Open Heart Surgery Rehab Requires Physical Therapy & Mental Health Supports (5)

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Boots Knighton [: 00:00:02

Hello. Thank you so much for joining me. This is Boots Knighton with The Heart Chamber Podcast, and, oh my gosh, it's the end of the year. I know a lot of you are probably opting for Christmas music instead of listening to podcast, and I totally get it. So, for those who are tuning in, thank you for being so dedicated and supportive to this podcast. I decided for the last 2 weeks of 2023 that I was going to rerelease episodes from season 1 that I felt were important. Last week, I rereleased episodes 1 and 2, which is my story. And I just find that it is really helpful for newcomers, especially that are just now finding my podcast.

Boots Knighton [: 00:00:51

And then this week, I wanted to reshare with to my episode with my physical therapist, Cassie Fuller. We had such an important conversation about injury and mental health, and I recently reinjured myself. I broke my leg in early December 2023, and I'm finding that this episode is more relevant than ever for me. I just thought that you would enjoy it too. So, thank you for supporting my podcast. Thank you for coming along on this ride. I'd love for you to join my mailing list, theheartchamberpodcast.com will get you there.

Boots Knighton [: 00:01:39

I have so much planned for 2024, so be sure to come back for new episodes starting in the new year. And until then, I wish you health, happiness. May 2024 be the best year yet for all of us. I love you.

Boots Knighton [: 00:01:59

Welcome to The Heart Chamber. Hope, inspiration, and healing, conversations on open heart surgery. I am your host, Boots Knighton. If you are a heart patient, a caregiver, a health care provider, a healer or just looking for open hearted living, this podcast is for you. To make sure you are in rhythm with The Heart Chamber, be sure to subscribe or follow wherever you are listening to this episode. While you're listening today, think of someone who may appreciate this information. The number one-way people learn about a podcast is through a friend. Don't you want to be the reason someone you know gained this heartfelt information? And if you haven't already, follow me on Instagram, 2 different places, at Boots.Knighton or at The Heart Chamber podcast. You can also find me on LinkedIn as well as Facebook. But enough with the directions. Without further delay, let's get to this week's episode.

Boots Knighton [: 00:03:13

Hey there. Welcome to another episode of The Heart Chamber. I am your host, Boots Knighton. Today, I interview my physical therapist, Cassie Fuller. Cassie has been a physical therapist in Jackson, Wyoming since 2015. She earned her doctorate of physical therapy from Pacific University in Hillsboro, Oregon. She specializes in the assessment, rehabilitation, and progression of the mountain athlete with additional certifications in the running athlete as well as professional bike fitting. Cassie is also a yoga instructor. She started the Fuller Yoga project in 2020 after finishing her 200-hour yoga certification. She teaches both private and group yoga classes where she combines the biomechanical background of physical therapy with the holistic approach of yoga.

Boots Knighton [: 00:04:12

Cassie and I's conversation is wide ranging. We talk about how she has progressed me through my cardiac rehab. We also cover the mental health aspects of open-heart surgery and how she is integrating the mental health aspects of healing from any injury into her physical therapy yoga practice. I hope you'll find this episode helpful whether you are the patient or you are the caregiver. And if you like this episode, please share it wide and far. Also, make sure you subscribe, and I am accepting donations on my website. You can go to www.theheartchamberpodcast.com, where you can either buy me a coffee or make a donation on PayPal. Your support is greatly appreciated as this podcast continues to grow and is listened to around the world. Alright. Let's dive in.

Boots Knighton [: 00:05:16

Cassie Fuller, thanks again for joining me. Cassie and I have become acquainted, thankfully, over my heart. She has been helping me bounce back, but Cassie's come on a little later in the game. Part of me wishes I had found Cassie sooner, but I also have to trust that it's all, you know, my path, my healing journey has fallen into place as it's meant to be. And so, Cassie and I did not start working together, gosh, until was it this past summer 2022 or spring?

Cassie Fuller [: 00:05:50

Yeah. I think it might have been summer. Anyway, yeah. Later, in your recovery.

Boots Knighton [: 00:05:53

It runs together.

Cassie Fuller [: 00:05:54

Yeah.

Boots Knighton [: 00:05:56

Yeah. And, originally, bless my surgeon, but, you know, his directed to me after surgery because I was like, what do I do? Do I go to rehab or whatever? He's like, just go on living your best life. And so, I did, and then I kept hurting myself because I kept doing too much. And then, you know, my heart kind of, like, teetered on heart failure, and then it had palpitations. And, you know, since Cassie and I started working together in a more focused cardiac physical therapy mindset, now I'm really starting to move the needle, and I'm finding that on a day-to-day basis, I'm the sense of hope that I'm going to be okay. So, yeah. And so, I thought today, we could first talk about what Cassie, Cassie, I was hoping you could explain what you and I have been doing together, and then we're going to zoom out for the general cardiac patient and approach.

