Andy Sabatier, PT, DPT is doing tremendous work with patients in the ICU setting – helping them get back to function by focusing on breathing properly. And since Andy is one of the few PTs in this setting that is doing front-line work with COVID-19 patients I figured it would be important to talk to him about how PT’s can help those who are dealing with the symptoms of COVID-19 to help them overcome and recover faster by teaching proper breathing techniques and exercises. The message is timely and not typical of the PTOClub topics, but hopefully of great value to the listeners.
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Breathing Exercises For Those Affected By Respiratory Issues With Andy Sabatier, PT, DPT
I’m bringing on the primary PT for a 24-bed ICU in Central Oregon. Andy Sabatier, who I met under odd circumstances, but we’ll get to that. He’s also the Founder of Academy West Breathing & Performance in Central Oregon. I wanted to bring Andy on because he has a unique perspective. As a physical therapist in ICU, he has seen the whole course of COVID-19 coronavirus pandemic in patients that have come through the hospital and they’ve seen the patients. They’re also gearing up for more. First of all, Andy, thanks for coming on and joining me.
I’m happy to be here. Thanks for having me, Nathan.
You’ve seen it all, from what I can tell so far, as far as the course of the coronavirus in the patients that you’re dealing with in the ICU. If you could share with us from your PT perspective and dealing with some of these patients, what does that course look like? I think there’s a lot of unknowing out there what this looks like, what patients are feeling, what they’re going through, what that course looks like. Could you share with us from your perspective what people are dealing with in the ICUs?
The word you used, unknown, is accurate. Every day we’re dealing with a new reality. We have been from a rehab standpoint trying to understand where physical therapy enters that patient’s care, whether they’re critically ill or mildly ill or somewhere in between on that spectrum of the disease process. Every day is a little bit different. To say that I’ve seen a whole course, I’ve seen how the course of the disease goes with the sickest people. We have only a little bit of knowledge to go off of. I’m trying to consume as much data as I can from the CDC and the WHO websites and trying to read up on the data that’s now coming out of China, Italy and Australia even. There seems to be a theme where things move fast. People’s incubation is anywhere between 2 and 14 days. Most people, it’s about 4 or 5 days. Once that disease has progressed to the point that they have to come to the hospital because of increased oxygen needs, low SpO2 values, we see a rapid progression.
What are the symptoms in those cases? What would the laymen feel in that situation?
The most common symptoms of COVID-19 appear to be fever, cough. Shortness of breath with some patients. Most are experiencing myalgia, but the two main symptoms that people are having are dry cough and a fever.
Is the myalgia simply the body ache?
It’s a body ache and there’s also an element of fatigue, where people are far more tired than they’re used to being in. It lasts day after day. There are also some people that that’s the whole disease and then they get better. Those are the people that are at home waiting this out, hoping that everything’s okay, but if it does progress and there is a respiratory element, you’ll know fast because all of a sudden it’s getting harder to breathe. As people need increasing amounts of oxygen, the speed at which the disease moves is fast. We’ve had a couple of people that come down to the ICU and are quickly intubated and things progress fast from there. Normal course, if we’re talking about the most critical patients, those patients are going to be intubated working on a mechanical ventilator.
Depending on the amount of support they need, their bodies may be working hard, which is counteracting how much they’re trying to get air in because they’re working too hard and it’s wearing them out. When somebody is working so hard that they’re wearing themselves out and they’re anxious, there are lots of drugs that are used to slow the body down and even to the point that they’re paralyzed. If somebody is paralyzed, they’re medically paralyzed to give their body a rest. The position of the body has a lot to do with how they want the lungs to drain or how they want the lungs to get rid of all the fluid, mucus, and consolidations that are built up.
If you can't breathe, you can't function. Click To TweetThose people that are progressing quickly, do they usually have other underlying medical conditions? Are they a certain age group or are you seeing healthy people regress that quickly?
Mostly it’s people with cardiac conditions, diabetes, chronic lung issues, liver conditions, kidney issues. All of those chronic problems get exacerbated. One of the things that are not necessarily being torn out there quite as much with COVID-19 is that there is a cardiac element to it. There appears to be COVID-19 cardiomyopathy that happens where all of a sudden their ejection fraction is poor. Somebody who’s got a functioning heart or at least a fairly well functioning heart will all of a sudden their heart will not be working nearly as well.
