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504: Dr. Michael Weinper: APTA Vision 2020 Aug 24, 2020

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On this episode of the Healthy, Wealthy and Smart Podcast, Dr. Michael Weinper speaks with guest host Dr. Stephanie Weyrauch about the American Physical Therapy Association's Vision 2020. Passed by the House of Delegates in 2000, Vision 2020 was APTA's plan for the future of physical therapy. In his 2000 Dicus Award speech, Dr. Weinper discussed his predictions of where the profession would be in 2020. Dr. Weinper and Dr. Weyrauch revisit the elements of Vision 2020 and analyze whether our profession has accomplished a vision of the future set twenty years earlier. In this episode, we discuss: -How has the physical therapy profession evolved since the drafting of Vision 2020? -The student loan debt to income ratio -Advocacy efforts to achieve full direct access in all of the States -The importance of lifelong learning and evidence-based practice -And so much more! Resources: Stephanie Weyrauch Instagram Stephanie Weyrauch Twitter Stephanie Weyrauch Facebook Email: sweyrauchpt@gmail.com APTA Website A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020! For more information on Dr. Weinper: Michael Weinper, PT, DPT, MPH, cofounded the company in 1985 with his partner, Fred Rothenberg, a former executive at Blue Cross of California. A physical therapist with more than 40 years of experience in clinical practice, management consulting, administration, and program development, Weinper is also a principal in Progressive Physical Therapy, a private practice, with four locations in Southern California. Weinper received a Bachelor of Arts degree in Industrial Psychology and a Bachelor of Science degree in Health Science (physical therapy) from California State University, Northridge. He received a certificate in physical therapy from that institution in conjunction with UCLA Hospitals and Clinics. Weinper later received his Master of Public Health degree (M.P.H.) from UCLA in Health Services Administration and his Doctorate in Physical Therapy from the EIM Institute for Health Professions in Louisville, KY. Weinper has been active in the American Physical Therapy Association (APTA). He has served as a member of the APTA's Task Force on Physician Ownership of Physical Therapy Services, as a member of its Committee on Physical Therapy Practice, as the association's chairperson on its Task Force on Reimbursement, on the Board of Directors for APTA's California Chapter and national Private Practice Section, and as trustee of the APTA Congressional Action Committee (now known as PT-PAC). Weinper received the prestigious Robert G. Dicus Award from the Private Practice Section of the APTA in 2000, and he received the Charles Harker Policy Maker Award from the APTA Health Policy and Administration Section in 2011. On behalf of the state of California, Weinper has served as a member of the Physical Therapy Subcommittee of the Division of Industrial Accidents, now known as the Division of Workers' Compensation. He also has served as an expert to the Medical Board of California, where among his activities he has appeared on behalf of the People in insurance fraud trials. He has provided expert witness testimony on behalf of more than 20 insurance companies. A former associate professor of health science at California State University, Northridge, Weinper is a frequent presenter for various professional associations including the National Managed Healthcare Conference, the American Medical Care and Review Association, and the APTA. He has authored many articles for both physical therapy and insurance industry publications. For more information on Stephanie: Dr. Stephanie Weyrauch is employed as a physical therapist at Physical Therapy and Sports Medicine Centers in Orange, Connecticut. She received her Doctorate in Physical Therapy and Master of Science in Clinical Investigation from Washington University in St. Louis. Dr. Weyrauch has served as a consultant for a multi-billion dollar company to develop a workplace injury prevention program, which resulted in improved health outcomes, OSHA recordables, and decreased healthcare costs for the company's workforce. She has served on multiple national task forces for the American Physical Therapy Association (APTA) and actively lobbies for healthcare policy issues at the local, state, and national levels of government. Currently, she serves as Vice President of the American Physical Therapy Association Connecticut Chapter and is a member of the American Congress for Rehabilitation Medicine. Dr. Weyrauch is also the co-host for The Healthcare Education Transformation Podcast, which focuses on innovations in healthcare education and delivery. Dr. Weyrauch has performed scientific research through grants from the National Institutes of Health and National Science Foundation at world-renowned institutions including Stanford University and Washington University in St. Louis. Her research examining movement patterns and outcomes in people with and without low back pain has led to numerous local, regional, and national presentations and a peer-reviewed publication in Archives of Physical Medicine and Rehabilitation, a top journal in rehabilitation. Read the full transcript below: Stephanie Weyrauch (00:00:01): Hello everyone. And welcome to the healthy, wealthy and smart podcast. I'm your guest host Stephanie Weyrauch and I am interviewing Mike Weinper who's the president and CEO of physical therapy provider network or PTPN as it's better known and also a private practice owner for progressive physical therapy in California. The reason that I wanted to talk to Mike today, as he won the Robert G Dicus award for the private practice section back in 2000, and he has been an instrumental person in practice, leadership, innovation, legislative, and political issues, healthcare reform, and a number of other areas where he's really had the opportunity to champion innovation and leadership. And one of the things that, you know, we know it's 2020, and obviously vision 2020 has something that has happened in the APTA was written back in 2000 and in Mike's Dicus award speech, he talked a little bit about where he thought the profession would be in 2020, in 2000. And so I'm really interested in kind of his take on where we are today. So Mike, welcome to the healthy, wealthy and smart podcast. And tell us a little bit about yourself. Michael Weinper (00:01:21): Well, thanks Stephanie, for the very nice introduction and it's a pleasure and an honor to be with you today. At some level, I'm considered by some, to be a dinosaur, having gotten my Dicus ward 20 years ago, and now long in my career, I'm just celebrating my 50th anniversary as a PT. So I hope that some people won't tune out just because of that. Maybe if nothing else, they can see me as a history lesson, any event, I can tell you that back in 1992 the California chapter of APTA now called California PT association created a long range planning task force that I was honored to serve on. And in that task force where a lot of leaders in the profession in California names that were household names, then probably names and most people would not know now, but our plan was to draft a long range vision. Michael Weinper (00:02:21): If you will, a crystal ball of what things would look like some 18 years later in 2010, kind of looking back, it's interesting to look at and we created, I believe 18 different points that would be goals if you will, of the association and the primary aspects of that working document, which was called PT 2010 by the California association. I'm sure if you were interested, you could look it up or get a copy of it. Then later became the working document for APTA called PT 2020. And since we are now in 2020, I wish we would have known then what we know now, because things have dramatically changed in many ways, but in other ways they have not. And so I guess I could give you some of the ideas we envisioned back in 1992, if you'd like, and then we can take it from there. Michael Weinper (00:03:23): So in that document, we said that PTs would be able to evaluate and diagnose conditions that's true today, perform specialized treatment procedures and work in teams with physical therapists and PT assistants. So all that did come true. Next, the PTs would be able to initiate services subsequent to their own evaluation diagnosis without referral from or diagnosis by another practitioner. And that in 2000 that had not yet been accomplished, but we, now we know we have independence and practice almost every state with regard to our licensure. In most therapists are, would be in independent press configurations with other therapists, maybe who would work in a hospital. In other words, there would be an opportunity to be clinically specialized in it with a board certification, which we now know has really grown quite a bit. Michael Weinper (00:04:25): And they would be sought out. These specialists would be sought out by consuming public and third party payers. Not as much. I don't think our profession has reached to the public well enough to get the public, to understand what a board certification really means and what it takes to become a board certified specialist in our profession, but I'm progressing for a moment. Anyway. So then we said that PTs would be able to be involved in the continuum of care from the hospital to the home, to the private practice. In other words, PTs would have hospital-based privileges and they would be able to go there. And then if the patient were home, many of them would be able to then go to the patient's home and treat them there and then follow them up in the office. And so that was another kind of idea we had way back then. Michael Weinper (00:05:21): So it would be basically following the patient through the episode of care from beginning to discharge and obviously getting them ambulatory and functional. We also said that this is a good one that PTs would become diagnosticians. And more importantly that we would be at the entry point in healthcare which wasn't the case in 2000, but in now in some places, it is that therapists are in fact these musculoskeletal specialists would be a cause we can do it musculoskeletal evaluation or diagnosis many states now recognize that. And some insurance companies have recognized that we can be an entry point into the system, which I believe going forward, it's going to become much more prominent because of the higher cost of care. And actually Stephanie, the difficulty we all experienced when we try to refer a patient to a specialist, state, an orthopedist or a neurologist to do an evaluation so we can follow the patient. Michael Weinper (00:06:18): We find that it can take several weeks for that patient to get in, to see the physician, whereas they can usually get in to see us in a few days. So I think that's something that we will see more of in the future, but back then we had it as a dream, but not a reality. We also said that at that time, that instead of 24 weeks of internship that were experienced by PT graduates back in those years, we thought internships would last one year. Now that I don't think there's a, but we have in fact seen fellowships and other levels of work where therapists are really going into specialization