Cassie Fuller [: 00:06:57

Mm-hmm. Absolutely. So, we have been kind of over the course of some months now working on objectifying some things and also kind of zooming out in other ways. So, we initially talked about what symptoms are, what symptoms are a part of the scenario. What matters more than other things? What's the priority as far as your symptoms go? And then in some way, shape, or form, trying to objectify them so that we could zoom out and see what the total picture was like. So, not just looking at 1 workout or 1 ski or, you know, even like a week, but having data for a bunch of different metrics that we could go back and see trends. Because a lot of times, I think, in all things rehab, especially for people who are in the middle of it, it's hard to see trends. It's hard to see, they may be small. Sometimes they're huge, which is great, and it's really obvious. But a lot of times, it takes physically writing things down so that you and I have something to chat about as far as what's working, what's not working, and then playing with those variables to figure out what the best scenario is for you, and you said it. I mean, everybody's different in their mindset, in their goals, in their past, how much things like this have affected them in the past and where they were coming from. And so, all of that, we've played around with. We did some treadmill testing to get actually, one of my colleagues did to get some baselines, and then we've used that when we can be in person to see progress and to also use it as a new baseline because we can bump up to new baselines and then have something to refer back to. So, I think that's been kind of the main thing that you and I have been focusing on and trying to figure out how all of that works in an environment, I mean, we live in Jackson Hole, so everything is quite aggressive, and we push our bodies daily for better or for worse and trying to figure out what's for better, which is hard for everybody.

Boots Knighton [: 00:08:52

Mm-hmm. And you and I have spent a lot of time talking about that. I hear a couple of things there. You helped me gain more awareness around my, I think you called it, like, load.

Cassie Fuller [: 00:09:05

Mm-hmm.

Boots Knighton [: 00:09:05

Can you explain that really quick, what load is?

Cassie Fuller [: 00:09:08

Yeah. So, we were talking about kind of the overall stressors or what contribute the general load of you as a human, for any human, whether that sleep's not great, whether my diet's kind of crummy because I don't make myself lunch, which I'm guilty of all the time. Whether it's stressors from social life or family or exercise or the stuff that I'm having you do at PT, all of the things contribute to an overall load, and we're trying to play with all the variables within the load to figure out what can we turn up and what needs turned down. So, we find this, like, equilibrium of balance between all of it, which is hard because everything changes every single day. It's not like we can turn 1 up and then it'll stay up and nothing else will go up at the same time. So, it's a lot of I mean, it is a bit of an experiment to see what each week will bring. And I think looking at the overall load, not just the physical tax on your system, not the physical tax on your heart and what those requirements are, but looking at all of the other factors that can play into the load that is on you as a human, which I think is really important in healing.

Cassie Fuller [: 00:10:17

And a lot of that kind of gets pushed to the side. You know? If you go to the doctor and you're like, my energy's low, and they're like, oh, well, you're just depressed or you just have anxiety or you're just whatever. And then, you know, maybe you get meds, maybe you don't, but then they send you out the door. And, like, what does that look like? What are the symptoms, and what does that mean, and how does that contribute to a healing body? Because it does make a difference. And I see it all the time in PT, especially for people who, you know, in this town, everybody's an athlete in their own way, and so we often use our athletic ventures as stress release or as identity or social interaction with other people. And then when that changes, it changes the overall load so drastically that we kind of get thrown off our game. And then, you know, we come back too quick or maybe we don't push in the right way or there's a lot of things that can contribute to that load and trying to figure out what those are for you.

Boots Knighton [: 00:11:11

Right. And perfectly stated. And I was all out of whack when I came to you, and I was trying to get back to a life that just wasn't for me anymore. And I think I knew that deep down, but I definitely wasn't accepting it. And, you know, I also just didn't have enough of the awareness and the knowledge. Right? Like, you had to teach me a lot. You know? And so, for listeners who maybe don't live in our area, you know, Cassie works at Kilter PT in Jackson, Wyoming and Jackson, Wyoming is a very active place and is filled with, you know, the typical extreme athlete is by, you know, it's very numerous. It's a mentality that tends to, it's part of the everyday conversation.