These are people who have cardiac conditions before?
Some yes, some no, mostly yes. When all those body systems start shutting down at the same time, it’s a matter of, “Let’s get everything to calm down. Let’s save this person’s life. Let’s make sure that all those systems recover before we start doing anything else.” At least so far, we’ve had a lot of patients that we positioned prone. We’ll have the person lying in bed and then we’ll flip them over so that they’re facing downward and their lungs are then allowed to drain a little more easily. The worst position the human body can be in to breathe is lying flat on your back. There’s something that I often say to my patients when I’m going in and meeting them and introducing why a physical therapist comes in to see you in the ICU on the worst day you’ve ever had. It’s basically because there are only three things you do lying down. We sleep, we have sex and we die. We’re here to do none of those things. It’s time to get you out of bed. That usually gets a laugh on hopefully what’s one of the worst days they’ve ever had.
Is it a good idea if someone’s may be recovering at home or maybe they are in the ICU wing of the hospital, to get up and sit up for quite a bit of time and walk around a little bit?
In general, in life, the bed is the enemy. There is nothing good that’s going to come from inactivity. Even if you are in some disease process, unless you’re so far advanced that you can’t maintain your breathing without help, you should be moving. I’m not saying you should be out running laps when you’re sick, but standing up, marching in place, walking around your house, making sure that you’re continuing to move is going to allow your body to get some of those secretions out. It’s going to allow you to move that venous blood back into the center of your body, move all that lymph system. Everything should be moving along with your body. When we sit, still, only bad things happen.
Even if people are recovering from home, they should at least get out of the bed, sit up, move around, walk, get some fresh air, I’m assuming as well you’re recommending. You might be able to do that with some of the people in the ICU, but when it gets to the point where they need ventilation, that’s because what’s happening at that point that they need ventilation. Are they not getting enough oxygen into their body?
I don’t want to tread too far into somebody else’s area because I will do a worse job of explaining medically why things are shutting down than their intensivist or their pulmonologist. The way that I try to explain it to patients before this COVID crisis, when we did have family members that were in the room and they’re wondering why things are going so badly, there are a lot of muscles that have to work in conjunction to accomplish normal breathing. When your lung tissue is suboptimal, when it’s stiffer or when it’s clogged with mucus and consolidations and fluid, any number of reasons that can cause you to have respiratory failure, it’s a matter of trying to support the body through that. Most people don’t have an understanding of what muscles they’re using when they breathe because they breathe without thinking. Oftentimes, they are working hard to breathe but not necessarily working smartly, if that makes sense.
This is the reason why I wanted to bring you on because you essentially teach breathing every day. That’s part of your job. You’re teaching all kinds of patients how to breathe properly. Doing some strengthening for the breathing musculature, we know it’s the diaphragm, but doing exercises for your breathing can improve your ability to overcome and recover from this flu epidemic. You see that as part of the process in the ICU.
I’ll only slightly correct you and then I’m sure we’ll come back to it. You’re right. The diaphragm is the primary muscle of breathing, but the muscles that accomplish your breathing, it’s a concert of muscles. Everything from starting with your mouth, orbicularis oris, glottal folds into the intercostal muscles down through the diaphragm, TA across the front. Quadratus lumborum in the back, the pelvic floor on the bottom. PTs talk about core muscles. Those are your core muscles. What’s more core activity than breathing? Usually what we’re trying to do is to train a little bit of every one of those, maybe not the pelvic floor in the ICU setting, but we’re teaching people how to use their mouth effectively. We’re teaching people how to use their glottal folds effectively for coughing versus huffing. We’re teaching people how to expand their chest. We’re teaching people how to recruit their diaphragm. The diaphragm is definitely the most important thing because if that diaphragm isn’t working efficiently and effectively, there is little chance of being able to take the breath that you need to take in order to recover and clear your lungs.
What does poor breathing look like compared to good breathing?
