10-25-2020 – Managing that Miserable Shortness of Breath


So today we’re going to talk about one topic. That’s probably the topic I speak more about than anything else on AR, which is shortness of breath. Uso what I’ve been doing for the past 28 years essentially is taking care of people with cardiovascular disease and or respiratory disease. And the number one most common symptom that I hear from people is shortness of breath. Umypically when people come to me, I say to them, why are you here? And they say something like either my doctor sent me, I don’t really know why I’m here or the breathing or the walking or the walking due to the breathing and in New York city. The thing that I hear most commonly is I hear people talking about walking up subway stairs because in New York city, the subway stairs are long and steep. Um hear people talking about walking up Hill and I, mou know, I have patients who can map out the neighborhood by, mhere the Hills are.


I have other patients who can map, map out the neighborhood by where there’s a place to sit down like a fire, a fire you know, one of those pipes. And I have other patients who can map out the neighborhood by aware, there is a public restroom. And,uI drive three days a week to the Hamptons, which is a two hour drive each way. And I can identify with that, which is, I know which exits have a place for me to stop if I need to either go to the bathroom or reveal on red bull. Umo shortness of breath, if you know my book, if you know my work, you know, that I’ve say over and over again, that shortness of breath is multifactorial. And what I mean by that is that there are many, many different factors that go into how well or how poorly we breathe.


So in light of the fact that I have some cardiovascular patients here, some respiratory patients here, and some COVID patients here, I’m going to make sure that I address everything in, in a, in a way that everyone will benefit from it, hopefully. And for the, for the COVID patients. I just want to say that so much of what we’re trying right now is based on our years experience with cardiovascular and pulmonary patients and with COVID in particular it’s a super challenge because unfortunately to this date, there’s so much that we don’t know. And, you know, we have a history of heart disease that dates back probably centuries. We have a history of respiratory disease. It probably dates back centuries, and we have a history of COVID that dates back less than a year. And so we’re sorry that was monkey. Sneezing. I bless your mom, but but the thing is that you know, we’re trying different things.


And the other thing that makes COVID so challenging is that everybody’s so different. So as I look around this screen I know so many of you and whereas with heart disease, we can say, okay, you’ve had bypass with a general kind of prediction. We can say, we expect this from you. If you have respiratory disease, whether it’s COPD or pulmonary fibrosis, we can say, okay, you have COPD. This is generally what we expect from you. And there’s going to be some variation there, but nothing like the variation that we see between COVID patients and often within the same patient from day to day or week to week, or sometimes even over the course of hours or minutes, it’s a, it’s a constantly kind of rapidly fluid type of situation. And so I would never come to a group like this and say to you, this is what you should or shouldn’t be doing.


Okay. I’m not a believer in that. Anyway, I’m a believer in kind of giving people the tools and allowing them to learn and make choices for themselves. And with COVID, what we really have to do is we have to try to give you as many tools as possible. So what I’m going to do, I’m going to start off with a breathing exercise just because I think it’s grounding. And I think it’s good for us to sort of like get rid of some of the jitters or the kind of anxiety or freshness or excitement or adrenaline that’s coursing through our veins. And also it’s grounding, it’ll be oxygen delivering to your brain. And I’m going to talk about shortness of breath. I’m going to give you strategies to try out. And when I say try out, because that’s what we have to do, we have to experiment, we have to try an air and we have to try and succeed.


And then I’m going to ask for people to give me or share with us if you’re comfortable, specific situations that relate to your shortness of breath so that we can try to problem-solve together, some of the causes of shortness of breath and what we can do for the different causes. All right. So first thing I want to do, and you can do this, either sitting down the first thing we’re gonna, we’re going to start sitting down and we’re going to do just the basic breathing scale. And the reason why we do this breathing scale is in the same way that an opera singer or a saxophone player, or anybody else might warm up a little bit, okay. The airways have smooth muscle inside of them. And it’s that smooth muscle that constrict and dilate that either allows for more air flow or constrict so that we don’t get toxic materials into our airways.


Okay. and into our lungs. But the thing is that one of the things we know about certain conditions, COPD, asthma, not so much pulmonary fibrosis, but in COVID we know that there’s often a hyper constriction of the airways. In other words, the airways are too active or too reactive. And it’s almost like a henhouse where like, you know, everyone’s just like, well, and they, and they kind of just like are very, very active and overstimulated. And that is one of the hallmarks of COVID, mhich is that we know that it’s an inflammation driven condition. We know that there’s a hyper, hyper activity of the sympathetic nervous system, which is the fight or flight system. And we know that there’s a lack of parasympathetic activity and that all leads to this kind of highly charged, energetic state, where it’s hard to kind of get any calm within the body.


And one of the things that I say over and over again is that I view this almost as an electrical grid, which is like, once you trigger inflammation in one area, it seems like that can trigger inflammation in other areas between the neck and the abdomen. Okay. Or essentially not the thorax in our abdomen. We have a lot of different systems. We have the cardiovascular system, we have the respiratory system, we have the GI system. And one of the confusing factors or complicating factors is that very often the symptoms of one cancer can mimic the symptoms of the other. And whereas if you mistake, uh t bean burrito that you had for lunch for your heart, and you treat it as if it’s your heart, and it turns out to be the bean burrito, no harm done, but if you’re having a heart problem or a respiratory problem, and you minimize it to gas or something like that, well, that’s a problem.


But part of what we try to do is we try to educate you and get you through experience different things so that you can determine what’s okay. And what’s not okay. In first and foremost, we always want to take care of things that are potentially going to be dangerous and especially life-threatening to you. So when I evaluate a patient and when I advise others on how they should be evaluating patients, my first and foremost is always going to be patient safety and risk stratification. And what I mean by that is I always want the heart ruled out first. So if anyone’s having any type of chest pain pressures, wheezing, radiation down the arms or anything like that, the standard workup would be EKG, but most people who’ve had an EKG. It comes back normal, right? Because the EKG is just a moment in time 24 hour or more a halter monitors, which is an EKG over time.


So for people who have intermittent symptoms that come and go, or they wake them from sleep or things of that nature, you have a much greater chance of catching it. If you have a video camera playing for, you know, a week versus a snapshot, right. Unless you’re having that problem at that moment of the EKG, then you are not going to catch it. And then ideally, we’re going to get a stress echocardiogram because that’s going to talk about the mechanics of the heart and also the electrical activity of the heart. And also indirectly the circulation of the heart when it comes to the neurologic system. The thing that we all worried about most was clots and strokes. Okay. Clots and strokes. That’s not what we’re seeing in long haul. Okay? So we’re not seeing people who are at risk for stroke at this moment. We’re not to say that it’s impossible that you could have a stroke, but it’s not the threat that we thought it was initially as it is in the acute phase.


And then the other thing that we think about as the respiratory system. So again, respiratory system, one of the things that we talked about early on was people were worried about permanent changes, scarring of the lungs and things like that. In my personal experience, I have not seen a lot of that in your patients. Now, a lot of people have chest x-rays chest x-ray is normal. Okay. But a chest x-ray is not that complete less people have cat scans, but many people have cat scans that are also normal and many people, even less people have pulmonary function test, which is spirometry, where you’re asked to breathe in and out of the tube. And very often those are normal. So that begs the question over and over again. If my cat is my chest, x-rays normal. If my cat scan is normal, if my pulmonary function test is normal, if my oxygen is 98%, why am I short of breath?


How many people does that resonate with sound familiar. Okay. All right. We’re going to talk about those things. The first thing I want to do, I want to start with a breathing exercise. So just find a comfortable position. And the breathing scale that I mentioned is designed to stretch out and relax that smooth muscle inside the airways in the same way, Kate, I don’t know if you’re taking notes, but this will be recorded. So you’re not going to catch everything I say, but I’d rather you listen and take it in, then watch the replay for things you missed and try to write it all down. And we have a transcript that will be posted each week with our, without things. So don’t, don’t feel pressured to write. But the thing is that in, in many cases, when your airways are tight, so a lot of times people will report when they get going too quickly, or when they first start out with exercise or when they go into the cold or things of that nature, they feel a pressure in their test or a tightness in their chest.


