debate or you know, Sunday morning politics, it’s probably not your heart. Okay. Although sometimes during that debate, I actually wished it was my heart.


I have to tell you but, but the thing is that if you’re out shoveling snow and all of a sudden you get this chest pressure, well, that’s a pretty big signal. Or if you’re walking up the statue of Liberty and you get almost up to the crown and you get that chest pressure, well, that’s a signal because coronary disease is based a lot on supply and demand and it’s supply and demand of oxygen. So the more physically active you are, the greater the demand. And if you do have any type of coronary condition, then that will diminish your ability to increase the supply when necessary. The next thing is P and P has to do with provocation and palliation. So what that means is what makes it worse? What makes it better? And people will say, well, you know what, when I walk up the stairs, I could get one flight up.


But if I go up that second flight there, that is or somebody, you know, this can also be, well, you know what? I had this argument with my husband or my wife or the grocer or the cab driver or wherever it is you’ve favorite person to argue with is and all of a sudden you got this squeezing feeling in your chest. Okay. So emotional can take its toll as well. Q has to do with quality. And this is really important, right? Because quality has to do with sharper DOE squeezing, pressing. If somebody tells you they have a pointy, sharp stabbing pain, that’s almost never the heart. Okay. And one thing that you’ll hear from people a lot when they’re having a heart attack is they’ll say, it feels like an elephant is sitting on my chest, right? And unfortunately, one of the asthma companies that make an asthma medication did a huge disservice to everyone having a heart attack because they made a commercial in which they said, it feels like an elephant sitting on my chest.


And now people think that that’s asthma too. But then it has to do with radiation. So in other words, is something staying in one spot? Is it radiating down my left arm? Is it radiating around to my back? Is it radiating under to my armpit? Is it radiating up to my neck or jaw? These are things that point towards the heart as has to do with severity. So on a scale of one to 10, how bad is it? If you have chest pain that usually comes on after two flights of stairs and it’s often goes up to four out of 10, but now it’s going up to seven out of 10. Well, now we have a situation that needs to be checked out. Ti has to do with timing. In other words, is it intermittent? Is it constant? How long does it last?


And then I has to do with, what do you do to intervene? My experience with COVID is that I have not seen a lot of people. Who’ve had heart attacks. Okay. As a result of COVID, as a matter of fact, I’ve only seen one and I’m speaking now strictly from my own experience. Okay. I used to, I used to tell people, I used to say, if I tell you something, you could put it in the bank because I won’t tell you something I’ve read or heard. I’ll tell you only things I know now I can’t say, I only will tell you things. I know I can only share my experience. I’ve had one patient who had a heart attack after having COVID, but the person had had a heart attack before COVID also, and the person had a lot of risk factors. So just as a a, you know, a position of reference, I don’t think that COVID is something that’s going to cause you to have a heart attack, unless you had a lot of risk factors for a heart attack before.


Now, if you had a lot of risk factors before, and the risk factors for heart attack are family history, age gender. So males more so than females, and then eventually females catch up race cigarette, smoking obesity. Yes. High cholesterol, high blood, blood pressure, sedentary, but stressful lifestyle. So if you have a lot of these factors and you are at risk for a myocardial infarction before, it’s possible that COVID will push you more in that direction. But rest assured I have not seen other than that one patient, anybody who has had a heart attack after Colby, it doesn’t mean it doesn’t happen. And I’m not telling you that there’s nothing to worry about, but I’m telling you that the news just keep in mind that what you hear on the news is always going to be designed to get you, to watch the news.


Okay. Or to read that paper or to click on that air. So just keep in mind that they’re always going to try to make some excitement where there’s no excitement. Okay. It’s the killer storm. It’s the tornado. It’s the, you know, so, so just take everything you hear with a grain of salt. The other thing we, we, we worry about, or I worry about when I see a patient for the first time besides coronary insufficiency is a Rhythmia. Okay. Now there’s different kinds of arrhythmias. There’s different flavors of a Rhythmia. So for example, one thing that I have seen a lot, a lot, a lot, a lot of in COVID is Tackett cardia. Okay. Which means fast heart rate and some bradycardia, which means slow heart rate. And I see some people who kind of cycle up and cycle down from fast heart rates, slow heart rates.