so that they in fact can do things over a year's period of time and then becoming sort of like specialists. So those were sort of the, kind of, I think the basic things that would be of importance today. Michael Weinper (00:07:15): We did also, this was a very important one. We identified that in the year 2010 PT would be a doctorate profession. That was what our key points of doctorate and profession. And lo and behold now our entry level is what a DPT, a doctorate. I'm very proud to say that I went back and got my DPT a little over 10 years ago. I talked back in 1982, and I certainly wanted to walk the walk before 2010. So cause that was our benchmark was 2010. So with that in mind I think it's important to realize that we have become doctoral people. In other words, we are now at a level of sophistication with our education and hopefully some research that gives the PT of today a much broader view of a patient, their wellness or their disability, and gives them better tools, which the function do the evaluation or assessment of the patient, and then follow up with treatment compared to how things were back when I graduated in 1969. Michael Weinper (00:08:31): So and I found that when I got my DPT that I learned quite a bit. I learned some of the things I learned actually were more on how to think differently than I had thought previously. And I will tell you that some of the things that I learned that were most valuable to me was how other people think so studying with other transitional DPT candidates gave me an opportunity for me because I was the oldest person in my class. Gave me an opportunity to hear people think and how they process, how they analyze and how they come to the decisions they do. And then how do they communicate it? I like to think I'm a good communicator, but oftentimes I get really wrapped up or wound up and, you know, I go off on a tangent and I probably go down the rabbit hole and maybe other people in today's world are much more succinct. Michael Weinper (00:09:31): And to the point also I can tell you that I was privileged back in 1975 to get my MPH at UCLA and the school of public health there. And I learned a lot about things that are important today, including epidemiology, which we now know is at the forefront of everybody's thinking and infection control and making for safe environments, which was only very basically touched in my DPT program. But one of the things that I really enjoyed was the differential diagnosis courses I took and the radiological courses I took that gave me a much broader sense for things that I'd studied back previously, or maybe taken some content courses, but went into much more depth and listening to other people discuss those kinds of things. So that's how things were back then. I can tell you also that insurance companies were perceived to be able to give PTs a lot more latitude. And it's only been in recent years that many insurance coverage industry to pay for PT. That's independent of physician referral. We're still working with Medicare on that. You and I know all the snow and I think the day will come that the feds will start to get a little wiser and realize the cost benefit of the PT being an entry point into the system. Stephanie Weyrauch (00:10:58): I think that that's a really great overview of kind of what you guys envisioned back in the early nineties and kind of correlating that with vision 2020. So the APTA vision 2020 and a couple elements that made that basically encompassed a lot of what you said. So autonomous physical therapist practice was one of them, direct access, evidence based practice, doctor physical therapy and lifelong education PPS as practitioners of choice and professionalism. So those were when the house of delegates discussed this, those were the main themes that they were looking for. So keeping those themes in mind, let's maybe start by talking about the doctorate of physical therapy. I mean, that was something that you were obviously very proud of. You will talk the talk, you walk the walk. So what do you think? Well, studies have been shown the DPT student debt now varies between 85,000 and 150,000. Okay. Do you think based off of what we're seeing today, as far as student debt, do you think that today's DPT is a good return on investment? And do you think that the salary for the physical therapist…

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503: Jamey Schrier: Reinventing Your Private Practice Aug 17, 2020

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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jamey Schrier on the show to discuss how to develop your dream private practice. Jamey Schrier, P.T. is the Founder and Chief Executive Officer of Practice Freedom U, a business coaching and training company. He's an executive business coach and leadership trainer. In this episode, we discuss: -Jamey's entrepreneurial journey -The importance of vision and giving yourself permission to imagine your dream practice -How to generate revenue even during unprecedented times -Why building a team of experts is necessary for you to grow your practice -And so much more! Resources: Jamey Schrier Twitter Jamey Schrier Instagram The Practice Freedom Method Facebook FREE GIFT Practice Freedom Method Website A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. For more information on Jamey: Jamey Schrier, P.T. is the Founder and Chief Executive Officer of Practice Freedom U, a business coaching and training company. He's an executive business coach and leadership trainer. Founder of Lighthouse Leader®, Jamey helps physical therapy owners create self-managing practices that allows them the freedom they want and the income they deserve. He is the best-selling author of The Practice Freedom Method: The Practice Owner's Guide to Work Less, Earn More, and Live Your Passion A graduate of The University of Maryland Physical Therapy School, Jamey specialized in orthopedics and manual therapy. He was the sole owner of a multi-clinic practice for more than 15 years. Jamey's passions are basketball, tennis, golfing, and reading. He and his wife, Colleen, and there 2 kids live in Rockville, Maryland. Read the full transcript below: Karen Litzy (00:00): Hey, Jamey, welcome back to the podcast. I'm happy to have you on again. Jamey Schrier (00:05): Karen. It's lovely to be here. Karen Litzy (00:07): Yes, no stranger to the podcast. That is for sure. And that's because we love having you on because you always give such good information to us PT business owners. So thanks for coming back now, you were a PT business owner yourself. People can go back and kind of listen to the past podcast that you did with us to get even a dive in a little bit deeper to your history and how you kind of went from a business owner to now coaching and mentoring in a training business. But can you give the cliff notes version for us now? Jamey Schrier (00:45): The cliff notes. That's how I got through school. Yes. Be happy to give the cliff notes. So I always wanted to have my own business ever since I was younger and went with my dad to his store. I thought it was the greatest thing. So when I got the opportunity to open up and put up my shingle, I went all for it. And I had my fiancé Colleen at the time. Now my wife who you have met, she was, yeah, she was my fabulous front desk. So it was a perfect scenario. Right? I was the quote, the doctor doing the treatments. It was the happy go lucky front desk. And it was a perfect scenario. And that lasted for a couple of years until we started to hire people until I said, honey, do you want to get married? Jamey Schrier (01:35): And she said, sure, boom. She left. She got 35 books on weddings. And she was like, not really there that much. So we had to actually grow a real business. Well, I really didn't know how to hire. I just assume everyone worked like I did everyone thought like I did. Everyone just did quote the right thing. And that's when a whole lot of stress and a whole lot of struggle started to happen, which caused me to create this sense of anxiety that I really didn't experience before. Definitely not as an employee, but I didn't experience for the first couple of years in business. So my hours started to increase. So not only that I have to do the treating and some of the other duties that I had to, but I also had to oversee them and all their stuff. So I took half of their job as well. Jamey Schrier (02:23): And about four years into it, a crazy thing happened, which I've shared before, but I will quickly share. It is my place burned down. We had a fire and it burned down and I was caught with these weird feelings of feeling relieved. Great. I don't have to go to work on Monday and feeling scared to death and feeling, Oh my God, what do I do now? Not just similar to what has happened with, COVID like, Oh my God, I wasn't prepared for this. What do I do now? Jamey Schrier (03:00): So after some soul searching, I realized, I don't know anything about how to build a business. I was a very good clinician. I thought being a good clinician was enough. It was not. So I spent the next nine years learning, trying, failing, learning again, trying and failing of how to build a business that can literally operate with a little bit of maintenance, but not me. They're doing all of it. And fortunately I figured it out and in January of 2013, I removed myself scared to death, but I did it anyways. Remove myself from the schedule no longer I was treating my team was handling it and my business shot up. So I got more time and I made more money and my team was great and my patients were happy and I was like, Oh my God. So I went on a webinar. I believe it was the private practice section webinars that they do. And I just shared my story. People reached out. And next thing you know, I was in the coaching business because they were asking me how I did it. And I've been doing that and being on a mission to help other practice owners try to build, grow their business for the last seven years. Karen Litzy (04:11): Awesome. And the name of your courses? Jamey Schrier (04:19): So the name of the company is Practice Freedom U, the letter U kind of playing off the university thing. And it is a really a business training and coaching firm. So we help the practice owners and we help their teams and grow and build the kind of business they like. So they can have the kind of life that they want. Karen Litzy (04:40): Awesome. And now you had mentioned in your story about when your practice burned down, you kind of weren't prepared for it. It's like kick in the guts. So the country, the world continues, not has been, but continues to live through the COVID-19 pandemic. A lot of clinics had to close. Some may still be closed as we tape this. I am in New York city. We are just reopening now. So as owners begin to reopen and restart, delivering their patient care, what are some of the not so obvious things that they should be aware of? Jamey Schrier (05:23): Yeah, that's a great question, Karen. What I learned in my experience when the place burned down and literally I had nothing to go back to, what was difficult about that was I was the only person going through that everyone else was just business as usual. And my initial instinct, because I am a high achiever because I am a doer was to do more like, okay, what do I got to