This podcast is designed to discuss heart and lung diagnoses, treatment interventions, research, current trends, expert opinions and patient experiences. The goal is to learn, inspire and bring Cardiopulm to the forefront of conversation.
Episode 20: What is the pulse-ox trying to tell you?
If you only had access to one PT tool or device for your eval and/or treatment session what would it be?
In this episode, Dr. Burriesci delves into the item she’d (likely) bring to a desert island, a pulse oximeter. She explains the invaluable information that can come from this device and it’s not specifically O2 related. Yes a pulse ox will give you a quick read on oxygen and heart rate, and yes there are common causes for inaccuracies, but what else is it inadvertently telling you? Listen in for a few clinical tips that you likely won’t find in any textbook.
And after this episode, you’ll have to let her know if you too will take the pulse ox with you on your deserted island.
In this episode:
- Normal values of spO2
- Common causes of inaccurate readings via pulse-ox
- Atrial fibrillation
- Premature Ventricular Contractions (PVCs)
Guest Episode: All Things Breathing
Today I'm talking with Dr. Rachele Burriesci who is a cardiopulmonary expert.
I am releasing this guest episode for April because we are just a week away from world breathing day on April 11th! (2023). You know I love a good world breathing day!
Dr. Rachel talks about her experience teaching and treating through COVID and has some great exercises for you.
We also get in to the power of breath, life expectations, and feeling like you've finally made it.
Get in there and give it a listen for more!
Episode 19: Wear the damn stethoscope
In this episode, Dr. Burriesci chats about how necessary it is to advocate for our own profession and sometimes that can be as simple as wearing your damn stethoscope. Although this episode is not specifically promoting wearing your stethoscope and it’s definitely not about shaming you for not wearing one, it’s actually about recognizing our role in supporting each other.
It’s all about elevating our profession while also educating other professionals and patients about what we are capable of doing. With such a wide scope of practice in our field, we have to remember that even if something is not in our comfort zone or even a skill we don’t personally enjoy, that does not give us permission to down our own profession. We need to do better and support one another, so we can continue to elevate our profession.
But if auscultation is a skill you want to become more comfortable with, start by wearing your stethoscope and finding a mentor that can help you master this skill. Like any area of your life, in order to improve your skills it starts with practice. And if you’re looking for a mentor, book yourself a mentor session with Dr. Burriesci.
In this episode:
Importance of elevating our colleagues
Promote your skills
Supporting our wide scope of practice
Learning a new skill requires practice
Episode 18: Pericarditis to Tamponade
In this episode, Dr. Burriesci reviews a recent patient case of pericarditis and the possible manifestations of this diagnosis. She explains what symptoms and presentations we may see from this patient population so we can be prepared when we assess our patients. She educates the patient on positioning to help relieve symptoms, breathing strategies, and exercises that can give us the most bang for our buck. She also walks us through what medical interventions are utilized while inpatient and when we should (and shouldn’t!) see these patients from a readiness perspective.
In this episode:
Pericarditis
Pericardial Effusion
Cardiac Tamponade
Pericardial drain
Differential diagnosis (angina vs. non-ischemic chest pain)
Breathing strategies, positioning and interval training
Importance of vital sign assessment
Episode 17: A different viewpoint: Cardiomyopathy w. Dr. Brunelle
In this episode, Dr. Burriesci starts by introducing Dr. Kyle Brunelle and his passion for lifting, hiking, jujitsu and breathwork. In 2020, he started a physical therapy business, Renegade Performance, with his wife. He is the optime of an athlete; yet there’s an invisible illness he’s been dealing with since 2015. He was diagnosed with Hypertrophic Cardiomyopathy and had an Implanted Cardiac Defibrillator in 2016 but has continued to maintain his high level of physical activity throughout his journey. Dr. Kyle brings a unique viewpoint of the healthcare field because of his clinical background and his venture as a patient. He also has a fun fact about an external defibrillator he carried around for months and a fascinating ICD placement that I can bet you’ve never seen before.
Find out more about his diagnosis, symptoms, and exercise routine now in this episode!
In This Episode:
- Dr. Kyle Brunelle's background as a PT and business owner
- Hypertrophic Cardiomyopathy
- Diagnostic findings and symptoms
- Symptom mgmt & treatment of HCM
- S-ICD and Kyle's unique placement
- AED / BLS
Find Dr. Kyle Brunnelle at:
IG: @renegademvmt
website: https://www.renegademovementandperformance.com/
Episode 16: 3 Roads to Specialty Certification
In this episode, Dr Burriesci breaks down the three main roads to becoming a board-certified specialist: residency, mentorship, and self-study. As someone who utilized self-study for her first certification, residency for her second speciality and now mentors people who are sitting for their CCS exam, she explores the pros and cons of each road. She explains that while one lane may not work within your lifestyle, another may be the exact fit for you. She navigates through how to apply, what the interview process looks like (from resident and facility standpoints), what moving across country looks like, tuition vs pay in residency and so much more.
