Mobility Minute: Kevin Brueilly details his early rehabilitation following a saddle pulmonary embolism
Today we have Kevin Brueilly, PT, Ph.D.
Brueilly's background in education and physical therapy clinical practice came full circle when he was diagnosed with a saddle pulmonary embolism in January of 2019. In this episode - we detail Kevin's lessons from going through this scary situation and how his focus has since shifted to bringing awareness and research around post-op recovery and mobility.
I think his story is something that we can all take something from and learn a little bit about what the risk factors are for DVT and how mobility ties into this whole story.
“I think the biggest misconception I had before doing any research was that a DVT was a small thing, you know, the size of a dime or something like that. But DVT is really when they break and they pulled and flow into the pulmonary vasculature. The really dangerous ones are really long like feet and inches long.”
Listen to the full podcast here.
Note: Podcast transcript below is a condensed version of the conversation generated using a combination of speech recognition software and human transcribers, and may contain errors. Please check the corresponding audio before quoting in print.
Kevin Brueilly's clinical background as a physical therapist began at Mayo Clinic in Jacksonville Florida in the 1990s. As a young professional. He was always questioning norms at his hospital, a trait that eventually led him towards a path and research and academia later in his career. One of his early observations as a clinician was the hands-off approach to patients diagnosed with deep vein thrombosis or DVT. The norm at the time was to keep DVT patients in bed and discourage movement at any level in order to let the body heal.
Now, Kevin knew through his training that this physiologically didn't make any sense, and began to look into this seemingly widespread problem. Along with other doctors at his hospital and his medical director at the time, he put together an informal clinical practice guideline at his hospital to address this.
Since then, Brueilly has gone on to receive his Ph.D. in education and is responsible for starting physical therapy programs at numerous academic institutions. His combined experience as a clinician and educator came full circle with his own personal battle with blood clots in 2019, Brueilly describes the sense of anxiety he felt in the days leading up to his eventual diagnosis.
It was alarming. It was in the wintertime, right after Christmas break, and I had been somewhat sedentary, but I wouldn't say I was sedentary. Typical Christmas break, watching football, you know. I remember laying on the couch, watching a couple of games, one day back to back, and thinking man, “this is the least I've walked in any day in my life I think.”
That's very possibly where I contracted it, but who knows. Leading up to that incident that day, for about two or three days before, I do recall having some calf irritation. I wouldn't say pain, but it was like an Achilles tendon strain. That's what it felt like. And I remember having some shortness of breath and nausea, but that's about all I remember. My wife was giving me a honey-do list one time on Saturday.
She noticed that I was breathing heavily, and she said, “do you know do you need to go to the doctor?” I said, “no, no I don't think I need to go to the doctor.” But at that point, I recognized I was breathing heavier than I normally do. And even that day I remember pulling up the Wells Criteria for DVT and scoring myself and finding out that I didn't meet the threshold of DVT being likely, but it did cross my mind.
So, that was a Saturday.
On Tuesday morning, driving to work, I started to have a real heavy unproductive cough. It was not the light, pollen asthmatic allergy kind of cough. This was a cough where you're trying to cough something up but I wasn't able to. And this is on my way to work at 7:00. AM. And as I came into the office that morning I had about a maybe 100 yard walked from my vehicle to my office and I just remember what a challenge it was to take that walk.
That must have been such an overwhelming feeling. What were some of the symptoms that you were experiencing at that time and what did you think that it could have been?
(I was) sweating profusely, and I could hear myself obviously breathing heavily and wheezing with the breathing. And I thought, “you dummy, you've let yourself get pneumonia from laying around watching football.” That's exactly what I thought.
So I went out and sought out one of the faculty members and asked them if they could get me a thermometer to take my temperature. I took my temperature and was normal. So I'm like, okay, something else going on.
I went and laid down for a few minutes and almost immediately after I laid down, I could not get enough air. I laid there for five or 10 minutes just struggling and decide I've got to get up. This is getting worse. And I got up, and went to the faculty member again and said, “can you give me a pulse oximeter?” And they did and what got me on it, but the battery was dead.