When we’re assessing breathing, we have to look at two things. We’ve got to look at their sequence in their pattern. The number one pattern that I see with most people, the poor breathers, is anybody that’s using that accessory muscle. All you have to do is ask somebody, “Please take a deep breath,” and you’ll know right away. You’ll see what they do. You’ll see what muscles move the most. Our traps are one of those muscles that take over. It’s a big bully group, a big massive muscle directly innervated into the brain through cranial nerves, not a spinal nerve at all. It’s one of the first muscles that form in our neural tube when we’re in development. If you let it take over, it will take over anything, whether that’s some physical movement like that you’d see in an outpatient orthopedic setting or somebody who’s relying on it for breathing. It’s a muscle that’s designed to keep you alive. It’s fight or flight. If you hear a bear behind you, your shoulders come up and you’re running away from them. If you hurt yourself, you stub your toe on the corner of the bed, you go, “That hurt.” Your shoulders come up.
The second you get anxious or worried, your shoulders start coming up. Anything that’s painful, it’s coming up. It’s one of these muscles that all those things that wreck your breathing are linked to your traps. Everything we’re trying to do when it comes to patients with difficulty breathing is getting them to calm down the accessory muscles, recruit the diaphragm because it’s the complete opposite of the traps. Traps are designed to move your head. They’re not designed to move 20,000 times a day, which is about how many times you breathe. Somewhere between 17,000 and 30,000 times a day. Your diaphragm, on the other hand, is designed to do exactly that. It’s a slow-twitch muscle. It moves in big, slow arcs up and down, and if you can train it, it will support your breathing without you even trying. It’s the most efficient and effective muscle in our bodies. It’s the second most important muscle in anybody’s body, but we don’t talk about it at all. That’s one of those easy things. You walk in and you say, “We fixed your heart. Now let’s talk about the second most important muscle you’ve got.” It’s right here and they don’t even know where it is.
What does a good diaphragmatic breath look like?
I’m going to slightly tilt you down because I’m a hand talker. When you’re assessing somebody breathing, you should be able to see SCM scalene traps, intercostals right down here. You’re going to want to follow their sternum down. Find that spot right with the xiphoid processes, that soft spot. That’s where your diaphragm is, and then tell them to sniff in. If you sniff with a quick little sniff, you should feel a quick impulse of that diaphragm. If you’re not getting that right away, you’ve already identified somebody who probably is sequencing. They are going to go up. All that results in is ineffective breathing, so coaching them through that, helping them understand this is where your diaphragm is. Feel it, understand it, touch it, because you have one. You have to learn how to use it.
From there, smooth, natural diaphragm contractions are going to pull. We’re going to have expansion in the lower fields. There’s a little subtle expansion forward. Lateral expansion of the lower ribs. Mid-thoracic, a little bit of expansion, slight expansion upward, but I’m tilting my hands because that’s the action of the ribs. They’re like bucket handles. They tilt up. As you inhale, the diaphragm comes out and then tilt up and never at any point am I raising my shoulders or using any of these neck muscles. If you get somebody to inhale maximally, it can be anybody, whether it’s an athlete or the layperson, the biggest breath you can take is at the end, going to recruit some of these muscles. These aren’t accomplishing any of that expansion of the thoracic cage. They’re finishing the job.
When you’re talking about sequencing, that’s the last part of the sequence, I’d assume.
Normal sequencing goes diaphragm, lateral expansion, upper chest expansion and nothing else. Nothing above where my hands are here. If you’re getting any movement above the shoulders, that’s more accessory muscle recruitment than you want during even normal quiet breathing or exerted breathing.
The incubation period of the coronavirus is between two and fourteen days. Click To TweetYou’re training this on every patient if they’ve got a respiratory issue and you’re hospitalized.
I’m training this on every patient. When I started going down this wormhole years ago, initially I was going, “Am I going to be able to do this with any of my patients besides these hearts or someone’s got pneumonia?” The more you see it, every single person breathes. Not every person breathes well. Strokes definitely have breathing problems. Kidney patients, there are tons of breathing problems. There are breathing problems on anybody with any neurologic compromise. TBIs, there are breathing problems. You name it. The more I started doing it, the more I realized if you can optimize anybody’s breathing right before they move, you’re going to get more function out of them.
It’s almost like giving somebody a supplement before they work out like, “Have this shake and it’s going to allow you to work out a little bit harder and get a little bit better, lift in and get more results.” It’s the same exact thing. If you can breathe better, you’re going to be able to walk farther. You’re going to be able to do more tasks, you’re going to be able to accomplish more. My mentor has a famous phrase. Mary Massery says, “If you can’t breathe, you can’t function.” She is 100% right. All the things that fall in their function, you’ve got to be able to breathe.