And this can potentially have to do with a tightening of the airways. Okay. Now, one of the, the ironies of that, or one of the caveats to that is that the harder you work to breathe in and out, the more air trapping you can get in the tighter those muscles become. So, in other words, if you have a tight muscle, the kind of harder ambassador, you stretch it, the tighter and tighter it’s going to become, and the greater chance you have of injuring yourself. So it’s really important. And this has been advice with everything. I think it’s good advice with everything in life, but I think it’s particularly good advice with all things COVID, which is that when you’re going to make a change, whether it be a behavioral change, an exercise or fitness change, a medication change, a supplement change, et cetera, a food change, mnything like that.


You always err on the side of going slower rather than going faster and give your body an opportunity to take in the change. See how it responds, not just during the activity, see how it responds later that day in immune suing days afterwards. All right, when you’re doing the breathing scales. And one of the things I particularly want to focus on today is recovery from shortness of breath. Okay? So in other words, being short of breath is a terrifying experience. Not being able to catch your breath is probably one of the scariest things that can happen to us. And so what I want to do today is I want to show you a bunch of strategies that will, number one, hopefully prevent you from getting short of breath, but also so that when you get short of breath, whether it’s when you’re walking, whether you’re eating, whether you’re sitting and doing nothing, or if you’re awakened in the middle of the night by shortness of breath.


And I recognize that often this is accompanied by a racing heart, palpitations vibrations in your chest and things like that. And I recognize that this is a very scary experience, but in the majority of cases, okay, it proves that it is not an excuse. We dangerous situation. Okay. It is a scary situation. That is a cute puppy, Susan. So it’s a scary situation. It can be terrifying and these symptoms can kind of build on each other and cycle, which is that if you get short of breath, it induces anxiety, that anxiety puts out more adrenaline. That adrenaline makes your heartbeat faster. That heart beating faster can make you short of breath. And before you know it, you don’t know who’s in control and what I need for you to do. And what you need for yourself is you need a way that you can stop this cycle.


And it’s really important for you to say to yourself, stop. I know what to do here, or if you don’t know exactly what to do, because I don’t think I’m going to tell you exactly what to do. There are different things we can try. And that’s why I specifically want to hear from different people about their experiences with racing hearts and shortness of breath, so that I can tell you what I think and give you some ideas as to what you can do for them. All right. So find a comfortable position and you could either do this seated and we’ll go to something standing in a few moments, but I want you to close your eyes. And the idea of the breathing scale is in the same way that if we were singing, we would be going. So Ray me, we’re going to start with breathing in for two.


And the excalation is going to be at your own pace. Okay? And we have to recognize that everybody is going to have a different kind of breathing pattern that may or may not be more comfortable for them. Okay. For some reason, when it comes to breathing, everybody wants to tell you the best method of breathing and there’s no one best method. That’s going to be the same for CLPD and obstructive diseases like asthma, pulmonary fibrosis COVID. Uand so I’m going to show you a number of different things today, and I’d like you to try them out and experiment with them, but to experiment with them when you’re not under distress, like the time to remember that you should have packed that life jacket is not after you fall in the water. So practice these things when you have control so that when you are an emergency situation, they come back to you.


So nice and easy. We’re going to start with a count of two and you’re going to breathe in, in, and then nice and easy. You’re going to exhale, but not forcefully. You’re just going to let the air out. Now often people ask me, is it better to breathe in through your nose? Is it better to breathe in through your mouth? And the answer to most questions you’re going to ask today is it depends. Okay. So if your nose is completely stuffed, well, then it’s probably not going to be that good for you to breathe in through your nose. Likewise, when you breathing in through your nose, there are certain benefits that your body gets. So number one, the air is warmed. The air is filtered and the air is humidified okay. But as we begin to exercise more, there’s a limit to the volume of the air that you can take in through your nose.


And even marathoners will breathe in through their mouth and out through their mouth at certain points. So I’m going to leave it up to you, what you choose as best for yourself. And I encourage you to experiment with different things, but there’s only four possibilities we could do here. We could breathe in through the nose, out through the nose. We could breathe in through the nose, out through the mouth. We could breathe in through the mouth, out through the mouth and we could breathe in through the mouth, out through the nose. Okay? So those are your four flavors, not Baskin Robbins breathing, but try them out and ask yourself. And particularly, I believe this is important for everybody, but so much more important for people who are undergoing care for post COVID is to consistently check in with yourself and ask yourself, is this making me feel better?


Is this making me feel worse? Is this not changing anything for me at all? And keep our records so that you can track pattern? Okay, that’s what I do. When I talk to patients, I’m keeping notebooks and I’m tracking patterns. It’s how we gotten the minuscule amount of information that we have. But as of this moment, I’ve seen 140 COVID 149 COVID patients. And I have hundreds of pages of notes, and we do see similarities amongst people. And we are seeing progress in people, but keep in mind that no healthcare professional, and this is true more than any other time in history, we don’t know much more than, you know, and we are counting on you to teach us and we can give you things to try, but we need feedback as to what’s working and what’s not working. So I think it makes sense.


Why don’t we start by breathing in and out through our nose. And the first thing I want you to do, I want you to breathe in for a town at two, you can close your eyes for this and be like, and I want you to blow out at your own pace. So that means if it’s in for two, out for two, great. If it’s in for two, out for three, great, it’s in for two, out for four. So be it. But what we’re doing, this is the equivalent of the beginning stretch. Okay. So if I wanted to stretch my hamstrings, I’m not going to plumb it myself to the floor because I’m struggling. My hamstrings would snap in half anyway, but I’m going to start with the earlier stretch. Okay? The light stretch. And once I get to here and things loosen up, I’m going to go to here.


And once I get to here, I have no choice because that’s, as far as I can bend down because my hamstrings are so tight. But the idea is that we’re going to start slow and what you should feel over the course of the first two minutes. And I know I’m talking a lot, I’m going to shut up in a second, but,uI feel it’s important to lay the groundwork, but what you should feel as we do, this is Europe. Airways should become more relaxed and your breathing should become easier. So we’re going to start close your eyes and take a nice, easy breath in through your nose for a count of two. And we’re going to breathe in, in, and then let it out through your nose, Read in, in,


Breathe, in, in, and let it out and open your eyes for one second. Show of hands. Does anybody feel any different after those three breaths? Okay. So at least a good, at least a handful, but I think a few more than a handful. How many people feel better after three breaths? Okay. So keep in mind that we hold our breath a lot. Okay. Where are you still like grinning and Barrett and power through things. Okay. And the reason why I stopped you after only three breasts is because I want you to recognize and prove to you that look what you just did. And three breaths. You already feel different, which means that you have some control over this. Okay. And there’s one of my favorite sayings is by basketball, coach, John wooden, and said, don’t let the things that you cannot do, interfere with the things that you can do.


And we tend to think in terms of all or nothing, we tend to think in black and white. And we tend to think that things are either all great or they all suck on any given day. Some things are going to be great. Some are going to suck most. They’re going to be somewhere in the middle, right. And the fact is some days it’s going to be all great. And take that in and appreciate that for the gift it is. And some days it’s all gonna stop. Hopefully today it’s going to be better than stuff. So let’s start again, close your eyes. Nice and easy breathing in through your nose and blow it out. Nice, easy breathing in through your nose and blow it out. Okay. And I’m going to stop talking in a second. So you can go at your own pace. And if it feels like you’re getting dizzy or lightheaded, you can alternate or take a break in between each breath. Nice, easy breathing in as you’re breathing, be aware of where your shoulders are. Are they up here, your ears, or can they become more relaxed? Is your chest squeezing forward? Or can you open it up a little bit more? Nice, easy breathing in through your nose,


Through your mouth. I’m sorry out through your nose. That one




As you do this, try not to think too much. Just focus on the air, focus on the breath. And if any thoughts pop into your head, just kind of acknowledge them and let them go. Nice, easy breathing.




