10-14-2020 Covid Rehab Update: What We Think We Know, What We Know We Think


So, this has been kind of a massive week for us. We did open our center this week and we did have some very positive experiences. Um, I know there’s a lot of new people here, so I want to refresh on a couple of things. I want to just kind of give you the state of the state. Um, as I see it, um, there’s a reason why this is called things we think we know and things we know we think because there’s still a lot of things, probably more things that are unknown that are known, but I feel confident that every week I know a little bit more and this week something that I have been thinking about for three or four months, uh, and suspecting, but had no way to prove it was proven to me this month, this week. So that’s very exciting and it’s, it’s actually good news.


So let me just start at the beginning. If people have questions, I’m happy to take questions at the end. I don’t expect this to go super long tonight. Um, but I do want to kind of catch you up because my time is limited and who knows when the next time we will be able to meet is. Um, but so what do we know about COVID? If there’s one thing I know about COVID that is very, very different than any other condition I’ve treated over the past 30 years is that it’s very unpredictable. It’s very variable. It’s going to vary tremendously from patient to patient. And very often it’s going to vary even within the same patient from week to week, sometimes from day to day, sometimes even over the course of the same day. So what does that mean? That means that we cannot lay out a longterm plan to say, this is what we’re going to do for the next 42 days, because it means we have to wake up every day and assess the situation.


And it means that rather than plan, um, rather than try to structure something that has proven in many ways on structural. I think it’s really important for us to kind of observe, to listen, to watch for signs and then to, to follow those signs and look out for red flags. Um, I think that instinctively, the body wants to heal and I think instinctively people often know what’s best for themselves, even though you may not be able to verbalize it, or you may not know the medical term for it. And I think it’s important that when your body says, I need to rest you rest, or when your body says I need to move you move. Um, other things that we found and, you know, just to give you a little history. So we had an online boot camp that was for cardiovascular patients and pulmonary patients for the past 28 years.


I’ve been treating cardiopulmonary patients. My average patient has been 80 years old, uh, going up into the nineties often and over a hundred several times. And we had a bootcamp for people which was a daily program that they were able to follow for 42 days. We thought this would be the perfect kind of jump off point for COVID once COVID hit. Except that what we found was that even the low level bootcamp was too difficult for many patients, my impression, um, and again, a lot of what I think I don’t have any proof for at this moment. It’s just what I’ve learned from speaking to so many of you. And at this point, I think we’re up to, you know, I’ve seen 145 long haulers for consultation and we have over 1500 people in bootcamp. So one thing that’s really, really important is to realize is that very early on, um, this is a hugely inflammation mediated condition.


And I view it as kind of people being in a range from negative 10 to 10, 10 is optimal health, negative 10 is not optimal health, but extremely mediated by inflammation. So for people in that state of the negatives, what you probably find, and by all means that people are finding different things. I’m happy to hear about them 95 or 99% of what I know I’ve learned from you, but it’s, it’s where any little thing could be, can disturb the system. So it’s like a hen house where you go in and one thing happens and all the hands get riled up. And I kind of described this sometimes as an electrical grid where inflammation in one area can actually set the entire grid off and we can actually see, uh, symptoms arise in other systems. So unlike cardiovascular disease, like, you know, coronary disease or somebody who’s had a heart attack, or somebody who said COSC COPD, or pulmonary fibrosis with those conditions, we kind of have a predictor double path forward.


We know, but it’s like, we’ve studied this for a long time. We’ve seen patients with chronic illness and for the majority of those patients, what winds up happening is that they develop disease and it progresses over the longterm. That’s different than many long haulers and the majority of long haulers who are really the majority of people. So I’ve seen one teenager so far, I’ve seen one person in their twenties. I’ve seen a lot of people in their thirties, forties and fifties. I’ve seen some people in their sixties and I’ve seen nobody in their seventies, eighties and nineties who are long haulers. Okay. So it’s a very different kind of thing. Uh, you know, when all of a sudden you’re healthy and active and strong, and then all of a sudden this has taken away from you, especially when it’s something that nobody has seen before, especially when it’s something that’s a totally novel Corona virus or a totally novel condition that you know, is also new to doctors.


Right? So as Karen said, you know, it’s, you know, I, I feel less that it’s, it’s that doctors don’t believe. I think it’s that so many doctors don’t know. Um, and I think if you don’t know, um, and I think part of the challenge comes in because people are testing normally in so many different ways, but their symptoms tell us that there’s definitely something that’s abnormal. So as an example, this is not like treating a cardiovascular disease or a pulmonary disease or a neurologic disease or a gastrointestinal disease. It’s like a cardiopulmonary condition superimposed on neuro superimposed on gastrointestinal. And then when we talk about dysfunction of the autonomic nervous system, that’s a whole mixed bag. That sort of means like we’re on a ship and the floor just keeps moving every day. So it’s almost like a moving target that never sits still for us.


That’s the challenging part. Um, something else that I definitely know is that for many people, um, when they overdo it, okay, it can set them back significantly. And that means it could put them in bed for a week. That means it can cause a relapse in their symptoms. That means it can cause an increase in severity of their symptoms, or it means it could even onset new symptoms. So when you’re in that inflammatory state, it’s really important that you under-do as compared to overdue. So what a lot of people find, and, and it also, when it comes to inflammation, I think there’s this idea of like net inflammation and kind of some of inflammation. So it’s like all the inflammation in your body adds up and it’s like a pot boiling over. And when that pot boils over, it’s almost like a cutoff switch, other things I believe strongly, I’ve spoken to you about the budget and it’s almost as if you wake up every day and you’ve got a debit card and this has a hundred dollars on it.


And it doesn’t matter if you spend that hundred dollars physically and physiologically emotionally or cognitively and intellectually, okay. It all comes from the same budget. So if you do something that’s extremely physical that might affect your emotional and your cognitive, if you do something that’s very cognitively demanding, like you do your taxes or something like that, that can take away from your physical. And if you do something that’s emotional, even if it’s good emotions, okay. Even if it’s that you got a call, that something great happened, um, and you have, uh, you know, uh, this excitement that can be enough to boil the pot over. So it’s really important to just be aware of this that’s things that we’ve known. That’s the thing, as we’ve observed in a lot of people, that’s things that you people probably know a lot better than I know now here’s some good news.


Okay. We’re seeing a lot of people starting to make progress. We’re seeing a lot of people starting to get better for some it’s taking longer than others. Um, we know that’s true. Um, but we are seeing a significant group of people that are able to do more, whose symptoms are becoming less severe, whose some symptoms are going away who are having less symptoms, um, and who are able to return to more normal types of lifestyle. And I’ve always believed that once we can kind of cool that inflammation off, that we will be able to push people more vigorously than we’ve been able to push the people in the more inflammatory phase. So, Oh, my, you know, ask of you is that for the people that are still dealing with this huge amount of inflammation, be patient, the work then is to quiet the sympathetic nervous system and to enhance parasympathetic tone so that your body can heal.


The sympathetic nervous system is fight or flight. It’s, it’s mediated by adrenaline. It’s very inflammatory. And that’s something that we’re seeing in a lot of COVID patients and it’s actually the big mediator in COBIT itself. So for me, when I see a patient or counsel a patient, the first thing I want to do is I want to make sure that they’re safe. So I want to rule out things that are going to be dangerous for them. And that usually goes in order of cardiac, okay. To make sure that people are worked up properly. And that means any EKG, but for many people, especially people who have arrhythmias, it means a, uh, it means a, um, halter monitor. It means an echo, which is going to tell us about the mechanical parts of the heart, and then in some people, a stress test, but for many people, a stress test is too vigorous to begin with.


Then it’s the neurosystem. So we want to make sure are people developing clots, are people at risk of a stroke? Uh, then it’s the respiratory system are people at risk of clots, are people having the Monia are people at risk of PE pulmonary embolism and are people at risk for pulmonary fibrosis? And then finally it’s, you know, this dysautonomia, okay. And the audit, the dysautonomia or dysfunction of the autonomic nervous system again, is the wild card. And that’s what controls your heart rate and can make your heart rate go in ways that it shouldn’t, it can control your blood pressure in negative ways and positive ways and many other things. But I have seen a lot of patients improving and now that we’ve gotten into the clinic, so we’ve seen three patients. And the reason why I wanted to get into the clinic is because I wanted to test a lot of the theories that I’ve having.


So let me talk for a moment about dysautonomia and orthostatic intolerance and pots. So one of the things that many people experience is that position changes are very difficult for them. So going from lying down to sitting up, going from sitting up to stand, and part of the reason for that is because when you change position to go from a horizontal position to an upright position, meaning sitting up or going to standing gravity is actually going to bring all that blood down to your lower body. And the big issue with that is that blood is not returning to the heart. And so the heart usually has two ways of increasing cardiac output. It could be stronger, or it could be faster, but if all the blood is down in the legs, there is no blood returning. And it’s almost like pressing a toilet bowl without giving it a chance for the bowl to refill or for the tank to refill.


So the heart is pumping, but you’re feeling symptomatic. What I’ve always suspected about COVID patients. And I’ve learned this based upon treating pots patients. And I’ve learned this based upon treating heart failure patients. And I’ve learned this based upon treating, um, pulmonary hypertension patients is that instead of babying certain people, once they get to a certain point or instead of taking them at now, there are certain people who we have to go very, very, very minuscule steps forward to make sure that we don’t overdo it. But there comes a point where if we actually get people moving and we can get their calves pumping, we can actually see a rise in their blood pressure and not a drop in their blood pressure. And that’s what we’ve seen this week into patients. And if it can happen in two patients, it can happen in many more patients.


Um, and that’s, that’s my report. So for those of you that are unaware, we do have a bootcamp for COVID patients. I encourage you to go on it, but contrary to what the original idea of bootcamp was, which was essentially, um, 42 days in which each day we progress you, it can’t be that way. It can’t be that set in stone. Okay. COVID is something that we have to show the respect COVID is in control, and we have to get up, see how we feel that day. Assess, listen to the signs, air on the side of caution, err, on the side of underdoing, rather than overdoing and as the body allows us to, then we take the steps forward questions and comments




Um, no, I was going to say that really like the beauty of the bootcamp in a way, because it’s set up where you can do one minute, one minute, two minutes, four minutes, et cetera, and kind of pick and choose what you’re feeling on that particular day. And that’s what I’ve been doing with it. I haven’t made it even though it’s been six weeks, I haven’t gone from day one to the sixth week glass day, but I’ve just been choosing what I can do on that particular day. And that’s, what’s really helpful with that. I think that it’s, you’re able to make it work for you in different days.


