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.
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.
Drew
00:00:08 - 00:01:09
Hey everyone! Welcome to the mobility minute podcast. I'm your host, Drew Martin. Today. We have a really special show with Kevin Brueilly, who is a physical therapist and PhD from Georgia and his story is very interesting. He has this background in education and clinical practice, but recently had his own battle with blood clots. I think his story is something that we can all take something from um and learn a little bit about what the risk factors are for DVT and how mobility kind of ties into this whole story. I want to thank Kevin for his time and his openness with this story to be able to help those who might be in a similar situation to his. So with that we'll get into the story and get into what happened in the events leading up to his pulmonary embolism in 2019 enjoy.
Kevin
00:01:15 - 00:01:33
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, this is getting worse. Both your pulmonary arteries are blocked, and I remember responding to him saying that's impossible. I'm still Alive.
Drew
00:01:33 - 00:02:32
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 discouraged 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.
Drew
00:02:33 - 00:02:59
Since then, Brueilly has gone on to receive his PhD 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.
Kevin
00:03:00 - 00:03:50
It was alarming, it was in the wintertime, it was January right after Christmas break, and I had been somewhat sedentary, but I wouldn't say I was sedentary, I was, you know, typical Christmas break, watching football, you know, I remember laying on the couch, you know, watching a couple of games, one-day playoff games back to back and thinking man, this is the least. I've walked in any day in my life I think. You know and that's probably 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
Kevin
00:03:51 - 00:04:39
but that's about all. I remember my wife was giving me a honey-do list one time on Saturday. I remember that and uh she noticed that I was breathing heavy 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 uh pulling up the wells criteria for the D. V. T. And scoring myself and finding out that you know I didn't 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
Kevin
00:04:40 - 00:05:06
and 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 to my office and I just remember what a challenge it was to take that walk.
Drew
00:05:07 - 00:05:17
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
Kevin
00:05:17 - 00:05:46
Sweating profusely. And uh, 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 ask 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. So I went and laid down for a few minutes
Kevin
00:05:47 - 00:06:22
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 uh, asked the, 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 and 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
Drew
00:06:22 - 00:06:40
thank you for sharing that story. I think it really shows that this could happen to anyone. I guess when they told you that obviously were probably surprised. But um, with your background and kind of understanding, you know what that meant? What was the first thing that went through your head there?
Kevin
00:06:40 - 00:07:14
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 P. And he said, why? I said because I haven't felt anything. I haven't, I haven't experienced any of the symptoms. He goes, he started going through the symptoms and I'm like, okay, yeah, you're right. I do. And, uh, and then about that time, the spiral ct results came back and it confirmed a saddle pulmonary embolisms. He said, by the way, it is a saddle pulmonary embolism. Both your pulmonary arteries are blocked.
Kevin
00:07:14 - 00:08:00
And I remember responding to him saying, that's impossible, I'm still alive. And he said I know. So, he said, but what we've got to do is make sure that we get you, get you the right care. And I remember at that point, the, uh, the respiratory therapist in the room has said they had exhausted all their options. And the next option was a ventilator. And this was a very busy time in the hospital. Uh, Covid wasn't there yet, but for some reason, there were, there were a lot of ventilators and use at the time on that date. And 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.
Kevin
00:08:00 - 00:08:04
So it was very surprising and it really took me back.
Drew
00:08:04 - 00:08:22
Yeah, 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. Um, in a way, can you kind of outline how that process all went down
Kevin
00:08:22 - 00:09:17
Basically. I used myself as a research subject, but it's not really my intention when I did it, it was more of, I understand what's going on and I'm going to make 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 uh make sure that I stay the best that I can be and not have some kind of long term uh 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 the fact that how debilitating bed rest is. Just seeing anyone, you know, after surgery, after injury, after illness,
Kevin
00:09:17 - 00:09:50
after any condition, you know, after a day or two in bed, it was requiring more than a day or two to get them back on their feet. And particularly that I see you acquired weakness, you know, that that was multiplying the number of days. It was requiring to get people back on their feet. I've had enough experience in my personal life, in my professional life. I should say that when this, uh, you know, this hit me in my personal life, it gave me a new understanding and a new appreciation that I could drawback on that. So
Drew
00:09:50 - 00:10:21
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. Um, 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 uh these milestones, these mobility milestones and getting up out of bed is so important.