do? What are we going to do? And it wasn't until maybe a couple days into it that I began to learn that, you know what me trying to do more me trying to be busy and filling up my day with just stuff. Even though I had no patience at all. And there was, by the way, there was no tele-health right. I mean, there wouldn't be telehealth right now if there wasn't a whole country, if it was just one person, the insurance companies wouldn't be changing all their rules. Jamey Schrier (06:26): So, but we didn't even have the technology for that. So what I did was I just started to sit and think and just sit with, well, okay, I'm going to rebuild this. If I'm going to rebuild this, what is it that I really want from this business? What wasn't working well. And I started to write out this, this idea, this outline of what I wanted the business to be. Now, mind you, I didn't know how I was going to get there. Right? I didn't know that, but the more I ask questions, the more I said, what would my business have to look like for me not to work 70 hours a week, which is what I was working, what would happen? What would my business have to be? If I didn't work the weekends, who would I need to hire ultimately to perhaps not have to treat or choose the people I want to treat. Jamey Schrier (07:26): So, as I started asking these questions and gave myself permission, love that word, I gave myself permission to imagine what it would look like. It started to create the outline. And this is exactly what I did and what I shared with other practice owners, what to do during this time. First of all, pause, acknowledge what the hell was going on right now, because it is unprecedented. I hate that word because everyone's saying it, but it is something that you are not prepared for. And it is something that everyone is going through. The people that are going to get through this and be better than they were before, or the people that are not trying to go back to where they were. It's the people that are pausing and saying what an opportunity to fix the things that were broken and to ultimately create what I want. Jamey Schrier (08:21): It doesn't mean it's going to happen today or even in a week, or even in a month, or even in six months. But it's something that can start to help you create the outcome you're looking for, which then causes you to focus on where do I work today, this week? Who should I keep? Who should possibly, I keep furloughed, right? If you're like me at the time I was treating for, you know, 12, 14 years, I was like, maybe you want to reduce your schedule. What would that have to look like to reduce your schedule? Because now's a great time to start searching for therapists. Cause they're out there. And then maybe you weren't as keen on some of the metrics you weren't as clear. Well, what a great time to start getting really organized. So I tell people the not so obvious things is for you to pause, reflect, and start to ask the question. Jamey Schrier (09:21): I love questions better than statements, but start to ask the questions. What would it look like in order to blank? What would it have to be? Who would I have to have in place? What technology we would have to be. You don't have to answer the questions. And that's the mistake that people make. They put all the pressure to have to answer them today because we are doers. We are problem solvers, give yourself a break, give yourself permission, just put them out there. And something interesting is going to happen. I know you and I have talked about this in the past. It's amazing how things start to happen. How people start to show up people that are like, wait a minute, fall into place. They start to fall in place. And it seems like this voodoo magic. It isn't, your mind will start to look for your subconscious mind will start to look for these and it could be right in front of you, but you never saw it before. It's kind of like, where's the salt honey, where's the darn salt. Then she comes in just right in front of you, your mind, wasn't seeing that. So that's kind of the things that I would initially suggest, and then that kind of guides you to. So what are the key elements that you have to do now, which I'm sure we can dive in. Karen Litzy (10:34): Yeah. So let's talk about that. So aside from the obvious safety of your staff and of your patients, that's clearly number one, right? And we want to make sure that when places reopened that that is number one priority. So putting that to the side, because that is hopefully a given for all physical therapy practice owners, right. If it's not, I think you need to go back and ask yourself some questions, but so that should be number one. I think the other thing that a lot of owners are struggling with is the lack of money, lack of revenue that you missed from your business, let's say over the past three months or so. So do you have any thoughts on how owners can build back that revenue? Jamey Schrier (11:22): Yeah. And that is from the people that I've spoken with the surveys we've done, I mean, that is the number one stressor. I mean, you would want to think it's safety it's to protection. Well, the thing that stresses us out is if we don't have any money, we don't have security and stability and we can't take care of our own family. And that stresses the living daylights out of us. Cause for many people, that's why we went into business to be able to have that control and freedom to create the lifestyle we want. So we know that the biggest stressor Jamey Schrier (11:54): Now, for many people, you have a PPP loan, you have maybe a EDIL loan. So it's important to get clear on what options you have find eventually. So some people are kind of coming out of that PPP loan, like the money's gone, they just reacted, they got the loan and they thought they were doing a good job by keeping their staff, even though their staff didn't do anything, except write some blogs and send out some YouTube videos, but it didn't generate anything. So you know, you have to look at what you have available. So that's number one, get your financials in check. So you know, for our business we brought in accountants, we brought in attorneys, I'm sure you know, Paul well so we brought in people and I know for me personally, when this happened, I reached out to experts in this area. I reached out to my accountant, to my financial advisor. Karen Litzy (12:55): Are you kidding me? I was on the phone with my accountant, like literally, almost every single day and emailing him several times a day and thank God for accountants, what gems. Jamey Schrier (13:08): Yeah. But you know, what's interesting, Karen, not everyone thinks like that. You see, we are rugged individualist at heart. What is this business? We struggled. We sacrificed, we studied, we got A's and that is not how you build your business. You need to be. Karen Litzy (13:25): Yeah. That's how I used to be. Now. I'm like could you help me with this, this, this, and this? I mean, because I don't, I'm not an account. I've never filled out. Like I got a PPP loan. I didn't know what I was doing. So I would take screenshots of everything, send it to him. And then he was like, put this number here, put this number here, put this number here. And I was like, did it digit to do? And guess what? It was approved. If I didn't have his help, I wouldn't have been able to do that. I have learned, I've seen the light. Jamey Schrier (13:54): Don't tell anyone. I did the same thing. I call my accountant very calmly. I said, Hey Greg, what should I do? He said, well, it makes no sense not to get the PPP loan. I mean, it's more or less going to be free money. Who knows what's going to end up happening with it. But go ahead and apply that. I said, great, can you have someone help me with that? Because if I don't feel like doing it and he's like, sure, yeah. So everyone's talking about PPP loan. Everyone's freaking out. I've had, I can't tell you how many dozens and dozens and dozens of conversations I've had with business owners. Because I asked him, I go, so who's on your team. Do you have an accountant, financial advisor, someone that understands this and they went, well, I have a friend or a neighbor that does my taxes. And I'm like, see there lies the problem because you don't look at your business as a team of people that are experts in different areas. Jamey Schrier (14:52): So if you're going to learn from this whole COVID thing, start building the experts in your business. So it doesn't fall on…

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502: Erica Ballard: Optimizing Performance w/ Nutrition Aug 10, 2020

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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Erica Ballard on the show to discuss how to optimize your health and performance through nutrition. Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals' energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules. In this episode, we discuss: -The impact of optimal nutrition on performance -How to detect and remedy vitamin and mineral imbalances in your body -Mindfulness strategies to cope with quarantine stressors -And so much more! Resources: Erica Ballard Website Erica Ballard Instagram Erica Ballard LinkedIn Pantry Essentials Playbook The Lies We've Been Fed Podcast A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. For more information on Erica: Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals' energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules. Erica has her MS from Tufts University School of Medicine, got her CHC through the Institute for Integrative Nutrition, is a regular contributor to WTHR 13, and has been featured by Women's Health, Lululemon, and the Young President's Organization. Read the full transcript below: Karen Litzy (00:01): Hey, Erica, welcome to the podcast. I'm so happy to have you on. And now, before we get into the meat of our discussion, I would love for you to talk a little bit more about you so that the listeners kind of know how you got from point a to point B to where you are now. Erica Ballard: Sure. So for most of my life, I have been a public health practitioner. People pleasing go getting type of gal. And so because of that, I thought I knew what healthy was. And so I was always trying to get there through the traditional means of, you know drinking the shakes, eating the bars, following the guidelines. But the thing about it was I never actually looked or felt the way I wanted to, which was again, so confusing because rule following people, please are working in public health. Erica Ballard (01:02): You think that I would look the way that I wanted to given that I knew quote, unquote, exactly what to do because I had these huge desires to not only have the body I wanted and look like the women I saw on TV or magazines, but I also had this like deep desire to be happy. And I thought that health or fitness, because I equated the two at the time was the linchpin for me because externally I had everything that one would desire, but internally I felt unfulfilled. And so the only piece that was missing in my exterior, you know, look was my weight. And so I was like, okay, that's it. So I did what everyone does, who tries to get healthy? I like, I count calories. I followed all the rules. I tried to outrun every French fry or glass of wine that I would