Thank you. That was actually an adaptation for COVID. So that was not in the original bootcamp, but we realized that we needed to cut things back a little bit. Um, and the other thing is that, um, so for example, um, in normal bootcamp, let’s say we would go four minutes, five minutes, six minutes, seven minutes, eight minutes, nine minutes, 10 minutes. But you find that when you get to five minutes, okay, you get tired. So if you get tired every time at five minutes, then you can imagine yourself going 10 minutes. So what, one of the things that we do with a lot of people is we’ll start, let’s say even at the very basic, so we’ll start at two minutes and two minutes, break it into two. So if you can’t walk for four minutes, you break it into two and two and then if the next day you, you know, and the other thing is, it’s not just that, Oh, we did it once we want to move up.


The goal of bootcamp is not just to increase time. The goal is to assess how you feel and the goal is no setbacks. Okay. So we only are going to go forward and we’re only going to go as fast as we can go safely and still feeling good. So if it means repeating a day, so be it, we repeat two and two, and then we repeat two and two again. And if we feel good and we get to the point to the point where, um, you know, uh, you know, we get to the point where, um, people are essentially, um, able to do a little bit more. Then we go from there, but we don’t want to go so fast. If you have to repeat the same day, you repeat the same day. And then when you’ve done it multiple times and you say, you know what, I’ve really got two and two down.


Then we go to three and two. Then we go to three and three. Then we go to four and three. So we’re still increasing by a minute, but the parts are broken up into smaller parts. And that actually makes it much more digestible for people. And I know that some people do one walk in the morning, one walk in evening. And if you have to go up by 30 seconds at a pop, so do it. So be it. But you have to ask yourself, how am I doing? And the key is that as we learn more and more, we’re figuring out that you know, that you have tools that you could use. You have breathing, you can use, you have calming methods that you can use. You have ways that you can lower your own heart rate, that you can lower your own blood pressure. We have tools like compression, stockings, electrolytes, uh, abdominal binders. But these are things to help get us over the hump until the body naturally kicks in on its own. Which again, I’m seeing more and more people system start to kick in and remember what it’s supposed to do.


Other questions or comments.


Yeah. Noah, can you speak a little bit? You said people are improving. And I remember in another talk, you went through the different systems in terms of pulmonary, cardiovascular and neurological and in terms of progress. And I wonder because a lot, my heart is a lot better. My neurological is a lot better, but the shortness of the breath and the gastro are still pretty prevalent. And the shortness of breath was my first kind of real symptom. And it seems like that’s lingering. So, um, when people are improving, are you certainly seeing a sequence in terms of the, um, different systems?


So a yes and no. So let’s start with this. The cardiovascular system progresses pretty quickly. Okay. The muscular system progresses pretty quickly. The neurologic system notoriously progresses very slowly. Okay. But you will only progress as quickly as your slowest system. Okay. So if you’re telling me that your heart and you know, this is, these are questions. Like when I speak, I try not to address one individual, but to give you questions to ask yourself. So if you were to say to me, my heart is improving. What does that mean to you, Dawn?


It’s not going into the TAC cardia as often,


So less tachycardia. Okay. So one of the things that a lot of people experience is tachycardia, fast heart rate. So anything above a hundred at rest is considered TAC cardia. But the good news is that for the people that are experiencing a arrhythmias, the arrhythmias that we’re seeing are what’s called SVT or a sinus tachycardia, which means that they’re coming from the sinus node. Um, they’re coming from the normal place. They’re just supercharged. Okay. So there are a lot of other arrhythmias that you can have that are very, you know, that are much of a concern that are potentially dangerous to you that are potentially lethal to you. Okay. That we’re not seeing those. I haven’t seen one of those. Okay. I haven’t seen one person who wasn’t in atrial fibrillation before that went into atrial fibrillation. I haven’t seen or heard of one person who’s had a ventricular tachycardia arrest.


I haven’t heard or seen one person who’s had V fit. Okay. So supraventricular, tachycardia or sinus TAC while very uncomfortable. Okay. Is not typically dangerous or lethal. Okay. So what it is is that the heart is beating very quickly. And the problem, as I mentioned is that it’s not that the heart is beating so fast, it’s that the lack of filling time. Okay. So the heart can handle that fast beat, but when there’s no feeling and when you stand up and the blood goes to your legs, okay. And there’s no venous return. The best way I can describe this is, imagine one of those long balloons that they make animals out of. Okay. So it’s like, if you put some water in there, that’s your blood vessels and that’s your blood. Right? So when the balloon is like this, the blood is kind of lined up along the bottom of the balloon.


And then when that balloon turns, all the blood goes down to the bottom. Okay. Now we have two main places where our body measures pressure, the carotid sinus, and the aortic arch, which is here and here. Okay. And even if I lean over the body, the autonomic nervous system is constantly monitoring. It’s like a super computer. So the autonomic nervous is going to say, wait, while our blood’s going over to the right. We better redistribute and constrict some blood vessels and dilate other blood vessels. Okay. So when you stand up, okay, or when you normally begin an activity, the body has two things. It could do. It could beat harder. It could beat faster. But one of the keys in terms of getting the heart to pump harder is venous return. The amount of blood that returns to the heart and a stretch of the heart, because that stretch is like, imagine like a boomerang and the harder you pull it back, the harder it’s going to pump.


But if all the blood is in your legs, then there’s no stretch. And there is no venous return. And then the heart only has the increased rate. That’s why compression stockings work because compression stockings are doing the manual work that the blood vessels are normally supposed to do. So we’re supposed to stand up carotid, sinus aortic arch says, Hey, wait a second. Our blood pressure is dropping. We better constrict all the blood vessels in our legs. But when you have autonomic dysfunction, one of the ways that it’s most prevalent is that you don’t get that vasoconstriction. And as a result, you don’t return the blood to the heart. So happens. You stand up, you feel dizzy. You say, okay, let me just stand for a minute. But think of it like an aunt Jemima syrup bottle, right? You turn it over. And when you initially turn it over, most of the syrup goes to the bottom.


But then over the next few minutes, if you leave it there more and more is going to drip down and you get to that critical point where you feel bad. So you may feel dizzy. You may feel lightheaded. You may feel vertigo. You may feel weak. You may feel like the blood is draining out of your face and your body doesn’t know what’s going on. So according to the carotid, the carotid arteries and the aortic arch, they can’t look down and say, Hey, Oh, it’s okay. We just stood up. And all the blood is now in our legs. It says, Hey, where’s all our blood volume. Did we get shot? We better raise that heart rate as fast as we can in order to make sure that we’re okay. So it’s a S it’s a, a give and take system. It’s like the autonomic nervous system is monitoring in response to the signals that get, it sends out other signals, and then the body is supposed to respond.


And then based on the response of the body, it’s going to send signals back to the autonomic nervous system. But for a lot of people, this dysautonomia or dysfunction of the autonomic nervous system, that communication process is off. So in the same way that if you had a broken leg, you might use crutches for a while. If your vessels are not constricting, that’s where the, um, you know, the compressions garments come in. So that’s like squeezing the balloon, the electrolytes and the fluids. Okay. That’s like putting more water in the balloon. Either one of those will increase and help you maintain the pressure in that balloon. So Dawn, the fact that you are not having as, so how do we determine, you know, if something’s getting better or worse, we look at trends, right? So if they’re happening less frequently, if they’re less severe, meaning that they, uh, your heart rates may be going high, but it’s not going as high.


Okay. Or they’re less period of time. Right? So it used to last for hours at a time. Now it’s only lasting for a few minutes. And if I do some deep breaths, I’m able to control it better. So that’s progress. Okay. And it’s really important. You know, it’s often hard, like when you’re digging through mud to kind of figure out where you are. And it’s really important, like to periodically look backwards and say, well, three months ago, this is where I was today. It’s not perfect, but I’m moving in the right direction. And my feeling has always been that there’s gonna come a point where that bird is falling, falling, falling, but still flapping its wings, flapping its wings, flapping its wings. And that there’s going to come a time when we can start pushing you. And I also believe that so many of these things are like these feedback loops and these cycles where it’s like this inflammation that causes pain and the pain causes spasm and the spasm causes more inflammation.


And if we can get, you know, to break into this cycle somehow, or if we can reduce the net inflammation somehow. So just as one example, you talked about gastrointestinal, right? A ton of people that have COVID or that are long haulers, have a big problem with acid reflux. Okay. And acid reflux. It’s not just like heartburn. Okay. It’s it’s not, that’s not the only issue with it. It’s that acid okay. Can go back. And the esophagus and the trachea are very close together. So when you lie flat again, gravity is going to move that stuff around. And if that’s stomach acid that the stomach is coated, like the stomach is able to take that. Right. But the trache is not. And the airways aren’t. So if that acid gets into the airways, now the airways have to inflame in order to protect you think about the fact that the majority of inflammation is really protective.


It’s this hyper inflammation that is detrimental to us. So like, if you’re standing on fifth Avenue and a bus goes by, or a garbage truck comes by in the middle of summer and blows all this in your face. Well, your body’s supposed to protect you produce mucus to catch it. Right. So it doesn’t get into your system. It’s supposed to constrict. So it doesn’t make it all the way into your lungs. But when it’s doing that and when the heart is in fight or flight, or when the body’s in fight or flight mode, pushing adrenaline all the time, that’s where the problem comes in. So Dawn, you talked about shortness of breath. So one of the tricky parts of COVID is that people are getting tested, right? So let’s first talk about the heart. So what do we learn from an EKG? We learn about the heart rate and we learn about the heart rhythm.


So we get some electrical information about the heart and we get some circulatory information because the heart has three systems, electrical, circulatory mechanical, but an EKG is a snapshot in time, right? So I could be looking at you all. You could all be smiling. I could turn around, you could all be giving me the horns or the finger or whatever it is you like to do, you know? And I missed it, right? So for people who are having these a Rhythmia’s or racing hearts or things of that nature, then we want to do a test. That’s going to catch it. And we want to be able to correlate it and see, well, what’s happening because different hormones are released when you sleep different hormones are released early in the morning, just before you wake up. And we want to know, is it related to activity?


Is it related to other things that you’re doing? And that’s where a halter monitor comes in. So in a halter monitor, is it 24 hour or more monitor? And that gives you a much greater chance to catch an arrhythmia. And that gives you an opportunity to keep a record of your activities and correlate the arrhythmia with whatever it is that you’re doing. And echocardiogram is important because an echocardiogram is going to talk about the mechanics of the heart. Okay. And that has to do with the pumping power of the left ventricle, which is the, the main pump of the heart it has to do with the valves it has to do with the chambers of the heart. And it has to do with your cardiac output. So that’s important. And then you can have a resting echo. Okay. Which is just, you go, and it’s an ultrasound of your heart, no activity, no medication, or you could have what’s called a stress echo.