If you want, as you breathe in, you can still put your head back a little bit to make room for that air. And as you blow out, tilt your head forward, Breathing in And out, Breathing in stew




And out. Let’s do one more


And relax and open your eyes. Take it everybody. All right, next. We’re going to do in for three. Okay. So you’re going to breathe in for a count of three. And again, you’re going to breathe in through your nose this time. I’m going to ask you to choose. You can breathe out through your nose or out through your mouth. If you’ve been a blow out through your mouth, blow out through what we call pursed lips, and you don’t even have to blow hard. We don’t want you to blow out hard. We just want you to create a space where that air has a space to come out. So let’s start by breathing in two, three, and relax. Nice deep breath in two, three. And how’d you.




Nice being two, three, and some people find it helpful to kind of visualize a color, moving in and a different color blowing out, maybe green, moving in and orange or black moving out. Or some people may find it helpful to see it as sort of like a puff of air or clouds moving in and then clouds moving out.




What we want is we want to bring in that good oxygen, rich air


And blow out carbon dioxide in for three.


If you’re finding that breathing in for three is too much for you, you can also go back to breathing in for it too. And again, you should only be taking the breath that is comfortable for you in terms of depth, Lang and speed. Nice, easy breathing in through your nose. And if, and when you feel ready, if you want to try to breathe in for a count of four, you can do that as well. So you breathe in two, three, four, and let it out. And if you feel like your eyes are getting heavy, just let them close and let them fall heavy. If you feel like your head is getting heavy, it’s okay. You can put it down. And if you feel like breathing in for four as a stretch, then feel free to stick with three,


Three more breaths. And only when you’re ready,


Feel free to open your eyes and return to the room


With calm.


Can I hear people’s reactions to that? Feel free to unmute yourself?


Well, I had a hard time breathing out through my nose. So, you know, that’s much better for me, that felt great. The first exercise was a struggle.


So breathing out through your nose was a struggle. Yeah. Well, you don’t even have to come up with an answer. Okay? You don’t have to be defensive about it. We’re not going to tell you bad nose breathing. But, but think about it. You just learn something about yourself, right? So you learn that breathing in through your nose, breathing in through your nose is okay. Blowing out through your mouth is bad. Right? Right. So that’s a strategy. That’s a different trial. You go, you go to the store, you try on different pants. You see which ones you like the best. Okay. Eventually you figure out what, what, what makes you look the best and feel the best. So how do you feel Diane comparatively to when you started


Today? When I started today, good, real relaxing. That’s how I get, try to go to sleep at night. Yeah.


Someone said calming, someone said breathing out in and out, felt good, but caused a lot of yawning. So you know what I do if I’m doing deep breathing and I, I start to yawn, I yawn and let it go. And then get back to the deep breathing. Hard for me to breathe through the nose since Kogan too. So Dawn, are you saying in or out, we’re about to add Lucio?


I’m just getting confused with the mute unmute. I find breathing through the nose is wonderful, but would, if I deep breathe too deeply, I have to stop myself from coughing.


Okay. So anyone else have that experience? Okay. So let me explain what that is to you. Okay. So if I were to try to stretch my hamstrings or anyone ever been to a a personal trainer that really should have been a prison guard. So you know, the thing is that if they push you too much, right? What happens? Your muscles bounce back and go into spasm. Right? And this is very common in people with respiratory disease and or tight airways as Matic. So Lucio, what I would encourage you to do, or I would encourage anybody else to do, if you can get up to kind of two or three, but if you go up to four and that triggers a cough and I would stick with two and when two feels like it’s too easy for you, then you move up to three.


Now we only did that for a few minutes. Okay. And people already feel, somebody said, Sherry said she increased her optimum from 92 to 96. So that’s awesome. Somebody said relaxed but freezing. Okay. We’ll talk about, it felt a lot of constriction when inhaling around my ribs. Okay. So let’s talk about those different things. So if you’re having trouble with inhalation, okay. And one thing that I ask people often is I’ll ask them, is it that you have no trouble breathing into a certain point and then you hit a block. Is it that you feel more resistance from the beginning? So in other words, more resistance to getting that breath going, or is it that you feel resistance throughout the entire breath? So Lucille, what I would suggest to you is start with two. Okay. When that feels like it’s getting too easy for you and it may take longer, right?


Because the tighter you are the longer it’s going to take for you to warm up. And however long it takes, that’s how long it takes. And if it means that you only get to two, you only get to two and that’s okay. Okay. But what we want to do is we want you to move as far as you can move before it becomes uncomfortable. Okay. Because one of the things with breathing and one of the things with COVID in particular is that when you start to over push that’s when we start to lose ground. Okay. So it means if you were walking and you feel like, Hey, this is getting to be too much for you. You need to stop and take a break. It’s all about supply and demand. And one of the reasons why people cough is because if they’re not used to taking that deep breath and think about it, many of us are used to taking really shallow breaths, right?


When you need that big breath, it’s not there for you. It’s like if you held your leg in a position for a long car ride, and then you get out and it takes a little while for that muscle to loosen it up again, it’s the same thing with the muscles inside the respiratory system. So I encourage you to go slow, go as slow as you need to, and basically see what feels right to you. Okay. If it feels whatever feels right to you, there’s absolutely no right or wrong for this. Okay. And you know, there’s a lot of breathing coaches that I, I over the years, and they’ll say you have to breathe in and out through your nose, or you have to breathe in through your nose and out through your mouth. You have to make your exhalation that longer than you. There’s a whole bunch of things.


Okay. But the fact of the matter is there’s no have to is experiment. And one of the ways that you can experiment with this is by making a little table two sides in out two, three, four, five, six, seven, eight on the inside two, three, four, five, six, seven, eight on the outside, try in for two out for to see how does that feel in for two, out for three? How does that feel in for two, out for four? How does that feel? It’s like trying on a pair of pants. It’s like 30, 30, 30, two, 30, 30, two 32. And again, it’s finding, and in particular with COVID more than any other condition I’ve ever treated, it’s finding your own DaVinci code and finding the combination that works right for you and keeping in mind that what may work in one situation may not work in another situation. Other, other comments or experiences.


I would like to just say one thing more Noah. I find that sitting and relaxing and in the home, I can breathe through my nose very easily. The minute I start walking outside my mouth and I become short quite quickly.


Right. And that’s a very common situation, right. Because it’s based on supply and demand. So when you get out, okay. And the difference in, in the seal, you know, because you’ve been to the pulmonary central core, but walking on the treadmill is a lot easier than walking outside. For most people, some people will say, Hey, you know, I can walk 30 minutes on the treadmill, but I walk outside. And all of a sudden I’m short of breath, couple of suggestions number one, start out slower. Okay. Unumber two, go at your own pace. Number three, try to tune out the things that are going on around you, because it’s very distracting when you get out. There’s a lot of stuff going on. And we see people and we see cars and we see all these other things. So I would say, you know, only continue walking when you feel like you’ve mastered the pace that you’ve got right now.


And as slow as that seems that’s a worthwhile exercise. And the other thing I’m going to tell you, and this is going to have to do with walking. And it’s also going to have to do with recovery from shortness of breath. So there are certain positions that are going to be more ideal for helping you catch your breath. So when you feel like you’re getting short of breath, there are certain positions that you can assume that are going to give you the greatest and the greatest possibility of retouching your breath. One of them is leaning forward on your arms. Okay. And there’s a reason for this. So if you think about this, I’m doing this right now on a desk. Okay. I can also lean forward on my knees. If I have to supporting my upper extremity, I can also hold on to a treadmill.