And very often there’s no rhyme or reason to why are they doing that? Okay. So just as a point of reference, braided cardiac is any heart rate underneath 60 Tackett cardia is anything above a hundred. And the thing that we hear bradycardia and in, in conjunction with, or, you know, as in the same conversation with, as it relates to COVID is pot and autonomic dysfunction, right? So pots is postural orthostatic tachycardia syndrome, but that’s a lot different than an arrhythmia that just the heart decides, Hey, I’m going to create an arrhythmia here. Right? We can understand that when you stand up and I’ve told you this before, but you go from lying down to sitting up or sitting to standing all the blood rushes down to your legs. And when the blood rushes down to your legs and nothing’s coming back to the heart, less blood is being pumped with each stroke.


So in order to accommodate for that, the heart has to be faster. Okay. But in almost every case there that is what’s called sinus tachycardia or sinus bradycardia, meaning that it’s coming from the sinus node, which is the normal pacemaker of the heart. And although it’s super uncomfortable, sinus tachycardia and sinus, bradycardia are not lethal. And there are ways that you can actually, you know, settle them down immediately. So if you stand up and your heart rate, you know, rises all the way up, you can sit down, you can lie down, you can bring that blood back to the core of your body. And that should settle it. I have not seen one patient who has had a new onset of a lethal arrhythmia or atrial fibrillation. Okay. Which are some of the more common ones. I haven’t seen it. It doesn’t mean they’re not out there, but I’ve seen a lot of patients and I’ve spoken to a lot of patients.


And so my point in telling you this is that I think, I think I’m not sure. And just cause it’s not the norm for everybody doesn’t mean it can’t happen to you. But I, I think that the risk is something that we have to think about. And I think it’s something that the medical community thinks about, but I don’t think it’s something that a huge number of people or a majority of people are going to experience. And then the final thing is heart failure. Okay. And again, heart failure is a lot related to you know, myocardial, infarction, weakness of the left ventricle you know, things of that nature. But my point in telling you this is that even though it’s not something that we see a lot, it doesn’t mean it can’t happen. And for me and my patients, I want people worked up. Right. So I want to talk a little bit about the workup of the heart. So how many people here have had an EKG before?


Is there anyone who hasn’t had an EKG? Okay.


Because everybody’s had an EKG. Good. Well, gene didn’t okay. Well, gene, I don’t know why that is, but anyways, so an EKG, I want to just talk a little bit about what can be told from something and what can’t be told. So an EKG can definitely tell you your heart rate and an EKG can definitely tell you your heart rhythm and an EKG can possibly tell you if there’s coronary ischemia and an EKG can possibly tell you if you’re having a heart attack at that second or during that six, second period. So a lot of times people get the false impression that their EKG is okay, therefore they don’t have any heart trouble. Okay. If you’re somebody who has a lot of ups and downs in your heart rate, then it’s really important for you to get at least a 24 hour monitor so that it can be seen.


What does your heart rate do? And what does your rhythm do over the course of 24 or more hours? And particularly during different activities, like for example, during sleep, during activity, during things like that. So that’s my case for a 24 hour halter monitor or more. I also want people to get an echocardiogram because an echocardiogram is going to talk to you about the mechanical aspect of the heart. And the mechanical aspects have to do with the valves they have to do with the pumping pressures they have to do with the walls of the heart and things like that. And then there’s a lot of valuable information there. So when we talk about the heart, there’s really electrical mechanical, and then vascular, okay. Or circulatory disease of the heart. And to, in order to really determine directly the circulatory, you would be looking at something like an angiogram.


Okay. And the majority of patients are not getting angiograms now for the simple reason that what I just said, most people are not having acute coronary syndromes. So we want to rule out the heart. We also want to rule out respiratory. Okay. So chest X, right? How many people here have had a chest X Ray. Okay. If you’ve had an abnormal chest way, keep your hands up. If you’ve had an abnormal chest X Ray, put your hands, leave your hands up. So some people have had abnormal chest X rays. Okay. So one of the things okay that, that you can find out from a chest X Ray pneumonia, a pleural effusion, there is a lot of stuff you can find out from chest X, Ray, but what’s, what’s happening with a lot of people is that they’re getting normal chest X rays. So they’re short of breath, but their chest X Ray comes back normal.