Boots Knighton [: 00:12:03

It's also the butt of the joke. It makes for a lot of fodder and, you know, our local plays and for good reason. And, you know, there's a lot of people proving themselves and it's a lot to be admired until, you know, that person is hurting themself. And I feel like, you know, in a way, I admit, you know, I don't know if I got caught up into that level of intensity, but I definitely did not want to let go of the life I was living, which was ski instructor and mountain biking a lot and climbing peaks, and it just my heart was just saying no more. And it took finding Cassie and Cassie being willing to speak truth to me and to educate me in a gentle, loving way to where I was able to hear her. And, you know, not every physical therapist has that ability. And, you know, sure. I'm sure a lot of physical therapists I worked with in the past or doctors wanted to meet me where I was at, which I appreciated, but I wasn't even able to see where I was at.

Cassie Fuller [: 00:13:09

Mm-hmm. That's hard when you live with it every day. Yeah. You're used to I mean, what we talked a lot about was, you know, we're in this town where we kind of size each other up based on our athletic ventures. So, on Monday morning, it's like, oh, what did you ski and how many times did you do it, and what kind of vert did you get, and how long did it take you, and who did you go with? And there's always this even if it's subconscious, like, we're all kind of trying to climb a ladder that matters. It does. Absolutely. But it's all physical. And then when that gets taken away, which happens a lot for athletes because injuries happen, overuse injuries, traumas happen, surgeries happen. And when that gets taken away, I feel like people don't know what's underneath it, and it's scary. It’s really scary. And it's happened to me. It's happened to my husband. I mean, it's happened to all of our friends. There will be things like your body will and this is different. This is kind of a new side of my PT practice that has come in the last probably 2 years is exploring more behind the physical.

Cassie Fuller [: 00:14:15

I do think that, you know, the things that we do physically as far as joint mobilizations and exercise prescriptions, all of that is very important. But I also see where the emotional side plays into it, and we're not addressing that. Especially in this town, we don't address that because it doesn't get you anywhere on the ladder. Nobody cares if, you know, you have a good relationship with your partner and you're a nice human and, you know, you care for each other. That doesn't move you up in a mountain town.

Boots Knighton [: 00:14:46

Well, maybe our conversation will change that today because it,

Cassie Fuller [: 00:14:49

I hope so.

Boots Knighton [: 00:14:50

It should all matter. You know? And well, let's, you know, trace our steps here. We had to figure out my load, which took a while because I had to remember to write it down. And then I started to remember to write it down, and I just slowly learned. But I get there eventually. I just don't get there very fast. And then it just popped out on the page. You know? And we had to really remind me if I'm wrong, but we had to really adjust, like, amount of weight I was lifting in the gym, the frequency of the gym, the intent like, a lot of it went back to the gym mostly. And then, like, sprinkling in other activity around the other days in a skillful way so that and then, you know, we had to identify, well, what signs my body was sending saying, hey. This is too much.

Cassie Fuller [: 00:15:42

And especially in going back to the Jackson thing, but it's what I do and who I work with, but and where I live. A mountain athlete, we push our bodies. That is how like, that is our relationship to our physical self is we're going to climb that peak and our body, our legs are going to be screaming. Our lungs are going to be screaming. We're cold. We have frostbite on our toes, whatever. It doesn't matter because we're going to do the thing, which is awesome. When everything's happy healthy, great.

Cassie Fuller [: 00:16:09

But when things aren't happy healthy, it takes very clear awareness to recognize the signals that your body is telling you and to actually listen to them instead of saying, like, not now. I'm going to go ski Taylor, or I'm going to, you know, go kayak down the snake. Like, there's so many ways that we say no to our bodies, and they will just scream louder and louder and louder and louder or physically put us on our asses to the point that, like, we can't do what we were used to doing, and we have to reset those priorities. So, a lot of it was stepping back and saying, you are an athlete and you have a certain relationship with your body as an athletic human, but what does that look like as far as the signals that your body is giving you that you may or may not have been aware of in the past because you haven't needed to. There hasn't been that communication, or maybe it was there, but it wasn't a clear need. And it's easier for people on the outside to be able to educate you on that. I mean, you know, I have my own symptoms that I'm figuring out myself in my own physical body, but it's think initially as you're getting back into activity to objectify it to a certain point of, you know, whether it's whatever the symptoms are, 0 to 10 scale or 0 to 7 scale, how hard was it for you, what did your heart rate do? How did you feel? What symptoms did you experience, and how significant were they? Looking at what your sleep quality was that week or what your lifts were and using those as clues. It's a puzzle.

Boots Knighton [: 00:17:42

Mm-hmm.

Cassie Fuller [: 00:17:42

That's really what we're dealing puzzle that we have to figure out what pieces matter and what pieces we can kind of just put to the side for now.