have, and I just couldn't get there. Erica Ballard (01:57): And that all changed though, when I moved from East coast to Indianapolis, which is where I'm originally from, I moved here and I went to the Institute for integrative nutrition, even though everyone said, don't do it because I got my master's at Tufts medical. I had still student loans, all those things. I was like, no, this is the thing. And it was like, it was the thing. It actually taught me that, you know, food sleep, stress. Those are the drivers of health. And when I figured that out, I went out and I tried to share this information with people. And when I did, they were like, no, that's not right. And so while I started to get results, I would hear them or I would hear society saying girl, no. And so then I would stop doing the thing that made me feel better. Erica Ballard (02:46): And it was this weird up thing that would happen until finally I decided now I'm the expert on me actually. And I'm going to let feeling good lead the way. And when that happened, it's like weight dropped. I was able to hold conversations and happy. My mom likes me again. Right? Like I wasn't the worst human being who was like constantly snapping and more. So I just figured out that, like I was in charge of my happiness. I was in charge of my health and I knew best. And so doing that journey is what has brought me here today to help not only continue to help myself, cause you never just arrive at health. Right. But also to help others who are really desperate to get healthy, do it because most of the people that I help are high performers are people that are willing to do the work and are just like, I am doing it, but I can't. And I'm like, I got you. I've been there. And so walk them through the things that they can do in order to really enjoy their lives while being healthy. Karen Litzy (03:49): That's incredible. And now let's talk about that. Cause I love that you work with kind of high performance people, high achievers, high performers feel like I'm the same way in New York. I don't know a lot of people in New York who aren't that way. I think that's part of living in that might be a requirement for living in New York city. But let's talk about how we can optimize our performance through food, right? I'm a physical therapist. So we're used to optimizing performance through strength, training, stretching, pro programs, plyometrics, but as a physical therapist, I also know that just what you said, sleep food are paramount to when it comes to being able to optimize your performance. So I'm just going to throw it over to you. And I would love to hear your take on what that means. Erica Ballard (04:42): Sure. So it was up to two things when I have this conversation because so many people will tell me all the time, Hey, I get so much done. Even though I don't eat the way I should or I'm drinking these Cokes or whatever it is. So like screw you Erica. And I'm like, listen, you're only in second gear. Like think about that. Like you're only in second gear, you get to fifth, you have to get your food. Right. And the first reason I think that I think it's so clear that we need to get our food right for this is Maslow's hierarchy of needs. So at the bottom of Maslow's hierarchy of needs is psychological and within psychological is food. So that means in order to get the self actualization, the top that, you know, essentially self fulfillment, you have to get the base, right? So without it, you just can't be. And if that's not enough, cause social science, isn't always enough for people. The hard data is starting to show that our brain and gut aren't connected. So we know that if what you put in your gut is not good, your brain will not function. And if your brain will not function appropriately or to the best of its ability, you can't optimize because a lot of your decisions are made with your brain. Karen Litzy (05:47): Right? Absolutely. Yeah. And, and you know, when we talk about that brain gut connection and you can correct me if I'm wrong, but we are really one of the bigger there is that Vagus, Am I correct? In that a hundred percent? Do you want to talk a little bit about that? Erica Ballard (05:58): Well, I think it's one. So for me, when I work with clients, I can, but where I always find it being interesting is that when I talk with people about how to get healthy every single time, I don't know, this is what happens to you when I get into the nuances. They're not, they're like, yeah, the Vagus nerve that matters, but I'm like, yeah. Breathing, putting things in making sure that like the fibers in your gut, they're all going up to your brain, making sure that that's, they're talking matters, but the nuances I have found people don't care as much about. Karen Litzy (06:36): I can definitely relate to that because I deal with a lot of people who have pain, more chronic pain. And so when I sort of go into kind of the neurophysiology behind pain, people like get it for a little bit, but then they just don't want to go that much deeper into the weeds with it. Like you said, like the nuances, but for the purposes of our discussion, I would like to, so let's pretend I'm like your ideal client and I'm like, Erica, tell me what does all this mean? Erica Ballard (07:10): So for me, when I look at our nervous systems and how they're connected, right, we have this nerve that literally runs through our body that connects these two entities and for it to be functioning appropriately, to make sure that the fibers around it actually work to make sure that it, all of the things that it's also then connected to work appropriately. It's really important that we put in foods and fibers and vitamins that our body need for those things to communicate and talk. And so what we typically do, right, is we're like, we'll put whatever it's in and it doesn't matter. And if I just drop weight, I'm going to be the healthiest version of myself. And it's like, no, you have, you have the Vagus nerve, you have your entire nervous system. You have your gut lining. Erica Ballard (07:58): You have these, like you have these different pieces within your body that need to appropriately absorb all of the nutrients in order to make sure that everything is communicating the way that they should. And so when I think about how to optimize and when I think about food and Vagus nerve and all of those pieces is I like where my head often goes is in order for these things to function appropriately, we need the right amount of nutrients and we need our body to be able to absorb them so that these things can talk. But we were like, we think that supplements work by themselves. And we think that vitamins and minerals work by themselves, but it's a payer to make sure the communication is appropriate. Karen Litzy (08:45): Okay. That makes sense. Yeah. And I think you do see a lot, I don't know about you, but I see a lot of people Hawking different kinds of supplements and vitamins and this and that. And then you hear research on none of it matters, right? Like, Oh, why take this? Why take that? Why take a multivitamin or take a plethora cocktail of vitamins that doesn't work. You should get it all from food anyway. So what do you say to that? Erica Ballard (09:11): So I think there is, I can understand where they're coming from. And I think that from a health perspective, if you're at the beginning and you're like, I'm trying to get healthy, I can't quite figure it out. Start with food nine times out of 10, or I would, should say eight times out of 10, start with food, making sure that you have of the highest quality items. But when I think about the importance, I used to really agree with that. But now I'm starting to understand the importance of supplementation or I have fully grasp it of supplementation because the soil in which our food grows does not have all the nutrients necessary for our body, for the plant to grow to the best of its ability and for our body then to take in all the nutrients that exist. Like as a society, we are magnesium deficient as a society. We are vitamin D deficient. And as a society, we tend to be omega-3 deficient and you can't often get enough magnesium through your food, especially if you're trying to make up and provide them in D like if you're in a Chicago or Boston or in New York, it is listen, it's cold outside. Like it is hard. Erica Ballard (10:22): To get those things in. So while I believe that food is medicine, I do believe often food is the first line of defense. If your thyroid isn't working appropriately, if you're in a lot of muscle pain, if you're not sleeping so well, those are, they're probably supplementations that you need to bring into your body to make sure that it's optimized. But, before going to experiment, I would always say consult with a practitioner or like PT health coach, like certified health coach doctor nurse practitioner, because you can't like you can't really OD per se, but you can get the wrong results from these supplements. Karen Litzy (11:04): And do you suggest people take blood work? Like if you're working with someone, do you suggest they get blood work taken so that you have a clearer picture or to see like, Oh wow, you really are deficient and XYZ. And then here's a way I can plan this. Erica Ballard (11:19): So when I work with people, what I always recommend is first start with your diet. So straight up, like most people are not eating enough vegetables. You know, if you're listening to you are like eat vegetables, try to also clean up your diet, take out where you can. And if you can organics pasture, raised grass fed really just up that quality and see what happens. But if you do that and in a month, you're not moving towards the results you want. Blood work, I think is, can be extremely helpful because like, for instance, going to like to the thyroid, the amount of hypothyroidism underdiagnosed in this country is, is pretty high. And when you also look at inflammation markers, even though you're eating a clean diet, like if we're having food, like we're eating things that we're intolerant to, maybe you can't get that exact number in, or that exact food item in the blood work. Erica Ballard (12:14): But I do think it helps really show same with magnesium, vitamin D cause there's different protocols, right? Based on different deficiencies that you have. And so to be able to task, versus just to think I provides a piece of mind that a lot of people want, especially going back to the high-performer piece, like your mind is always going, like you're going a thousand miles a minute, but if you can get paperwork that will show you what's happening and different ways to track, it can feel really nice. And it also can feel like an accomplishment. Karen Litzy: Yeah, I agree. And I think that it gives you, like you said, a goal to work for, to work towards maybe like, I know I'm like a big numbers person, so I really like to see the numbers. So for me, if I had like a blood test, let's say I was vitamin D deficient, which I am by the way. And then I was like, okay, well let me change my diet or let me take this supplement. And then I got another blood test in six months and it was better than I would be like, okay, this is a little bit more proof for me. This is what I needed. And it would encourage me to stay on that healthy path. Erica Ballard (13:09): Yeah. And I think there's nothing wrong with that. I think that that's why there's such beautiful things with all the tracking devices and blood work and the availability of multiple different types of blood work now to test all these different things, because what I always find, and this is neither good or bad, it just is. It's not a lot of folks are sicker than they know that they are. And because they're so used to feeling a certain way, they don't even know that they're in deficient levels or dysfunction. Erica Ballard (14:00): And so that blood work can also, as a practitioner help us show that there are different ways to feel better. Because going back to the vitamin D example, I mean,…