Kevin
00:10:21 - 00:11:10
The reason that we don't want people lying all the time is the pulmonary LV, solar 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. And 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. Their 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. So all I could do was lie on my back
Kevin
00:12:01 - 00:12:47
so I could 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 uh you know moving and maintaining what I had. So I didn't lose anymore and then focus on gaining that strength back. So I kept the, you know the readings that I knew in my mind that I wanted to keep myself oxygenated, which to me was a 90 or above. So I made sure that I maintained that I didn't want to make myself too fatigued or push myself to a limit where it would cause me any difficulty. So I limited it to any exercise that would if I would get to a position of where I felt like I was going to Hyeon exertion using the board scale than I, I backed off. And I remember there were a couple of instances where um I pushed myself a little too hard and got a little chest pain as a matter of fact, and then I had to back off there, but I did very short bouts of activity. Uh I remembered again what I had looked up, you know, in my days as a clinician that as long as I'm an anticoagulated,
Kevin
00:13:30 - 00:14:00
that clot is attached to the end of the legal wallets, it's not going to propagate and it's not likely to move and if it's gonna move, I'm in the right place for it to happen. So I made myself get up out of bed almost immediately when I got to that hospital room and they had removed that, that uh, cannula from my leg. And um and just started myself going through short bouts of exercise to my level of tolerance until I got home. And then I continued it.
Drew
00:14:01 - 00:14:22
Yeah, and that's the important thing is continuing it, right, um continuing that exercise and continue 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?
Kevin
00:14:23 - 00:15:15
Well, first of all, it couldn't happen to me. I was in that, you know, I denied it and as I said, It crossed my mind. I've been a physical therapist for close to 30 years and I've caught patients that had Dvds and got them help and, you know, potentially saved them from having a P. But I was, for whatever reason, I decided it didn't happen to me or couldn't happen to me. So I think that's probably one of the things is um, you know, be in tune and make sure that you're paying attention. Um, I think, I think another one is that it requires, you know, a lot of risk factors when really, in fact, it doesn't, you know, blood clots happen to everybody every day. Even healthy people throw pulmonary emboli, but they're microscopic into their lungs
Kevin
00:15:16 - 00:16:09
and it's when they start getting larger as when the problem occurs. So it does happen to everyone. Um, I think the biggest misconception I had before I started doing any research was that a DVT was uh, you know, in my mind, it was a small thing, it was uh, you know, the size of a dime or something like that. But DVT is really when they when they break and they pulled and they flow into the pulmonary vasculature. The really dangerous ones are really long like feet and inches long. So the one that that uh we believe that I threw went from the length of my knee to my hip And I'm six ft tall. So that's you know 2024 long and this is a blood clot, you know, probably the size of a pencil or larger.
Kevin
00:16:09 - 00:16:56
So 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. So you know, the misconception of being a small amount is not true because when I came to the hospital I still had the remainder of the clot from my need to my ankle. And that you know that kind of gave me the confirmation that this was a 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 D. V. T. S don't occur to people that move period. So 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 gonna get a pulmonary embolism.
Kevin
00:16:57 - 00:17:20
So that was the first thing in my mind as I'm getting out of this bed. You know, even though I knew I was anticoagulated, uh that it 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,
Drew
00:17:20 - 00:17:43
Wow, I think those are some powerful messages and maybe some things that people don't consider when they think about DVTs. And P. E. So thanks for sharing those. Um, I also want to get your thoughts as a physical therapist. Uh and someone that's been in the hospital. What are the best ways to motivate a patient to be mobile from your perspective?
Kevin
00:17:44 - 00:18:23
I mean someone in the hospital, it's obvious you know you have to weigh the risks and benefits of getting them up. You know 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. It's uh it's it's you know I need to be getting up and moving and 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 uh to tell myself, you know, hey, you met your goals today or you didn't meet your goals today and tomorrow you got to do better.
Kevin
00:18:23 - 00:18:57
So what we, so today we reap tomorrow, uh not only in the vegetable market but also in our health. So you know, that's what I try to teach my patients is that you know, 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. Um, so you know, adopting um an up-and-add and moving lifestyle is certainly something that we would want everyone to adopt that's pasta that is able to do it.
Drew
00:18:58 - 00:19:20
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. Um 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.
Kevin
00:19:21 - 00:19:35
My whole, 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. And it's been the effort was worth it. Right,
Drew
00:19:35 - 00:19:43
well, thank you for your work. Thanks for joining us today on the Mobility Minute podcast. We appreciate your time and talking with us today.
Kevin
00:19:43 - 00:19:44
Thank you very much.