What are some of the exercises that you’re giving some of your patients or anyone who’s reading, saying, “Are there some exercises that you’d share with us that you’d take people through if they’re feeling some of these issues?” Even if they want to breathe better in general, what are some basic exercises that they can do?
Basic exercises for anybody to be able to do. That one we talked about where you identify your diaphragm, the first thing you’ve got to be able to do is to find it. Once you find where your diaphragm is and feel like you can breathe using it every time, training yourself on it in the nose, out of the mouth breathe where you feel a big expansion and getting comfortable with that. I usually will try to pair that with some other visual input. One of the reasons why we don’t breathe or we don’t understand the way we breathe is because we don’t see it. I know how my arm moves because I can see it. I understand the elbow. I understand my wrist. If my fingers aren’t moving right, I can tell because I can see them.
I have no idea what’s going on here and ignorance is bliss. I go about my life. If you can get yourself in a situation where you can see yourself breathe, that’s going to help. I tell all my patients, “Tonight when you go home and brush your teeth, I want you to stand at the sink for one minute with your shirt off and breathe.” That throws some people off, but it’s your anatomy and you have to understand how to use it. Nobody’s there watching you. Spend a minute watching yourself breathe, understand what moves and understand what doesn’t move. Given the knowledge that we went through. We talked about this should move, this should move and you want motion here and you want motion here. You don’t have to get into all the anatomy. You have to show them where things are.
Once you have that, that starts to change how you think. Most of what changes breathing is thinking about it. I’m not saying you should be walking around all the time thinking about how you breathe, but it’s going to be hard not to think about it if you’re understanding more of it and you know how to be more efficient. Here’s a way for you to walk and save your energy. I’ll buy into that. All it is, control your breathing. Have a breathing strategy. Be purposeful about what you’re doing. When you’ve got somebody walking out in the hallways in the hospital or somebody out training for a run or somebody that’s trying to motivate themselves to have lower stress levels at work. All of that can be accomplished by having a breathing strategy ready to go that’s based on knowledge. It’s understanding how to use your tool.
What I’m gathering from you is if I was at work or if I got sick, I’m going to start thinking about sitting up upright and thinking about in through the nose, out through the mouth, but also maybe feeling my stomach or looking in the mirror. I’m feeling my stomach expand and contract, feeling my ribs flail out and in or up in front and down. I’m concentrating on that. Would you have someone do that a certain number of repetitions if you were essentially in a therapy setting?
In a therapy setting, it’s like you’re under my control. I’m going to be working with you and I’m going to tell you what to do. There are lots of cues and I’m going to look for those little things. I’m going to use my hands to try to get you to understand where I want you to move things. For homework, it can boil down to being as simple as devote 60 breaths every day to getting better. You take 20,000, you can probably find 60 breaths to make yourself a little stronger and a little better. Thirty breaths while you’re lying in bed, trying to focus on how much your diaphragm moves. Maybe that’s 30 breaths when you’re out walking around, taking them slowly in through the nose, out through the mouth, relax the shoulders and slowing it down.
Doing it while you’re active and understanding that I can deep breathe when I’m out taking a walk, I can deep breathe while I’m sitting there typing away. There is literally not a time when you’re not breathing, unless you’re here and we’ve got a whole other circumstance, then you’re definitely not working with me. It’s changing your perspective on things. If we’re talking about this specific exercise to strengthen the diaphragm, it’s like any other muscle. It wants resistance. There are lots of respiratory trainers out there that you can put in your mouth and you can breathe in and breathe out and we’ll give you a little resistance. The best respiratory trainer you have is right here. Orbicularis oris is one of the strongest muscles we’ve got.
What I tell my patients is, “I want you to purse your lips tightly, like we were doing when you were blowing out, like you’re blowing out candles. Except this time what I want you to do is have that hand down on your diaphragm and you’re going to inhale through that same tightly pursed-lip mouth.” If I’m here, I’m going to tilt this down slightly. I’ve got my fingers on my diaphragm. You can see my mouth and I’m going to go. It’s the opposite of personal breathing. It’s personal inhalation rather than personal exhalation. What I was able to do, because I was breathing slowly and I had a little bit of resistance, feel the diaphragm completely expand and then gradually moving there up into the chest and feeling, “This is where it stops. This is as much as I can fit in before I start pulling my shoulders. It’s time to let it out and then open mouth and let it out, relax.”