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502: Erica Ballard: Optimizing Performance w/ Nutrition Aug 10, 2020

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501: Dr. Kameelah Phillips: Optimizing Health During Pregnancy Jul 27, 2020

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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Kameelah Phillips on the show to discuss optimizing health during pregnancy. Dr. Kameelah Phillips is a board certified Obstetrician and Gynecologist, wife, mother, and lifelong women's health advocate. Since high school, she has been involved in local, national, and international organizations aimed at advancing women's health care issues through advocacy and direct patient care. In this episode, we discuss: -The impacts of COVID-19 on pregnancy and post-partum -Factors that impact the United States' maternal mortality rates -Six ways to optimize your health during pregnancy -The importance of interprofessional collaboration -And so much more! Resources: Calla Women's Health Website Dr. Kameelah Phillips Instagram Calla Women's Health Instagram A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. For more information on Dr. Phillips: Dr. Kameelah Phillips is a board certified Obstetrician and Gynecologist, wife, mother, and lifelong women's health advocate. Since high school, she has been involved in local, national, and international organizations aimed at advancing women's health care issues through advocacy and direct patient care. Dr. Phillips graduated from Stanford University with a degree in Human Biology with an emphasis in Women's Health and Human Sexuality. After graduation, she worked at the San Francisco Department of Public Health in the AIDS office as a Research Assistant on HIV vaccine studies. She relocated to Los Angeles to attend the University of Southern California Keck School of Medicine. During medical school, she received numerous community service awards. She was privileged to travel to Ghana, Cuba, and Tanzania on health missions during this time. Upon completion of medical school, she attended a competitive OB/GYN residency at the New York University School of Medicine. She also served on an emergency medical mission in Port-au-Prince, Haiti to provide women's health care during the 2010 earthquake. Dr. Phillips is an educator, mentor, and expert in women's health issues. She loves to help women and girls feel comfortable with their bodies, so that they can be aware of changes or new developments. Her interests include Minority Women's Health and health care disparities, lactation, sexual and menopause medicine. Dr. Phillips is a member of the International Board of Lactation Consultants and speaks Spanish. She enjoys teaching residents and medical students. Her guilty pleasures include reality T.V. As a Real World Alumnae, she has used this platform to travel nationwide to discuss domestic violence, smoking cessation, and other health-related issues. She loves a good bargain, flowers, and deep-tissue massages. You can follow her on Instagram @drkameelahsays Read the full transcript below: Karen Litzy (00:01): Hi, Dr. Phillips, welcome to the podcast. I'm excited to have you on. And this is the first time I'm having an OB GYN on the program. I've had lots of physical therapists who work with women's health and pelvic health. So this is really exciting to get a different point of view on women's health and on pelvic health. And now, before we get into the meat of the interview, we are still living in a pandemic, COVID-19 is still here. It has not mysteriously disappeared or vanished. And so there are a lot of women who are getting pregnant, who are living through pregnancy at this time and who might be a little nervous, a little concerned about what can happen during their pregnancy is COVID affected. So what I would love for you is any advice for those pregnant women in the time of COVID? Kameelah Phillips (00:58): Yeah, absolutely. You know, one thing I really try and impress on patients that is absolutely unique to OB GYN is despite what's going on in the world, whatever chaos is going on, women still have babies women still go into labor. Women still take healthy babies home. So for us in particular we've made some minor, not, I shouldn't say minor there there's significant, we've made some changes in how we deliver care and the hospital setting, but for us, it's really been, you know, not so huge of a change because you know, hurricane Sandy earthquakes in Haiti, I've been through both of those, we still deliver excellent care to women. So one thing I would ask them to do is just really take a deep breath and while things are going on around us remember that their primary concern is to take care of themselves so that they can take care of their baby. Kameelah Phillips (02:11): I have told patients that a little bit of their OB care is changing. So we might have fewer visits, but really the important things we will always make sure that we hit the important time points and hallmarks of a pregnancy. So you won't miss anything. I've been telling them that labor and delivery has changed a little bit. And I think this changes pretty much coming across country, but whereas it used to be a time where, you know, extended family was welcome. It's important that they recognize now that only one or maybe two people will be allowed to be present for labor and delivery. And our hospital in particular, both moms and support family are being asked to wear a mask. We do check moms for coronavirus. We use the nasal swab. The extended family is not tested, but they're expected to keep their mask on. Kameelah Phillips (03:16): And most of the time our moms are coming back negative, but if they do come back positive, you know, we have a discussion and education with them as to what it's going to be like, knowing that they're now corona virus positive and going to be taking home a newborn. So we talk about those things. But for all intents and purposes, women are coming in. They're having healthy, safe deliveries, both C-sections and vaginal deliveries. Their hospital stay we've shortened a little bit in New York, we're going back to keeping women two days or four days, but other places in the country are, are shortening. The hospital stays in an effort to get women home safely and so that they can use hospital resources for the people that need them. But we're having healthy and safe deliveries. There was a panic, I think, amongst the pregnant community at the beginning of the pandemic, and everyone wanted to have a home delivery that still continues to not be the best response to this. Kameelah Phillips (04:28): It is still safest to deliver in a hospital or birthing center, certainly not at home to have best outcomes. We still recommend that women breastfeed that's the best way to feed your baby despite Corona virus, even if you were previously infected. And when women go home, I just ask them to be considerate of the new immune system in their house, right? So limiting visitors, washing their hands. If people come over, keeping them not being afraid to say, Hey, keep your face mask on while you're with the baby or around the baby. And really using the technology that we have to their benefit. So while it's not what we're used to, the grandparents meet their babies over FaceTime or zoom now. And that's not going to be forever, but you know, if you have people who are unable to quarantine and can guarantee that they're negative, I asked them to defer visiting. Karen Litzy (05:29): Yeah. Thank you. That's all really great advice. And I should have mentioned in the beginning that we are both located in New York city. And so right now it's different. Kameelah Phillips: Yeah. So obviously New York was the epicenter of the pandemic, certainly in the United States, if not the world at one point we have now our numbers have gone down, but the safety for the pregnant and new moms have, has not is right. Yeah. Right. So we are still on top of new infections, preventing infections in the hospital, the doctors, the nurses, the people who clean your rooms, we're all washing our hands, wearing gloves, keeping our mask on because it is our priority that you come in healthy and that you leave healthy. Karen Litzy (06:33): Yeah. Perfect. All right. Well, thank you for that. And hopefully if there's any pregnant moms or other healthcare practitioners that are working with pregnant women kind of give them a little bit more information to pass along or to kind of keep in their heads. So now let's switch gears slightly here. I'd love to talk about maternal mortality rates in the United States now in the United States. We know, unfortunately that we do have a very high maternal mortality rate amongst advanced countries, or what's the best word for that advanced countries? Is that the right developed countries, industrialized countries, like we know what you're talking about, you get it right. So the questions that I have are what populations are most effected. And then what, in your opinion, do you feel like needs to be done to improve those maternal mortality rates? Kameelah Phillips (07:32): I am firmly under the belief that we can as a nation, as a country walk and chew gum at the same time to make these rates better. So to answer your first part of your question we have plenty of data that show that black women, African American women in particular are most vulnerable during pregnancy labor and delivery. And postpartum times the rates of increased death can be anywhere from five to seven times higher than their white counterpart. And these rates are abysmal for a developed country to have such a discrepancy in healthcare is really saddening and frankly just discussing it's unacceptable. But there are other ethnic groups that are also at risk that, you know, we always talk about black and white and really this country is so diverse, but our native American population is also significantly affected by maternal mortality rates that are poor as well as Alaska. Kameelah Phillips (08:57): We always forget about Alaska. So African American women, native American women and Alaska women, and it's complicated. It is a combination of access to care. It's unfortunate that we seem like we're talking about the same things over and over, but access is a big issue. We live in the biggest city in the United States, but you know, Manhattan alone, what the Island of Manhattan has four hospitals there used to be more, there used to be more can you imagine? But some of our outlying communities that are more ethnically diverse or Latino or African American have far fewer hospitals. And certainly in those hospitals, the