Okay. So for example, if you have, uh, you know, uh, a defect, if you have a limitation, if you have some dysfunction of some sort, it may be perfectly fine at rest because a lot of things related to the heart and the lungs are based upon supply and demand. So when we’re sitting here and doing nothing, the demand is very low. So your body may be able to meet that supply. But when you get exercising, then it may not because the demand goes up and the supply may be limited. So those are the things with the heart. Okay. But the majority of people have normal EKG. Yes, I do. I have seen a lot of people. Who’ve had halter monitors who do have runs of high heart rates and low heart rates. And that’s also related to autonomic dysfunction. But I think that can be affected in a positive way over time.


I have not seen a lot of people. Who’ve had a chamber changes. Okay. And I haven’t seen anybody. I’m not saying they’re not out there, but I personally haven’t seen anybody. Who’s had a heart attack post COVID, except for one person who had a heart attack, pre COVID and had a lot of risk factors for heart disease. So haven’t seen anybody with a healthy heart that had no preexisting conditions that had no preexisting risk factors that how a heart attack due to Kobe. That’s a good nose. Suzanne, are you saying that you did you’re muted. You’re still muted now you’re not. Hi. Hi.


Hear me now. So you are the human being on the planet who talked me down. My heart is not gonna explode and I can breathe. I’m having all sorts of infections. I’m an as an eczema person, but I’ve had that under control. But anyway, the doctor, you know, doesn’t believe COVID. So I had the EKG in the office and I walked in, the doctor was like, Oh my God, her blood pressure is one 70 over something at home. It’s one 30, one 40. And sometimes I feel a little stressed and it’s one 45 anyway, all that’s fine. But I’m going through these tests, eczema. Um, when, when they said you don’t have COVID you pass the test, you don’t have COVID. You know, I said, okay, give me a dose of prednisone because the skin is falling off. Um, I’ve had infections. My, my arthritis is acting up the bad elbow, the thumb, when, when I take prednisone, that all gets better. So I had a dose of prednisone. And as soon as that ended, I got eczema all over cellulitis infection, infection. I, and I can get rid of some of them by just raising your leg. And, and it’s not bleeding oozing. It’s just, it doesn’t it antibiotics. So I’ve had cellular,


Hang on one second. Wait, hang on one second. I’m going to address that. But if you just give me a few minutes, there’s a, uh, there’s a re an order and there’s a reason, and there’s a rhyme to what I’m like. I’m building a story here. So you’re jumping to the chapter on eczema, which is almost near the end of the movie. So just let me, let me build this case for a few minutes. And then if I don’t answer your question, then, then we’ll talk. But, okay. You’re talking about inflammation and you’re talking about prednisone, which is a very powerful anti-inflammatory. And you’re talking about a systemic anti-inflammatory that generally will reduce inflammation everywhere, as opposed to let’s say a steroid inhaler that acts locally in your respiratory system. Okay? Yes. When you come off prednisone, you can flare your inflammation and it also happens to lower your resistance and make you more prone to infection.


Now, let me just go back a little bit. Okay. Let’s go back to the heart. Okay. So the thing is that most people are not having, uh, you know, heart attacks. Most people are not having lethally arrhythmias. Their hearts are cycling up and down and their hearts are overexcited. Okay. So in the end, I explained to you, the reason why somebody’s heart rate might go up, but that can be trained. Okay. That can be retrained. The autonomic nervous system can be retrained, but how do we do it? It’s a big mistake that most people have. And I see you, Marie Regan, I’m going to get to you at some point. Um, but the big mistake that people make is they overdo it. So they are sick, sick, sick. I have COVID COVID COVID and then they feel good. And they’re like, you know what? You know?


And people say, and then I started feeling good. And my next question is, and what did you do? And it usually is something like I walked a mile or I went to the club, uh, not, not go to the club really, but some people do go to the club, but they overdo it. And this overdo it it’s like a shutoff valve. It’s like, you flooded your engine. And again, like I said before, it’s that either ones you up in bed or it flares your symptoms, or it sets you back and you have a relapse. Okay. So the key is move forward, but throw the stone, wait for the pool to ripple and see the impact of that activity before you throw that next stone. Right? Like we are so used to being in a society where it’s like, go, go, go, go, go. And if you’re doing nothing, then you’re lazy.


Or you’re a slacker or you’re a wimp or something like that. No, it’s really important. If COVID can teach us one thing, it’s that we have to learn to just be like, we have this constant assault on our senses. That is just very, very inflammatory. It’s very fight or flight mediated. And it’s very adrenaline mediated. So adrenaline and this fight or flight response was a human. And it’s also an, all the animal world. It’s an adaptation. It’s an adaptation. So that if a caveman is out picking berries and a saber tooth tiger jumps on him, he could either fight it or he can run away. So it puts out all this adrenaline. That’s why, like, we hear these stories of like, Oh my God, the child was stuck under a car. And somebody lifted the car. Right? They get this superhuman strength because it’s adrenaline based.


Okay. But that’s not supposed to happen. If your wife changes the channel, that’s not supposed to happen. If somebody is writing a check in front of you on the checkout line, that’s not supposed to happen. If somebody wants to switch lanes and you decide to let them in, and then they don’t take you up on your offer, but we’re constantly pumping this adrenaline. And one of the things that we know about COVID is COVID pumps adrenaline, right? So how do we cool that off breathing is very important. Okay. We know that breathing is the portal to the parasympathetic nervous system. So when I see people in this inflammatory phase, the first thing I want them to do is I don’t want them to push this. Isn’t no pain, no gain time. And I’m not a, I’m not even a believer in no pain, no gain.


My belief is no setbacks for all of my years. I do what I do. I want a no setback approach. And that means if I work you out hard, or you come to me the first time and I overdo it with you, and then you can’t move the next day. Cause that’s the most you’ve done in 40 years as is often the case with some of my patients. Well, you’re not going to come back. Right? The body hopes that if it makes you feel bad enough, you will stop doing the things that you did to make it feel bad. Okay? There’s the heart. What’s the workup for the co for the, for the, for the respiratory system. The first thing is a chest X Ray, right? How many people here have had a chest X Ray, how many people here have had a normal chest? X Ray, keep your hands up. How many people have had an abnormal chest X? Right?


So look at how many people have had an abnormal chest X, right? As compared to the number of people who have chest X rays. So you go to the doctor and you say, I’m short of breath. So weight, chest X, rays clear, why are you short of breath? We were oxygen’s 98%. Why are you short of breath? Even your pulmonary function can be normal. Why are you short of breath? Why are you short of breath? We don’t know. Right. We don’t know. But it doesn’t mean that you’re not short of breath. Right? Some people’s, you know, I always say that breathing is multifactorial. So there are many, many factors that contribute to how well and how poorly we breathe. Can anxiety play a role? Absolutely. Okay. But it’s probably not just that. It’s unlikely that a hundred thousand people are just anxious all of a sudden, right?


It doesn’t make sense. Right? So there’s gotta be something there. And as investigators and as clinicians, we have to be open to the fact that there are things that we don’t know and that we don’t understand. And that there might be things that maybe the test isn’t even invented yet. Maybe a chest X Ray is not enough. Right. So if you don’t see something on a chest X, right, the next logical step is going to be a cat scan without contrast. And it’s gonna be a cat scan with contrast, right? But most people are having these tests and even those tests are winding up normal. So people look at you like, you’re crazy because it’s like, well, look, all your tests are normal. I can’t tell where you’re short of breath, but this autonomic dysfunction can make you feel ways that are disproportionate to what you’re actually doing at that moment.


Okay. So under normal circumstances, we elevate activity, heart rate is supposed to go up commensurate with the activity. So in other words, if I’m doing this, my heart, isn’t supposed to go up 50 beats. Right. But as I increase the intensity, it goes up more and more, same with systolic, blood pressure, same with, uh, things like oxygen. Okay. So the idea is that when these things are out of whack and there could be something wrong with the color, right? It could be something wrong with what the person is saying into the phone. It could be something wrong with what the body is hearing from the phone. It could be something wrong with what the body is sending back because it heard something wrong and it could be something wrong with what the other person on the other side of the phone can hear. So it’s almost like a game of telephone that shows itself in a ways, respiratory ways, gastrointestinal ways and neurologic ways.


But again, there’s ways to retrain the system. At the beginning, we have to retrain very, very slowly. It’s like marriage counseling, right? I say this over and over again. It’s like a marriage counselor. Couple comes in, they’re on the verge of divorce. You want to try some exercises. The first exercise, shouldn’t be a three week trip to Euro Disney, right? It should be like, why don’t you go out to lunch? See if you can eat together without fighting for an hour. Right. And it’s the same thing with the body. So it’s like initially we have to give it little bites, little bites, little bites when it shows us that it can handle those little bites, no sooner, no sooner than it shows us that we can handle these little bites. Do we go forward? And what I’ve always believed is that we’re gonna come to a point and I’m looking around.


I know so many of you personally, and I believe that the majority of people here are going to come to the point where we’re going to be able to start pushing you again. And we’re going to be able to break some of these cycles and that can be done through exercise that can be done through, um, I have another theory, which I’ve spoken to you about several times on, over the last several weeks where I’ve taught you some of this self massage, right? And I’m showing you some of these trigger points. And this week I was able to get my hands on somebodies, neck, and shoulders and back and head. And what I thought was going to happen actually happened. And we were able to affect this inflammatory process. And again, a lot of these things are cyclical. Okay. So we have these muscle fibers.


We have these fascia, okay. We have this muscle, this, all this stuff that’s connected. And there’s that grid again? Where like so many of you it’s like, and we’re home alone. Right? So it’s like, if your neck hurts and you live with somebody or somebody was coming out, you could say, Hey, could you rub my neck or something like that. Right. But we’re not doing that. We’re home alone. Right. Or, you know, I said, I said to someone today, so maybe a massage will help. Some people say maybe a massage, maybe a massage will help, but it may, it has to be the right massage. Right. So I’ve been to, uh, massages where you leave and you feel like a new person. And I’ve, I’ve been to massages where I leave. And I feel like I’ve gotten hit by a truck and I’d rather have no massage than a bad massage.


But the idea is that there are ways to disrupt the cycle, but we have to figure out what’s going on. And once we disrupt the cycle, let me just give you one example. There’s something called the pain spasm cycle. Okay. Spasm muscle spasm is also a protective mechanism. So if all of a sudden I’m holding something, that’s too heavy for me, or I try to lift something that’s too heavy for me. If I actually went through with it, I might tear that muscle off the bone. Right. But instead the muscle goes into spasm. It doesn’t let you move. It feels terrible, but it may have prevented you from having a much worse injury. And now the muscle is contracted. That’s what spasm is. It’s constant contraction of a muscle and a way that muscle gets nutrition, which is blood and oxygen. Is it relaxes? Right?