So I said, “I don't feel well. I think I need a ride over to the emergency department.” That’s probably the best decision I made. I stumbled into the emergency department and they quickly brought me back and diagnosed me with a DVT and PE.
Kevin Brueilly, recovers in the ICU at the Augusta University Medical Center, GA. He recalls being in disbelief at his saddle pulmonary embolism diagnosis although he felt quite calm knowing he was receiving excellent care.
Thank you for sharing that story. I think it really shows that this could happen to anyone. When they told you that obviously were probably surprised. But, with your background and understanding of what that meant, what was the first thing that went through your head there?
It's actually comical now that I think about it, but my first response to the dock, when he told me you have a pulmonary embolism, I said, “I can't have a PE.” And he said, “why?” I said, “because I haven't felt anything, and I haven't experienced any of the symptoms.” He started going through the symptoms and I'm like, “Okay, yeah, you're right. I do.”
(Chuckles)
About that time, the spiral CT results came back and it confirmed a saddle pulmonary embolism. He said, “by the way, it is a saddle pulmonary embolism. Both your pulmonary arteries are blocked.” And I remember responding to him saying, “that's impossible, I'm still alive!” And he said, “I know.”
I remember at that point, the respiratory therapist in the room said they had exhausted all their options, and the next option was a ventilator. This was a very busy time in the hospital. Covid wasn't there yet, but for some reason, there were a lot of ventilators in use. She said they had one clean ventilator in the hospital, and that she was going to take that with me to my treatment room so that in case I needed it, I would have it available. So it was very surprising and it really took me back.
I'm sure that's a really scary situation to come out of. Um, And how did you start to look at your rehab? And it seems like you almost became a research subject of your own in a way. Can you kind of outline how that process all went down?
Basically, I used myself as a research subject, but it's not really my intention when I did it. It was more of understanding what's going on and making myself better sooner. So I am not going to allow myself to lay in bed for days and then try to get better. I am going to work through this and I'm going to make sure that I stay the best that I can be and not have some kind of long-term disability or problem as a result of this.
What I saw in the hospital and what really made me want to learn more about mobility and particularly mobility after blood clots was how debilitating bed rest is. Just look at anyone after surgery, after injury, after illness, after (almost) any condition. After a day or two in bed, it requires more than a day or two to get them back on their feet.
Particularly that ICU-acquired weakness was multiplying the number of days. I've had enough experience in my professional life that when this hit me in my personal life, it gave me a new understanding and a new appreciation that I could drawback on that.
First of all, I'm glad you're able to recover from this situation and you're able to kind of take what you've learned from that situation and bring it straight into your research. I think that's very telling of how personal this got for you.
How did you take, what had happened to you and bring it into your research and can you talk a little bit from your physical therapy background of why these mobility milestones and getting up out of bed is so important?
The reason that we don't want people lying all the time is the pulmonary alveolar and gas exchange, but just as important as the fact that when you're upright, your heart has to work against gravity. So it's giving your body more of a challenge to push that blood up to your head and keep your brain perfused and the rest of your body. So it's actually a therapeutic effect to get a patient from lying to sitting. You know, even the smallest amount of upright puts a tax on the heart and allows the heart to have to work harder in order to maintain that equilibrium.
That's why, you know, when we faint, we fall and that's a safety mechanism so that we continue to get blood to your brain because if we stopped moving and never went down then you know, potentially would not give blood to our brain. And if you lose blood to your brain, it doesn't take long at all for brain death to occur.
Thoughts of my rehabilitation revolved around the rehabilitation of my own physiological self to build my strength back and to combat the effects of lying in a bed in intensive care for two days when I could not move because that ecosystem catheter was in my venus system through my heart and into my lungs. And so I couldn't move around because that was all attached to a pump that was basically saving my life to break the clot. All I could do (in the ICU) was lie on my back and do isometric exercises with my other leg and my arms and my core and things like that. But I couldn't get up. So that was the one thing that I really wanted to do was get up out of that bed and test my system and make sure that I was moving and maintaining what I had so I didn't lose anymore and then focus on gaining that strength back.
