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Red Light Green Light: Reasons to Play and Reasons to Stay with Dr.’s Patruno and Czysz

Episode 14

“The biggest thing is to listen to your body knowing again, don’t try to just push yourself through it.”



This week on Talk of the T-Town, Joan sits down with Dr. Patruno and Dr. Czysz, both doctors from our partners Valley Preferred and The Lehigh Valley Health Network (LVHN), and discuss all things COVID: symptoms, recovery, and what things could look like moving forward.


Dr. Joseph E. Patruno, Past President, Medical Staff, Gynecology, The Lehigh Valley Health Network
https://www.lvhn.org/doctors/joseph-patruno

Dr. Aaron J. Crysz, Critical Care Medicine, Pulmonology, The Lehigh Valley Health Network
https://www.lvhn.org/doctors/aaron-czysz

Coronavirus and COVID-19 Vaccine Resources

Visit: https://www.valleypreferred.com/for-health-care-providers/provider-support/coronavirus.aspx

LVHN COVID-19 Help Center: https://www.lvhn.org/covid-19-help-center



Transcript

Joan Hanscom:

Welcome to the Talk of the T-Town Podcast, where we discuss all things track cycling. Broadcasting from the Valley Preferred Cycling Center, I’m your host and Executive Director, Joan Hanscom along with my cohost Athletic Director, Andy Lakatosh. Welcome to the Talk of the T-Town Podcast. I’m Executive Director, Joan Hanscom and today we are taking a bit of a departure from our normal very track centric conversation and looking at things from a more medical perspective. We’re going to talk about cycling in the world of COVID and we are very fortunate to be joined by somebody who is very hands-on in this world. He is Dr. Aaron Czysz, who is a physician who specializes in pulmonology at Lehigh Valley Health Network, which everybody here in the Valley affectionately refers to as LVHN.

Joan Hanscom:

But not only is he a pulmonologist, but he rides competitively including here on the track. He raced for three years in a row in our corporate challenge including on a first place winning team that was comprised of fellow employees from LVHN and their subsidiary Populytics. So we’re very fortunate to be joined today. Welcome Dr. Czysz. We are thrilled to have you to talk about cycling, your experience on the bike, your love of the bike, but also what we sort of need to know in the day and age of COVID. I know we have athletes who are recovering. We have athletes who are worried about getting sick. We have lots of questions because this is brand new territory. So welcome and thank you.

Dr. Aaron Czysz:

Well, thank you very much for the introduction and I appreciate the opportunity and it’s my honor and pleasure to be here today.

Joan Hanscom:

So before we started recording, we were bantering back and forth a little bit about how currently you’re not getting out to ride very much for myriad reasons. One of course, to state the obvious, you’re very busy on the job. But when you do get out and ride, tell us a little bit about you and your life as a cyclist.

Dr. Aaron Czysz:

So it dates back to basically when I started med school after college and not having organized competitive sport anymore, cycling became a new avenue to be able to continue to try to stay at a level of competitiveness as well as a level of athletic, sorry, a level of athletic involvement to be able to keep myself involved in what I had ingrained and going through my years growing up as always having some level of competition in place, but allowing me do that on my own timeframe. And like I said, that powered me to medical school, residency, fellowship and even stays with me today in practice at that LVHN. The track became a new love. And I think 2013, when I did the air products, Try the Track Program and actually the developmental program with the track in 2013. And then when I joined the staff at LVHN in 2014, I was granted the opportunity to cycle with the team then and had been going ever since obviously, not this past year due to obvious reasons with COVID.

Joan Hanscom:

I think that’s one of the things that I love most about our sport is that you can play Pop Warner football in Grammar School and you can play high school or college football, but you don’t really play football when you’re in your 20s, 30s, 40s. That’s a sport that falls away and cycling is for life really if you want it to be. And I love that about it because I would have bought my, well, I did buy though I didn’t use it, my 20th bracing license last season. Hopefully, I’ll get to use it in the upcoming season. But I do love that we can do this forever. And then it does keep us competitive and keeps us part of an athletic community that is really energizing. So I’m glad you sort of share that same long time love of being competitive. I think it’s important. It keeps us young. I always say that cycling is the fountain of youth. But you touched on COVID and a lot of people bought bikes in the last year.

Joan Hanscom:

A lot of people found bikes in their basements that have probably been gathering dust or not been touched in a decade and trotted them out and got out on two wheels for the first time in a long time. And I think that’s awesome and I think it’s a moment of great opportunity for us here at the Valley Preferred Cycling Center, where maybe we can find more people like you who have rediscovered bikes and now who maybe want to do just what you did, do a Try the Track and come out and experience what we do here at the velodrome or they just want to join in some of the group rides that leave from here and become part of that community. But with all that said, I guess, there’s stuff they should know. There’s stuff to get right into the meat of our conversation. There’s stuff that people who are leading active healthy lifestyle should know about COVID and they should know how to participate in this sport safely. And so let’s talk about that. Let’s talk about what we know, what’s emerging about what we know about COVID and its transmission and start there.