If I have to, I can also hold on to a rolling Walker. I can also put my elbows down on the desk like this. I can also be sitting in a chair and lean forward and put my elbows down. Why does fixing the upper extremities work to help us become less short of breath? Number one, this is called open chain activity. Okay. When I’m moving my arms and my arms are not connected, they’re free to move around in space. And when I’m in open chain, my chest does things like this. And like this, my back does things like this. And like this, my shoulders do things like this, like this, like this right. That’s open chain, but it’s poor mechanical advantage for the respiratory muscles. When I fixed the upper extremity, okay. My hands are no longer. The open, free moving arm. My hands now become the fixed part that my thorax was before.


And all the muscles that I just mentioned to you chest back and shoulders, all work in their reverse action by helping to elevate the rib cage. Okay. The other thing is that by leaning forward, all of your abdominal contents drop forward and clear the way for the diaphragm, because we have our abdominal contents, your diaphragm sits on top lungs are above that. The diaphragm contracts downward, and that creates a negative pressure that causes the lungs to inflate. But if we have extra weight around our stomach, if we just had a big meal, if we haven’t gone to the bathroom in a couple of days, all these things will increase the inter abdominal pressure and increase the resistance against which the diaphragm has to contract. So by leaning forward like this, or like this, the diet, the abdominal contents drop forward and clear the way anyone else want to have another comment on, on their experience, their Sylvia you’re muted. Yep.


Thank you. Thank you so much, Noah. This is is, is, is a godson. Appreciate it. I am. I get short. I’m short of breath right now. I was short of breath before we began the exercises. I tried to take my two sets,ubefore we get started and the best I got was 74. Now I think maybe I’ve got a problem. I just had pulmonary function test done a week before last. And they, the word I think is this Nia, I don’t have written, what is it? That’s it


P N E that that’s your perception of shortness of breath.


D Y a S P


E N E.


My perception. It was unspecified. I get short of breath talking on the telephone. I’m still not mobile. This has been going on since April. I was diagnosed presumptive positive code by my PCP and I had lost sense of taste and smell neurological issues, lack of coordination and gay gastrointestinal heart palpitation who gambit and also, Oh, two sets that were registering down by 86. And I, my,umy PCP wanted me to get to the hospital, but,uuthere was a field hospital being built by the national guard here in Hanover, New Hampshire. And I didn’t want to go unless it was absolutely,


I don’t mean to cut you off, but do you have any question that you want me to know?


And in terms of getting short of breath, just talking and having very limited mobility and I bending forward seemed to help. Yeah, I, yeah, I do have the yawning. Thank you. I’ll, I’ll take all, all hints and tips and try to put it into place.


All right. So here’s, here’s some other things. So a lot of people are awakened by shortness of breath, right? Anyone show of hands, how many people wake up short of breath sometimes. Okay. So there’s a number of different possible reasons for this people breathe often more shallowly when they sleep. It could also be positional. It could also be that when you’re lying down, as compared to standing up a lot more blood is returning to the heart. And so there’s increased pressure in the thorax. One thing you could do, and, you know, sometimes what we’re trying to figure out is how do we just break the cycle? Okay. And what happens very often is if we’re short of breath or it’s very similar to, if we are choking or we swallow something and it goes down the wrong pipe,uyou know, it’s very easy to panic, right?


Because we have this immediate kind of like, Oh my God. And I’ve had this a few times, if you, if you listened to me and you’ve heard enough of my talk. So you know, about the time when I got a piece of chicken, chicken kebab off the street, and it got stuck in my throat and I was going to get out and knock on the cab driver’s door to try to get help me. And then I decided to eat a second piece of chicken kebab, and that knocked the first one down, but it’s terrifying, right? It’s a panic inducing situation. And that panic induced any situation is going to trigger the fight or flight response. And one of the things with many conditions where you have shortness of breath is that you have a hyperactive fight or flight response anyway. And particularly with COVID, which is so mediation, so mediated by inflammation and sympathetic tone.


So if you find yourself waking up and you are short of breath, it’s hard to do, but say something to yourself, talk to yourself and say, stop. I know what to do here. Okay. And in the same way that I told you that leaning over gets the abdominal contents out of the way, rolling onto your side, okay. Will help to drop the abdominal contents forward and give your diaphragm, the smoothest excursion possible. And it’s sometimes a process. It’s sometimes something that may take a few seconds even to you minutes to really catch your breath. But it’s so much better to know, Hey, guess what? My car is going really fast, but at least I know I have brakes, right. And I know that if I keep holding on, I’m going to be able to slow the car down. So I encourage you to try to just roll onto your side.


You can even put your hands down on the bed to further support your respiratory muscles and just start to breathe in through your nose and out gently through your mouth. And very often when you’re in that stressed out position, even that first breath is enough to just sort of relax your shoulders and giving you that ability to say, you know what? I have something I can do here. And when one breath can do that, or when three breasts can do that, imagine what five minutes of breathing will do. And imagine what 10 minutes or 15 minutes of breathing will do 30 minutes of breathing with meditation. Okay. And the other thing that these things do in addition to relaxing the airways is they also decreased sympathetic tone. And they’re the portal to the parasympathetic nervous system that helps us rest, digest and heal Kimberly questions.


Yeah. Thank you. I just wanted to find out how often we should be doing that.


So again, I’m not going to tell you how many times you should do it. Okay. think of it like this. How often do you take a drink each day? Alcohol? I thought you meant my coffee or water. But I looked at my coffee. But we drink when we’re thirsty. Right. We drank when we eat when we’re hungry. So we know what this tool is used for. This tool is used for calming this down, just to lose you for giving us greater control of our breathing. This tool is calming the sympathetic nervous system. So number one, it doesn’t hurt to start first thing in the morning. Okay. Because even just a few minutes, because we know that shortly before we wake up, there’s a surge of catecholamine, which I like adrenaline and things like that. Okay. So it’s helpful to start the day with just a few minutes of deep breathing. Somebody asked the question and said, m wake up with mucus, blocking my throat. Okay. And that’s another situation that could potentially cause you deep breathing, u,ortness of breath. But the thing about that is that when we’re upright, okay, gravity will bring everything down. And if you think about, give me just one second, because I meant to bring something here.




All right. So this right here is a trachea. Okay. A trachea is a wind pipe. This is the wind pipe. This right ear is called the Carolina. This is where we split into right. And left main STEM bronchitis. One of them is called the bronchus. And then these are further smaller branching, bronchitis, bronchitis, and then it continues to branch and continues to branch. So the point in telling you this is that if you look at this right here, you notice that it’s pointing downward, right? You notice that this one particular bronchus is pointing downward and this one particular bronchus or these Bronco right here are pointing downward. So if you think about this, like the catch-up box, right. If I wanted to get some catch-up on my fries, and this is what I do, well, not much, catch-up, it’s going to come out of it, right?


I mean, you’d have to shake itself furiously that everybody in the diner would be covered in catch-up. But if you notice, now this is my right. Okay. This is my right lung is my left lung. This is me lane on my left side. And now you see that all these things that were pointing downward before, or rather upward downward before are now draining in this direction. So that gravity is going to assist with it, bringing up. So this right here and keep in mind that the cost mechanism is only effective in the larger airways. So if you put your hand, if you put your hand on the top of your sternum and then go down, you’ll feel a little notch over here. This is where this is. And so if you think about it, if I’m coughing and coughing and coughing, but gravity is bringing everything down, then I can cough till the cows come home, nothing’s going to come up.