So if your muscles doing this, guess what? It’s never getting a nutrition. And not only that, the way that a muscle gets rid of waste products, is it contracts. So a contract weight waste products are pumped out. It relaxes, it gets a new supply, fresh blood, fresh oxygen, right? But when you have this spasm that, or you have pain and then your muscles go into spasm, well, guess what? That causes more pain. And that pain causes more spasm. And that’s where we get stuck. And people can be stuck there for weeks or months or years until we do something to disrupt that spasm. And I think it’s the same thing with the airways. I think it has a lot to do with the smooth muscle that’s in there. And that’s why I taught you the breathing scale this week, but there are ways to affect these things.


And we’ve known about them in our practice for many, many years. And we’ve been utilizing them for many, many years, but they’re things that are not common knowledge. And the thing is if we can somehow break into that cycle. So if we reduce the pain, right, well then the muscle can calm down and the spasm goes down. Or if we can reduce the spasm and there’s ways to reduce spasm, it could be heat. It could be cold. It could be manual therapy, it could be acupuncture or other things. Well guess what? Then the pain goes down. Shortness of breath is very anxiety provoking, right? So shortness of breath creates anxiety. Anxiety puts out adrenaline, adrenaline, and anxiety make you more short of breath. If we give you more control of your breathing, your anxiety comes down. If your anxiety calms down, you have more control of your breathing.


Same thing with your heart. If your heart can calm down, it can slow down. It could fill more, it’s more effective. So the idea here is that I don’t see a whole bunch of people that are putting together the kind of big picture and treating people based upon the fact that it is a cardiovascular issue, superimposed on a respiratory issue and superimposed on a gastrointestinal issue and superimposed on a neurologic issue. And then again, we have our friend autonomic dysfunction, which is there just for shits and giggles, you know, and essentially that’s what you have to do. And you have to get good at listening to the trees. Okay. We have two eyes, we have two nostrils. We have two ears, we have one mouth, right? So everyone’s, and everybody wants to talk about, you know, I have this, these are my symptoms. This is how long, but no, listen to yourself.


And you know, I see so many groups where, and, and don’t get me wrong. I give all credit. And I give all respect to the Facebook groups that really brought individual grassroots attention to these issues. Okay. It absolutely had to happen, but there’s something called the repetition compulsion, which is that we keep talking about things. It’s like, I’m walking to work and some jerk who’s wearing headphones and texting and talking on the phone phone at the same time bumps into me, it knocked me into the garbage, right. And I’m pissed. And my heart pumping and I got adrenaline running through my system and I looked back, this guy doesn’t even know he hit me. Right. And then I go to work and I go, can you believe this? I was couldn’t work? And this guy was in headphones. And guess what? Now, again, my body’s putting out adrenaline.


My heart is pumping fast and it’s almost like we’re reliving the experience physiologically. And again, we have to break the cycle. We have to resist the urge to just constantly be focused on the things that we cannot do. One of the greatest quotes is by John wooden basketball coach. And it’s, don’t let the things that you cannot do interfere with the things that you can do. Okay. And we do this to ourselves all the time, and we get involved in this black and white thinking all or nothing. It’s either all great or it’s not bad, or it’s all bad. And what we have to do is we have to get up and it’s as if you were going to cover me for the day we share a job, we share an ambulance together, right? And we’re going to a new ambulance. How do we know what supplies we need?


How do we know what the supplies we need before we start the day we have to look and we have to compare and we have to take stock. This is what we have. We have to take it can inventory, right? If we take an inventory and it turns out that we have, we’re supposed to have 20, right? And we have 20 bandages. Well, then we’re not going to waste our time going and getting more bandages. Right. We have to get the things that we don’t need. So what I’m trying to say is when you get up in the morning, take stock, ask yourself, how am I doing today? Get a set of vital signs, heart rate, oxygen, saturation, blood pressure. Don’t flip out. Okay. Don’t flip out. You guys survived. COVID okay. That’s part of the problem is that you survived. COVID when at any other moment in history, if you would have gone to the hospital with 103 temperature saying you have pain in your chest and you can’t breathe, how could they say go home and wait it out?


Or don’t come to the hospital. Right? That’s what I suspect is probably a big contributor to many of the long haul situations. But the idea is get up, take stock, check your vital signs. Don’t react like the hands in the hand house and go, no, take stock. Look at the trends. Okay. Look at the trends. Are they getting better over time or are they getting worse over time? Is there something dangerous? First order of business is always, is there something dangerous? So for me, the first thing I want to assess when I see a patient and that goes for my cardiopulmonary rehab career, that goes for everything I know about COVID and it goes from my EMS career. Is there anything that’s going to kill my patient? Right? And I look at the heart and the lungs and the brain. And if there’s nothing that’s going to kill my patient, then I say, well, what’s making them the most uncomfortable, right?


Steve Covey, seven habits of highly effective people keep the main thing, the main thing. And by keeping the main thing, the main thing I say, deal with the squeaky wheel, right? Whatever’s giving you the most discomfort. That’s what we want to deal with first. Because guess what? That thing that’s giving you, that discomfort is probably spilling over into your other systems. And if we can cut that back a little bit, then everything can settle down. We reduced the net inflammation and it’s like a pot. Okay. Everything you’re doing is adding heat to that pot, adding heat to that pot. Right. And so if you see that, that pot’s about to blow over, like, we all have that feeling where we’re like, I’m about to, I’m about to go bananas, right? I’m about to flip the fuck out. Right. We all know when we’re about to get there.


Right. But we’ve got to say, hold on a second, hold on a second. I’m going to kill her. Alright. No, calm down. Take some breaths. Right? Cool. The pot turn the heat. I like to scream a lot. Okay. I like to scream. Not just cause I think it’s funny. I don’t scream in anger a lot. And I just think it’s really funny. And I have a patient that also loves to scream. So we just scream at each other nonstop. Like he’s a, he’s a nut. Like he’ll come in, he’ll be holding a bat, a banana and I’ll be like, get your fans up. Do you want me? Or I’ll say it’s a, where’s my wife. And, and it’s perfect. Cause I have a convertible. And when I talk on the phone, I just have to scream all the time. But it’s really funny. Cause I get to scream at the top of my lungs and I call people and I’m screaming, which is very pleasurable for me.


But the idea is don’t let the pot boil over. Okay. Stop yourself. Recognize that. Even though it’s going to feel, it’s not going to feel good. Okay. It’s like when you punch a wall, like you think it’s going to feel good. And then you punch the wall and your hand is all black and blue and broken and swollen. And you’re like, what did I do that? Right. And I’m going to tell you a story right now. It’s called autobiography in five parts. And if you, you may know this, okay, it’s from bootcamp. It’s by portion Nelson. This is what it is. I’m walking down the street. I fall into a giant hole. I am flabbergasted. I have no idea how I got here. And it takes me forever to get out. The next day, I’m walking down the same street. I fall into this giant hole.


I’m shocked again, but I get out more quickly. The next day I’m walking down the same street. I fall into the same hole. I’m not surprised. I get out very quickly. The next day I’m walking down the same street and I walk around the hole and the next day I walked down a different street. Why am I telling you that? Okay, this is learning. This is behavior. This is psychology. This is physiology. Right? And the idea is that as you learn, right, how many people here have been in therapy before? All right. I’ve been in a lot of therapy. Okay. I need, I have a team of therapists. Okay. But it started when I was in my twenties because I was having difficulty getting along with people. And I was like, alright, it’s one of those things. It’s like, if you think that everyone, you know, is an asshole, it’s like, you got to read the signs.


You got to read the writing on the wall and say, you know what? The odds of this is probably not inconsistent is not consistent with science. But the idea is you learn, right? So it’s like, you slip up a lot. You say the wrong thing, you put your foot in your mouth a lot. And the thing is that, you know what, initially, as soon as you, you know, you don’t even realize you’re offending people, then you know, it’s like you put your foot in your mouth and as soon as you say it, you’re like, and then it’s like, you think of it before. And you’re like, Oh, I better not say that. And then over time you lose the urge to say the wrong thing. And that’s autobiography in five parts. And that is the way that we learn about COVID. So the idea is that we look at what works for us.


We look at what doesn’t work. Okay. This is not as random as it seems. Okay. It’s it looks like, okay. And I know that other people were quoted saying this, but I was the first, but it’s, I always say that like, it’s like when, when, when you reach into a bag of symptoms and you pick out these symptoms and this is what your day is going to be like, and every day it seems random. Right. But I could tell you that from talking to so many of you and I don’t do 10 minute consults, okay. My consults are sometimes two hours long, but I’ve learned that there’s very, very, very, very often in fact, most of the time, some kind of cause and effect that we can find to say, well, why did I have such a bad night? Oh, you know what? I really shouldn’t have eaten that 42 ounce porterhouse at 11 o’clock before I went to sleep. Okay. Or other things or say, you know what? I really felt good. And so I to, um, you know, or I haven’t worked in six months, so I went back and worked a 10 hour day. And the idea is that you will heal. I am convinced of that. Okay. I am convinced that you will all heal.


I really am. I have been since the beginning and the more I get to know, and the more I get to see, and the more I listen to people, um, the more, what I think is playing out, but we have to find your perfect combination. Okay. And that means that we need people to listen to you. And it means you have to have the right tests. And it means you need somebody who can synthesize that information and that it can’t all exist in a vacuum. So you can’t have your cardiac tests here and your pulmonary tests here and your GI test here, and your neuro tests here, because guess what? All these things are connected and you need somebody who can look at it and say, well, what’s, you know, it’s like solving a mystery, but it’s like detectives solving a crime and you say, well, what’s the common denominator here?


What is it pointing to? And you know, we live in a time where medicine is very fast paced and it’s very knee-jerk. And if you, you know, I always say 95% of what I know I learned from my patients, the other 5% I learned from watching house, because it’s like, when you watch house, they do a true differential diagnosis, which is when somebody comes in with a nonspecific symptom, which COVID has a lot of nonspecific symptoms. Right. Which is also what makes it so tough. And when I say nonspecific symptom, it doesn’t mean we don’t know what the symptom is. It means that that symptom does point to one condition. It could point to a lot of conditions. So when people talk about chest discomfort, that could be cardiovascular in nature, it could be respiratory in nature. It could be GI in nature. It could be neurologic in nature.


And you need somebody who’s going to write all the possible things on the board and go through this differential diagnosis, crossing things out, crossing things out, thoracic things out until there’s only one thing. And you can say it was mr. Plum in the study with the candlestick. Right. And that’s how you’re going to figure out what’s going on with you. And if there’s one thing that I know I’ve been very, very blessed in that I’ve had tremendous mentors over the years and people who are tremendous diagnosticians. And if I can’t figure out what’s wrong with you, I can get you to the right people. And I can make sure that you’re being seen hopefully by the right people, um, questions or comments.