Boots Knighton [: 00:17:50

Right. Right. Mm-hmm. And I found that one of the more helpful things was, you know, being able to identify the parts of my body that were letting me know when it was too much. And so, one was obviously heart pain. The other was I would get deep crippling fatigue, and that would be just the immediate signal of stop.

Cassie Fuller [: 00:18:13

Mm-hmm. For most things and it's strictly orthopedic or cardiac or, I mean, those are the ones that I most have experience with. But if we're quiet and we listen to ourselves, our body will let us know when we're getting to resistance before we get to whatever the symptom is. And most of the time, we just blow past that, and we hit full on fatigue or we hit full on heart pain. But if once we're able to recognize, like, oh, I mean, it's a subtle symptom, but if I pay attention to it now, I don't get to that extreme anything because I don't have to. Because we're now communicating well enough that I can trust that information and know from experience, if I go past, there are things on the other side that don't feel great. But it's subtle. Really subtle. And you have to take time to learn what that is.

Boots Knighton [: 00:19:00

And I know why, but can you explain to the listeners, like, why it was so important that we nip all this because I was experiencing extreme pain, you know, ER level heart pain and fatigue and the palpitations and the heart skipping. Like, why was it important that we keep me from even getting to that level?

Cassie Fuller [: 00:19:22

Just because the risk is so high for either even more changed your life. The risk to you outplayed everything else where we had to figure out how to navigate those variables so that you weren't pushing to the point. And it wasn't purposeful, but that you weren't pushing to the point where, yeah, pain so bad that I need medical attention. Like, the risk of significant events, cardiac events happening, I don't want that on the table for you. So, trying to figure out what does that look and can we keep you and progress you as an athlete and an active human in a mountain town, but not to the point that you're pushing yourself to that level of risk because it is. It's a risk. It gets scary at that point, and we don't have to go there because we can play it here with all the other variables, and they're really fun to play with, and you can still ski.

Boots Knighton [: 00:20:17

That's the cool part. I'm still doing everything I want to do. I just have to be really mindful and moderate and measured.

Cassie Fuller [: 00:20:26

Which, yeah. Which to a certain extent, like, we all should be kind of doing. We and, again, it's fine when everything's fine. But, yeah, like, I went to PT school in Portland, Oregon, and my first job was working with not necessarily a healthy population and then moved to Jackson. And I remember this, like, moment where in the initial eval, you ask all the questions of, you know, what does your lifestyle look like? What are the symptoms? When do they come on? When are they better? What's your support network? And I remember having to consciously remember to ask, what do rest days mean to you, regardless of what the patient was seeing me for. Because a lot of times, I'd have people come in the door, and they're like, I have chronic knee pain. I have chronic hip pain. I have heart like, all these symptoms, but and I'm like, okay. When was the last time you took a rest day? And it's very frequently that I'd have patients tell me, 2 years ago, I took a day off, and their bodies just can't, it can't do it. It's not possible.

Cassie Fuller [: 00:21:30

And it will make you stop either in a really big way or sometimes we're lucky and we listen to it, and it, like, just slows us down a little bit. And we let things heal and we rest and we let our body recover from the things that we've been pushing ourselves to do for years, or chronic things like stress fractures don't need to be part of people's future. There are things that we can do, and a lot of them involve just listening to your body in a really healthy way.

Boots Knighton [: 00:21:55

And you hear a lot of, like, hip replacements in our area, pretty young age, or knee replacement. And I know we're talking about hearts today, and but, like, that's something we hear about a lot in our community is replacement of joints, and something's up with that. Well, I'm not interested in replacing my heart. I'd like to keep mine. And, you know, so that's why I went to Cassie. That was the main goal. So, my heart has been remodeled and it may need another remodeling, but you know and that's just because of the way I was born. But I'd like to think that, you know, if I take good care of my bicuspid aortic valve and, you know, and mindful of how I use my heart that, you know, I might be one of the lucky few who lives a full lifetime with a bicuspid aortic valve. We'll see.

Cassie Fuller [: 00:22:49

Yeah. Yeah. We are so close friends.

Boots Knighton [: 00:22:55

Yes. Well, Zooming out a little bit for our listeners. You know? Like, I wanted to just give my case as an example to others. And, you know, I know I'll have a lot of cardiac athletes that will listen to this podcast, and, you know, I want to hear from you. Like, you can go to my website, theheartchamberpodcast.com, and you can leave me a voice mail and tell me about your cardiac rehab. I'm curious to hear from listeners, and, you know, I feel lucky that, you know, Cassie is in my life. But, you know, Cassie, how can the general open heart surgery patient, for whatever reason they need open heart surgery, prepare for such a surgery from your perspective as physical therapist.

Cassie Fuller [: 00:23:41

Yeah. That's a really great question, and there's a lot of answers to it.