And sometimes people don’t want to order a cat scan. You get a lot more information from a cat scan than you do from a chest X. Right? So that’s something else that, you know, I really would love people to get. And then, you know, we talk about the neurologic system and the neurologic system has a lot to do with the brain and stroke. And again, the majority of people are not long haulers who just one day have a stroke. These are people who were prone to strokes, usually who had a stroke during the initial phase. So let’s go back to chest pain and discomfort. So what are the more likely causes? Okay. Gastrointestinal, very common reflux. Okay. People underestimate reflux, right? People think it’s funny. You go to Nathan’s, you have that hot dog and you burp and you have that heartburn later and you feel like you deserved it.


Cause you had been Nathan’s and then you went on the site clone, but it can have real effect on other parts of your system. So for example, if you have bad reflux, okay, keep in mind. What is reflux? Gastroesophageal reflux disease means stomach esophagus means your stomach contents, which are very acid. Okay. The stomach has a lining. That’s supposed to be protective and that stuff is not supposed to come back up. But when it comes up into your esophagus, it can cause burning and it can cause chest discomfort. And in fact, the trachea and the esophagus are very close together. So stomach acid can actually come up and get into your respiratory system and inflame your airways. It can come up during sleep and inflame your sinuses. It can cause sore throat. It can cause force voice. So if you haven’t had reflux looked at as a serious cause of some of your concerns, you absolutely should.


Somebody asked the question is is bronchitis detectable on chest X Ray? Sometimes it depends on the severity. And what about silent reflux? So silent reflux. That’s a great question. So many people have silent reflux, meaning they don’t have that burning. Okay. But they do have other symptoms, meaning they may have the sore throat. They may have inflammation in the lungs and the airways. And that is something that should always be considered. A quick, simple way to tell if something’s is. So someone was telling me the other day they were having chest discomfort. At the moment that I was speaking to them and it didn’t sound like it was cardiac. He took four Toms and a large glass of water and it went away. So that doesn’t guarantee what it is, but it tells you pretty much that the stomach acid was something that was causing inflammation.


And one thing, if you’ve been listening to me at all over the course of Kobe that I believe is that there’s something called net inflammation, meaning some inflammation. So inflammation in one area contributes to inflammation in other areas. And I think that the more common places we’re going to see are going to be the respiratory system, cardiovascular system, the neurosystem as well as the vascular system, as well as the GI system. And I’m a big believer that inflammation in one area raises inflammation in other areas and it all contributes. And the more inflamed you are, the less chance you have appealing. So sometimes even a little bit of relief in your gastrointestinal system or a little bit of relief in your, in your respiratory system is enough to kind of quiet things down enough so that your body can start to heal because I’m also a believer that the body wants to heal.


And I’m also a believer that the body knows what to do to heal. And that very often we’re getting in our own ways by either overdoing it or someone, you know, I, I was talking to my friend who works at this famous chemist in New York city the other day. And he was saying, people are coming in, they’re buying 10 anti-inflammatory herbs or supplements, you know, at the same time. And they’re starting to take them all at once. And guess what? Seven anti-inflammatory herbs may actually increase inflammation. Okay. so it’s really important that we you know, that we try to just introduce new things once at a time, one at a time so that we can really tell what’s what so other things, so you were told, okay, someone said I’m having terrible GERD and have since March, I think this is the root of my breathing and heart issues.


GERD is very, very much related to respiratory disease. And so if shortness of breath is one of your issues and the other thing is he, even during exercise, the behavior can be the same, right? Because when we’re exercising, what’s happening, we’re increasing the intra abdominal pressure. So if you think about your, your abdomen in your thorax, as like a suitcase increased pressure in one area is going to encroach on the other area. So that’s why after like a big meal, or if your clothes are too tight or something like that, a lot of us have difficulty breathing or we have more respiratory problems. So my point in telling you all this is that number one, a lot of people have discomfort between the neck and the BeltLine, as well as the fact that it’s often not worked up. And I think that, you know, it’s really worth your while, especially for anyone who considers themselves a long hauler, then you know, you have to have a full cardiac workup, full respiratory workup, full GI workup, full neuro workup because that’s when your body will heal.


Okay. Once we know it’s nothing, that’s going to be dangerous for you. Then we could look at the things that are maybe not dangerous, but that are very uncomfortable, but that may contribute to your body’s total. Inflammation. I was checked for acid reflux was cleared and told it was inflammation. It could be something else. You know, an inflammation is a, is a very general term, large hiatal hernia and reflux. Again, if that’s the case it’s worth treating, I’ve been very swollen from the get go and think the diaphragm is pushing up into the chest, thus causing palpitations, awful, also inflammation in the head causing brain fog. So whether or not the diaphragm is pushing up into your chest that’s easy to tell that’s that’s detectable on a chest X Ray. So that’s definitely an issue. And that could also cause how petitions other questions started having PVCs post COVID.