I, yeah. Um, this is all really helpful Noah. And you know, I want to thank you again for doing this. Um, I, I think I’m, you know, one of the ones now that’s like moving in some push that’s maybe not a bad thing. Um, but I’m having two questions. One is about, you know, I’m trying to do that, listening to the trees thing. And I’m trying to check in, I have lists checklists for me to remind myself what to do. Um, but you know, I’m also, I I’m, I’m working out on recumbent really in a very measured way, but, um, you know, sometimes it’s tiring, you know? And so not letting that be tiring and not setting me into a setback is what I’m, you know, modulating now I haven’t had a setback. Um, but learning, you know, that exertion can cause fatigue, but it’s not going to whiplash me is okay,


Let me give you, let me ask you a question and then give you a suggestion. Okay. Are you saying that you’re working out recombinantly and you are pushing it, but you’re afraid that you may overdo it.


I’m being super careful not to overdo it and watching my heart rate. I’m like really not overdoing it, but I’m just sort of, as I’m getting stronger and able to do more, I’m not doing much more, but like, you know, today I felt after I, I did this really machine thing, I felt like not exhausted. You know, I felt tired from it. And my pre COVID, I would have been tired from it, but I’m a little paranoid


You’re you’re literary because you know that it could lead to more than fatigue. Did you ever play blackjack? Yes. Let me give you a suggestion. Split your ACEs. Okay. Split your ACEs. So you know what? You get two ACEs. You’re like, Oh no, I got two or 12. Right? What should I do? Split them up. So if you’re doing 15 minutes and you’re not sure about that, go to seven minutes and seven minutes. Right? Cause you know, you could do seven minutes. Seven minutes is awesome. Right? You’re not even gonna break a sweat doing seven minutes. So you do seven minutes. Take a break, see how you feel later in the day you do seven minutes. That should be a piece of cake for you, right. Eight minutes and seven minutes the next time. So when you feel only when you feel like you’re ready, okay. To move forward again, you increase the first one to eight minutes. And the second one is seven minutes again. And then again, same thing.


I guess the other question I have in this is I just don’t understand. But the way you talked about everything, about how the body works today was helpful. So I thought I’d asked you this previously, I had trouble with the stairs was staying somewhere else and like walking up and downstairs, you know, and also I was like, totally over resting deconditioning, but I want to start walking upstairs again. But again, I’m afraid. So I’m having some pots dysautonomia. So I want to understand if, if how I should do that.


Alright. So there’s two things here. Okay. So there’s two things here. So let me, let me talk first about the first one. So the first thing is, if you’re worried about the length of time, right? You break it into parts, I’ll tell you a funny story. Has anyone ever choked before? Because I don’t ever like really seriously choked on some food. Okay. One time I was eating something and it got stuck in my throat. There’s two times that I choked one time when I was home. And I started like, I panicked for a second. I was like, Holy shit. I was like, and it was like, you know what, when you see, like, when you say I need the time and I was like, I was like, all right, let me get out of my apartment. I went and I was going to knock on my neighbor’s door.


And then I was like, what is wrong with you? And I went back inside and I threw myself over the couch and I gave myself the Heimlich maneuver and I coughed it up. Okay. That’s one time I choked, but that’s not the funniest part. The funniest part. The funny time when I choked was I was in the back of a cab and I was eating straight meat, the chicken kebab. Okay. I ate one piece of chicken and it got lodged in my throat. Okay. And I had that same reaction and I was like, all right, wait a second. I was like, I’m going to, I felt like I was going to get out, go to the driver’s door, knock on the window with the driver and be like, I’m choking. And then I was like, wait a second. What if this is New York city? I was like, what if, when I get out to tell this guy that I’m choking, he takes off.


So I thought of this idea. I was like, you know what, eat a second piece of chicken. And I ate a second piece of chicken and it knocked the first piece of chicken down my throat. Okay. Why am I telling you that story? Okay. I’m telling you that story is because if the piece is too big, cut it into, okay. Split your ACEs. And that is when you get stuck. Okay? Because a lot of times people will get to a point where they’re at a plateau and we have to get away around the plateau. You can’t force yourself through a plateau. It’s a plateau for a reason. It’s a physiologic plateau. So let’s say we’ve been cruising along, cruising, along cruising along then. We’re stuck. So someone this week told me they’re cruising along, cruising along cruising on there. They’ve been increasing intensity, increasing intensity, increasing intensity.


Then they got stuck. I say, you know what? Decrease intensity, increased time. Change the metabolism, change things up, right. Shift the energy. And that’s the way to do things. Okay. If one thing’s not working, we have to keep trying, okay. I call myself Malcolm X, physical therapist, which means by any means necessary, I don’t care what it is. And one of the things is, you know, for each person here, it’s like finding your own DaVinci code. Remember that thing in the, in the, in the, in the code, you gotta that Coda. You gotta find your own thing. So that’s why a lot of times when I see the group, some of the groups are just so fast paced. It’s like, somebody will say, you know, has anybody ever had this? Has anyone ever passed gas in the middle of star Trek? And it’s like, you know what I have?


And it’s like, is that COVID, you know, it’s like, you know, it’s, it’s like, and the thing is that we have to it’s, it’s great because we all want saw solidarity. We want to feel like we’re not alone. Right. But some things we have to figure out for ourselves, right. Because if you look around this screen, okay, there could be 20 people here with the exact same symptoms and they could be coming from 20 different things. So we have to listen and we have to look. So now next order of business, um, you were saying you want to walk upstairs, right? So how many people have difficulty walking upstairs? Okay. So in New York city, the complaint that I hear most is walking up subway stairs. Why is that? Okay? Because they’re long and they’re straight up, right? They’re not built for comfort. They’re built for space saving, right?


This is New York city. So people say, I have difficulty walking up subway stairs where people say, have trouble walking up Hill. So you have trouble running for the bus. That is what I previously referred to as the New York city, pulmonary triathlon. So it’s like, you run up a flight of subway stairs, walk up a Hill, run for the bus. Okay. But why do people, why does, why is walking upstairs? Our universal difficulty? How many people have difficulty in the shower or getting dressed after the shower? Why is that a universal difficulty? Right? It’s all based on supply and demand. And it’s all based upon met levels and metabolic equivalence. Right? So here’s how my program of pulmonary rehab is different than every other program. With the exception of one where the chief is my former student. Okay. But if you look at traditional pulmonary rehab, okay. They work people out at a very low intensity for a long duration because they believe that endurance is everything right? So you go and let’s say, there’s something called metabolic equivalents. So when you’re sitting like this, doing nothing, that is one metabolic equivalent, walking up a flight of stairs might be 12 metabolic equivalents, which means that it’s 12 times metabolically harder than sitting and doing nothing. Right? So if your life requires you to do, to do


Six minutes and you can


Come to pulmonary rehab and I exercise you at two meds, you could do that till the cows come home, but that’s not going to make you better at walking six minutes. Right. Does that make sense? So it’s like, if you, you know, if you want to lift 25 pounds, but I lift one pound, you know, and I just do this forever. That doesn’t mean I could lift 25 pounds. So it means that we have to support you in whatever way you can so that you can reach that metabolic threshold. And it means gradually increasing over time. It means if we have to give you oxygen, we give you oxygen. It means if you have to wear support hose to keep your pressure up, we do that. And it means if you have to use special breathing techniques, you do that. But again, whatever it takes, it’s not a crutch.


It’s a tool. Okay. Why is taking a shower so difficult for people? Because overhead activity is very difficult. Okay. It puts the respiratory muscles at a very poor mechanical advantage. It’s hot. Okay. It’s steamy. It’s breathy. Right? So it’s very difficult. It takes a lot of energy. And the thing is that we have to build up over time, but we do it safely. And we do it gradually a little bit at a time. If you do it all at once, that’s when you picked up something too heavy, your muscle goes into spasm. So you’ll be able to walk upstairs, but you know how you’re getting to learn to walk upstairs. You’re not going to start with one flight. You’re going to start by walking up a step. Remember the step classes. So you walk up a step, you walk down a step, you walk up the step, you walked down a step, one step, start with two steps, start with two steps.


But you know, it’s like this. It’s like, if I say, how, how do you want to learn to walk? Don’t walk out a mile. It’s like swimming, right? So it was only one time. Now there were two times in my life. When I thought I was going to die. I’m only going to tell you about one of them tonight. I swam a little too far out to shore. This was when I was 25 years old. I was a lifeguard. I was in peak physical condition. I was in Martha’s vineyard. There was no one else on the beach. And I swiped a little further out. And then the current shifted, okay. I spent about 30 minutes swimming as hard as I could. And when I got to the beach, it was like one of those movies, like where you draw your name in the Samuel thing, I made it back.


Um, but the thing is, my point in that is if you’re not sure, if you can walk 10 blocks, don’t walk out five blocks because you have to get home. Right? So the idea is walk out a block and come back a block. If that was easy, do it again. Right? And so with the stairs, you’re not going to go from not being able to walk up a flight of stairs to walk them up at 20 flights, staircase. I mean at 20 step staircase, but you can start practicing using the muscles activity is very sport specific. So in other words, playing basketball, doesn’t make you better at football. Okay? And other things, if you want to get good at walking up the stairs, you have to walk up the stairs. But I would go to the stairs. I would walk up, walk down the step, walk up to step, walk down the stairs. Yeah. And in the same way that you build up bootcamp and you build up the walk about one minute at a time, that’s how you build up the stairs. And when you can do that 50 times, then you know, you can walk up the flight of stairs. That’s simple other questions


And that’s everything. That’s everything I’m teaching all about life tonight. I’m teaching you what to do. If you get a piece of chicken kebab stuck in your throat, I’m teaching you what to do. If you swim too far out to shore, okay? Show of hands. What are you gonna do? If you get chicken kebab stuck in your throat, how many people are gonna eat another chicken kebab? That’s right. I’ll tell you another funny story. I used to work EMS. I got called to a job in central park. They called me because they knew that I’m an expert in chest physical therapy, which is helping people clear secretions from their lungs. There was a fancy dinner in the park. One of the guests swallowed an entire chicken nugget and it went into his lung. He believed, okay. So they called me from another ambulance and I did chest therapy on this person in the back of the ambulance.