You see some incredible results with your COVID patients, I’m assuming.
I’ve had the patients that I’ve worked with, my COVID patients are the ones that I like to say where is physical therapy entering into their continuum of care? Some people, it’s like they’re coming into the hospital and they’re feeling sick and they’re up on the medical floors and we’re helping to keep them moving and keep them doing things. The patients that I’m encountering are the ones that crash. The ones that come down that go into multisystem organ failure, go into respiratory failure, are intubated and then often prone, and paralyzed. After 4 or 5 days, when their lung function starts to recover, then we start weaning them from sedation.
I’m the first person you see when you can move. You see your nurse in and out of the room, but the first time you sit up at the edge of the bed is with me. What I’m doing with those patients is first we work on your breathing mechanics. We try to make sure that you’ve got all those things we talked about. Once I feel like things are moving in the right direction with somebody behind you and somebody in front of you, we help you sit up on the edge of the bed. Now you’re sitting up on the edge of the bed for the first couple of minutes, maybe 10, 15 minutes on the edge of the bed. That might be your whole PT session.
Through those fifteen minutes, we’re going to be working on trying to focus on deep breathing, getting your mechanics to be sound, and making sure your breathing is moving in the right direction. Everything is about nudging the system. Our bodies are designed to breathe well. It’s why none of us have to think about breathing. When you can’t breathe well, we’ve got to try to do something to nudge your system the other way. COVID-19 is what wrecked your breathing or it was all these other complications and comorbidities that you had prior to admission. Now we need something to push the other direction. By getting a little bit of a nudge towards sound mechanics, we see people start to improve. Once those improvements happened, now it’s time to do something with it.
For me, I’m thinking of two things. Your breathing is improving. Now we want to add a functional task and we want to change your position. By giving somebody a functional task, let’s say it’s reaching or balancing on the edge of the bed or standing up or walking or any of that, making sure their breathing is solid first and then giving them a functional task and do at the same time. You’ve got to be able to walk and chew gum at the same time. With those patients, their first PT session, the next day you come in, you’re seeing significant changes. They’re more alert, they’re more awake, their mechanics are better, their oxygen requirements are lower and their activity tolerance is much better. As fast as the disease can come on, it can be as fast as the disease process can accelerate, the recovery process can have equally impressive leaps. At least that’s what I see so far.
It can be spurred along as long as they’re breathing better, as they’re getting deeper breaths and strengthening up the diaphragm and becoming more functional, getting out of the prone and supine positions and sitting at the edge of the bed and walking. It starts coming back quickly.
The bed is the enemy. Anybody’s going to get worse in bed. It’s the one thing we know. We know that no matter why you’re here, this bed is the thing that’s ultimately going to take you down. It’s not going to guarantee that you get better, but the whole point of the ICU is to increase the percent chance that you survive. We increase the percent chance that you survive when you move, when you get out of bed, when you start doing functional tasks. Along with the physical aspect of it comes the cognitive aspect. People that have been down in the ICU for days, they lose track of day and night. They lose track of life in general because no cues are coming to them, saying, “You’re awake. It’s daytime, it’s nighttime, it’s time to sleep.”
Breathing is the point wherein the physical and mental aspects of your body collide. Click To TweetIt’s all one bizarre reality. Like the bizarre reality we’re living in now as a society, we have a way of resetting that. They don’t. The PTs and the OTs, we are the ones that are trying to restore function. We’re trying to restore something normal. That normal thing is you got out of bed, you took deep breaths, you coughed, you moved, and you did all that but you also stood up. You also sat on a toilet, looked in the mirror and brushed your teeth. Those little things help to cue the brain that, “We need to start moving along. This is important that we recover and we play a role in this.”
It sounds like you provide hope like, “I’m getting back to normal function,” and so you’re showing the light at the end of the tunnel.
We hope so. One of the things I ask all my patients and I have a lot of one-way conversations because I have a lot of patients that are on ventilators or can’t talk. It becomes like a stand-up comedy. One of the things I say to them is, “Do you feel like you accomplished something?” By and large, they say yes. I say, “Remember that because this place is going to play tricks on you. Your job is to keep it together for the next 23 hours because the next time I see you, I want you to be still progressing.” There are many things that we do for you at the hospital.