I’ve had an echo and stress test and they can’t yeah. Find the clause. So can you, VCs are premature ventricular contractions, and most of us have them from one time to another or from time to time. Very often it could be related to electrolyte imbalance. So one of the things that we recommend to people over and over again is compression stockings, why to keep compression and maintain homeostasis Stacy’s and maintain balanced in the blood pressures electrolytes, because of this inflammation, we want to feed the body in ways that you know, is most natural to the body. That’s why electrolytes work and things like potassium, chloride, sodium, these things affect respiratory system. They affect the cardiac system. They affect electrical rhythm of the heart and so on and so forth. But then there’s the musculoskeletal stuff. So if you are able to palpate or reproduce your discomfort with your fingers or your hands or with a certain movement, then that is not your heart and that is not your lungs.


And that is something that we have a shot at taking care of. So one thing that we hear a lot is something called costochondritis, right? And what is that? That’s inflammation of these muscles and these ribs and the joint between the sternum and the ribs. And this can become very inflamed. And if you think about it, when you’re having difficulty breathing, okay, you’re working harder to breathe. Think of it almost as like an arthritic type condition, but for the thorax. Right. And also so normally the lungs will sit, the ribs will sit like this. So normally the ribs are at about a 45 degree angle. If you have an obstructive condition like emphysema, the ribs are flatter like this more horizontal and your chest is more hyperinflated. But if you’re not able to take a deep breath or you have pneumonia, or you have another respiratory condition, then there’s going to be a greater angle.


And in the same way that my fingers are very close together, these things can rub on each other. So this is where things like anti-inflammatories, this is where topical agents like heat and cold can help. This is where stretching can help. Okay. But my point in telling you all of this is that we want a simple answer, right? We all want a simple answer and there are no simple answers here. So it’s, it’s, it’s a lot of times you’ll see an article, that’ll say, this is the, this of COVID or this is why people get chest pain and Kobe. And I’m going to say that I think it’s probably different in different people, but a very good differential diagnosis and a good workup from the specialists is a way to figure out what it is. And until we really know what it is, you can’t treat it effectively questions.


I have done a full chest workup, cat scan, echocardiogram, and GI issues was told. I had gut and lung inflammation five months ago and was treated for both gut and chest are much better. However, I have a mid back behind lung pain as if I’ve been punched since five months ago. How do I tell if it’s musculoskeletal versus inflammation in lungs? Still? I noticed when I overexerted physically, cognitively, et cetera, my back pain seems to increase and decrease when things calm down. Okay. So that’s a lot right there. Okay. But here’s a couple of ways. Okay. So first of all, when you squeeze your shoulder blades together, okay. Try just squeezing your shoulder blades together. How many people feel tight when you do that? Okay. So if you do something like this, like you bring your arms all the way back and squeeze your shoulder waves together, then that elicits your symptom. That’s the musculoskeletal symptom. Okay. Put your hand on, put your right hand on your left shoulder and twist towards the left.


Anybody feel tight?


Okay. Musculoskeletal switch side.




Anybody feel tight? My back. Just want it to almost go into spasm there. My bipolar, I felt my back start to go. Whoops. And I, I luckily got out of it. That’s musculoskeletal. Okay. If leaning over. Okay. Another thing be aware of what you’re doing all day and your posture. Okay. Because a lot of people are spending time in bed. Okay. A lot of people are spending time just sitting. We’re sort of like, you know, totally supported at all time. The body is meant for bounds and it’s meant for balance between right. And left front and back top and bottom side to side. Okay. And a lot of us do this, right. So just, even if you just look at my position here, okay. A lot of us lean forward. A lot of us have these rounded shoulders. So if you think about what’s happening in my chest right now, my chest is like this.


My ribs are very close together. The muscles that we use displays our shoulder blades together. Those are completely stretched out. So let me tell you this, the way that a muscle gets nutrition and the way that a muscle re releases waste products is by contraction and relaxation. So when it contracts, it squeezes the blood out with waste products and painful metabolites. When it, it brings in blood that is nourishing and there’s something called the pain spasm cycle, right? So we have pain. So our muscles go into spasm to protect ourselves, right? So they go into spasm so that you don’t bend too far over and rupture a disc. But when your muscles in spasm, that means it’s always contracting and it’s not relaxing. And so it’s just squeezing, squeezing, squeezing, building up painful metabolites and waste products, never getting this. And this is where things like massage, acupuncture, physical therapy exercise, stretching, yoga, Tai Chi, all of these things come in.