And sure enough, this guy coughed up a whole chicken nugget. Okay. Saved, went back to the reception. The shit of this story is that the next Monday I get called into the chief’s office because these guys who called me to their ambulance reported me for doing something that’s outside of the scope of EMS practice. And so now I’m because a little hearing and I said, well, you reported me for doing something out of the scope of EMS practice, but all you guys are EMT. So if you only wanted something, that’s in the scope of practice, what’d you call me the ambulance for. Right. Makes no sense. Anyway, you didn’t like that story as much. I think I’ll stick with you. Didn’t like it enough, you can’t have everyone be a winner. It’s okay. Other questions or comments,


Martha, I was just going to tell Marie that, you know, you, I’m the, one of the ones that you told me to back off of my 15 minutes and go to seven and seven and it’s just, it’s want to tell them away that it’s like, it’s kind of changed a lot for me in part, because I had the same anxiety you’ve had to worry about like, am I, I’m getting a little tired? Am I about to have a big setback? Am I going to be in bed for two days? And the seven and seven, uh, actually met like seven and six this week. Uh, just gives me so much confidence. Like I can do seven and six. I feel like a champion. I feel like Rocky. I feel like I just got out of my previous orange theory, hit workout. I feel like I’m the beast of a 60 year old here. You know, I just feel like myself for the first time in a very long time. So that little change that for some reason I couldn’t work through myself. When Noah said to do that, I was like, okay, I’ll do that. And it’s just,


But think about that. You’re succeeding. You’re succeeding, we’re succeeding. Right? And success. I need success.


Not thinking about chronic fatigue syndrome anymore. I’m just doing my little minutes and my six minutes,


You know what? You’re going to build it up again and you’re going to build it up. And then if it turns out that you know, you get there, then you break it up.


Know it’s accessible. Yeah.


Listen, five nickels or one quarter. It’s the same thing. Okay. And that’s how you got to think about it. And the idea is why set yourself up for failure, right? If you know that something’s not gonna work for you, or if you are, you know, if you’re taking your life in your hands and you’re only making it back to the beach by the grace of God, why do it right? Why do it let’s build success? It’s the same repetition compulsion and the same way that when you succeed at something, it releases endorphins and it releases positive healing chemicals. And it calms the system failure does the opposite, right? So there’s many, many, and I hate to saying more than one way to skin a cat because I love cats. I love all animals. I would never skin a cat, but there’s so many different ways that you can tinker with this.


And if you’re not sure contact me because my team has been doing this for a long time. We said, we get sent patients when like people seriously, like nobody knows what to do. They say, send them to us. And what a lot of people call the end of the line, we call the starting line because I know you didn’t try everything. And if you didn’t try everything, then there’s always something else we can do until you did. And nobody here looks done to me. So, and nobody here even looks close today. So, you know, it’s, there’s always something you could do, but we have to be inventive, but we have to also look for the signs and we have to figure out what’s actually going on. Right. What’s going on here because a lot of times we’re reacting to things and we’re treating things in ways.


We’re treating the wrong thing. We’re treating the wrong thing and we’re addressing the wrong issue. And it’s like, you know, a, screwdriver’s great for scrolling, but it’s not good for hammering things in. There’s a tool for everything. And we just have to find it and we have to get to the right people. And if at first you don’t succeed, you have to keep trying and keep trying and keep trying. When a doctor says to me, you know what, there’s nothing I can do for you. I thank them for their honesty. And I find another doctor. Okay. Cause I don’t want, I don’t want to sound like Trump and say like, I don’t like people who attach it. I don’t want a doctor who doesn’t put, there’s nothing that could do do for me. I want a doctor. Who’s going to say, you know what? Let’s try this. And if this doesn’t work, I got 26 more tricks up my sleeve. I don’t want a one trick pony. It’s like, if you thought, if you go to Thor for help, what tool do you think is going to use the hammer it’s always got? Right? What do you think the whole it’s gonna use? It’s gonna, it’s gonna punch, right? So you want somebody who’s got more than one tool in their toolbox. Other questions? Comments.


When is sorry.


Good question. Yes. Um, can I do bootcamp and I have a severely dilated atrium,


Atrium or aorta? Atrium? Which one? Left or right left. Do you have mitral stenosis? No. Do you have aortic stenosis? I have. No. Do you have cardiomyopathy? No. Do you have left ventricular? What do you have? Tommy?


I have a left ventricular dysfunction diastolic.


Okay. So you have diastolic dysfunction. So you have sisterly and you have diastole. Sisterly is when the left ventricle contracts. Diastole is when it feels diastolic. Dysfunction means you have no trouble contracting, but it’s stiff. Right? So because it’s stiff, what happens is blood there’s increased resistance. Blood goes back through the mitral valve and the left atrium and larges. Okay. So can you do bootcamp? Yeah. Yeah. Okay. Um, so what do you have to be worried about? What do you have to be concerned about? So the concern is, um, let’s say you overdo it, right? So you have to be more careful than the average person, right? So you periodically check your blood pressures. You periodically, you know, make sure you’re taking your medications, but what would be the potential downside? So the potential downside, I was talking about supply and demand before. So if you overdid it and your ventricle could not expand enough, right.


To get enough blood so that it pumps your cardiac output could diminish and it could either increase your pressure or it could lead to potentially heart failure and heart failure is such a terrible name for it because it sounds so much worse than what it actually is. And it’s a, it’s a transitional thing. It’s a, it’s a, it’s a dynamic condition that can get better or worse. So you will just watch yourself, you’ll monitor your symptoms, you’ll monitor your heart rate, you’ll monitor your blood pressure. And I hate to be, uh, you can tell me at another time I’m gonna use an example. Okay. Let’s say you’re 50 years old. Okay. Uh, I use, most people use something like 220 minus your age as a peak heart rate, I use 200 minus your age. So if you’re 50, that means the maximum heart rate I would ever let you get to as 150 in your case, if you’re, you know, if we would say, the reason why I use 200 is, cause that gives you a 20 points safety zone.


Right? So the idea is that with that 25 point safety zone, because we know you have diastolic dysfunction because we know that if you don’t fail, what could theoretically happen? You could get dizzy, you could pass out, just go nice and easy. Okay. Uh, I’ll give you a very simple way to gauge, um, effort. Right? I’m going to give you three terms, fairly light, somewhat hard and hard. Anyone heard this before? Okay. So there’s the board scale, right? So we’ll ask you on a scale of six to 20, how bad you feel. So it could be very, very light, very light, fairly light, somewhat hard, hard, very hard, very, very hard. But I like to make it simple. Is it fairly light, somewhat hard or hard, right. So Helen, you would start your workout in the fairly light range, right? That’s your warmup. And you’d get to somewhat hard during the workout.


Now, if it starts to get harder than that, to where it’s okay. It’s no longer, somewhat hard. It’s actually hard. Or you notice any discomfort in your chest or more shortness of breath, or you could periodically stop every five minutes, check a blood pressure, make sure. And for blood pressures for people over 80, I keep them below one 80. Okay. Cyst out under one 80. I think I said over, but I meant under one 80. Um, but the idea is when you feel like you’re getting past that somewhat hard range, either back off a little bit in intensity or take a little break until it resets, but yes, you can do bootcamp. Thank you very much. You’re welcome. Rob Gregson, what? I’m right. Robson. I’ve had some pneumonias pre COVID and now I’m worried about pneumonia seasoned and I’ve had my pneumonia shot and flu shot.


Do you have any suggestions besides watch your hands and, yup. So, yup. So I’m thankful to say that nobody in my cardiopulmonary group has died of COVID. Okay. And part of the reason for that is because when the warnings came out, they took it seriously. And we’ve been practicing for this for years, because guess what? All of the things that prevent COVID wearing a mask, avoiding compliance spaces, avoiding big crowds, avoiding sick people, frequent hand washing, or the same exact things that prevent pneumonia that prevent the flu that prevent the common cold. But okay. But there’s one caveat here. Uh, you’ve had pneumonia before. Do you know why you’ve had pneumonia before? No, it was very odd. I’ve had three otherwise very healthy. You’ve had three bouts of pneumonia. Okay. So, um, some things happening in your lungs, there’s something about your lungs or your respiratory system that for whatever reason, you pick up bugs quickly, okay. Somehow you come in contact with it and it’s somehow settles in your lungs. There’s a device called the aerobic.


Let me see.


It looks like this. Okay. I would buy one and I would use it every day. I would do a hundred breaths.




150, a hundred breaths in the a hundred breaths in the evening. And I would do some of them lying on your left side. And I would do some of them lying on your right side, because what that’s going to do is that’s going to make sure that your airways stay open, that your alviolas stay open, that you’re milking secretions up. Right? Because maybe there’s something about you that you don’t clear secretions very well. Right? You make cough, but you don’t, you’re not able to clear them. But the best way to prevent infection is by keeping your airways clear. And we have a webinar on one of our websites. We have a whole section under the webinars. That’s on airway clearance. And there’s a webinar that I did with Mary cause it’s called Zen and the art of secretion clearance. Watch it. It’s going to explain everything to you about why you may be picking these bugs up, but the basics like wearing a mask, avoiding crowds, avoiding sick people, washing your hands.


A lot. Those things really work. Um, I tested negative yesterday for COVID. I tested negative for antibodies. Um, I was a germaphobe before. Um, I’m more of a germaphobe now, but I was happy. I, I I’ll tell you some, uh, I’ll tell you a personal thing. I w I had an exposure. Uh, unfortunately I had somebody who didn’t tell me that they, they knew, uh, that they were exposed and they didn’t tell me. Uh, so I luckily was never exposed to the person who actually had COVID, but I was exposed to somebody, two people who were exposed to somebody who had COVID. So I got three tests in a row every other day, they were all negative. But the, what that makes me feel happy about is that what I’m doing and the way that I take it seriously is working. Right. So I people say to me, you know, New York city is such a mixed bag of like, what are people doing to protect themselves?


Um, I don’t think it’s that easy to get COVID I don’t think it’s that hard to get COVID, but I don’t think it’s that easy to get COVID. And what I mean by that, um, I think if you do the wrong things, you know, if you, if you really careless with it and you expose yourself frequently, and for long periods of time, I think you can very easily get COVID. But I wear a kn 95. Every time I work, every time I worked with a patient I have on a mask, uh, I think one of my biggest risks is getting my car from the garage because the attendant brings it to me. And they’ve also been in 5 million other cars that day. So before I even get to my car, I go with, uh, this is not exactly what I bring, because this is, uh, to get rid of powdery, mildew off of trees.


But I go with something like with, um, like alcohol and before I even get in the car, I spray my entire car. I sit down on a wet seat for the first 15 minutes of the ride. I’m soaking wet. Um, luckily I have a convertible, so I dry in a reasonable, reasonable period of time. But the idea is I’d rather be wet from alcohol than get Colvin. Right. And these are the of things you have to think about. And I talk about the difference between potential exposures and possible exposures, right? Uh, or probable exposures. I mean, so, you know, is it like we, well, I’ll look like, am I probably going to get exposed? There’s no, probably is. Unless you like in a whole room full of people with COVID and you’re not wearing a mask, but if it’s possible, then you have to treat it with universal precautions. And to me, universal precautions is I assume that everybody’s got everything. And if I act accordingly, then I’m protected. And that’s what I learned as an EMT. It’s what I learned in working in a hospital. And it’s what I apply to everything else. I don’t want assume nobody has nothing. I assume everybody has everything, but I think the robocall will help you and watch Zen and the art of secretion clearance and prevention is really possible. It’s very important. Other questions


I just want to ask about, uh, joining the bootcamp. Is there, is there a beginning and an end and I’m in the middle or how does


No? So the beauty of bootcamp is that it starts whenever you want to start your day. One is the day you start. So it goes by one, two, three, and it goes day by day. And for the people that have had COVID or a postcode with long haulers, I say, don’t worry so much about the days I have about 125 people who send me an email every day. And they say, this is what I did. This is how I felt. And these are my numbers. And I write back and I say, either, stop, go backwards, go forward, stay where you are, go forward, go backwards. Okay. So it’s very individualized. They don’t use the days. Literally they were designed initially for a cardiopulmonary, uh, group, but it’s, it’s there in order each day. There’s stuff for you to do. Um, but don’t get overly wrapped up again. Keep the principle in mind that we want no setbacks.