If you feel like there’s a missing piece in your practice or that you desire more mentorship in a specific topic, check this episode out!
In this episode:
How to tackle applying for specialty
Qualifications to sit for a specialty exam in cardiovascular & pulmonary
Finding a mentor
Pros and cons between self-study vs residency
Applying to a residency
Setting yourself up for success
Is it a good fit for you?
Episode 15: Stop Blowing out the Candles
In this episode, Dr. Burriesci chats about Pursed Lip Breathing (PLB) as an intervention for patients with an Emphysema diagnosis, anxiety or post-exercise. This intervention is extremely popular and easy to perform, but the traditional cue of “blow out the candle” is often misused. We want to give our patients a different cue that is mindful of the 1 second inhale to 2 second exhale, to prevent air trapping, encourage air to move out of the lungs and pace breathing. But if we stop saying “blow out the candle”, then what do we say? Find out now what phrase we should use to maximize PLB and get the most bang for your buck.
In This Episode:
Mechanism of pursed lip breathing (PLB)
Pathophys of Emphysema
Importance of the words we choose in cueing
Visual feedback techniques of PLB
Episode 14: Did you do breathing exercises w your patients today?
In this episode, Dr. Burriesci educates on the importance of utilizing breathing exercises and how they can be incorporated into patient sessions, across the spectrum. She explains that almost every patient/client can benefit from breathing exercises and that there are specific breathing exercises that can be used to help each diagnosis. But the benefits of using breathing are endless, even if you are not treating patients with cardiac or pulmonary conditions. Incorporating breathing will help set your patient up for success, it will put them in the driver’s seat, give them control and give them the tools to manage a number of issues: SOA, pain, anxiety, atelectasis, pulmonary edema, mucus, diaphragm strength/endurance, gas exchange, the list goes on.
So, while this may not be your common practice (yet), we have to remember to use interventions that we know will make a difference and to treat the whole person. Let’s individualize care for our patients, maximize function and utilize breathing to do just that.
In this episode:
Discuss the benefits of breathing exercises
Discuss how to perform the following breathing exercises:
Inspiratory holds
Stacked breathing
Paired breathing
Incentive spirometer
Discuss which breathing exercises will benefit post-surgical patients
Post-surgical patient: median sternotomy, thoracotomy, clamshell incision
Define atelectasis
Discuss changes that occur in the lung post-general anesthesia
Ep 13: Heart Failure from a PT perspective, review of the CPG
In this episode, Dr. Burriesci walks us through the latest HF Clinical Practice Guidelines (CPG) along with the New York Heart Association classifications. The goal of the CPG is to establish an evidence-based approach for the optimal treatment of HF. Dr. Burriesci dives deep into how we can utilize these recommendations for our patients and explore the research behind the 2020 CPG. She reviews the daily activity, education, neuromuscular electrical stimulation, resistance breathing training and exercise recommendations set in the CPG. She goes on to explain how we can tailor these interventions to our own patients. This episode gives us, as clinicians, the knowledge of what the perfect numbers should look like, but the realistic insight that we must meet our patients where they’re at to reduce their overall risk.
In this episode:
Unpack the Heart Failure CPG
Describe ACC stages vs NYHA Classes of HF
Discuss 9 action statements aka recommendations for treating patient with heart failure
Increase physical activity
Educate!
Aerobic training
HIITs
Strength training
Inspiratory/respiratory muscle training
NMES
Ep 12: Heart Failure it Doesn't Happen Overnight
In this episode, Dr. Burriesci goes through the pathophys of heart failure and the subsequent signs and symptoms that result. She explains that the pressures exerted on the chamber, the afterload, cause the chamber to fail over time and cause a back-up. Follow the back-up and you will find the symptoms. We flow further into the information by looking into what other systems are impacted when the body begins to compensate for heart failure. This again impacts how we, as clinicians, will chart review, think about testing and how we treat our patients. All of these factors help set our patients up for success over the years.
In This Episode:
Difference between left and right heart failure
Difference between systolic and diastolic dysfunction
Structural difference between dilated and hypertrophic cardiomyopathy
Signs and symptoms common in both left and right heart failure
Discuss the systems compensations in response to failure
Ep 11: Are they cardiac risk factors or so much more?
In this episode, Dr. Burriesci walks us through how lifestyle modifications may take us down a path of less disease. She reviews how chronic kidney disease, coronary artery disease and diabetes all have similar risk factors that link back to lifestyle modifications of, you guessed it, diet and exercise.
This episode puts in perspective the importance of educating patients on lifestyle modifications and utilizing adequate exercise prescription to make an impact in our patient’s daily lives and create longterm change . We empower patients with knowledge to increase their aerobic fitness while reducing their BMI, blood pressure, glucose levels and more. Each of these put our patients one step closer to living an overall healthier lifestyle and mitigating disease risk. Movement really is medicine.