resources aren't comparable to anything that you would see in Manhattan. So along with, you know, access there's hospitals, there's doctors there's birthing centers, all of these are less often found in lower resource places. Kameelah Phillips (10:06): So access is a big one education both on the part of the health field and of patients themselves is a problem. I think we're starting to really get some traction on the African American population, helping them understand that this is a very critical time in their life. And so they have to be hypervigilant about blood pressure, weight gain, diabetes, all of things, all the things that can be triggers for issues in pregnancy. Those are the big things that stand out access and education. Karen Litzy: And do you also find that, and I find this in other aspects of healthcare especially when it comes to feeling pain that oftentimes women are not believed as much as men are. And, that is in other parts of healthcare, certainly true. Do you find that women maybe during pregnancy or even post pregnancy, like maybe that the day they gave birth, if they're there trying to explain things that are going on and perhaps they're not being believed and are just yeah brushed to the side so that I think is absolutely the case for a lot of the issues that women experience around the maternal period. Kameelah Phillips (11:22): And it's not limited to women. It also crosses ethnic and socioeconomic boundaries. We have a real issue and I'm part of the establishment, right? I'm part of the medical community. So I feel free to air up our dirty laundry, that we have a real issue with bias and medicine and we talk about racial bias and how that can impact black people. But we have a bias against women. We have a bias against women and, you know, she's being hysterical, she's being dramatic or pain's really not that big women in our discomfort in our needs are routinely downplayed and even by other women, because we've sort of ingrained in our head that, you know, women tend to be more dramatic, whatever. Kameelah Phillips (12:30): We downplay the needs of poor patients who come in, Oh, you know, she's just being loud for no reason or, Oh, that's just how they're. So this isn't just an issue of women. It goes across class, it goes across ethnicities. But for us, when we're pregnant, it has to be addressed and highlighted because when a woman is saying something isn't right. Something isn't right. And that should be taken seriously because in the postpartum period we get lucky a lot of times because women are generally young and healthy, but when things go bad in obstetrics, they happen quickly and then its big. So for example, if a woman was like, my bleeding is kind of heavy and say, maybe she just delivered a baby, a woman could easily lose one to two liters of blood in like a few minutes. So we had a really bad postpartum hemorrhage the other day. And I was like, this is impressive when you see what the body can do. Especially in labor, it happens quickly. And so it's incumbent upon us as healthcare providers to take women seriously. Karen Litzy (13:27): And then I would also think there is, and again, I don't know if this is true or not, but I know kind of where I come from more looking at the pain world and from my own experiences, as I personally would downplay my own pain. So as not to bother someone. Right. And do you feel like in the world of OB GYN, if you're going for pregnancy, like, do you have to kind of really educate those patients to say, listen, if you're feeling something doesn't feel right, like you need to speak up, right. Well, like you're bothering us. Have you encountered that? Kameelah Phillips: I have encountered that. And it's really incumbent upon all of us to relearn these narratives that we've picked up just growing up in the United States of like not being the complainer or not being the squeaky wheel, not rocking the boat. Like those all have negative connotations right. Kameelah Phillips (14:47): In the obstetric space. When you don't speak up, we can have really negative, horrible outcomes. So part of my experience with patients is to listen to what they're saying really repeat back what they're saying, like, okay, I hear you're having X, Y, and Z. Did I get that right? And if it's something that is quote unquote normal in the space of a, you know, a growing uterus or a growing body part of my job is to really provide education, to help them manage their expectations for what they should expect. Growing uterus, growing weight gain, swelling, what they should expect from their body. If it's the first time they've been pregnant or the sixth time they've been pregnant, you know, all the pregnancies are different. And if we have a clear understanding her giving me her complaint, me giving her feedback on what I think she's saying, and then giving her the anticipatory guidance, I think she needs, and we still have an issue. Then it's incumbent on me to escalate it and really make sure th…

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500: Dr. Susie Gronski: Male Pelvic Pain: The Ultimate Cock Block Jul 20, 2020

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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Susie Gronski on the show to discuss chronic pelvic pain syndrome in men. Dr. Susie Gronski, licensed doctor of physical therapy and board-certified pelvic rehabilitation practitioner, is the author of Pelvic Pain: The Ultimate Cock Block, an international teacher, and the creator of several programs that help men with pelvic pain get their pain-free life back. In this episode, we discuss: -What is chronic pelvic pain syndrome/chronic prostatitis -Sociocultural barriers unique to men receiving pelvic pain care -Male expectations and reservations during a pelvic health treatment session -Strategies to increase patient self-efficacy -And so much more! Resources: Susie Gronski Instagram Susie Gronski Facebook Susie Gronski Twitter Treating Male Pelvic Pain Course for healthcare practitioners Pelvic Pain: The Ultimate Cock Block Book In Your Pants Podcast Men's Online DIY program: use code painfree20 for $20 off! One-on-One Intensive Program A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here. For more information on Susie: Dr. Susie Gronski is a licensed doctor of physical therapy and a board certified pelvic rehabilitation practitioner. Simply put, she's the doctor for 'everything down there.' Her passion is to make you feel comfortable about taboo subjects like sex and private parts. Social stigmas aren't her thing. She provides real advice without the medical fluff, sorta' like a friend who knows the lowdown down below. Dr. Susie is an author and the creator of a unique one-on-on intensive program helping men with pelvic pain become experts in treating themselves. Her enthusiasm for male pelvic health stretches internationally, teaching healthcare providers how to feel more confident serving people with dangly bits. She's determined to make sure you know you can get help for: painful ejaculation problems with the joystick discomfort or pain during sex controlling your pee without needing to be embarrassed... So whatever you want to call it, (penis, shlong or ding-dong), if you've got a problem 'down there', she's the person to get to know. Dr. Susie is currently in private practice in Asheville, North Carolina specializing in men's pelvic health. Follow her on Instagram, Facebook, Twitter, YouTube and listen to her podcast, In Your Pants, for expert pelvic health advice without the jargon. Read the full transcript below: Karen Litzy (00:01): Hi Susie, welcome to the podcast. I'm happy to have you on. And now as the listeners may know, I've had a lot of episodes about pelvic health, pelvic pain, but most of them were centered around female pelvic health and pelvic pain. And today, kind of excited to have you on Susie because today we're going to be talking about chronic pelvic pain in men. And I think this is a topic that is not spoken about a lot. I don't know if it's still considered taboo in many places. We'll talk about that today as we go through this podcast. But before we get into it, can you tell the listeners what is chronic pelvic pain syndrome or chronic prostatitis, which I don't know why I have a hard time saying that word and I'm looking at it and still have a hard time. But anyway, that's neither here nor there. That's my problem, not yours. So go ahead and just give us what is it? Susie Gronski (00:52): Well that's okay about the not able to say the word prostatitis because it is a bit of a misnomer when we're talking about male chronic pelvic pain syndrome. So it's okay. I wish that word wasn't used as frequently anyway to describe what we're going to be talking about. So the official definition that one might read in the literature is that chronic pelvic pain syndrome or chronic prostatitis is having recurring symptoms lasting more than three to six months without a known cause or pathology. And that typically results in sexual health issues, urinary complaints, and obviously a lot of worry to say the least. So that's the official definition of chronic pelvic pain syndrome. Susie Gronski (01:46): Now the NIH or the national Institute of health classifies, I put in bunny quotes here, prostatitis into four categories and briefly those categories are an acute bacteria prostatitis, chronic bacterial prostatitis, chronic non bacterial prostatitis, both inflammatory and non-inflammatory, which is the realm that physical therapist will work in. And then you have a category, interestingly enough, asymptomatic inflammatory prostatitis. And I think that's really important to stress that you can have quote unquote inflammation in the prostate, but you still have individuals who are asymptomatic. So when it comes to the word prostatitis and itself to describe male pelvic pain, I think it is a bit of a misnomer because a lot of cases are not bacterial related or infection related. And actually in fact 90 to 95% are not infection related or bacteria related. So I think we need to shift from using prostatitis as the main umbrella term. Susie Gronski (02:52): Because you know, it puts the blame on the prostate when we know that's not the sole cause or what we're dealing with in the long run. Karen Litzy: Got it. So that, that can be a little confusing for people. Cause I'm assuming if you're a man and you hear that diagnosis prostatitis that that's gotta be kind of unnerving to hear. Right? For one you don't know what it is. Susie Gronski: Yeah. It's like, well, and I don't want to stereotype, but I think when guys really hear prostate, anything, what's the first thing that might come to mind? Cancer, cancer. Right. And so now you're freaked out like what's wrong with my prostate? Am I going to have cancer? We know it's highly prevalent. And so yeah, I think it is a bit of a misnomer in terms of when you have pain down there especially without a known cause that leaves the fear of, well, they must be dismissing something. Susie Gronski (03:50): There must be something really seriously wrong that the doctors are not just finding. Karen Litzy: And what are some common symptoms? I know you mentioned a couple in the beginning there, but if you can kind of repeat those common symptoms that people may experience with chronic pelvic pain syndrome and is pain one