Is it a particular time of day?


Anytime you want, the only things that are particular time of day are these meetings. Okay. And you can break bootcamp up over the course of the day. Other questions, comments run Rowan might as well. Keep going. Yes, sir. Hi. How are you? Don’t fail.


I’m okay. Thank you for this. And, uh, just also, just to tell everybody to just keep fighting and keep going. Um, quick question. So I’m to kind of at that point where I’m somebody who lifted weights, you know, since I was 19 years old, did not really do much cardio. Um, and now when I lift weights, um, even if I can keep my heart, I’ve been able to keep my heart rate down better. Um, I still get this like courses every now and again, and the breath thing is still there. But, um, whenever I lift weights and I’m saying like 10 minutes of resistance training, um, I’m okay. During the, during the session, I’m okay there in the nighttime and then like middle of the night or something, get this, like my abdominals are tight or I wake up short of breath. And so I’m trying to get out of that mindset. I know I need to be more relaxed and that sort of thing. So I’m thinking of like a cardio more piece of equipment. I just wanted to know if you had, like, you know, obviously now I’m on this, like, do I get a row or do I get a bike? Does it not matter? Um, where


My favorite piece of equipment is a treadmill. Okay. I think it’s the most controllable. I think it’s the most functional since you are walking around, but let me just put you in check for one second. Okay. So you have a couple of things. If I may just discuss you for a second. Okay. So you have a couple of things going on, right? So you’re talking about your stomach. You’re talking about your heart rate, this and that. And you’re saying the next day or overnight you’re we know we talked about reflux, right? And we talked about inflammation and we talked about the role of anxiety and reflux. So as I told you, you know, my feeling is if you have reflux, okay. And this goes for anybody, if reflux is a significant issue for you, then you need to manage your reflux first and foremost. Okay.


Uh, and that’s not just a gut feeling. That was a joke. I’m just kidding. But I gotta, I think of him. I got to throw him out. But the idea is that reflux can be so detrimental to you. Okay. More than just the heartburn, right? Because it can come up the esophagus and the trachea are like, this acid can go from your esophagus, into your trachea. And the, the lining of the trachea is not made for that. Okay. It’s not made for that. So the idea is that if you don’t treat that reflux, that could be affecting your respiratory system, when you sleep, it can come up, it can go into your sinuses. It can be increasing your allergies and think about that net inflammation. So you say you wake up and you’re, your stomach is bothering you. Right. So that could tell me one of, a couple of different things.


Maybe you’re lifting too much. Okay. And again, I told you before, you’re only going to heal as quickly as your slowest system. Right? Well, a chain is only as strong as its weakest link. There’s a reason for that. Right? So, well, maybe your core is weaker, right? If your core is weaker and you’re doing, you know, some exercise that is too much for your core, then it could be muscular. Okay. But it could also be your GI system. But that being said, if you are somebody who, um, you know, you’re used to lifting weights, but you’re finding that you’re fine during the workout. And, um, you are, you know, only in the middle of the night, are you starting to feel symptomatic, but the next day you don’t feel so good. And a lot of people have this experience, which is that they feel okay during the activity.


And then they feel okay later in the day. And then the next day they don’t feel so good. Then you have to cut back. Okay. So it’s like this same thing with, right. So I have a friend who works at Wilner chemists, which is like, how many people saw the movie city slickers. So you remember there were two brothers on the trip. Right. And they were the ice cream Kings. Right. And their specialty was, if you told them a meal, they would tell you the exact perfect flavor, ice cream to go with that meal. Right. So they’d be like, all right, I’m going to have a flaming and be like rum punch. Right. And it was like that. Okay. Wilner, chemists is like that with supplements. Okay. You go in there. These guys are like supplement nerds. They know everything humanly possible about every supplement and they know where it is.


But what they’re telling me is that people are coming in and they’re buying 10 anti-inflammatory supplements. Right. So if you’ve never taken a supplement before in your life and you add 10 anti-inflammatory supplements, do you really think that’s going to be soothing when your system no. It’s going to be inflammatory. Okay. So the idea is don’t believe everything. That’s on the box and take baby steps, go slow. Imagine you’re walking around in the dark and don’t just swallow everything that says it’s anti-inflammatory for you. And if you’re taking a lot of supplements, one of the things I try to get people to do is cut back. Unless there’s something that you specifically know, the, you can literally see the effect of it or feel the effect of it. If you don’t know the difference, then you shouldn’t be taking it. Because my gut feeling no pun intended about COVID is that the less you ask your body to deal with the more time and energy and sustenance, it has to devote to healing.


So don’t give it 26 things. It’s like, if you make an, a soup and you say, you know what? This soup needs a little something. Let me put in some salt, pepper, and nutmeg, another piece of chicken and some rice. And then you taste the soup and it tastes better, but you don’t know what did what, right? So it’s like part of knowing what’s working for you sometimes involves scaling back. And that goes for exercise. That goes for what you’re eating. That goes for supplements. That goes for medications, right? How many people here have 20 medications? Sometimes you don’t even remember what they’re for. You don’t know what’s doing what? And if you add multiple things at once, it’s like, you’re not going to try to, you know, one time my cousin was trying to kill a fly with an ax. Right? So it’s like, you don’t need to blow it out of the water.


You want to be able to do things in measured strokes. Um, so that you’re not overdoing it. The less you ask your body to do, it’s a trust thing. Right? So you say, mom, could I have a friend over? Yeah. Don’t have a house party. Right? So it’s like, bring one friend over show. You could be trusted. Take one supplement, see how your body responds. This is about building trust, rebuilding trust between you and your body, rebuilding trust between you and your physiology, rebuilding trust between your autonomic nervous system and the rest of your body. And it can happen. I know it can happen because I see it happening. Other questions.


I have a question, Noah. Okay. I’ve learned how to pace myself. Cause I was doing too much exercise. I did like 15 minutes, one time and I over did it. I paid for it the next day. So I’m learning to pace myself. I’m doing better. But the question, another question I have is I’ve been told by my doctor that you can have a cold. What happened to you again? Just a little bit scary for me. Cause I already had it once I almost died. I don’t want to have it again. And they said there’s many strains about it. So I don’t know how true that is for. Have you heard anything about,


I’ve never heard that there’s many strains of Kobe as anyone else. I’ve never heard. There’s many strains. I’ve heard of people being reinfected. I heard, I have heard of people. I don’t think we know if there’s many strains of it. Again, I think there’s a lot of things that we just don’t know. And I think that sometimes especially people who are supposed to be experts don’t want to say they don’t know. And I think sometimes people will say something just to, to not have to say they don’t know. And I think that, you know, particularly in the time of the world that we are in where it’s like soundbite, soundbite, soundbite, and it’s like somebody says cardiac and it’s like all the fish swim to the cardiac section of the tank. And then we say respiratory PE and all the fish swim over here and all the fish went over here.


And that becomes the new cycle for that day. Right. And before you even know it, like in a certain point, you have to take a breath and you have to ask yourself what is going on here. And at a certain point you need the quiet and you need to be able to hear yourself think, and you have to think for yourself. Right. And there’s trust me. I talk to doctors all the time. A lot of them don’t know a lot of them do know that’s not a criticism. Okay. I think the doctors, nurses, respiratory therapists, people who clean the halls, people who deliver the food from the restaurants, these people were heroic during this time. Okay. This was like a battle time. They got up to speed super fast. There were no, you know, so the idea is, it’s just, we don’t know. It’s like we were a ship and the ship is preparing for certain emergencies and you’re preparing for icebergs and you’re preparing for, you know, hurricanes and you’re preparing for this.


And next thing you know, Mothra is in the sky. You know, you weren’t preparing for that. How could you know about Mothra? So the idea is that, you know, I think that you can’t over worry, right? Like you can’t say to yourself, I’m terrified that I’m going to get a different strain of COVID. I think you have to be vigilant and you have to keep doing the things that you do. Um, and I think you to trust science and I think you have to stick with people, you know, there’s a great, uh, meme that I love. It’s a pack of lions. And it says, uh, it says, tra you know, travel with, with people or travel with a pack that, or travel with a pride that’s on the same mission as you. Right? And it’s like, think about people who are, are, are, you know, I see this all the time.


Two people walk in the street, one’s wearing a mask, the other, one’s not wearing a mask, two people working right there in a truck together, one’s wearing a mask. One’s not wearing a mask. So, you know, mass to become politicized. That sucks. Right. But you know, there’s a funny part like when Seinfeld used to be stand up, right? So he talking about this thing where he’s talking about a bird parakeet flying into the mirror. Right. You know, anyone known as Joe. So he goes like this, he goes, parakeets. They fly into the mirror, they get killed twine as a man. He goes, you would think that even if they didn’t know it was a mirror, they would try to avoid the other parity. Right. So the thing about this is like you say, like, forget it, like, all right, you don’t care. Right. If you don’t care or you think we should have heard immunity, or you don’t want to do this, like at least have the respect.


Like if, if, if some, if your friend is kosher, like Doni bacon in front of them, like, it’s that simple? Like, so it’s like, if you see that somebody’s wearing a mask and you’re not wearing a mask, at least have the respect to social distance from them. Right. I mean, it’s that simple. So Rosemary, why am I talking about this? Why am I going on a, a sociopolitical rant? Because I’m just trying to say to you, you can’t worry all day every day about what might happen. Because most things that we worry about don’t actually happen. Other things happen to us, but be vigilant. Right? So universal precautions, massive frequent hand, washing, avoid people who are sick, avoid crowds. Uh, you know, if you’ve been someplace, like if you’ve been on the bus and you know, your, your clothes have been touching places that a lot of other people have touching.


When you come in your house, take them off, change your clothes, things like that. Um, you know, but be vigilant. You know what I mean? You, there’s only so much you can do believe me. I’m the same way I want to carry a stick. And I wanna, I wanna, you know, like I want to do that March of the wooden soldiers with like Laurel and Hardy, I want to be, I want to be whacking them with those sticks and those and those darts, but you can’t do that. But I think if you were an in 95 and 95, and I think if you get into serious situations, like where you’re on the subway or where you’re really going to be close cores, the people and you can’t wear a mask, uh, you know, I carry, uh, you know, this is funny. I go to the Hamptons three days a week.