Dr. Aaron Czysz:

Yeah, no, you touched upon a great point as far as people being part of a community and feeling part of a community when you become a cyclist or when you continue to be a cyclist just because of… Again, it crosses decades of participation and it’s again, a lifelong sport that you can continue to be a part in. And even if you’re not being group rides, like you said, people either bought bikes or they got these online training with whether it’s an app or a device itself that has your programs that you can log into for your spin classes or anything like that. Again, it allows you to feel like part of the community and in a timeframe where we are under essentially social isolation because of social distancing, it gives you that great mental aspect and mental break to be able to, again, feel like part of the community again.

Dr. Aaron Czysz:

And again, for people that are lifelong athletes, it again, allows you to kind of still feel like part of a team. Now that being said, when you’re talking about the community aspects. Again, unfortunately at this point, it still seems like we have to be cautious and continue to be in more of a solo rider kind of role because group rides still are going to present the issue with, again, the transmission of COVID itself because obviously even if you’re not in a section where you’re kind of drafting and or riding tightly packed in a group, the congregations before and after the rides, give timeframes and opportunities for virus to spread. Again, then obviously if you are working on drafting or riding closely tight in a group, then you are in a much closer proximity and doing a fair bit of heavy breathing where you have the opportunity to spread virus if somebody is indeed carrying it and is especially, kind of the most dangerous aspect of being asymptomatic carrier, where they don’t know that they have it, but they’re still going to spread to others.

Joan Hanscom:

I think this is particularly interesting right now to folks who maybe have gotten a little bit of riding solo fatigue going on. We’re coming up on a full year of this now, but we’re starting to learn more about variants and potentially different strains of COVID now that are potentially and I say potentially just because we don’t really know yet, although I guess, signs are pointing that way, that they’re more transmissible. And so to me, what you’re saying really rings like, yep. Just Joan, keep riding solo. It’s okay. When you don’t know if things are more transmissible, why take the risk and just keep plugging along on those solo rides while we sort this all out.

Joan Hanscom:

And hopefully, folks start getting vaccinated and the vaccines are successful and we’ll all be back to group rides at some point. But yeah, your point is well taken that why risk when we don’t need to. But then what if you do get COVID. I read an article in Bicycling magazine that really sort of at a very top level of or very normal person level laid out some of the complications and lingering health impacts of COVID. And what are you seeing? What do you know that’s important for us perhaps as a motivator to not take risks, but also just if you do get sick, what do we need to know about these lingering impacts of COVID?

Dr. Aaron Czysz:

Mm-hmm (affirmative). Yeah, all very good questions and I’ll just touch back to your points about the variants that are emerging and everything like that. As far as what we do as of today, the research that we’ve seen is that yes, the variant seems to be more contagious because they have a higher concentration of virus in the middle secretions. And so you can then just be much easier to spread it to others. As far as we know, the vaccine that has been developed for SARS-COV-2, which is COVID-19 as we know it, that has been possibly rebate available commercially by two manufacturers so far in the US that should still offer protections for that new shrink. Now as far as getting COVID and how we go about exercising in and around that timeframe, COVID is really a game changer as far as what competitive and recreational athletes are used to as far as their norms for their exercise routines.

Dr. Aaron Czysz:

So firstly, exercise has been well-documented as having many health benefits and there’s even some basic science research going and looking at certain enzymes that are released or produce and then released by skeletal muscles and transport to the rest of the organs in the body that has an antioxidant and protective effect from some of the deleterious effects of COVID. But when we talk about actually getting an infection, the biggest thing to know is… Again, basic, the medic carriers are going to be a big portion of population. Again, the biggest concerns that we have are obviously where people would end up hospitalized and or in the ICU after getting acutely ill. Trying to exercise this in acute COVID infection is actually not going to be the intro that you want to kind of look to for a competitive and a recreational athlete.

Dr. Aaron Czysz:

Often that’s not the case. Usually the practice that they have is to kind of push through and at least get some exercise in to kind of make yourself feel better, get some blood flow and you start feeling like you’re back to your normal self. Again, when athletics and exercise is ingrained in your DNA, you just don’t feel like yourself if you’re not still able to do what you normally will. So again, if you have a COVID infection and again, the signs that we’re going to be looking for are going to be your cough, your shortness of breath, tachycardia where your heart rate is faster, computations where you feel like your heart’s racing. Those are all signs that, again, you might be having COVID infection as well as the others that the CDC recognizes as far as fevers, chills, body aches, nausea, vomiting, diarrhea, loss of taste and smell.