of them. Yes. Right? Susie Gronski: Yes. Most often it is a sensation that is not typically pleasurable. It's painful. It may or may not be associated with urinary issues. In general. You'll have any sort of pain or discomfort in the abdominal or genital region. It could even be around the tailbone or even pain with sitting, sitting around, you know, around the sit bones in the groin. It may or may not be associated with sexual function. So for some men they might experience pain after completion or with an erection. Susie Gronski (04:46): They might feel pain with bowel movements. It might be testicular pain. It might be pain between the scrotum and the anus, typically known as the taint area. So there's a lot of overlapping symptoms that one might have. Again, everyone's so unique, but those are some of the common themes that one might hear in the pelvic health world. Karen Litzy: And so if you're experiencing these symptoms, let's say for more than a month, I mean, will people experiencing these symptoms for, let's say a couple of weeks before they go see a doctor or go to look up their symptoms and see what's going on? Susie Gronski: I think that varies on the person and their personality in terms of like their health and healthy behavior in terms of men health seeking behavior. We know that when you compare it to, for example, women, they don't tend to kind of seek out the help of doctors as women might do. Susie Gronski (05:50): Right. and I think that's across the board in terms of international standards as well in terms of the seeking behavior, health seeking behavior. I don't think I can have like a, I don't have a stat or factored on that, but I do think that men tend to kind of like watch and see what happens or you know, I think many of us do. Like if you feel something you're like, well that'll just pass. Right? I don't know if I gave an answer that fully. I just know that sometimes people wait and sometimes people go right away cause they're afraid or whatever the case may be. But I do think that the sooner that you can get reassurance for what you're experiencing in term, and I mean reassurance from not just take these antibiotics and come back and see me in six weeks, it should go away. Susie Gronski (06:42): Because that's typically what will happen when a guy will seek help. And I think the main one of the main barriers too is that where does a guy go get help from when something like this happens? Cause for females we have a gynecologist or a woman's doctor, right. But guys, like I know my husband just, he's like, I would have no idea where to even go. Who do I seek for help for this kind of thing. And so I think when we're talking about barriers for seeking help, that's one of them. I just don't know where do I go. And then you'll go to your primary care physician who may or may not be familiar with, you know, chronic pelvic pain or being able to differentiate, you know, whether it's an infection and what tests to do. Susie Gronski (07:26): A lot of times men are given antibiotics without even having diagnostic tests to see if there's an infection, which is unfortunate. And they'll do this for several rounds too. And so I think the longer that happens, the more that we're making the situation worse in terms of, you know, we know we've got microbiome, we'll plan to those pictures. Well it may or may not have been an infection that triggered this. We know the immune system plays a role in chronic pelvic pain. So, you know, I think having a well versed, fuzzy healthcare professional who can really help this person say, Hey, this is what could be happening. We know a multifactorial and multi-modal treatment approaches is very helpful for what you're going through and that, you know, these symptoms shouldn't last forever. Here go see a pelvic therapist if we know that's not happening. Susie Gronski (08:23): And I see guys several years later or years later before they even have an appropriate diagnosis, which I guess brings me to say that chronic pelvic pain syndrome is a diagnosis of exclusion. So, before they even come see or get a referral to see and see if they're lucky to get a pelvic health referral, they'll go through a lot of invasive tests. Cystoscopies colonoscopies. I mean, you name it. So I just think that by the time they do get the help, the right care that they need for the issues that they're experiencing, they've gone down a really dark rabbit hole by that point. Karen Litzy: Yeah, and that's sort of looking at, I mean, it's not that they're healthcare providers are intentionally doing them wrong, right? They just don't know. Right. So we're talking about, I guess this more traditional view of a medical process for men who are coming in. Having these complaints is saying, well, let's check this, this, this, this, this, and this. Like you said, a diagnosis of exclusion. And then years down the road they come to see you and I can't imagine, forget about their physical wellbeing. I can't imagine their mental and emotional wellbeing is doing all right either. And now the pelvic physical therapist has a whole lot of comorbidities to deal with. Susie Gronski (09:21): Absolutely. Absolutely. And with any type of persistent pain, not just chronic pelvic pain syndrome in men, but I think with any type of persistent pain, we really have to be looking at the psychological and sociological aspects of that person's experience. Because at this point now we're dealing with an emotionally driven process versus a purely nociceptive in nature. You know, it may have started that, but now we're dealing with this like this cat yarn, I don't have cats, but a kid, I know they like to play with yarn and you have this big ball of yarn that you're really just taking one strand out at a time to really unravel and everyone is so unique and very different. Susie Gronski (10:30): So yeah, I think that's where we're dropping the ball with getting quality pain care for these individuals. Number one, just getting rid of some of these barriers of a lack of education on the practitioners, you know, perspective of what do I do in this situation? Why do we need to have all these invasive tests done? In my opinion. I don't think we need to do that, but they're really not getting the referral to see qualified, you know, pelvic therapists who can really rule out, you know, biological triggers and even work with the psychological and sociological aspects of that person's experience. Just to, again, calm things down. And to reassure that person that things are going to be okay. And to that extent, I think this would be worth noting as well is some men do not have positive medical experiences in that they're not being validated, often being dismissed. Susie Gronski (11:23): And no one's really actually looking at their genitals. To this day, I still have men say it's all about just finger, finger in the butt, checking out the prostate, and no one's really addressing like, take a look at my testicles, look at my penis, like treat it like any other part of my body. And then you're then that kind of plays into the blame and shame of one's body. And just again, not knowing, no one's really looking at it. I want somebody to look at it to tell me I'm okay. And I think that's really being missed as well in those early encounters with medical providers. I think that's so important. Karen Litzy: And you know, you had touched on it a few minutes ago talking about not just what we see from a physical standpoint, but a socio cultural standpoint as well. So what are some common barriers that are unique to men from a sociocultural standpoint when receiving care for chronic pelvic pain? Susie Gronski (12:25): Well, the first one that I touched base upon as you said, was having an outlet to get medical care. So there isn't a, you know, male gynecologist per se for men. And so I think just having a lack of that awareness of where does a guy go get help for these types of things. Where would be the best physician, let's say for health urologist or urologist. But that isn't usually the first line of the encounter. It's usually an internist or primary care physician. And sometimes it could be even other healthcare professionals like a massage therapist or a chiropractor, an acupuncturist who's hearing these the symptoms or men feel comfortable enough with the trusted provider that they trust to talk about even what they're going through. Cause I think that brings me into the second, I think barrier is I think if I can say this, the masculine side of culture, right? Susie Gronski (13:33): Like, what should men like mentioned man up and not have these issues and what if something is going on down there? Like, you know, guys aren't really talking about their private parts in the locker room per se. And I speak, again, I'm speaking for the heterosexual male, but like, you know, I think it's just uncomfortable in terms of how the society that we live in to even have that conversation be brought up so that being one of the barriers is just, we're not really talking about sexual health…

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499: Dr. Jennifer Hutton: How to be an Ally Jul 13, 2020

Show notes

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jennifer Hutton on the show to discuss Anti-Racism & Allyship. Dr. Jennifer Hutton, aka Dr. Jpop, is a pediatric physical therapist from Nashville, TN. As a Black woman, Jennifer knows what it is like to identify as different, and it has helped in her quest to be an ally for children with disabilities inside and outside of the clinic. Now she is educating others on how to be effective allies to BIPOC and furthering her desire to create a diverse and inclusive space she calls Dr. Jpop's Neighborhood. In this episode, we discuss: -How racial trauma impacts the biopsychosocial determinants of health -The difference between an ally and a white savior -Implicit bias in healthcare -The lifelong process of Allyship -And so much more! Resources: Jennifer Hutton Facebook Jennifer Hutton Twitter Jennifer Hutton Instagram Jennifer Hutton Website Anti-Racism & Allyship for Rehab and Movement Professionals A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020! For more information on Jennifer: Dr. Jennifer Hutton, aka Dr. Jpop, is a pediatric physical therapist from Nashville, TN. She became interested in PT when her youngest cousin was diagnosed with cerebral palsy. Jennifer spent time observing him in different therapies, and subsequently determined that she would work with children in a similar capacity. She graduated from Loma Linda University with her Doctorate in Physical Therapy in 2008, and moved back to her hometown. She spent two years treating in an ortho setting before finally transitioning to her dream job with children. Jennifer enjoys treating the developmentally delayed population, as well as children with neurological and orthopedic diagnoses, both congenital and acquired. While the world reminds children with special needs of their limitations, she believes they are all capable of the impossible and helps them see that their special gifts will help them be their best selves. Jennifer loves to showcase her "pop stars" and share creative treatment ideas on Instagram. She is also an instructor for RockTape and is currently working on her own educational content for pediatric movement specialists. As a Black