I remembered again what I had looked up in my days as a clinician that as long as I'm anticoagulated, that clot is attached to the endothelial wall, it's not going to propagate and it's not likely to move. So I made myself get up out of bed almost immediately when I got to that hospital room and they had removed that cannula from my leg and I just started going through short bouts of exercise to my level of tolerance until I got home. And then I continued it.
Yeah, and that's the important thing is continuing that exercise and continuing to progress in your mobility is important for recovery. What do you think are some of the common misconceptions about DVT s and pulmonary embolism that you might have had before it happened to you?
Well, first of all, “t couldn't happen to me.” I was in that, you know, I denied it. I've been a physical therapist for close to 30 years, and I've caught patients that had DVTs and got them help and potentially saved them from having a PE. But, for whatever reason, I decided it didn't happen to me or couldn't happen to me.
I think another (misconception) is that DVT requires a lot of risk factors when really it doesn't. Blood clots happen to everybody every day. Even healthy people throw pulmonary emboli, but they're microscopic into their lungs and it's when they start getting larger as when the problem occurs. So it does happen to everyone.
I think the biggest misconception I had before I started doing any research was that a DVT was a small thing, you know, the size of a dime or something like that. But when DVTs break and they flow into the pulmonary vasculature, the really dangerous ones are really long like feet and inches long!
The PE that we believe that I threw went from the length of my knee to my hip, and I'm 6-feet tall. So that's you know 20-24in long and this is a blood clot, probably the size of a pencil or larger. That's a lot of solid material to go up into your lungs and just start bawling up, and that's what shuts off your blood flow. And that kind of gave me the confirmation that this was a big caliber clot that started from my knee and went to wherever it ended.
Most of my reading has taught me that DVTs don't occur to people that move period. It's just not likely if you're up and moving around regularly, you're probably not going to get a DVT and thus you're not going to get a pulmonary embolism. So that was the first thing in my mind as I'm getting out of this bed. Even though I knew I was anticoagulated, that (the clot) was not going to grow, I just knew that I wanted to get up and I didn't want to have the effects of immobility jump on me and have a long rehab because I need to get back to doing what I want to do. I just have too many things to do to not be healthy.
Wow, I think those are some powerful messages and maybe some things that people don't consider when they think about DVTs and PE.
I also want to get your thoughts as a physical therapist and someone that's been in the hospital. What are the best ways to motivate a patient to be mobile from your perspective?
I mean someone in the hospital, it's obvious you have to weigh the risks and benefits of getting them up. What's their condition and what's occurring. But for someone who doesn't have active pathology at the time, it really is a mindset. I don't know how many people have an Apple Watch, but I got one about six months ago, and it gives me my score at the end of the day, if, how many times I've been up on my feet and how much movement I've made and how much exercise I've had. And it's a really good reminder to tell myself, “hey, you met your goals today or you didn't meet your goals today and tomorrow you got to do better.”
What we sow today we reap tomorrow, not only in the vegetable market but also in our health. That's what I try to teach my patients is that your lifestyle today is what you're gonna be looking back on 10 and 20 and 30 years from now saying, “I wish I should have done it or could have done it differently.” Adopting an up-and-moving lifestyle is certainly something that we would want everyone to adopt that is able to do it.
That's very true. And something that we want to encourage people to continue to do with this podcast. So thank you again for your research and your time today. I think it's a good reminder that even people who know the risk factors of DVT and immobility are still at risk so thank you for documenting that and making it a part of your research.
My whole thought and publishing it was If I can save one person out there that recognizes it and goes and gets treatment and doesn't have to go through what I did then the effort was worth it.
Thank you for your work and thanks for joining us today on the Mobility Minute podcast. We appreciate your time and talking with us today.
Thank you very much.
ABOUT THE AUTHOR
DREW MARTIN
Drew works as marketing manager and takes care of digital and content marketing efforts for Recovery Force Health. He enjoys learning about and discussing newer medical technologies and adopting them into everyday marketing practices.