We can do everything for you. We can keep you alive without your brain even functioning. The one thing that I tell patients is, “Your job is to breathe. I can’t do that for you. I can help you. I can show you and I can help nudge your system along, but these are the exercises that I want you to do. This is your incentive spirometer. This is your acapella. This is diaphragmatic breathing. This is personal breathing. This is how to cough. This is how to huff. This is how to whatever. This is your job. We’ve got jobs and you’ve got a job too. Your job is to breathe.”
Tell us how someone should cough if they are having some of those issues?
Everybody’s a little bit different. Some people when they cough, they get into coughing fits and then they can’t take a deep breath in. I would say five mini coughs are not effective. In fact, coughs are a high-risk maneuver if we’re talking about pulmonary clearance. Sticky secretions get stuck in the lungs and cough is a high-pressure move. Closure of the glottis, developing all that pressure using all those muscles we talked about and then a big cough out. Sometimes that cough can be so much that that high pressure reaches a choke point and it pushes the secretions back down. Sometimes it’s preparing yourself to cough. Making sure that you’ve done all the techniques you can to try to loosen all that gunk up before you cough. One of the simple things we teach people is cycles of breathing. That’s one of those things we learned in PT school.
I remember hearing that term, active cycles of breathing. It does work to try to get people taking big, slow, deep breaths and then moving some of those secretions along with a maneuver called a huff. A huff and a cough differ whether or not the glottis is closed. A cough, the glottal folds close and the pressure’s built up in you, but a huff, you keep the glottis open and you try to move things along. You can have a smaller huff, a medium huff, a big huff, depending on the airways you’re trying to clear. That’s the thing that’s guided by somebody who is around you or written down on a piece of paper. You can say, “I want you to follow this step-by-step thing, so that every time you’re going to get a big old cough because it takes a lot of energy, I want you to try and get as much ready as you can so that you’re coughing effectively.”
Some deep breaths followed by some huffs and a full-blown cough?
An active cycle of breathing is 3 to 5 deep breaths all the way in, 2 or 3-second hold, casually relax, let it out. It’s not like blowing out. It’d be hold for 2, 3, all the way out. Repeat that 4 or 5 times. You’re going to start doing huffs where you have little huffs, medium huffs, big huffs. Finally, once you feel like you’ve got things going, now you cough. You tell them, “Take that big cough, build up pressure, and then out it comes.” I naturally do that thing where I’m a sternotomy patient. I’m holding my cardiac pillow, but it works for me. A cough can be a double-edged sword because a cough can send you to a coughing spell. Everybody’s been there where they’re coughing and they can’t take a big breath in without agitating our airways.
It’s more about, “If you’re in a coughing fit, we want you to slow things down. We want you to breathe in the nose, we want you to breathe out the mouth and slow it all down.” How you cue people as a therapist is important like the timbre of your voice. If you want somebody to inhale, you can use big, exciting cues. “Inhale.” If you’re trying to get somebody to exhale calmly, you’ve got to slow it down. You want their diaphragm involved. That’s a slow-moving muscle and it’s a calm muscle. Calm language and using your tone of voice to try to get people to do what you want them to do. Your job as an educator turns into something different than you’re used to.
I love what you shared with us so far because it’s about breathing and not only breathing, but the anatomy behind it. The proper breathing cycle and the huffing and coughing for those people who would get to that point where they might have some productivity in their lungs. How much it can help people to overcome and recover from some of these flu-like symptoms that they have. It’s imperative, especially considering this as mostly a respiratory issue, that a lot of this information gets out.
I’m glad we’re talking about all the pulmonary clearance stuff and the mechanical stuff that has to do with breathing. Breathing is the point where your physical body and your mental body, for lack of a better term, collide. For somebody who is anxious breathes differently than somebody who’s not, we know that for sure. We also know that you can use your breathing to slow your heart rate down, to lower your cortisol levels, to get your body’s sympathetic nervous system to calm down and your parasympathetic nervous system to turn on and bring some of that balance that our body is supposed to have. Owning your breathing means owning all those different aspects. Owning your own role in your anxiety. Everybody’s been anxious and this is an anxious time. We all know that panicking doesn’t do anything. Panicking, buying all the toilet paper in the world doesn’t prepare you for this. Being calm and taking 30 deep breaths, you will feel better than you did before that. Did you solve everything? No. You had a positive effect and you’re halfway to those 60 breaths that you’re supposed to use to make your body better every day.