Dr. Aaron Czysz:

Those, again, are things that, again, that’s accompanying a feeling like you’re not able to do the things that you normally have been able to do as far as you’re not able to complete the ride that you normally would or it’s taking you longer to complete that ride or there’s a particular section or a hill climb that you’re just kind of dragging through. That’s one of the things that athletes are seeing because they might not necessarily get knocked down at rest, but when they’re exerting themselves, that’s when they’re having the biggest limitations. The scary parts, and again, this is a very rare instance. But again, the scary parts are that there’s been at least one case of a healthy individual in her 30 who ended up getting COVID, went out for a run and actually died from a heart attack because of what’s called a myocarditis or inflammation of the heart muscle.

Dr. Aaron Czysz:

Okay, again, that’s a very, very rare instance. However, again, these are things that have been documented in the literature. And again, the kind of thought behind it that I try to exercise through COVID would be okay. Maybe as we exercise, you’re increasing what’s called our cardiac output, our heart rate goes up and you’re taking a little bit increase in the actual how much is your stroke lying or how much blood you’re moving with each heartbeat. So more beats per minute and a little bit more blood volume per beat, you’re going to get more blood flow and more liters per minute of blood flow throughout your body. And the concern of being okay, are you going to then allow for viral replication to be at a higher level?

Dr. Aaron Czysz:

So that’s kind of what happened. The concerns about trying to exercise if you do get COVID. Once you do get COVID, you’re kind of stuck with typically 10 to 14 day window of not doing anything. Reason for that, again, being that monitoring severe exercise, your moderate to vigorous activity can sometimes, again, lead to inflammation of the heart muscle, in the lungs. And again, because COVID is such an inflammatory disease, we also run the risks of making those, excuse me, of being at a higher risk for like in that myocarditis or having worsening lung disease or anything like that as side effects of COVID itself. So from that standpoint, we don’t expect that people… Oh, sorry.

Joan Hanscom:

Just one really quick question on that topic because I think what’s interesting and I think really good for our listeners to hear is that you mentioned a person who’s 30. So this is not what we hear on CNN, which is oh, the people that… And yes, you indicated that it’s a rare case. But we’re referencing the sphere of athletics in this conversation. So we’re not talking about senior citizens per se, we’re talking about how this could be applicable to athletes in their peak of their prime. And I think that’s just something that we want to reiterate particularly, I think for parents of juniors who are worried about their kids’ training plans as well as young adults right up to masters athletes like myself that this is not something that is only being seen in the senior population.

Joan Hanscom:

And I wanted to reiterate that again, because we run a program for juniors. Obviously, there’s a lot of junior cycling programs that happened around the track and I understand that the research isn’t quite as robust on teenagers. But it does seem to me if it’s happening in a younger population, we should sort of just call that out as an area to just, hey, this applies to the younger folks too, not just the 65 year olds. So I didn’t want to step on you there, but I did want to just take that opportunity to flag up something that you said that jumped out at me.

Dr. Aaron Czysz:

Yes, and again, oftentimes 65 and over, hypertension, diabetes, obesity, those are going to be a risk factors for more severe disease, higher risk of being hospitalized, needing oxygen, needing the ICU, higher risk of death when you do get COVID. But again, yes, the younger population is going to be at risk for, again, these severe complications. Again, but be a much more rare level. However, again, as athletes and especially if you’re asymptomatic often because if you had exposure say with our teams that are at school or in sports programs and they go through… Oh, this person. There’s a person under team that had a positive test and now you go through a kind of a post-exposure screening and that test comes back positive, but you’re asymptomatic.

Dr. Aaron Czysz:

That’s still is a very important time from… Sorry, that’s still a very important time to take that at least 10 days off post diagnosis at least seven days after symptoms have been resolved and overall generally about two weeks. And again, it’s just different studies, different recommendations for that timeframe. But again, about two weeks from the time of the COVID test, that was at least two weeks from the time the COVID test became positive and typically, two weeks from the time that your symptoms end. So again, if you’re asymptomatic obviously, that’s a two week timeframe. If you have symptoms in a mild case and those go away after about seven days and stay away, then find three weeks later, you’re back to trying to start activity. It’s not going back right away at 100%, this is a very gradual step, a wise approach back into the ring if you will.

Dr. Aaron Czysz:

One important thing to note is that oftentimes, there’s this bi-modal distribution of symptoms, where the first couple of days you feel really bad and then you start to kind of have this honeymoon period where you start to feel like you’re a little bit better. And then that’s where on that second wave of symptoms at about 10 days, 10 to 14 issue somewhere in there, we’re seeing people have much more, again, incidents of feeling worse, but having been back to trying to get back to their training and again, having flushed applications because of that.