And again, my message from the beginning has always been, don’t let the things that you cannot do interfere with the things you can do. And a lot of us have this very all or nothing, black or white thinking. So we’re like, well, you know what? I can’t do the things that I used to do. So I’m not going to do anything. Right. But trust me, the greatest successes I’ve had with long haulers have been people who have been paying and willing to inch along inch along. And they want to go in there, chomping at the bit and they want to go, go, go. But they, you have to be patient with them. Other questions, what does a good GI workup consist of covert symptoms? It really, it really depends what’s wrong. So it could be endoscopy. It could be, I mean, I would say like ream, Sheree, Shariah, who is the gastroenterologist that sees a lot of COVID patients with us, it could be something, it doesn’t even have to be a full endoscopy.


It could be something that just goes right in your nose, in the office to look at this, the throat in the esophagus to see if there’s inflammation. It could be something more like an endoscopy. I had a cat scan and have scarring in the lungs due to RA trouble breathing in, but no trouble breathing out, anything I can do to make breathing easier frequent cough when, when breathing in. Okay. Great question. So let’s talk about that for a minute. So when we talk about a respiratory disease or respiratory conditions, there’s two main delineations there’s obstructive conditions and there’s restrictive conditions. So obstructive is like COBD asthma emphysema, chronic bronchitis, difficulty blowing out. So people with obstructive disease will wind up with bigger longs hyperinflated lungs for people who have difficulty taking a deep breath that’s restrictive disease. Rheumatoid arthritis is a classic cause of restrictive disease as are things like pulmonary fibrosis, IPF arthritis or kyphosis and the way that you work on that.


Okay. Now the question Jean is what is really the issue. So is it that your rheumatoid arthritis has created a cage and you really can’t take that deep breath in, but the answer to, how do you develop bigger lung volumes are breathing exercises, focusing on breathing in, blowing out and exercise. Exercise is the single best way to improve lung function. I had a consultation with you in two weeks. I have a constant. So I wanted to ask that question because I was wondering if I needed to get another chest cat scan might go to doctor before seeing no, you don’t have to, unless there’s a reason why, you know, something else new going on, I had an echocardiogram and they said my ejection fraction was about 50 and I have some suspected atypical anteroseptal hypokinesis is suspected. So they have ordered a cat scan, CT angio.


Okay. So normal ejection fraction is 55 to 75%. So that’s how much of the blood is being pumped out with each stroke. So 50 is not terrible, but hypokinesis means that you’re not getting a strong a strong pump and a CT angio will tell potentially what the reason is. Julie. I frequently experienced painful pressure on the left side for several hours at a time, I was told that it’s probably a pulled muscle. Is there anything I can do to alleviate the pain and pressure when I have these episodes? Yes. All right. So let’s say this, how many people have pressure or pain on one side? Okay. So let’s say right now we have it on our left side, take your left arm and lean over and try to create like a half moon shape on your left side. Does that elicit the issue? No, let’s do it to the right side. Does that elicit the issue? No. Does it feel more inside than outside or does it feel like something when you move for me? You mean? Yeah.


It’s I mean, I, yeah, it definitely feels more inside. And it, it occurs. I mean, it can occur when I’m moving. It can occur when I’m watching TV. There’s really no pattern that I’ve noticed in terms of,


Okay. So let me talk about pain and pain as a general rule pain spasm discomfort. There are two things that are very simply simple to use, very simple to try and there’s virtually no potential harm that can come from them and they’re opposite to each other. They’re heating cold. Okay. So if you want to know, I mean, even if it is inflammation, cold will usually cool off inflammation. Okay. Warmth will usually relax spasm and alternating heat and warmth are actually very beneficial. So let’s say I have some, some swelling or some inflammation here in my shoulder, and I know it’s a little bit different than what a lot of you are experiencing, but when I warm it and heat, it, it dilates the blood vessels. It brings blood to the area. It brings healing nutrients to the area and it relaxes the muscles and the blood vessels.