Boots Knighton [: 00:23:46

Right and honest.

Cassie Fuller [: 00:23:47

Yeah. I think, a lot about kind of the emotional side of the prep for that type of surgery because it is I mean, it's your heart. It's a really personal thing. It's different than, like, you know, having a shoulder operation or you or whatever. So, I think a lot of, to be honest, therapy would be great. I think there's a lot that our minds and our bodies store up in relationship to whatever it is that we're having done to ourselves surgically, and I think that disconnect carries over into our post-op protocols and our rehab and what that looks like as far as our relationship to this situation as well. And that's the part of PT that I think I'm starting to recognize more and more and more is that relationship between not just the, you know, the valves and the output and what does you know, all the numbers and the progression and as far as that goes, but what the rest of your perspective is on that. So, I do think that there's a huge need for preop for all of us therapists in general, mental health therapist, but especially for something as personal as your heart. That's different. It's very, very, very different.

Boots Knighton [: 00:25:02

Yeah.

Cassie Fuller [: 00:25:03

So, I think kind of the of that is huge. I personally have gone down a little bit of a road for a variety of different reasons in our family systems. So, yeah. So, the theory behind it being that our body will physically give us some kind of clue as to what it needs or what it wants to tell us or what it doesn't want to do for a lot of reasons, and so it's taking time to feel what your heart is like. Do you have elevated heart rate because of anxiety? Do you, you know, have a pit in your gut because you're so, so anxious about what's to come? Rightfully so. It's a scary thing. And can you have communication with those the parts of you that are trying to tell you something? And all they want to do is whisper. They don't want to have to yell to get your attention, but it does take illness for you to be able to recognize that. So as far as leading up into it, from that side of things, I think some kind of guided relationship between your mind and your body emotionally matters a lot. I will say that, like, in this town and the clinic that I work at, we don't really see many acute cardiac patients because there are specialized centers, we see more of once they go past that acute phase, there's a gap between, I'm seeing my cardiac rehab specialist, PT, this many times a day. We're doing this, you know, whatever the protocol is, the step in the protocol that you're in to going back to your life. I mean, just as you said, Boots, like he's like, okay. Off you go. Like, good luck.

Cassie Fuller [: 00:26:39

And that gap matters a lot because it can be significant heart pain, like, I need to go to the ER, this is not okay, or we can play in that gap and figure out a way to get you back to what you want to do physically without those symptoms. So, I kind of look at it from pre leading up, and then we'll rely on the acute therapist for that phase. And then as far as, like, the chronic and what that looks like moving forward, that's kind of where, at least my expertise, I guess, kind of plays into it and what that looks like for athletes.

Boots Knighton [: 00:27:16

Great. And that's where you and I, that's the level you and I have been operating at.

Cassie Fuller [: 00:27:20

Yeah.

Boots Knighton [: 00:27:21

How about, would you recommend, like, any specific activity leading up to open heart surgery? I mean, honestly, listeners, if, like, you're greatly incapacitated, like and always talk to your own medical providers. Like, this is just general, very general guidance Cassie is giving.

Cassie Fuller [: 00:27:40

Yeah. I mean, I think it's so individualized. I don't know if I want to really throw a blanket free, going into it. I do, I mean, what would be awesome for all of us, especially for those of us that get you post-acute, to do some of the, like, the writing down that you and I did, Boots, as far as, looking at the different biomarkers of, you know, what your heart rate is, what your blood pressure is, what the heart rate variability is, those kind of metrics leading up to it so that you know what you're getting into or what your body how it's performing at its current state, and then we can use that after. I do think that there's such a broad range of physical function that people can go into the surgery, so I don't really want to throw a blanket statement out there. And, again, in mountain town, we tend to have a generally like, the baseline human in Jackson Hole is very athletic. So, somebody from our population is going to be very different. Like, when I was in Portland, and I was working with a lot of sedentary people.

Cassie Fuller [: 00:28:50

And I do think that having ideally, this doesn't always happen, but meeting with a therapist, a physical therapist going into it and having whatever the personalized exercise program is that you can and get in the habit of doing it. Being aware of the symptoms like we talked about before and listening to what your body tells you. But I think as far as that goes, I would say more the, like, setup. Behind the scenes. These are the things that I think matter as far as after you get past that acute phase. So, I think I'm going to do a cop out and throw that out there instead.

Boots Knighton [: 00:29:25

It's definitely not a cop out, but, I mean, everything you said, though, is still helpful. And I can't emphasize enough the therapy, and I talk about it a lot in my 1st episode when I share my story. So, if you're just picking up on this podcast now, and you haven't listened to previous episodes. Go back to episode 1 where my story's a little long. Apologies, but it there's so much to it. And I go in-depth into the therapeutic work I did before and after. And I will say, even today, I had an incredible session with my therapist. We will hit 9 years together this May 2023, and she and I actually were working on internal family systems.