Joan Hanscom:

So that’s interesting. That’s like the old, it doubles down on you. It comes back and it comes back to bite for round two. What are some of those signs and symptoms that you’re seeing? Is it the same if you’re getting that second wave of symptoms? Or say you have an athlete that’s like, okay, I’ve done my three weeks of not training. I’m going back, baby steps, easy rides and they start to experience symptoms. What are those symptoms looking like? How are they presenting? Is it the same loss of taste? Is it coughing, breathing? What do we look for in that second wave perhaps?

Dr. Aaron Czysz:

Yeah, and so I guess, the differentiation would be second wave of the acute infection is going to be different from somebody who has what has been kind of termed as long-haul COVID and we’ll touch base upon that later on. But again, this is just… Again, within that first two week timeframe, we’re going to have basically similar symptoms to what you presented with. Again, fatigue, body aches, shortness of breath, cough are going to be the big ones. Maybe some persistent low grade fevers. And so those are the things that we have to look forward in that first two week timeframe.

Dr. Aaron Czysz:

If you have gotten to outside of that 14 days and especially into that three to four weeks and you’re feeling back to your normal self again, then I feel there’s something where that can be where you kind of surpassed that 14 days from symptoms being done. And again, I think that’s just the kind of the biggest thing to note. If you’re 14 days symptom free, regardless if you were asymptomatic, that’ll take you to two weeks minimum. If you had some symptoms and again, a rebound of symptoms that should happen within that 14 day timeframe. So once those symptoms start again, your time clock starts again and you have to wait for those symptoms to be done. Wait another 14 days before you start trying to go back to activity.

Joan Hanscom:

So you touched on what’s known as that long-hauler syndrome and I’ve read a number of articles about athletes who are experiencing that. And obviously, there’s a tremendous amount of frustration that goes for anybody that is experiencing long-term after effects of this. But what do we know so far about long-term effects for folks? And it was interesting. I ask this question particularly because one of the parents of one of our junior riders was like, “Well, it’s like the flu and you get it and you’re over.” And I was like, “No, no, hold up. You don’t want to get this one because it’s not like the flu and there is potential for these long term impacts.” What are some of those long-term effects and what do we know so far?

Dr. Aaron Czysz:

Mm-hmm (affirmative). Yeah, that’s a very good question and a very good point for your junior parent there that yes, COVID is a whole different animal than any other type of infection that we’ve had to deal with as far as athletes go. First things first is that again, we don’t really… Again, even though it’s been around for more than a year at this point in time, there’s, again, still a lot that we don’t know about it. Because COVID is family of coronavirus related to SARS, essentially SARS one that was around in 2003, 2004 realm as well as MERS, Middle East Respiratory Syndrome that was in the 2010, 2012, somewhere that timeframe. We have some long-term effects known from those, again, having some long-term respiratory musculoskeletal, neuropsychiatric, sickle it.

Dr. Aaron Czysz:

We know from a lung standpoint that your PFT is your pulmonary function tests, where we actually test how well you would get air flow in and out of the lungs as well how well does oxygen transfer from the airways into the bloodstream. That we’ve still had some mild to moderate, again, restriction difficulty giving the air into the lungs mostly due to the muscle weakness, the rest of the muscle weakness. So I’m Polish. So I often will tell my patients, it’s like an accordion. If you had somebody who’s not able to expand the accordion out as much, you’re not going to make as much music. So you have to be able to expand the accordion. The lungs are bellows just like that. You have to expand the lungs the way that they need to to be able to move air effectively.

Dr. Aaron Czysz:

We do know that in about 1/3 of patients that impairment was seen out to about a year. We’re still persistent at a year for about 1/3 of those patients and their 60 minute walk test basically just chatting how far do they walk over 60 minute timeframe at one year. That was also still impaired. So that’s what we can kind of take from what we’ve had as far as coronavirus experience in cousins to COVID-19. Now as far as COVID-19 goes, again, it’s something where there was a US study that looked and said about 65% of patients that had previously been healthy, once they got COVID, about 65% were able to get back to their previous level of health by about 14 to 21 days. Okay, but that still leaves about 1/3 of the population that is not quite back to where they want to be.

Dr. Aaron Czysz:

The British study at a British Medical Journal in August of 2020, where they saw about 10% of people that had COVID ended up with a long-term illness. Now that was taking all comas. But if somebody was admitted to the hospital, that those numbers go up to about 1/3 of people will have persistent cough, about more than 1/2 people will have persistent shortness of breath and more than 2/3 of people will have persistent fatigue at the one to two months post, quote, “recovery or post discharged from the hospital.” Overall about 13% of people had symptoms lasting greater than 28 days, about 4% had symptoms greater than 56 days. And then looking at greater than 90 days, it’s about more than 200 or .5% will have symptoms at that point in time.