I have a patient that I see three days a week. So I have to drive two hours there. I see him for an hour. I drive two hours back. Okay. I have a couple of places I stopped. There’s one parking spot that has the parking area has a port, a potty. Okay. There’s a gas station that has a porta potty. I often stop for a red bull. Okay. In the, in the gas station. And I sometimes stop for gas. Do you know how many people I see about to go into a porta potty without a mask? Whenever I go to a public restroom or something like that, I carry extra masks. Cause I know I’m always going to see somebody who and the other day, sure enough. I see somebody. I said, Hey, don’t go in there without a mask. He goes, what I got to, I got to wear a mask to take a leak.


I said, listen, let me just explain this to you. Okay. We know that it’s transferred in feces. Right? So you’re going into a little compartment with an open hole with feces of 500 people put on a mask. Right. But when I do use that, I wear my mask. I wear, I take my spray gun. Okay. I spray the handle. I go in, if no one’s around, I leave the door open. Okay. I don’t mind telling you that. Okay. But then I come out and the first thing I do is I wash my hands and I sanitize my hands. Okay. So be prepared. That’s the other thing is be prepared. Have these things with you so that if you get into a situation, like, I always say the worst thing you get into New York city cab and the seat is wet. Oh, what does that mean? Right. So it’s, it’s you there’s times where you can’t wash your hands. So the idea is be prepared. Think of the situations. Think for me, it’s going to the garage to get my car. Right? High source of potential exposure. I go ready? People look at me like I’m a nut because I’m carrying around this giant spray bottle. I don’t care. I don’t want Kobe no matter what. Okay. I’ll do whatever it takes not to get COVID.


I carry a box of Clorox with me all the time with me too. So I’m also preparing and gloves.


Yup. Same thing. Same thing with flying. I’ve been doing that for years. Okay. I flew once during COVID I flew to LA I made it. Um, but you know, I used to wipe my seat down. Right. These things come, come off black. They come up black. I once said to a flight attendant. I said, I said, how often do you guys, you know, clean the seats. She was like, clean the seats. This is before COVID now. I think they’re doing it. But to me, I always say, I trust me. Okay. It’s like, when I go scuba diving, I will pack my own tank. I will set up my own regulator. If I’m in a parachute, I will pack my own parachute. Why? Because I don’t know what this guy was doing last night. Okay. So if he was sleepy or drinking and he’s talking to his friend, when he’s packing my shoot and something goes wrong, that’s on me. So I’m saying, take responsibility for yourself. Don’t count on the other person to keep you safe.


Can I just add something?


Yeah. So yes. To everything you said, and I am not an infectious disease specialist at all, but, um, my read of the scientific literature is that yes, there are like minor, like genetic mutations that are occurring. But we don’t know that that’s why there are these reinfection that are being reported in the scientists.


That’s a good point. That’s a good,


The only reason why they’re there in the scientific literature is because they can say, okay, well they had this strain and that I don’t even want to use the word strain. And they had this version. And then that mutation was showed up in the second time. But that doesn’t mean that, you know, one could only be reinfected with a different strain or different, you know, genetic mutation. It also doesn’t mean that most of us will. Um, we really don’t know. And so I don’t know that that’s going to make anyone feel better, but I also don’t know that anyone needs to be super.


Yeah. And you won’t know, and you won’t know anyway, like it’s not like you can be like, Hmm. She looks like she has you Alyssa Milano straight. You know, it doesn’t work like that. Okay. It doesn’t work like that. But the other thing is COVID is not mutating. Like there are things that mutate and are constantly like, I’ll give you an example. Cystic fibrosis. Okay. Cystic fibrosis. We can never have two cystic fibrosis patients in the same room because the bugs are constantly changing. So it’s like, you don’t want your bugs mixing with someone else’s books. COVID to my knowledge. And again, there’s still so much that’s unknown, but I don’t have the impression that it’s constantly mutating or that it’s getting true. Listen, COVID, doesn’t Covance tricky. But look at the way our country is handling COVID it doesn’t have to be that tricky.


Okay. It doesn’t have to be that tricky. We’re doing it to ourselves. Okay. We are doing it to ourselves. So we say, okay, we are thankful. We’ve never had a ground war in the U S short of the civil war. Okay. But if there were a ground war in front of your home, would you be fighting for your constitutional right? Not to wear a Bulletproof vest. It’s it’s idiotic. Right? So the idea is it’s not like science. It’s not like, everybody’s like, okay, we’re all in this together. We’ve got to come up with a plan. It’s independence day. Let us do this. We got it. All right. We’re all on the same team. Whoop. Oh, Kobe, you mutated and tricked us. It doesn’t have to be that smart. All you have to do is look around. We’re doing it to ourselves in many ways. Not you guys.


That’s not what I’m saying, but I’m saying, look, you could do everything right. You could still get COVID okay. It’s like, we all know uncle Jack, who’s 88 years old and five packs a day. And somehow he’s still able to go square dancing at the barn on Saturday night. Right? There’s this there’s exceptions to every rule. Okay. But we play the odds, play the odds, right? There’s a reason why the casino always wins. It’s stacked, but we can stack the odds in our favor. How do we do that? Wear a mask, wash your hands socially distance. Right? How important is it that you get your haircut? How important, or the people that eat outside of New York city, they act like eating at the table. It’s like a force field against COVID and they’re just like happily. No, it can happen. So you gotta take it seriously. You have to take it seriously. That’s basic, you know, that’s the basic fact. So that’s a long winded. I went way off tangent, but the idea is, don’t worry about the next train. Do all the things you would protect against this strain. And the number of people who have gotten reinfected is still extremely, extremely small.


I’ll just add an analogy. Um, maybe you all know this, maybe you don’t, but so, you know, women are born with certain number of eggs and they don’t reproduce, but male sperm, like regularly reproduces. And most of the time it reproduces. Right. And there are, you know, no abnormalities, occasionally there is, you know, a mutation and occasionally that results in, you know, some kind of either disease or susceptibility, but it’s rare. And I think my understanding, and again, we don’t know, but from what I’ve read in the literature and my understanding of, you know, disease replication is that this really is like sperm and it’s rare. It can, there can be a mutation, but even when there is, you know, it doesn’t seem, we don’t have any evidence to suggest that it results in, you know, Obrist case or again, reinfection or anything like that. And I wish I have now, but just wanted to kind of, you know, put that in perspective that I think about all the times that, you know, people who’ve reproduced and their kids have been fine. That’s how I look at COVID as it reproduces, essentially.


Hi, we see, um, you know, I’m not gonna lie. I feel a little worse now that I know it’s like sperm. Um, but uh, you know, now I’m a little, now I’m going to make sure I wash my hands even, even more. Um, yeah, that’s a good point also. And, and so, you know, again, the other thing is, you know, we have enough to worry about right, try to turn your brain off sometimes and try not to make everything medical, you know, um, try to not be making everything about your, your medicine and your, your illness and this and that. Again, don’t let the things that you do interfere with the things you can do and focus on the positive. Okay. Um, I always say that when people are diagnosed with a chronic illness and this is before COVID, they become like these monochromatic black and white versions of their former selves, completely devoid of art and music and fashion and literature and this and that.


And the other thing, and there is still beauty in the world and we have to find it sometimes and it’s sometimes gets dark and we have to really squint to see the good, we will pass this. You will pass this. Uh, we will, we will. And hopefully we will learn something from this. Hopefully we will learn something about this, you know, from this that we need to work together and that we need to respect each other and we need to respect the environment and that the earth is not here for us to utilize for everything that we want. Oh, that’s nice. Rosemary. Who’s that guy, Rosemary. That was sweet. This is like the kissing cam, you know, like you’re at the basketball game and they turn it to you and it’s time to kiss. Alright,


One minute warning.


One last question. We’ve gone way over, but it’s okay. It was very enjoyable. One last question. Otherwise, I’m going to tell you, uh, uh, I’ll tell you a story. It’s another soup story. So man, calls the waiter over. He says, waiter, try the soup. The way it says, is there something wrong? The soup says way to take this. The soup says what’s a matter is that you don’t like the soup. Cause way to try the soup. He goes, all right, give me the spoon. He goes, aha. Sorry that I spent, that’s such a corny joke, but I like it anyway. All right. Any one last question? I like that bag. I like that bag. Anyone. Last question. All right guys, hang in there. Things are getting better. Okay. In some places they’re getting worse, but that’s life. Okay. Life is ups and downs, ups and downs.


Embrace it, embrace it. Okay. After nine 11, which was probably the toughest time of my life. And I’ve had other tough times. My sister said something to me. She said, maybe you learn something about yourself. She said, well, at least you learned something about yourself. I said, what did I learn? She said, maybe you learn that you’re not as strong as you think you are. I said, well, how is that a good thing? She said, it’s not a good thing or a bad thing, but it’s a real thing. Authenticity is key. Be yourself, hang in there. Have faith in yourself, have faith that your body knows what to do. Stay out of it’s way, help it assist it. Things are going on behind the scenes. Even if you don’t see the outward expressions of them immediately have a great evening everybody. And before we do go, I’m going to just introduce somebody who’s here tonight. Laurie needle, Laura, if you want to maybe just say hello to everybody. Laurie is a PhD doctor, Lori Nadler. She’s a psychotherapist. And she moderates the Sunday evening. It starts with yes. Group with us. And I’m glad to see you here tonight, Laurie.


Well, thank you. Um, and thank you Noah. Thanks. Every one of you for being here this evening, um, when you’re living with a longterm illness, uh, every opportunity to get information and to provide each other with information is so important, you know, kind of building your network of, it’s almost like there’s a grassroots movement. That’s developing here of a community of, of, uh, healthy people who have gotten this terrible illness over before dealing with other longterm illnesses. And it’s so important, um, to do whatever we can to come together, to enforce the, uh, to, to reinforce the idea that we can experience, uh, calm and wellbeing and empathy. Uh, and we, we can, we can be here to learn from each other. Um, even when we’re feeling that, uh, where we’re not as functional, perhaps as we used to be, or we would like to be everyone here has something to contribute. And I hope that you’ll join us on a Sunday evenings at seven, um, getting to yes


And everybody remember a few months ago, monk was paralyzed from the chest down and here he is walking around. So you can, if he can do it, you can do it. Have a great evening. Everybody have a great week. Hang in there, Rob Gregson. I know you already forgot what I told you. It’s called the aerobics. Don’t forget hundred breaths in the morning hundred breaths in the evening. Have a great night everybody. And hang in there. We’re going to get through this. Bye. Bye.