And this is me lying on my right side. And this is the best position to drain the left lung. And this is me lying back down flat. But think about the ketchup bottle again, if we lay the ketchup bottle on its side overnight, then at the beginning of the day, all that catch-up is going to be up here. So that’s the perfect time to do some deep breathing in order to help clear those secretions from you. But again, if you wake up and you’re short of breath, it’s hard to do, but you get better at it. The more you do, it’s like any emergency fire drill procedure. And again, practice it when you’re not in distress, but say, stop. I know what to do here, roll onto my side, put my hands down to help with breathing. And then, and if you’re having trouble breathing in, okay, the first thing is to focus on the exhalation. So if you know, we all feel like we’re like gasping for air, but you’re not going to get that air in by continuing to gas. The way you’re going to get that air in is by putting on the brakes and blowing that air out. Any questions about that? So far,




Have a quick question. What if shortness of breath is proceeded? I vertigo. So you get vertigo and then you get shortness of breath. Yes. Every time. Yes. Okay. So that’s a different, that’s a different that’s a different ball game altogether. So in that situation, if we can say, Hey, the shortness of breath is being caused by the vertebra vertigo, or as an associated symptom of the vertigo, then we have two options. We can treat the vertigo, you can diagnose and treat the vertigo. And there’s certainly medicines for that. There’s also something called the stipular rehabilitation, which helps with inner ear balance and equilibrium problems. Umr the other thing that you can do, ms you can, mhen you start to get this vertigo, I’m wondering if you’ve started the deep breathing, as soon as you got the vertigo, could it possibly push the vertigo back? So in other words, if you feel, Hey, I’m getting up and now it feels like the room’s spinning. I would say again, talk to yourself, say stop. I know what to do here, breathe in.


And it’s a similar type of situation where you know, people who wake up and their heart is racing, right? I know a lot of people describe this or they’ll feel like an internal vibration that although we don’t know exactly what it is, we believe it’s somehow related to dysfunction of the autonomic nervous system. Sometimes position change will help you to reacquire deliberate. And particularly with the, the, the, the fast heart rate. A lot of times when people get these best bar weights, and there’s a ton of different reasons why people get this pre COVID post COVID there’s even more reasons. But most of the time, it’s not a dangerous arrhythmia. It’s what we call sinus tachycardia. And sometimes it’s in, it’s a response to blood pooling in the lower body. And one thing you can do is to lie down, switch positions, and sometimes bringing one or both knees to your chest will increase the pressure and increase the venous return to your thorax and your heart. And because there’s more venous return, the heart can slow down because it’s beating more with each breath. I want to do a standing relaxation exercise with you for five minutes. And then I’m going to take questions and comments about shortness of breath and moving forward. So if you feel up to it, you can stand for this. If you don’t feel up to it, you can sit for this. If you feel like you want to stand for it, and then you don’t feel like continuing, standing by all means, sit down and I’m going to just,


And I’m going to unmute here. So, so the key to this is to find relaxation. And the key to this is to find a pattern that’s going to be comfortable for you. So, first thing I want you to do, and you’ll be happy to know last weekend. We a ton of Tai Chi and Qigong moves with Brian [inaudible] and we’ll have those available soon. One thing is find a comfortable position for your arms and just, it seems to help if you kind of hook your thumbs over your pants as if you were in a, some kind of a draw and just close your eyes and take some nice, easy breaths in through your nose and out gently through either your mouth or your nose. Nice, easy breath in through your nose And out gently through your mouth or your nose. And with each breath. I want you to try to think about your eyes, becoming heavier, your head, becoming heavier and your shoulders becoming more and more relaxed.




And I want you to put your hands down at your side and this time as we breathe in, raise your shoulders up. And as you blow out, squeeze and hold your shoulder blades together and let them down. So we’re breathing in shoulder blades together and squeeze and breathing and shoulder blades together, squeeze and down, breathing in shoulder blades together, blowing out and down. And now I just want you to let your hands float up to about shoulder level and then turn your hands over and just very gently. Imagine that you’re pushing down on some water, almost like a canoe. So let’s breathe in. And then




Nice deep breath in through your nose, out through your mouth.




Take your right hand, Keep breathing as you do this.


Let’s go down


On arm.




When we get down here, you can just turn your arm over,


Down the arm, turn the arm over, switch sides down, breathing in, breathing in.


Now what I want you to do, I want you to face your thumbs forward, and then just turn your thumbs to the back. As you breathe in, head goes back




Blow it out and bring your hand down.




Squeezing the shoulder blades in the back and blowing out,


Breathing out, breathing in.


And now we’re going to raise one arm up. Put your other hand on your hip and just slide your hand down the side. As you reach over and hold two, three, four switch sides. So this hand goes on my hip. This hand comes up and I slide his hand down my head as I lean over and hold two, three, come back up. Imagine you are now kneeling down, scooping up that waterfall and letting it come down your back. Refreshingly. Let’s go again and scoop breathing in. Okay,


Come down one more.


And then I want you to just move your hands in a slight circle like this. Imagine that you’re sort of a sourcer getting ready to cast some kind of spell or for the Mahjong players in the room. Imagine you’re just mixing up your tiles and let’s go out to the side. And as you do this feel what your body is telling you, okay. Feel that squeeze in the shoulder blades. If that feels good, feel that stretch in the chest. Nice and easy breathing in




To the left and blow out. Come back to the center. As you breathe in, turn for light and blow out,




In, as you turn to the center, blowing out as you turn to the left, breathing in as you come to the center and put your arms down and just put your hands together like this, and just nice and easy, close your eyes and listen to the running water and imagine yourself at the base of that babbling Brook at peace in nature.




If you want, you could bounce your legs a little bit, and then I want you to just clap, Put your hands together like this as if you’re making a pot on a wheel and you can reminisce back to that time. Patrick Swayze and Demi Moore were making some pottery and ghost




And when you’re ready, put your hands back on your belt, put your head down, Close your eyes, and think about how great it is to be alive today. And to have some control over many things in our lives, even though there are still things that we can’t control, Or one of my favorite sayings is relaxed. Nothing is in control because that’s really the truth of the matter. And when you feel ready, you can open your eyes and relax.


All right. Would anybody like to share their experience?


I mean, with the exercise we just did, is that the


Or life in general, if you have to offer us?


No, just when I do I I’m past seven months long haul. And when I did it, when I did your pump, the bootcamp too, but when I, we do the breathing, like where we deep breathe, deep, breathe, deep breathe, and we do it for a long period of time. Is it normal to have, u,always get it and I still get it. Like, it starts to either it’s either fatigue or it’s not pain so much as just sort of, it just feels sort of searing, but through the throat and lungs, is that normal where it starts to kind of become uncomfortable.


So the question is, is that normal? No. So if you had never had COVID would that happen? Probably not. Right. What I would say. And that’s a great question to kind of start the Q and a with, but the thing is that if you think about any exercise, whether it’s walking or a bicep curls or anything else, right. We think of breathing as just sort of this thing that we do. Right. And we don’t think of it as an exercise, but what I would encourage you to do is I would encourage you to back off if you, and this is true of anything, anything was causing you discomfort, or if anything is okay for you, but then get to the point where it’s uncomfortable for you. Take that as a sign. So you said when you do the deep breathing for a long period of time, so guess what if you’re good till six minutes, six minutes and 15 seconds.


Well, guess what, you’re starting to experience that, that sensation. What I would recommend you do is you back off and a strategy that I started using with people, which seems to work well is break it up into three minutes and three minutes, right? So you do three minutes, take a break, give your body a chance to reset, do another three minutes. Then when you get comfortable with that, you’d go to four minutes. The first time, take a little break, three minutes the second time, when you get comfortable with that and go four and four, and they get comfortable with that five and four. But if you can pinpoint a point or a moment in time where you say this is no longer fun for me, and I’m starting to develop symptoms that you know, like, so a lot of times he wants to say, well, is this normal?


No, that’s not normal. Okay. And we don’t want to push you there. So in other words, it’s not like weight lifting or other things that we know before. We’re going to be like, come on Anna, you could do it for one more minute. Now I say back off, I say, let’s break the workload down and let’s rebuild the strength little by little and over time. That’s how your body will get better. And it serves two purposes. Number one, desensitizes the airways, actually more than two purposes, but it desensitizes the airways, making them less reactive to that. We need to do this. Um, other thing it does is it quiets the sympathetic nervous system and it helps to enhance parasympathetic tone. So if something becomes uncomfortable, there’s many, many, many, many ways to do and accomplish the same thing. And if you have questions, shoot me an email because you know, again, we’ve been doing this for a long time and we have a lot of different trips. There’s not one way that’s going to work for everybody. And if something doesn’t work, we’ll try something else. If that doesn’t work, we’ll try something else. But eventually we will figure something out that will work for you.