Joan Hanscom:

Wow.

Dr. Aaron Czysz:

So again, we know that although that’s a very small percentage. Again, when you take the millions of cases that have been confirmed, the biggest thing is to know you’re not alone. And obviously at some point, that’s going to affect high-level elite athletes or used to being at a VO2 max say in the 60s to 70s for men, 50s to 60s for women and yeah, they might be able to still have a, quote, “normal B02”, but they’re still performing yet 2/3 of their pre-COVID performance level.

Joan Hanscom:

Yeah, and I think that that’s the thing that to be very honest has motivated me to sort of stay in and wear my mask and not ride with folks because I’m terrified of losing that whatever fraction of my VO that I’ve got in my very average cycling life. I think that’s the thing though, the message that it isn’t the flu. You do have potential and not everybody will, but you do have potential for these lasting impacts and they’re pretty scary when you take your athletic life seriously. And so it’s just something that we all need to keep at top of mind I think especially as we… Again, as the frustration is like, oh, we’ve been doing this for a year now. I just want to go ride bike with my friends.

Joan Hanscom:

These are the kinds of things that if you have this awareness, it might help make it easier to manage. I don’t know. These elements of control that we have to impose upon ourselves and that’s a mental test as much as it’s a physical test. And with that said, we are very fortunate to also be joined today by Dr. Joseph Patruno, who’s the Chief Wellness Officer at Valley Preferred in addition to being a practicing physician. And he too is an avid cyclist although not so much on the competitive side as you are Dr. Czysz. But we are thrilled to have you join us, Dr. Patruno and you’re joining us right at the time where I think it’s useful because we’ve talked about the science of actual COVID and the symptoms and the life cycle perhaps of the illness.

Joan Hanscom:

But there’s a component of mental wellness and wellness that we’ve been sort of dancing around all of this time and I think that’s where you’re able to speak a little bit to what cycling presents to us and perhaps some resources to help us deal with stress and how you view physical activity as a stress manager. And then we balance this all together is like, okay, we have this great tool, the bicycle that can help us with our physical and mental health. We have Dr. Czysz’s perspective on perhaps why it’s smarter to do it so low at the moment. But let’s start talking about that mental wellness piece that I think a lot of people are struggling with and jump right in on what we know about cycling or exercise as a driver for mental health and how as we look at February of 2021, a full year of COVID, how we use this to our advantage if we can.

Dr. Joseph Patruno:

It sounds good, Joan. Now I appreciate being invited to be part of this podcast and I appreciate Aaron’s input. Obviously, he’s certainly the expert in terms of COVID and its effect on the body. But as our Chief Wellness Officer, we’re always looking for ways to keep our clinicians and our physicians well both on a physical and on emotional level. And I think biking certainly offers great opportunity with this. And my story is a little bit different than Aaron. I’m more of a recreational rider I would say. I picked up a bike about a year ago mostly because my knees won’t allow me to play soccer and tennis as well as I used to. And I knew I needed some sort of outlet.

Dr. Joseph Patruno:

So I actually picked up a great Marin bike off of Craig’s list and have been riding since. And other than one little visit to the emergency room for a connection with a fans of **[inaudible 00:31:26]loved my experience with my bike. But certainly, when you look at wellness, both on a physical and from an emotional standpoint, biking has great benefit. And we know that certainly biking accomplishes the CDC recommendations for aerobic exercise. I mean, most of the folks who are listening to this podcast are way out in terms of 75 minutes of heavy duty exercise a week, which is the recommendation or a 150 minutes of sort of low impact aerobic exercise.

Dr. Joseph Patruno:

So great benefits there physiologically. And I think if you think about what biking does, there’s actually quite a bit of basic science that shows that its effect on the body is significant with the oxygen deprivation, it leads to an increase in neural development as well as it boosts a number of feel-good chemicals, serotonin and dopamine and those natural other chemicals we have in our body including endocannabinoids get activated when we’re out biking and so great benefit from that standpoint. Aaron shared some of the clinical research regarding long-term or long-haul COVID. There’s actually some really good research looking at the benefits of biking in terms of long-term cognitive function.

Dr. Joseph Patruno:

And we know that people will live longer if they bike. In fact when they looked at professional bikers, they live to be 81.5 as compared to 73.5 in the general population. This was actually from 2011. Probably life expectancy has increased in both of those populations since. But clearly, biking has a significant benefit in terms of life expectancy. And it’s also been shown to help out with conditions like Alzheimer’s disease as well as ADHD in young kids who bike. So there are many benefits in regards to the cognitive function as well as the physical function.