I love the information that you shared, Andy. If people wanted to get in touch with you, ask you more questions from the PT side, from the general public, how can they do that? How can they get in touch with you?
You can email me at Andy@AcademyWestPerformance.com. Things are crazy and we’re shut down on an outpatient basis, but I’m here full-time at the hospital and working as hard as I can to try to get us ready. The nurses that are here and the docs that are here and the respiratory therapists, because what I’m doing is a little bit different than what most PTs are doing. All those people, whether it’s doc, PT, nurse, RT, none of those people own breathing. I think it’s important that educating everybody around you, if you have some understanding about how to breathe a little bit better, share it. That’s why I’m talking to you.
This is an important thing for everybody to understand that we’ve all got the same tool and we all could use a little bit better breathing. Can you find one person that says, “No, I don’t want to breathe any better.” If you start looking at it and start thinking about it, you will start understanding this. It’s a matter of saying, “I’m going to start looking, I’m going to start thinking about breathing, period.” You probably have it. If there’s a curiosity and you want to learn more, the courses by Mary Massery will change how you look at the body. I would recommend any PT or OT or speech therapist to sign up for those with Mary Massery.
I’m looking forward because I know you’re going to be eventually having your own clinic and focusing on Academy West Breathing & Performance. I’m excited to see what you do in the future, but what you’re doing now, I have to thank you. You’re on the front lines. You’re doing so much for those people in Central Oregon. Hopefully, people can recognize that the work that you’re doing is something that saves days of people in ICU and the recovery time is faster. They’re able to overcome quicker and get back to functional activity. You’re improving people’s lives faster, quicker. You’re saving hospitals millions of dollars. Your work is amazing. I hope it gets more promotion, more publicity going forward.
I appreciate that. I think you’re right in that it’s important work that we’re doing down here. People ask me why I work in the ICU. I work here because this is where the best team is. There is a blurring of lines the more critical the patients get. The PTs, OTs, respiratory therapists, nurses, and doctors job, they all blend together and there are tons of communication. There are tons of collaboration. I’m trying to be the best advocate I can for that team and for my patients and trying to do my part.
My part is I want everybody in this community and everybody in this hospital to breathe better and to maximize how much potential they have physically and beyond. That starts with how you breathe. It’s not what I expected to be doing when I went to PT school. I could take you down the road of how I ended up here. I think it’s a good story, but suffice to say, I love my job. I’m happy to be here doing this even though it’s such a messed up time to be working in an ICU and seeing things you haven’t seen before in the volume that you haven’t seen before. We’re going to get through this as we get through everything else.
I wish you luck. Good luck with everything. There might be more coming around the corner here soon. I wish you the best. Stay on top of things. I wish you the best in Central Oregon and in your work. Stay safe and stay alive and good luck with everything. I appreciate you working in your time.
I appreciate you, Nathan. I think we’re probably going to hear in about May. We’re settled in for the long haul. I’ll leave you with this. This struck me. The military has a term called VUCA. It stands for Volatility, Uncertainty, Complexity and Ambiguity. We are without a doubt in a time of VUCA. With every period of volatility, there’s always opportunity. I think that this period of volatility has opened an opportunity for physical therapists and rehab specifically to have an impact on our patients through improving their breathing and doing that on a grand scale. There’s going to be a ton of PTs that need to go back to work when all this settles down. There’s going to be a ton of people with respiratory issues that have no idea how to breathe and no idea how to use their bodies. Nobody out there is better at explaining your anatomy, your biomechanics, how you use your body and how to perform better than a physical therapist. It’s time for us to shine.
Let’s incorporate all of that back into everyday function and high-level performance. Run the gamut. Thank you for your time, Andy. I appreciate it.
It’s my pleasure, Nathan. Thank you very much.
Important Links:
About Andy Sabatier, PT, DPT
Andy Sabatier, PT, DPT is doing tremendous work with patients in the ICU setting – helping them get back to function by focusing on breathing properly. And since Andy is one of the few PTs in this setting that is doing front-line work with COVID-19 patients I figured it would be important to talk to him about how PT’s can help those who are dealing with the symptoms of COVID-19 to help them overcome and recover faster by teaching proper breathing techniques and exercises. The message is timely and not typical of the PTOClub topics, but hopefully of great value to the listeners.
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