Thank you, Noah. I have a question. I I have three different kinds of things in my medical history. I have a moderate risk restrictive disorder in my mostly my right lung. And then from, from best breast cancer radiation, and then and interstitial lung disease that was kind of part of the longterm of that. And then the COVID. So I don’t know. What’s what, except I know what I was able to do before COVID and what I can’t do now. So all this time that I’ve been thinking, I have shortness of breath. I don’t know that you’d call it shortness of breath. I don’t, I don’t ever panic. I don’t ever feel like I can’t catch my breath instead. I kind of do a lot of gasping and and when I try to lengthen the time of my inhalation it catches and then I have to exhale. And it, I just started the second week of bootcamp and I love those breathing days because afterward everything kind of smooths out and my breathing will be much more fluid. Now, if I then take a walk, you know, it can ramp back up. But anyway,


So yeah, so there’s a couple of things there. So number one, you had post radiation know, you probably had a pneumonitis at some point that, you know, go up into,uyou said an interstitial lung disease, like pulmonary fibrosis. Is that all from the radiation?


The, well, I don’t, they, nobody wants to really, you know, say, this is what happened to you,


Even if it is, even if it’s not for anyone, who’s got a pre-existing respiratory condition, okay, everybody’s got a range, everybody’s better range. And if you do everything right, you’ll be at the top of your range. And if you do everything wrong, you’ll be at the bottom of your rink. Right. So we know that you already had a limitation before, maybe it wasn’t as a parent for you. And the other thing is that it’s a lot different when you have, let’s say emphysema and you lose maybe like one or 2% over the course of a year over. So you’ve lost 10% or 20% of your activity level over the course of 10 years versus the situation of majority of long haulers who were previously young, healthy, and active when all of this comes at one shot. So that’s a very different experience. But what I would say is that COVID probably just put you over that tipping point where you become symptomatic at certain levels.


And I would say the same things that we would try, you know, if we had never had COVID, we would still try, but we’d go a little bit more slowly and again, build up over time, build up over time. And because you said, I think you said it was your right lung. So then I would specifically spend some time lying on your, on your left side, doing the breathing exercises to align on the left side with your arm up like this, because what this is going to do is this is going to put the air so that it goes deepest into the right lung, because air is always going to rise and blood is always going to go down. So for example, this is my right lung, right? So if I lie down like this, this lung here, the bottom lung is compressed, but air goes writings here.


So we’ll address the area that we know is effective. And again, sometimes it’s just a matter of working you back up that Hill again, after you’ve had a setback. And the other thing is that there are primary issues like shortness of breath, but then there’s behavioral issues that we do to adapt to that. So if I know I get short of breath. When I walk up the subway stairs, maybe I’m going to take the bus instead. Or maybe if I know that this block has a Hale and I don’t take the hail well, eventually, you know, your body’s going to be conditioned. So your body gets good at doing what you ask it to do. And doesn’t matter if it’s shortness of breath, chest pain, hip pain, back pain, et cetera, et cetera, et cetera. If you stop avoiding the activities that causing discomfort, your body conditions, and then you become symptomatic at lower levels.


But the, the beauty of that is as opposed to what most people hear about chronic progressive disease or chronic diseases, is that you have a chronic, progressive disease that gets worse. And then you die, which is always like an uplifting sermon that I love it. People get that, but it’s that a lot of it is behavioral. And we know when I said that breathing is multifactorial very often. I’ll see somebody a year later and they’ll say, you know what? I’m much more short of breath. I was good last year. Now I’m much more short of breath. We look at their pulmonary function test. Their pulmonary function tests are exactly the same. So we ha we know that there have to be bangs besides just the respiratory system that can cause us discomfort. So we say, okay, well what’s different. Well, you know what? I retired from work.


Okay. So you retired from work. So now instead of taking the subway to the city five days a week, where you’re walking two flights down and two flights up, which is, you know, essentially 20 blocks a week time, h0 flights a week, times, 50 weeks a year, that’s a thousand steps. So a thousand flights. So do you think if you walk a thousand flights less stairs this year than you did last year, that you’re going to de-condition a little bit absolutely. Right. But the other thing it could be is that, Hey, you know, mhat else? So what, what have you been doing all winter? Well, I’ve been sitting here watching television and, hating, and then you go and you look at someone and say, well, I’ve put on 15 pounds, right? So 15 pounds is a bowling ball. So imagine if you had 15 or, you know, some people put on 25 pounds.


So imagine if you had a bowling ball hanging off of a rope down here or chain to your thorax, and every time you wanted to take the breath in or out, you had to lift that bowling ball. Well, naturally you’re going to become more short of breath. Naturally, you’re going to become more fatigued. Naturally. You’re going to try to avoid those activities that cause you this comfort, but that’s where the snowball starts. Right? And the key is us to break into that cycle and don’t break into the cycle by trying to do a mile, the first day break into the cycle. I was talking to someone this week. I said, you know what? He was actually a therapist that I work with. And he said, you know, my dad doesn’t want, I said, you know what, don’t start with 50 steps again, 50 steps the first day, right?


Because if I say, Hey, walk a thousand steps the first day, and you only get 500 steps, very demoralizing, number one, your body’s not ready for it. Right. You just didn’t prepare for it. And so the idea is I’d rather you succeed. I’d rather you get your 50 steps and add 25 steps a day as you feel comfortable and you can rebuild the body back. And I do believe that COVID, and I did see a question here that says,uI have you seen people completely recover from COVID shortness of breath. I have specifically the heaviness burning and feeling that it’s very hard to draw in a breath. I also have times on and off of where I hit a wall and I’m unable to get a breath that comes and goes, I have no issue exhaling. It seems to be very slowly improving,ueight months.


So J the answer is yes, I have. Okay. I have seen people fully recover from COVID and I expect all of you to get better. Okay. And I know that it, trust me, this is so frustrating. And I know it’s so stressful and it’s stressful, not just because of your own physical limitations, but it’s stressful because of the world situation that this moment, right? I mean, this is a condition it’s not like nine 11, which was very stressful, but it brought us together as a country. Like this is something where everyone’s divided, we’re divided over mass, we’re divided over open and shut. We’re divided over this, that, and the other thing. And it’s very stressful. And it’s not like if you just get sick and your family can comfort you, or your community can comfort you or your country can, can commiserate with you because everybody is undergoing some form of stress.


And you have to recognize that. And you have, I mean, for me, thankfully, I’ve never had COVID. I am so careful to guard against it, but it’s very stressful. I mean, it’s been, you know, I closed one business, I opened another business, but I’m not used to, you know, I’m used to success. I’m used to things working right the first time. And,uyou know, it, it’s stressful for everybody. And the key is don’t give up, it’s gonna take time. It’s gonna take more time. And, you know, part of the frustration I think is because every time something comes out in the news, we all flock to it, like guppies in a fish tank. So it’s like, you put your finger here. And it says two week virus. And it’s like the flu when we all flocked a two week virus and it’s like the flu, and then we hear it four weeks, but why aren’t I better yet?


And it’s two months and it’s four months. And now it’s like, okay, we saw these MRIs of the heart. And everyone’s like, Oh, is my heart okay? Oh, we heard pulmonary fibrosis of the lungs. Oh, are my lungs okay. Long haulers, you know, it’s, it’s, it’s a challenge. I do believe that people are going to get better. I really do believe that in my heart. And I’ve seen it and I’m seeing, okay, I’m seeing evidence of it. And one of the frustrating aspects of this is that it often seems like we’re taking seven steps forward and 6.9, five steps back. And you know, the only thing I can encourage you to do is be here happy for that 0.05 step forward that you can take and try to be patient and try to, we’re trying so many different things. And, but I am, I promise you, I’m not a bullshitter.