Boots Knighton [: 00:30:18

We started doing that in preparation for my heart surgery, And I had this vision of a little girl who was in the form of a jumpy little heart with pigtails, some blonde hair, and I could see, like, pigtails, and my heart was letting me know it needed help. And it manifested as being stuck in a basement, but prying open the door and begging for help. And the moment I had open heart surgery, like, I talked to my therapist within a couple of weeks after that my jumpy little heart was completely at peace. So, you know, there's a lot of research into the internal family system, and it really is kind of I think it's just now coming on board more mainstream maybe, and it really is powerful stuff. And today, you know, we were able to start really addressing something called the central self, which is our, like, internal presence, and it's just amazing, you know, how since my surgery and since I was willing to, like, dive in and do all this work and work with, like, my firefighter self, which is another part in IFS, and then there's the manager part. And my poor manager part was, like, trying to save my life. My firefighter part was, like, trying to put out the quote, fire in my heart. Like, everyone was, like, all systems go. We've got to save this body that we're a part of.

Boots Knighton [: 00:31:48

And, you know, now I can do, like, this really incredible continued healing. And Cassie is right. Like, having heart surgery is, it's like the highest level of intensity of, like, what can go wrong in a body or right. I mean, we have a choice in how we look at it. You know, I now think of my open-heart surgery journey as one of the greatest moments of my life. And I think I'm able to say that because I work through all of the muck of it because there is a lot of muck, and there's a lot of stories you make up about that you can make up about it. You know, I talk a lot about in another episode with Kari Potter, I talk a lot about how I went through this whole mindset of I'm defective. I was born broken. You know? How am I going to fix this? Am I ever going to be perfect? And there's just not even such a thing as perfect, but, you know, you just go through all these different stories you tell of yourself, and none of it helps you going into surgery.

Cassie Fuller [: 00:32:47

Mm-mm. Or after.

Boots Knighton [: 00:32:49

Or after. Exactly. Okay. So, what does it mean to heal well after open heart surgery?

Cassie Fuller [: 00:32:56

This is where you and I are. Healing well is really hard, and there's a lot of components that play into it just as we were talking about the overall load to all of it and trying to be objective, but also their subjective feelings and try to navigate that world. I do think healing well, from my perspective, involves all of what you just said. So, it's not just the physical healing of the structures that you had affected by this scenario. There's so much more to that, and especially if you're wanting to get back to highly athletic ventures, that is huge.

Cassie Fuller [: 00:33:40

It's really, really, really big to figure out why it is that you're doing what you're doing, what that means to your identity, is that all of your identity, which happens a lot in this town where people come here to ski, they are skiers. All of their friends are skiers. All they can think about is skiing. And then skiing gets taken away, and they don't know what to do. So, I think doing a little bit of background work on figuring out why it is you want to get back to doing what it is that you did before? Or if it's a modified version, same question. Why is it that you want to do whatever it is that you are doing? And whose expectations are you putting on yourself? Because even the subconscious ones or the nonverbal ones that we get from other people, that plays into your decision making, my decision making as far as what steps we make in the healing process. So, I do think, you know, all of the emotional work that you have done, and its emotional work is needed in the right terminology. It's so much more than that. But all the work with the IFS and figuring out who you are as far as your essence, that matters way more than all of the ladder that we're judging people on as far as their physical feats over the weekend, none of that is going to get you through rehab and healing well.

Boots Knighton [: 00:34:56

Yeah.

Cassie Fuller [: 00:34:56

That stuff is the end goal, eventually, yeah, we want to get back to doing what it is that we want to do, but are you comfortable enough in yourself to say, like, oh, I, you know, I really want to do this one thing a couple times a week, but then you write down all of your markers, your list of your heart rate, and your heart rate variability and all the things that we've talked about, and you recognize, like, that may be something that isn't right for me right now because timing does matter. It may be right for you in the future, but right now, they're when you write it down, it's easier to see. It's clear that that might not be the best use of your time right now. So, there's a lot behind it. There's a really, a ton behind it. And I do think there's a huge need for more mental health guidance through that regardless of what you're healing from, but especially for your heart. I mean, that's like your essence. That's your when you talk about your true self, your center, I mean, that that's right there. That's what that is. And so, trying to figure out how to be true to yourself and what that looks like for you and not based on your previous expectations of yourself and not based on other people's expectations of you. Because in the grand scheme of things, those aren't going to keep your heart healthy.