Joan Hanscom:

Yeah and I think that’s so important right now because speaking again, for our community, I know people have been hoping and praying that racing is going to come back and that they’re going to get their competitive outlet back. They’re going to get their social life back. And when it starts to seem like a bit of a far moving horizon for that date to come, people are losing that motivation to train. And I think what you’re saying, Dr. Patruno, that’s so important for folks to hear is like, yes, maybe that competition date has pushed further back on the timeline, but there are so many reasons to keep going. There’s so many reasons to keep that motivation up to keep training.

Joan Hanscom:

And one of them being your mental wellbeing. Yes, maybe we can get away from doing some of the high intensity intervals right now because racing isn’t right around the corner. But man getting out and continuing to ride, even as those competition dates may slide down the horizon a little bit, it’s good for us mentally as we’re in these PA gray days. There is real benefit to us to still get outside, still get fresh air mentally so we can keep focusing at work when we’re at work from home. I mean, all of these great things that what I hear you say is that there’s a lot more benefit for training than just getting fast on our bicycles, which I think sometimes you need to hear when you’re getting discouraged on the racing front.

Dr. Joseph Patruno:

Sure. Yeah, and I completely agree, Joan. I mean, obviously one of the biggest ramifications of COVID is how it’s affecting us mentally. And certainly, we’ve seen great increases in depression, anxiety and even suicidal ideations not only in our healthcare community, but globally, we’re seeing this. And we do know specifically, this has been looked at with cycling that it does improve stress reduction. And there actually was a study in the Lancet in 2018 that showed that cyclists enjoy almost 22% fewer days of poor mental health. And it was only second to team sports in regards to keeping people well. So cycling has a very sort of unique I think value for many people in terms of keeping their stress down.

Dr. Joseph Patruno:

So I think absolutely it is a tremendous outlet that we’re seeing our riders have the ability to tap into in this really trying times. And certainly, obviously the competitive components of it drives many of the listeners of this podcast. But certainly, the training and what’s going on physiologically has great value as well. And I agree completely with you. I think continuing with the training protocol and being mindful of the value of that in terms of mental health goes a long way. And they’re also actually… Biking is really sort of a unique activity and sport from the standpoint of it can either build community, but it can also provide a real sort of foundation for mindfulness and sort of that inner centering that comes with someone who’s riding independently. Community, obviously in the form of riding with colleagues, riding with friends, riding on your team.

Joan Hanscom:

Oh, it’s funny that you say that one of the… I had my annual physical exam at LVHN, just a little side plug there and I was talking with my doctor and she’s lovely. And she was telling me about how much she’s been riding her Peloton bike. And I think that even if you’re not able to get out and ride outside and doctor, she’s mentioned this too that there are so many virtual community options where you can still feel connected. And so she was talking about how she’s been really embracing her Peloton. And she actually is so excited about how much riding she’s been doing on her Peloton that she’s going to come out here and do our Women’s Wednesdays program come the summer because she’s really feeling like she wants to take it that next step. And so I of course love to sort of be Johnny Appleseed of cycling and sort of spread the seeds of cycling all around.

Joan Hanscom:

So I was delighted to hear it from my own personal doctor that she’s really been embracing it. And now we’re going to try to suck her into life out here at the track too. So next I’ll be trying to lure you in. We’ll have you on the Try the Track before you know it. But yeah, I think these are all such super important facets of our relationship with LVHN and with Valley Preferred to let folks who may come to the track and not know what our partnership is all about. This type of conversation with both of you I think shows a real value to our relationship and our partnership. And I think this year has provided the opportunity for that relationship to get stronger. And I wonder if you guys, either of you, have resources at your facility that you want our listeners to know about for our Lehigh Valley listeners? Is there stuff going on at LVHN or Valley Preferred that folks who be struggling or who have questions, are there places that we can refer them to so they can take advantage of our partnership?

Dr. Joseph Patruno:

Well, why don’t I take the question first and I’ll let Aaron talk a little bit more maybe about the clinical side. And certainly, for those riders who may be have been exposed to COVID or recovered from COVID and are struggling on the emotional side and I sort of go through the history a little bit and you know it pretty darn well, Joan. I mean, I think the word is synergy. I think Valley Preferred and the cycling center have always had synergy and have had a relationship for about 20 years now is my understanding. And I think our goals at Valley Preferred are to provide our physicians with the most resources to advocate for them. But over the last five to 10 years, it’s been clear to provide them with resources that will help keep them well and allow them to continue to function both professionally and in their personal lives.