In This Episode:
- Cardiac risk factors
- Diabetic risk factors
- Chronic kidney disease risk factors
- Metabolic syndrome
- Understanding the link between all four processes
- Identifying the importance of lifestyle modification
Ep 10: Heart disease in Women its not just a male disease
In This Episode:
- Bring awareness of risk of heart disease in women
- Common misconceptions of heart disease based on gender
- Identify atypical signs of angina
- Cardiac Risk Factors
- Reasons for misdiagnosis of heart attack in women
- Obstructive disease vs. microvascular disease
EP 9: COVID-19, What you still need to know
The novel virus, COVID-19, is unlike any other virus that we have had to deal with in the modern age. It quite literally hits both ends of the spectrum, causing issues with both clotting and bleeding. It hijacks a person’s system and creates chaos for an undetermined amount of time. However, Dr. Burriesci is here to give us a 40,000 feet view of what COVID looks like. She explains what symptoms looked like at the beginning of the pandemic and how that has shifted to what it is being seen today. She also chats about her journey through the start of the pandemic, including the loss of her mentor and coach Joe Lewinger, her wife treating on the front lines, and her family back in NY.
In This Episode:
Dr. Burriesci’s Journey through the start of the pandemic
Defining Acute COVID-19
Pathophysiology and signs and symptoms of COVID-19
Making sense of the moving target
Understanding the location of ACE 2 receptors systemically
Progression of signs and symptoms and change with more recent variants
Guest Episode on The Fire Rescue Wellness Podcast
Covid did a number on the world and unfortunately, we still don't know all of the impacts. In Episode 31, I sat down with my girl Rachele B to talk all things cardiopulm physical therapy and Covid/Long Covid as it relates to firefighters.
Rachele Burriesci received her Doctor of Physical Therapy from the New York Institute of Technology in 2009. Rachele received her board certification from the American Board of Physical Therapy Specialties (ABPTS) in Geriatrics in June 2013 and her board certification in Cardiovascular and Pulmonary in June 2015. Rachele practiced at the VA Ann Arbor Health Care System for four years post-residency where she was a primary mentor in the Cardiovascular and Pulmonary Physical Therapy Residency program, implemented and developed the Home-Based Cardiac Rehab program, and directed the facility-based cardiac rehabilitation and pulmonary rehabilitation programs. Rachele is a former assistant professor at Rockhurst University. She is now the owner of All Things Cardiopulm, LLC, and works as a PRN PT staff member at the University of Kansas Health System. She is passionate about physical therapy, the education of cardiopulmonary wellness across the lifespan, and the benefits of PT interventions across many cardiovascular and pulmonary disease processes.
So what, now what?
If you had Covid and feel like you've never quite recovered, you might be correct! The great news is that awesome people like Rachele can assist.
Ep 8: Educate! Educate! Educate!
This episode serves as a reminder to educate our patients so we can give them autonomy and the power to make safe decisions for themselves when it comes to their care. When we educate our patients, we also give them the words and empowerment to ask the right questions, advocate for themselves and understand their current situation.
In this episode, Dr. Burriesci explains that our patients aren’t as fragile as we may think. When we educate our patients, we get to link arms with them and partner in their care. We give them control of their body, help prevent re-admission, better their health outcomes and so much more!. No matter the setting we practice in, we are always in a spot to educate our patients. When we do better, our patients do better!
Ep 7: Episodic & Reversible - All Things Asthma
Dr. Burriesci gives us the good news that asthma is both reversible and episodic. She takes us through the pathophysiology, 6 types of asthma, diagnostic tools, signs, symptoms and medications that can help manage the disease. She also explains the best way to manage asthma symptoms is through prevention and education. As an asthmatic herself, she explains her story while also diving deep into the information that can assist others on their personal asthma journeys. Whether you’re an athlete who is triggered mid-workout or a middle-aged person experiencing symptoms later in life (hint, there’s a larger population than we realize!), there’s a solution for you!
In this Episode:
Pathophys of asthma
Types of asthma
Diagnostic testing for asthma
Symptoms of asthma
Common medications used to control asthma
Management of asthma
Ep 6: Surviving Cardiac Arrest it Takes a Village
In this episode, Dr. Burriesci helps define the differences between cardiac arrest and myocardial infarction and brings to light the frequency of these episodes in the community. She describes how cardiac arrest occurs and potential causes of this type of event. She brings to light the things we can do in those moments to better our patient/family member/friend’s odds of survival, including the importance of BLS (basic life support) as a community member, activating emergency response system, locating AEDs in the community and apps that can help with CPR.
Ep 5: Putting the SMART back into SMART goals
Transcript Ep. 5
In this episode, Dr. Burriesci breaks down the SMART AF goals that help pare down goals to meet you (and your patient!) where you’re at. This takes those overwhelming, vague goals and turns them into actionable and achievable goals. With this concept of making each goal SMART AF, you take the overwhelming and time-consuming portion of writing goals and streamline it to find that Goldilocks “just right” for each individual person. This concept can be applied to each of your physical therapy patients or to your personal goals any day of the week, not just in this new year. This gives you actionable steps to Get After It!