When I put heat on the area that constricts the blood vessels and reduces inflammation, which means that all that blood and stuff that I just brought there, including the waste products can be evacuated from that area. So alternating heat and cold. And again, some of these things, we don’t know what the causes okay. But these are very simple physical therapy modalities that work. So he called stretching things of that nature. And if it is a pulled muscle, then it, you know, and again, any injury you get first 24 to 72 hours, ice is very important in terms of reducing inflammation. But again, there’s lots of different things that you can try. And one of the reasons why I am not hesitant to try different things with different people is because if nothing is happening, if there’s no diagnosis of something dangerous and you know, there’s no treatment being offered, then we have nothing to lose by trying stretching by trying different positions.


By also looking at your posture everyday, looking at your sleep patterns, because all these things contribute and, you know, getting moving, doing some basic stretches every day, doing the, you know, starting to get exercising little by little by little and once you’ve, that is once you’ve had the dangerous things ruled out hot and cold showers, not as effective. Okay. Because hot and cold showers are going to be the whole body. Right. And what we want to do. So think about it like this. If it’s the whole body, then the whole body is going to dilate. We want, if this shoulder hurts, we want to bring the blood specifically to the warm area. So same with the cold wondering when to see a neurologist for the vertigo, cognitive fog issues, a strange cognitive one I never had was I stuttered the other day and couldn’t let words out.


Couldn’t think of correct words. And when I finally found them, I stuttered and then had to pause a lot to get my brain back, lasted for a few hours and then went away. So that to me is an immediate co you know, that’s something I would go to the hospital for quite frankly, I would go to the, like, if ever you are in a situation where suddenly your, you can’t speak, you are, you want to say dog, but you say whistle. I don’t know. I just said dog whistle. I know why. Cause it’s in the news that wasn’t a dog whistle to anyone just in case you’re wondering, I wasn’t trying to send out a silent dog, but if you want to say one word and other words are coming out or different kind of tones are coming out, or you can’t think of a word, not that you can’t think of words.


Sometimes we all can’t think of a word and it’s like, you know, Oh, what’s your McCall or something like that. But if you’re stuttering and you never stuttered before, if you’re trying to say a word in other words are coming out to me, that is a potential sign of an acute neurologic condition. And I would go to the emergency room for that. And the reason I say that it could be, and the fact that it’s, it’s not, you know, that it’s back to normal now. It doesn’t mean that there’s nothing wrong. It means that it could have been what we call a Tia transient ischemic attack. And again, I’m always going to err on the side of caution. And if you say, Hmm, is this a hang nail? Or did I, did I bump my nail into something? I’m not going to run to the hospital for that.


But again, if it’s something that could potentially be life-threatening or life altering a stroke, a heart attack, a seizure, anything like that immediate care should be gotten. So if you’re okay now I would try to see a neurologist, as you know, like now is not, you don’t have to go to the emergency room the second, but I would try to see it in neurologist immediately, you know, as soon as you can ideally tomorrow. And if that ever happens again, I would simply call nine one one, and I would go to the house. I’m much, much, rather both as a patient. And also as an EMT, I’d much rather someone go to the hospital and I’d rather take you to the hospital a hundred times and a hundred times have it be nothing than not take you that one time and find out, Hey, something happened to you. So, and I know that the majority of people I work with, unless they’re lazy scales feel the same way. And you know, we’d rather take somebody to the hospital and have it be nothing and then find out, Hey, we miss something.




Any other questions, comments, feedback,




I wrote when I moved my head from right to left that vertigo. Yeah. And, and yeah


Go, a lot of people experienced vertigo. A lot of people are also experiencing other kinds of head, you know, equilibrium things as it relate as it relates to COVID. But I’m less concerned about that because vertigo is not dangerous to you. It’s super uncomfortable, but it’s not dangerous as long as it’s not a potential side effect or symptom of something else that’s going on. What, what concerns me more, more about that was stuttering. Couldn’t think of the correct words. You know, that’s, that’s something, I mean, a lot of patients who’ve had COVID are kind of reporting what, what they’re calling brain fog. And I believe that’s possibly inflammatory, you know, related and not necessarily an acute emergency, but if something changes, like if all of a sudden you’re fine. And then the next thing you can’t think of a word, not, not think of one word, but I’m saying you were stuttering.