Boots Knighton [: 00:36:08

Yeah. And in my case, I mean, my feet were swelling and my heart rate was all over the place. I mean, I think back to last winter when I tried to go back to work and in a very physical job teaching skiing, and my body just kept yelling at me over and over again. And, yeah. I just lacked the education to know how to listen, and it took me being put in the hospital.

Cassie Fuller [: 00:36:34

Mm-hmm. Mm-hmm. Their attention.

Boots Knighton [: 00:36:36

Mm-hmm. So, with that, you know, what's the importance of cardiac rehab? Why is it important to go to cardiac rehab after open heart surgery?

Cassie Fuller [: 00:36:46

Because of these parameters that we're talking about and how to navigate them. There are so many things to be aware of, and I think that, you know, to see things written on paper or to even have somebody, whether it's doctor or a PT or whoever, tell you these things and then kind of send you out into the world, I do think that having somebody to come back to and saying, this is what I tried, and I'm talking more of on the chronic side of or, like, the past acute side of things. This is what I tried. This is what worked. This is what didn't work. How do we revamp that so that we're making progress every time instead of just, like, trying 1 path and that path definitely didn't work. So, then you go back to the beginning, and then you try a different path, and that path definitely didn't work. And then you come back where you can kind of be a little bit more fine-tuning.

Cassie Fuller [: 00:37:34

I think initially having guidelines as far as this is what we want your heart rate variability to be. This is what parameters we want as far as the level of symptom that you're getting with, you know, if it's a cardio activity or weight training or whatever the case may be. Having those guidelines in the back of your head, but then knowing what that means practically because there's a difference. You know, for me to say, okay. I don't want you to go above a 3 out of 10 or whatever the symptom is. Okay. That all is fine, but what does that mean for you, and what does that look like, and what variables do we need to adjust to get there? So, I think having somebody who understands the, like, mechanics of it and the cardiac function and the need for our body when we're doing the physical activities that we're doing, but also helping you figure out what that looks like in your life.

Cassie Fuller [: 00:38:25

That's what matters the most is and you then do that for yourself. Really.

Boots Knighton [: 00:38:29

Right. It's like you have to be kind of, like, part mental health therapist, part life coach, part PT.

Cassie Fuller [: 00:38:37

Which I'm happy to do. Yeah. I mean, I do, I'm out about myself. I graduated from PT school in 2014, so I've been out for a while. And I feel like I'm just now figuring out all of these, at least from not just the physical part of the physical therapist. And we get some of this training in school, but, I mean, it's similar to what we just talked about. Until you do it and you figure out what it looks like for you and how you can relate to other people in that way, you know, if you have blinders on and you're just going to do the protocol and that's all that's going to happen, there's a huge part that I think you and I would have missed if we weren't able to have these conversations.

Boots Knighton [: 00:39:16

And I think that, you know, that it's important for listeners to understand, you know, I'm not afraid to go there. And you know, I feel like when I had well, I hit my head several years ago, and that has helped me become more vulnerable in a healthy way, but then my heart surgery really kind of solidified that skill of willingness to be seen, to, you know, to be vulnerable, to ask for help. And so, Cassie and I are able to go there because I allow it and I welcome it. And I just want to invite you to do the same with your health care providers. It's amazing when you're willing to ask for help and to ask for honest feedback and, you know, lay it all out on the table and be like, what am I doing wrong here? A lot of magic can happen, and your life can be so much brighter. And the spectrum on which you're living as far as emotions and just being a human just becomes so much more expansive. It's really an incredible journey. It really does come down though to being the willingness to be vulnerable and to be seen and knowing that, you know, you're not necessarily knocking it out of the park that day, but someone could help you get on the right track.

Cassie Fuller [: 00:40:33

It's your story, really. The rest of us just get kind of in the background helping where we can, but I done a really fantastic job of yours now. Like, this is your story. And, I mean, obviously and with the stories that you get to tell with this podcast is amazing. But I think knowing that that is the case and the rest of us are just here to support, to help you with your story, whatever you want that to be. And as with anything, I mean, there are patients that have no desire to sit still and listen to what their body's telling them, and there are PTs that have no desire to recognize that that's a thing. I do think timing matters, and I do think finding somebody that you connect with in a deeper way is quite helpful. And or practitioners recognizing saying that, like, maybe I'm not the right fit for you right now and being able to send people out to other resources.

Cassie Fuller [: 00:41:30

Because it's not our story. This is not my story to tell. I'm just I'm in the background and happy to be there and so should everybody else. We're all in the background.