If you know me, I can’t lie. Even when it’s in my best interest to lie. Okay. I can’t do it. I try, I would love to be able to lie, but I can’t. But the idea is if I didn’t think there was any hope, I, I wouldn’t be telling you. I think there’s hope. And I wouldn’t be spending any time on something on a situation that I think is hopeless. I spend my time on things where I think I can make a positive impact. And I can tell you that from the time this begun to now, okay, I’ve seen individuals get better. I’ve seen individuals get better some quicker than others, but as a group, I believe the group is getting better collectively. And is it as fast as anyone wants? No. Is it as much as everybody wants? No, but people are getting better.


And what you can’t do is you can’t get locked in on, is this ever going to get better? Because, you know, and, and again, what I’m about to say is not in any way, shape or form to minimize your experience. It’s not being talus. It’s not being uncaring, but listen, people get hit by trucks, right? People have massive strokes. People have massive architects, children are born with cancer, and sometimes the recovery is long and arduous. Okay. And this is the nature of the world, and it’s not fair. And often there’s no rhyme or reason to it. Okay. But this is very, kind of heavy on our shoulders because of first of all, the numbers of people involved, the magnitude of people, you know, the magnitude of the symptoms, the number of the symptoms. And again, I encourage you to just focus on the things that you can do when something goes, well, be thankful for it.


Once you have a setback, understand that this is part of it. And, you know, it’s, it’s, it’s part of it. And again, the stock market, you know, I’m not using that literally, but you know, it’s like we don’t expect a straight uphill climb, but if the overall, and this is where it diaries and journals coming really handy, continue to look back to where you were and how much more you can do now than you could before. And if you’re really stuck, like you can look yourself in the eye and say, you know what? I am no different than I was six months ago. Nothing has improved or I’m worse than please get in touch with me. And let’s try to figure something out. Because even if we don’t have the answer, we can get you to the right people, questions or comments about anything, shortness of breath, anything else?


Well, no, I’ll just add, so I wouldn’t say I’m better. But I realized on Thursday, actually that all of a sudden I could breathe. Like there is no heaviness. There was no, you know, and I had forgotten, like I wasn’t thinking about it anymore because it just felt normal. You know, and with COVID I don’t declare anything anymore. Cause I took cleared. I was better so many times in the spring. But I do, it does feel qualitatively different. So I don’t know if it’s helpful to hear that. But it feels great to be able to breathe.


What, what was the secret of your success? Listening to Noah? I’m just kidding. I’m just joking. Like if I could talk about you for a moment. Okay. so Julie is a college professor. She’s not a type a personality, she’s a type triple a bus bus, bus personality, who doesn’t like sitting and doing nothing. Okay. And many people here can identify with them and we want to go, go, go, go, go. But we don’t set our schedule. Okay. This is COVID is like the cruise ship from hell where you will watch whatever show they have fighting that day. You will eat whatever food they’re serving that day. Okay. And if COVID allows you to take a step forward, then you take that step forward. And one of the challenges with Julie was getting her to buy into the idea that sometimes less is more okay.


And overdoing. It is like flooding your engine and it’s only going to, and that’s hard for us, you know? And you know, there’s, there’s, I believe there’s lessons to be learned in most situations, good or bad. You know, for me, I know when things have been up against the wall, like I I’ve learned things about myself and sometimes they’re things that you don’t necessarily want to learn. Like, you know, it, there was a time when my sister said to me, you know, maybe you learn something about yourself. And I said, what do you, what I learned? I say, she said, maybe you learn that you’re not as strong as you think you are. But as to how is that a good thing? She said, it’s not a good thing or a bad thing, but it’s a real thing. And I believe there are lessons here for everybody.


And I believe there are challenges. And I believe this is a reset that we should look at as an opportunity to me. I’m not congratulating you on having COVID I’m not saying like, this is awesome. I have COVID. But what I’m saying is there are signals and there are lessons to be learned here. And I think globally, there’s a lesson to be learned about how we treat the earth and the environment now, animals and things like that. But if we go through this whole thing and nobody learns anything and we don’t become better people for it. And that really sucks. And that’s really a waste. Not that I would ever wish COVID onset, but like, imagine if, if there was never COVID, we’d be like, , today’s Sunday. I got to go to work tomorrow. Right. We’d be complaining about going to work. We’d find something it’s human nature. Okay. But the idea is to be patient, be gentle with yourself, be compassionate with yourself and, and give yourself the gift and the grace that you need to just keep stepping forward. One of my favorite quotes is sometimes courage. Doesn’t roar. Sometimes it’s that quiet voice inside of you that says I will try again tomorrow. And that’s what I encourage you to do. Other questions, comments,


One question. Is there any difference in shortness of breath or responding to shortness of breath in the shower?


In the shower? Okay. So yeah, so showering is a super challenge for anyone. Who’s got shortness of breath. If you think about why, okay. Number one, you have the steam. So when you’re breathing in and out, that’s steam theme, that’s like the difference between breathing in water from a straw versus breathing in a milkshake and a straw. So it’s like you’re working harder to get it in our out. The other thing is this type of activity, overhead activity, upper body activity. If you think about what I said before, about open chain versus closed chain, this is very, very challenging to you. Okay. So number one, take it slow. Okay. Number two, you can try, you know, one hand over your head at a time instead of this, right? Because then it needs to have one long in a good position. One load out of, out of a, not in a good position to accommodate for it.


Hasty yourself, focus on the breathing techniques, crack the door of the bathroom to minimize the humidity. Those are some things, I mean, if you, if you really are struggling and you can’t shower, I would suggest putting us a stool in the shower so that you can sit during the shower. But showering is notoriously showering and dressing is notoriously. One of the most breath, challenging activities are two of the most challenging activities that there are. But again, this thing, anytime that you’re doing this, that’s going to make it tougher for you to breathe. So pace yourself, even if you had to lean over for a minute or put your hands on the shower wall for a minute and just lean over and take some breaths. But again, these are techniques to get you through the app and this should get better over time. Other questions, Diane?


Quick question first. Thank you for spending your time with us. Sylvia said the same thing. Any tips on like, I feel winded when I’m pocket.


Oh yeah. I meant to get to that. Yep. So so think about it like this. Anyone here play a wind instrument. Anyone here sing anyone here, like to scream at their kids. I knew that would get a lot of you. Okay. So think of it like this. Any time you are blowing out, it’s the same as if you were to blow up a balloon, talk, anything like that, you are controlling your breath on exhalation, right? So you get winded when you’re walking and talking or when you talk in a lot, because unlike me, who can take about talk for about 20 minutes on one breath and I talk fast, but if you’re going like this and you’re going, Hey, guess what I’m doing this? And the next thing I knew I was going like this. And next time you do that, going to think about what’s happening. You’re exhaling, exhaling, exhaling, exhaling, inhaling, exhaling, exhaling, and then guess what you like?


So what I would do is I would number one, and this is good for social skills also, right? Because we live in a society where everyone’s talking at each other, right? So at the time when you’re supposed to be listening, you could be breathing in. So it’s like, here we go. One, two, three, four, five, six, seven, eight, nine, 10, and start with exercises like that because, but this could also have something to do with your voice box. It could also have something to do with laryngeal spasm. There’s again, a whole bunch of stuff that could be there, but I would encourage you if you can’t figure it out, go to an ENT. Let’s find out what’s going on there. And then one other important thing about breath is that a lot of people in general, but a lot, a lot of people with COVID have developed a vicious acid reflux and acid reflux is more important than heartburn.