Dr. Joseph Patruno:

And I think this community has always been really very focused on the value of cycling. So I think there are certainly programs out there and we’ve certainly developed many through Valley Preferred. And a lot of it’s on the educational side of our community members need information, certainly COVID and obviously clinical information we will provide for our community. But I think there’s, from the standpoint of our clinicians and our stakeholders, we have really been focusing on what can we do to keep you resilient, keep you strong, keep you well during this especially trying time. And for our listeners I would say, look for those resources. And they may be a valid preferred, but they may be through your other community organizations, whether it be spiritual organizations, your employment. If you were struggling certainly with stress or dealing with the fear of COVID that so many of us are. There are resources out there for you and I would definitely encourage you to seek them out while you continue to stay on your bike and keep yourself healthy from that standpoint.

Joan Hanscom:

Yeah, right on and Dr. Czysz, what about from your perspective in terms of resources or things that folks who are potentially in that, athletes who are in that post COVID recovery timeframe as they come back to sport or to play, do we have resources available for athletes recovering from COVID?

Dr. Aaron Czysz:

Yeah, it’s a very important question and one that as far as specific programs, there’s I think specific as far as rebuilding your athletic prowess if you will. The important things to note are that again, most patients are going to be able to resume their activity and after that two weeks of kind of being symptom free. But again, for those that are concerned, again, that they have a long-haul COVID or having difficulty returning back to form, that’s where a visit to their PCP would be useful to kind of go through it kind of history and physical exam to determine are there any risk factors, are they experiencing any kind of, again, palpitations, feeling like your heart’s racing? Is your heart rate higher on your daily rides and normal or is it peaking or is it getting up to a higher level at a quicker rate and is it harder or taking longer to recover?

Dr. Aaron Czysz:

For most instances, a patient will be able to… Most instances, athletes will have a heart rate monitor that they often will go off of. One thing with COVID is that because it affects the lung so much, monitoring the pulse oximetry, your oxygen levels in your blood are also going to be important if you’re having those feelings of ongoing shortness of breath with your exercise. And so there’s a whole barrage of tests that can be done be it labs, be it imaging. Again, all of it’s centered around a cardiac and pulmonary side of things. But those are the types of things that we look for for again, people that may have had COVID or feel as though they may have had COVID because by the latest criteria, you don’t necessarily need to have a positive COVID test in order to be diagnosed with long-haul COVID if your symptoms match up with the level or if they match up with the kind of usual pattern.

Dr. Aaron Czysz:

Reason for that being is at times, at the beginning onset, they’re not necessarily everybody was getting tested and also we know there’s false negative tests out there. So that’s again, kind of the things to watch for, again, returning to sports. Now again, be it recreational or competitive athletes going back and trying to get back up to their previous level, again, heart rate monitoring, oxygen level monitoring as well, again, especially if you’re feeling more shorter breathe with the same amount of exertion because again, myocarditis being you get that inflammation of the heart muscle being a big concern. And again, if that is something that is diagnosed, that is something, again, that’s the one that can be rather rare, but deadly. That’s one where the timeframe to going back to sport is a much different timeframe.

Dr. Aaron Czysz:

It’s usually about three to six months as opposed to two weeks or so post symptoms. And that’s usually done within conjunction with the cardiologist. So again, for those patients that are feeling that they’re not quite back up to where they want to be, again, I would encourage them to go see their primary care doctor and then that will then make the determination of, okay, do we need to do any kind of testing? Do we need to refer you to a cardiologist, to a pulmonologist? And then just to determine is there any kind of organic abnormality that we need to be concerned for? Either, it’s the heart or the lungs. And then if warranted, oftentimes we can either do a cardiac stress test or cardiopulmonary exercise test, which is what people often refer to as a VO2 max test.

Dr. Aaron Czysz:

And this is one where I often tell the story to my patients that one of my teaching professors in training, he said, “Aaron, brains are good, but all chest x-rays are better.” And being the idea that if you have a baseline, if you know where you were, again, be it heart rate that what your usual resting heart rate was or usual pulse ox was and what your previous VO2 was, we can then know where we are currently then to kind of make a time for getting back up to where you want to be and where you were before. If we don’t have those, then again, we can at least try to make a timeframe of or make a diary of what your normal resting heart rates are, what your normal resting pulse [oxes 00:47:00] are in that immediate post COVID timeframe and then know what are warning signs would be for, are we desaturating? Are we having a loss of oxygen during the timeframe of a return to sport?

Dr. Aaron Czysz:

Often, if you’re trying to get to that, again, competitive or elite level again, that should be done. The timeline, again, is going to be variable unlike any kind of musculoskeletal injury, there’s no documented timeframe that is going to be set for recovery. And at two weeks, you can do this, at three weeks, you could do this, at eight weeks, you can do this. I know when I torn my ACL in med school, I had a very regimented time frame of this is where you’re expected to be at three months, six months, nine months, 12 months. For this COVID, it’s not known because again, everybody is variable. I can say marathon, not a sprint. Biggest thing is listen to your body knowing again, don’t try to just push yourself through it.