You, you were, you had some clear neurologic kind of alerts. I want that checked out this week, for sure. So I want to leave you with a short meditation. And this one’s not going to be any movement. It’s going to be just a relaxation. So just close your eyes and find yourself in a comfortable position and start with a breathing pattern that is comfortable for you breathing in through your nose. And if you like, you can either breathe in through your nose or, or your mouth, whichever is more comfortable for you. And for this one, I’m going to ask you to suspend your reality for a few moments. And I want you to think of yourself as one member of our group, which is a pod of dolphins. And we are swimming in the ocean, nice, easy breathing in through your nose or your blow hole and out gently through your mouth.


And today is a simply glorious day. The water is warm and the sun is shining and there are several hundred of us. And if you feel like it, you feel like jumping out of the water and swimming or spinning by all means, do it. The water is crystal clear, and we could see our friends, the fish and the whales and the sharks. Nice, easy breathing in through your nose, out through your mouth. We can hear the boats above, and we know that those are our friends, the scuba divers that we see periodically look up ahead. There is what we’re looking for. A school of sardines, and we are swimming in and out, in and out having a delicious Sunday, brunch of sardines and we’re swimming faster and faster. And we’re screaming to each other, making those dolphin noises that dolphins love to make. We’re smiling. We’re laughing, we’re joking. The ocean is ours. The air is ours. The earth is ours, man. That sun feels good on our backs. And now that we’ve had something to eat, we’re starting to get sleepy. And the sun is starting to come down. Nice, easy breathing in through your nose or your blowhole out gently through your mouth.


Our eyes are starting to get heavier and our dolphin heads are starting to get heavy. As we start to slow down, the water feels so relaxing on our bodies and on our smooth skin, we’re returning to home and we’re starting to settle in for the night next to each other, feeling the warmth and comfort of our friends and our loved ones. Thinking back on that wonderful day that we had full of sunshine, sardines, swimming, peace, relaxation, and now we settle in for rest healing and rejuvenation. Keep your eyes closed and continue to breathe, allowing your head to become heavier and heavier. And if it wants to go down, allow it to nice, easy breathing, let your breathing slow down, let your Highlands become heavier and heavier. And only when you are ready, return to the ocean floor with peace and calm. Knowing that tomorrow is another day thoughts or feelings


Anyone want to share.


I never thought that I never thought to think of myself as a porpoise. And today that gives me a, a nice purpose. I think that was a very cool imaging and swimming sardines and sunshine is a good mantra. So I thank you for that. That’s quite a unique little revelation for me today. I’m going to porpoise today.


Julie said she, she had to pretend it was pizza instead of sardines. So guys, let me just say this. There is no absolutes in life and there’s no absolutes in Kobe for sure, but we’re going to keep trying different things and I encourage you to try different things and look for different solutions. And if things are helpful to you by all means share them. I could tell you that a hundred percent of what I know about covert, I’ve learned from you guys and we’re continuing to learn and you know, we will get through this. You will get through this. Okay. Don’t give up. And for those of you that haven’t yet bootcamp, okay. Bootcamp and have a great day tonight. Erica mashed pro bono and Lori needle, it starts with yes. And that will be more of an open discussion. And I hope that you all have a peaceful, exciting Sunday full of sunshine and sardines and Julie for you pizza, you know, it’s funny, you’re making that face.


I’ll tell you a funny story about a sardine. I went to, I’m drawing a blank on this chef’s name. He’s a super famous chef that has a Oh, Boulay chef David Boulay. So I think it’s a little late, but they started having these, these things dinner with the doctors where you’d go and you’d have dinner, they’d create a special, a special special meal for the thing. And a doctor would give a talk. And one of the things was a sardine and boy, I am really turned off by sardines. I don’t know why. I think it’s probably dates back to childhood when we’d see them in cartoons or something like that. But the person I was with was like, just try it, just try it. It’s rude not to try it. And I was like, I don’t care. I was like, it looks disgusting.


I was like, and then finally I was like, all right, I’m going to try it. And I tried it and I was like, like, Oh my God, I had to get this whole sardine into my napkin. And then I just, I took it home with me. I threw it out outside, but I don’t like sardines either, but dolphins love sardines. And it’s really exciting when you see dolphins in a in a pot of sardines or a pot of dolphins in a school of sardines, everybody a great Sunday. I hope you get what you want today and be kind to yourselves. And I will see you tonight, hopefully. And if I don’t, I hope you’re going to be doing something much better. So enjoy


Love you. [inaudible] [inaudible].