Okay. it’s not just like, Oh, I have the heartburn. I shouldn’t be eating that Chile. Right. Because what acid reflux can do acid, our stomach is line to deal with that acid, right? Our esophagus isn’t really certainly our airways are not certainly our sinuses are not. So if you’re producing a ton of stomach acid and that acid is not only coming up your esophagus, but creeping over into your trachea and going down into the airways, well, guess what? All that smooth muscle becomes inflamed and cause increased constriction. And if you have difficulty with your throat or your voice or talking or things like that, I would unquestionably make it your business to see either an EMT or a gastroenterologist, because you do have reflux that could be causing a lot of your other additions. I’ll take a few more questions if anyone has them.




Noah, what are the symptoms of acid reflux? Do you have all that acid in your throat?


You don’t have to. Okay. So you, some people have what’s called silent reflux. And so if they don’t feel any heartburn where they don’t feel the acid in the throat, but they have a scratchy throat, they have a dry hacking cough. When they want to speak, if you watch the first week of bootcamp, I recorded that on in the Cayman islands. And I had to just constantly reshoot and reedit because I was coughing constantly. And I couldn’t figure out what it was. And then I came back and I went to one of the most brilliant doctors. I know David [inaudible] and he diagnosed it as acid reflux. He worked up my lungs, which would be the, you know, the, the normal way to go. But then he diagnosed it as acid reflux. And if you go to our webinars, we have a webinar called eat cough bream in which he talks about the relationship between eating,ucoughing, breathing, acid reflux, and, you know, webinars that I did with Rob cane or about interstitial lung diseases.


One of the things that he says is that what is the single most important thing in terms of interstitial lung disease and pulmonary fibrosis, they have number one, getting the right diagnosis. Number two, if you have acid reflux, getting your acid reflux treated. And for some reason, a ton of people have acid reflux because we also did a webinar with somebody named ream, Sariah, who is also, mhe’s a Cornell doctor and she’s seeing a ton of patients. She wrote one of the first papers on COVID and gastrointestinal system. So, but symptoms could also be heartburn, sore throat coughing. Um, could be also if you wake up in the morning and your sinuses are inflamed, because when you lay back down again, same thing that acid come up and really infiltrate your sinuses. And you know, one of my big beliefs about is that, um know, inflammation in one area leads to inflammation in other areas or inflammation to get to inflammation. And it’s kind of like this net inflammation that we try to little by little reduce in any way we can.


So what are you ready?


The men for the acid reflux, because it’s my understanding that preps it or any of those over the counter meds are not good for you. Doctor has me on it for my CLPD and all the meds he has me on. Okay.


That kept saying, what is not good for you? Why


I don’t have the article in front of me, but you can research it just causes other conditions, other problems.


Okay. So great, great point. Okay. And, well, I think it’s less related to Pepcid. As much as more like the protein proton pump inhibitors, things like Omet, Rizal Protonix penciled, frazzle you know, pry Lasek things of that nature Nexium, because those do have more side effects, but let me tell you one thing, okay. This is like,uthe, the lady who swallowed the fly, right? So it’s like you swallow the spider to capsule, fly, swallow, the birds catch the spider. Ubut I’m a believer in keep the main thing, the main thing that’s from Steve, Coby’s seven habits of highly effective people. So keep the main thing, the main thing. So if the answer is, guess what, I can’t breathe. And I can’t, I can’t breathe because every time I want to take a deep breath, I cough because my lungs are being infiltrated by stomach acid.


And now I have inflammation in my airways or reactive airway disease. And now I have aspiration pneumonia, or I can’t talk because I have a sore throat. Well guess what, which is most important to you. So yeah, meditation do sometimes have side effects and some things do have unintended consequences, but you know, to me, I say, well, what, what, what I rather have and which one is most effecting your quality of life. And again, which one, and it’s sometimes hard to quantify some of these things, but, mike which one is causing the most inflammation. So guess what, if you can quiet your, your, u, system and well, guess what, now you’re not getting acid into your lungs and now you can breathe better. And now you’re not getting acid into your sinuses and you can breathe better. Or now your voice is not a force when you want to talk or now you can talk more or now you’re not coughing because of this stomach acid.


Well, that’s a worthwhile solution at least temporarily because I’m a believer and I have no proof of this. Okay. There are certain things I used to say, if I tell you it it’s because I’ve seen it and you can put it in the bank. I don’t, I can’t say that about, COVID a lot of things I think, and I’ve seen, I don’t have any proof, but if you can quiet that inflammation and overall your net inflammation gets better. Well, I think that could be a worthwhile thing, but that’s a discus discussion that you have to have with your doctor and or doctors. And it’s, it’s been tough. It’s getting easier. But at the beginning it was super tough to see specialists because so many people were told that everything’s normal when you know, darn well, everything is not normal. So I would say until we find an answer keep digging and keep trying to find a different doctor.


I would like to say one thing. UI coughed for 20 years and I went to every pulmonologist in New York city. And,uthen I found a doctor who,uwas willing to,uexpand my horizons. And I went to an E N T doctor and in five minutes he found out that I had paresis and,u


Gastro-Paresis okay.


It just said per Reese on the




No, in my throat, my, my, I had one,uone flap, one lobe, u,at, u,dn’t work correctly. It flapped, instead of, so my breathing, I couldn’t really breathe well. And, u, gave up on me, but then she sent me to another, u,d, u,terologist at, u,K. And, u,e, she gave me many medications that did help, but for a short time. And then she, the last time I saw her, she gave me injection into my, u,to my larynx, I guess, for the nerves. And I had two injections apart, one on one side on the others and it helped, but, um, ed with the cough. But I mean, I do have reflux and I think my whole coughing stems from the facts effect of reflux, but I also had Mac, I went through everything and, um, nf the, of Mac is cough,


Chronic productive, cough. So know situation like that. Like, I wouldn’t think reflux first, I would think secretions and I would get a device like the Aerobika or the acapella or something like that.


I, I have everything. In 20 years I have everything then existed on this planet. But I, I believe a lot of the coughing comes from the reflux because sometimes the other night I took a pill and it got stuck on my throat. And as you went through your whole dissertation on not being able to breathe, I felt every pain that you were talking about. Cause I couldn’t be, I couldn’t breathe. And eventually I just kept drinking water and it subsided, but now my cough has come back more. But


Have to try to get your reflux under control if that’s what you think it is. Okay. Again, you have to keep the main thing. The main things. When I used to work EMS, I got, I got called to a job at central park and somebody had swallowed a chicken nugget and he thought it went into his lungs. And so I got called by another ambulance because they knew my specialty. And I could hear from listening to the guy’s lungs where the chicken nugget was as crazy as that sounds. And I was able to put them in the position on the ambulance so that the exact place, whereas chicken nugget was, was gravity assisted. And I did some chest therapy on them where I was beating on his back. And sure, as the sky is blue, this guy coughed up an entire chicken nugget. And he was able to go back to the party.


We didn’t have to take him to the hospital. I had another friend who was putting some stuff up on one of those pin boards, like with the push pins. And he was holding a fish pen in his mouth and he caught and swallowed the push pin, except it went into his airway instead of his esophagus. And the doctors wanted to put them under anesthesia and sculpt them and take it out. But again, we were able to see exactly where it was and we put them in the right position and we would get able to get them to cough up the pushpin without surgery or anything like that. Anyway, I think we’re out of time, ladies and gentlemen,uplease, if you have questions, feel free to email me. We are doing consultations both remotely and in person at the pulmonary wellness foundation,uCOVID rehab and recovery clinic in New York city, which is on 43rd.


And second, we do take insurance if you’ve got it. Tonight at 7:00 PM, as we do every Sunday, which is going to move to Wednesdays, we have it starts with yes, which is dealing with emotional and psychological and other challenges to dealing with COVID and other medical conditions with dr. Laurie needle and a social worker, Erica master of water. And I’m there for comic relief to shoot little spitballs from the peanut gallery. And and I hope you’ll join us there tonight. If not, I hope you have a great Sunday and hang in there guys, it’s gonna get better. We just have to keep trying different things. So have a great day, everybody. Thank you so much. Have a great weekend.


Love you. [inaudible] [inaudible] [inaudible].