Dr. Aaron Czysz:

Again, this is not something that you can push yourself through because again, it is going to be affecting your body in a very different way than any other type of illness. As far as again, trying to get back to training. Again, it should be… One of the recommendations that I’ve seen has been, again, once you have completed that 14 days of symptoms free, getting back to kind of your mild or getting back to your activity in this kind of 50, 30, 20, 10 rule, which has been kind of endorsed by the National Strength and Conditioning Association as well as Collegiate Strength and Conditioning Coaches Association were basically the first week back, you get back to your activity at 50% of what your normal exercise load was.

Dr. Aaron Czysz:

So if you’re used to riding 10 hours a week, be it five days, a two hour rides or two five hours a week, whatever it is, you just do 50% of your total ride time, but spread out evenly over seven days. Again, we don’t want to push yourself too hard or too fast because if you have return of symptoms or you have limitations during that timeframe, you’re just moving back a week and trying to, again, take it a little bit slower as far as a ramp back up. Okay, if that goes well, the next week you get up to being at a 30% reduction of what your usual workload is followed by 20% and then 10% reduction. And then hopefully, [inaudible 00:49:21] well over that four week timeframe, you then rent back up to what your previous workload was again.

Dr. Aaron Czysz:

Following that you have any kind of, again, return of symptoms. Again, shortness of breath, palpitations, racing heartbeats, fatigue and again, shortness of breath that is out of proportion to what you usually expecting. And again, if you are having that shortness of breath that proportion to what you typically would have, that’s where, again, we monitor not only your heart rate, again, to see what the variability in your heart rate is, but also your pulse oximetry. And that should be done with a commercially available pulse oximetry monitor, not something that’s done on like a smart device, a smart phone or anything like that.

Joan Hanscom:

I think that’s such a great point to reiterate as we sort of look at this post COVID life thing. It is such the trend of the athlete or the mindset of the athlete to just want to go right back at it. And so I appreciate your point very much of, hey, no, you can’t just go back full throttle with this particular one, you’ve got to step it in. There’s a process for coming back for this. There’s a process for doing this smartly and safely because if you do it wrong, let’s use the word wrong. But if you do it incorrectly, you could actually just, you said it, you set yourself back. You’ve taken the step forward. And if you overdo it too soon, too fast, you’re just going to end up setting yourself back and potentially setting yourself back further, which if you’re playing the long game in sports and sports performance, you definitely don’t want those steps back at all.

Joan Hanscom:

It may feel painful in the short-term to do 50% of your normal workload, but if you’re playing the long game, that’s really the way to look at it so that you don’t end up with those steps backwards. So everybody out there listening, remember, don’t overdo it when you come back because you’ll end up off the bike longer and you’ll be sad. So it’s really the moral of that story I think in a very lay-person interpretation of what you just said. And I just want to take this this moment to say that this conversation has really underscored for me and I hope for all of our listeners that there is just tremendous value in this partnership with Valley Preferred and with LVHN. And what a great resource you’ve both been this morning on the topic of COVID, but also just more broadly speaking on the topic of wellness and mental and physical wellness.

Joan Hanscom:

And how very, very appreciative I am of you both being so giving of your time to talk to our listeners about stuff that we’re all just starting to figure out and how lucky we are to have you as a resource today. So for me, that’s a big, big thank you for sharing your perspectives on it. And hopefully as we roll into 2021, this is a partnership that we only just sort of strengthen these synergies with and get you guys back for our listeners again and talk about maybe what we are as we emerge from COVID and revisit some of these other aspects of cycling and wellness and how we’re going to get folks out here to the track to experience the health benefits and the social benefits and the mental benefits, your physicians and members of the community who maybe our first time bike riders. And I think we’re going to accomplish a lot of really good stuff together in 2021. And this conversation is just the kickoff for our partnership in 21. So thank you both.

Dr. Joseph Patruno:

Thanks very much, Joan.

Dr. Aaron Czysz:

Thank you. Again, my pleasure. Yeah, my pleasure to be here.

Joan Hanscom:

So this has been the Talk of the T-Town Podcast. And again, big thank you to Dr. Patruno and to Dr. Czysz. We are super lucky to have such great partners. And we hope you listeners enjoyed this week’s episode. If you have questions, we will have some resources linked to this conversation in the show notes on our website, thevelodrome.com. So you can click through and learn more about the LVHN COVID Help Center and wellness services available to our listeners here in the Lehigh Valley. And thank you again. Everybody wear your mask and stay safe. This has been the Talk of the T-Town Podcast with host Joan Hanscom and Andy Lakatosh. Thanks for joining us for this week’s episode brought to you by the B. Braun Medical Inc. Head on over to our website thevelodrome.com, where you can check out the show notes and subscribe so you’ll never miss an episode.