Boots Knighton [: 00:41:41

I hear that a lot of wisdom is needed and, you know, to know when it's the right time and to know when to ask for help. And we all have that innate wisdom. Like, no one listening here lacks wisdom. I just don't believe that. I truly believe we're all very powerful, wise humans who can live a beautiful life no matter what is thrown at us. I fully believe that. And, you know, that's one of the reasons why I've decided to launch this podcast because, you know, I had 2 choices.

Boots Knighton [: 00:42:16

I could be a victim and the fact that I need is heart surgery, or I could just dive right in and make this the most incredible opportunity I could for living my best life. And, you know, my best life to me is being vulnerable and messing up and then asking for forgiveness. It's like all the messy parts of being human and beautiful parts of being human and asking for help and doing it all, you know, from a wise mind who just shows up every day doing the best they can. Like, that to me is such a purposeful life. And I'm as long as I continue to the trajectory that you have me on, I think I will be able to be even more active than I am. But, you know, I've kind of let go of that. It's interesting. It doesn't have the level of importance that it used to because I've come to a more peace filled, joy filled place that no longer needs the level of activity that I used to fill in what was missing.

Cassie Fuller [: 00:43:25

Mm-hmm. Mm-hmm. You have compassion for yourself, which is lovely.

Boots Knighton [: 00:43:29

The concept. Yeah. It seems to be the theme of the year for me.

Cassie Fuller [: 00:43:34

You're doing amazing. It's amazing. I'm so proud of you.

Boots Knighton [: 00:43:37

Thank you. Thanks for being my teacher. Thanks for saying yes. You could've run out of the room screaming when you first met me. Oh, Cassie, this has been great. Are there any other nuggets that you were just anxious to tell our cardiac friends or and or their caregivers or advocates.

Cassie Fuller [: 00:44:00

Yeah. I mean, I do see how it can be a very frustrating process to find the right people to work with, and they're out there. It may take, you know, some being vulnerable and maybe that not being well received or, you know, some shutdown from whatever the practitioner is, but I think to think about it as your story, and if they don't want to be a part of the story, that's great. And they can keep doing their thing, and we can find somebody else that can help progress you in a way that's really healthy is I mean, that's kind of the name of the game. Yeah.

Boots Knighton [: 00:44:35

Yeah. And don't lose faith or hope. Like, if a practitioner isn't the right match for you, the quicker you can say no and move on, the quicker you'll find the right person. So, don't stay in something because you're worried, you know, then it's not going to work out. It will work out. Be in the flow. Like, trust that the universe, God, whatever is your belief system has got your back. Because if they've gotten if whatever you believe in, let's just call it God for now has you're surviving and you got through open heart surgery. There is a plan for you. You will be cared for. This I can promise you.

Cassie Fuller [: 00:45:16

Mm-hmm. And finding practitioners that are okay letting you go to some other practitioner.

Boots Knighton [: 00:45:21

Yes. Yeah. If they're not okay then you really need to run. Like, don't walk. Run.

Cassie Fuller [: 00:45:26

Yeah. I do that to have whatever the practitioner is, PT. I mean, I there are times where I'm not the right fit either, and to be able to be a part of the team enough to recognize that from a professional perspective, I think, is huge as well. So, if you do have a practitioner that's just like, this isn't working for whatever reason, you know, it's not a failure on any side of the coin. It's just not either the right time, not the right person, and that's just kind of part of the story. And for people to be able to recognize that for the patient, for the caregiver, for the practitioner, for all of us, we're all on the same we should all be on the same team, and sometimes I'm not the right answer for the certain the situation that we're in right now, or I might be the answer later, and that's great.

Boots Knighton [: 00:46:14

Wise advice from Cassie Fuller, thank you so much.

Cassie Fuller [: 00:46:19

Yeah. I'm so happy you asked.

Boots Knighton [: 00:46:22

This is really fun. And you'll be able in the show notes, you'll be able to go find Cassie. Please don't fill up her schedule because I still need to see her. She's really hard to get into. But, yeah, I'll highlight our interview in the notes and give you all kinds of great ways to connect with her.

Boots Knighton [: 00:46:42

Thank you for sharing a few heartbeats of your day with me today. Please be sure to follow or subscribe to this podcast wherever you are listening. Share with a friend who will value what we discussed. Go to either Apple Podcasts and write us a review or mark those stars on Spotify. I read these, and your feedback is so encouraging, and it also helps others find this podcast. Also, please feel free to drop me a note at boots@theheartchamberpodcast.com. I truly want to know how you're doing and if this podcast has been a source of hope, inspiration, and healing for you. Again, I am your host, Boots Knighton, and thanks for listening. Be sure to tune in next Tuesday for another episode of The Heart Chamber.