woman, Jennifer knows what it is like to identify as different, and it has helped in her quest to be an ally for children with disabilities inside and outside of the clinic. Now she is educating others on how to be effective allies to BIPOC and furthering her desire to create a diverse and inclusive space she calls Dr. Jpop's Neighborhood. Read the full transcript below: Karen Litzy (00:01): Hey, Jennifer, welcome to the podcast. I am so happy to have you on. And now for those of you who are, maybe don't know you by your full first name on Instagram and social media, she is Dr. J Pop and last week you gave a wonderfully informative thought provoking webinar, and we will have the link to that in our show notes. Cause people can still watch the replay to that, correct? Yes, the replay is up and it will be for the foreseeable future. So what I'll have you do quickly because I don't want to put words into your mouth, but I would love for you just to tell the audience a little bit more about what that webinar was about and why you did it. Jennifer Hutton (00:58): Yeah, so it was anti-racism and allyship for rehab and movement professionals. And I went through from the beginning, literally started with the history of white supremacy in healthcare, through slavery. The Jim Crow era talked about racial trauma and the effects that it can have psychologically and physiologically. Then I went through the stages of allies and all of the things that you can do in each stage. And then I have portioned it out for the examination phase and for the action phase and kind of let people know in their different settings, be it education, be it healthcare or fitness, the action steps and the questions that they can ask themselves to be a better ally. I just, I wanted to do it. It's been a passion of mine for awhile talking about cultural competency and diversity, and I could tell people were awake in a way that they've never been awake before, so they were ready to receive the message. Jennifer Hutton (01:57): So when everything happened with, you know, Brianna Taylor, I'm not arbitrary and George Floyd, it was kind of like the cherry on top that everybody now is ready to listen. And so I found this was a great way to just get my thoughts across. Karen Litzy: And obviously we're not going to have you retell that entire thing because people can go and watch the replay. Like I said, there'll be a link in the show notes but for me after watching it and I also watched the replay, so I sort of like went through it twice. Just because, you know, I want it to be really clear on what I didn't know. And good. Yeah. And so we're not going to go through all of it, but what I do want to touch upon today is, and you mentioned it in your description just now is racial trauma. And I also want to talk about allyship. So what can people specifically in healthcare do to be allies to our BIPOC community in healthcare? Jennifer Hutton (03:00): Right? So we'll get to that. But first, what I want to talk about is racial trauma. This was a very, very powerful part of the webinar for me. And it is certainly part of our social determinants of health. And as physical therapists, if we are treating under a bio-psychosocial lens, social is part of it. We need to be aware of what racial trauma is and how that may affect a person mentally, physically, and emotionally. Jennifer Hutton (03:47): Racial trauma is basically the cumulative effects of racism on an individual's mental and physical health. And I thought it was really important to highlight because we do a great job of talking about healthcare disparities. We do a great job of, you know, singling out the races and what you will see in the trends and the diseases. But we don't really look at the root cause of why this may be something that is more prevalent in different communities. So I kind of explained that racial trauma is likened unto PTSD. The only difference is we cannot separate ourselves from that toxic environment. So you start to see the manifestation of that stress. The weathering is one of the terms that you will hear when it just breaks down the body because of all of the stress that you are feeling and seeing. So you start to have increased suspicion, sensitivity to threat you know, physiological symptoms using other mechanisms like alcohol and drugs, increased aggression no thoughts of future. Jennifer Hutton (04:54): And I also have looked at research that where they look at the Holocaust survivors and how they actually saw changes in their DNA from the stress that they went through. And that's what they're starting to look at with our DNA as well, seeing that we pass these things down through generations, which is why it's called generational trauma. So to just say, Oh, well this, the African Americans are most likely to have these diseases. It's like, well, what are they dealing with outside of your clinic walls? That would cause this. And it was funny cause the students loved that part. The most, those were actually in professional school. Cause they're saying this would be extremely helpful to relate to patients when I actually go into the clinic or healthcare setting. So I focused on that and I also kind of showed way that you cope with racial trauma and all of the ways that you'll see in the communities is racial storytelling. Jennifer Hutton (05:58): So being able to tell you some of the experiences that I've had in this America validation, naming the trauma, understanding that the microaggressions that you're feeling are a part of the racial trauma that you're experiencing it. And the problem they're finding, even with some of these coping mechanisms is great for the moment. But what happens when the next event comes around, they're going right back through those stages of grief and stress. So I think it's important to see in every facet of life, there are the effects of racism, the effects of white supremacy. And so if you're hitting that on every facet of your life, you're more likely to present with physiological issues. Karen Litzy (06:44): And as a, let's say, as a clinician who might be treating someone who let's say does have high blood pressure or heart disease and is part of the African American community or BIPOC community, is it part of our job to then educate our patients on this? So cause they may say, well, you know, it runs in my family, right. I don't know why it runs in my family. So where does our job come in as the healthcare provider? What is our duty to those patients to address? Is it our duty to address that and to help with coping mechanisms? Or is it just a referral to someone else? Jennifer Hutton (07:25): Right. I think it's definitely our job to consider it when we are approaching different patients to consider that this may be something and a lot of times you'll hear it in their rhetoric. I think I had a student in the chat during the webinar say I have someone who said, he's afraid that if a cop actually comes and he can't put his hands up, that they'll feel like he's resisting. And it was because he couldn't get enough external rotation. Did you read that one? Karen Litzy (07:56): Yeah, I read that too. Yeah. Yeah. Jennifer Hutton (07:58): It was like, see that, that right there. That is something that probably wouldn't have come to your mind when you were thinking about his plan of care, but now maybe you need to change your approach because you're actually tapping into something that makes him feel outside. You feel something that just about the pain that outside and his wife. So I think we definitely have to keep it in mind and consider it. I also think we have access to and knowledge about so many different ways that we can take care of our body. So even if you were to start incorporating some of those into the treatment plan so that they can understand, these are things that you can use and you don't have to name it for them, you don't have to say this is because of racial trauma or give them all of the facts. But you, as a clinician recognize it might be something that's beneficial to them. So that's why I say to my Pilates instructors, to my yoga instructors, you know, you're a key to coping. You're a, something that could be helpful for them. And if they don't know that it, yeah, it is your job because you know about these things. So you can give them as a resource. Karen Litzy (09:02): Excellent. Thank you. And now, let's move on to the concept of being an ally. So before we start and get into how to be an ally certainly within the realm of healthcare, I would love for you to just, can you just define what an ally is? Jennifer Hutton (09:25): Yes. So an ally is a person group or nation that is associated with another group or others for a common cause or purpose. So that just means no, this is not something that affects your daily life personally, but you see that it does affect the way someone else's life is and you want to help make it better. So where you're using your privilege and your position to help further the cause. Karen Litzy (09:51): And how is that different than white savior racism? Jennifer Hutton (09:56): Yeah. So white saviors and still comes from the perspective that you are superior, that if you were not doing the work, then it would not be done and that you are absolutely needed. And I agree your voice is needed, but if you're still approaching it from a superior mindset, because you haven't done the work through those stages of allyship than it actually is a hindrance and it's not as effective. Karen Litzy (10:25): Got it. All right. Good, good change. They're good. Because I think oftentimes we maybe think we're an ally, but maybe we're not. And the concept of white saviorism, is that something that someone is consciously thinking or could that be an unconscious thing? Like you really think that you're there to help and you're trying to do your best, but you're may not be helping in the way you think you are. Jennifer Hutton (10:58): Right. And that's, to me, that's where the self-examination comes in. That's where those questions that you ask yourself about your upbringing, what you believed about black lives matter before all of this happened, what you thought about the killings that were happening in the people that were speaking out against them. How you viewed other races, the things that you said, the things that you've heard, because now you are able to see, yeah. Maybe you're not a racist, but you may have biases that are affecting your thought process, affecting your decisions. So I always say, check your intention. Like, don't just say, well, I intended to do good. Look at the impact that it had. If the impact does not measure the intention, then maybe we need to go back and do some homework on that intention. Because if you're doing something only to make yourself feel better, like, okay, I'm doing it. I'm that good person, not the best intention if you're doing it because like, Oh, they need me, like I talked about thinking that you have to give scholarships to all black people. Like they don't have the money to pay. That's why saviorism that is still coming from a bias mindset of, they are poor. They have less, they don't have the resources and I need to step in and save the day. But I don't think it's ever intentional. I still think it's just coming from your perspective and you really gotta check your perspective. Karen Litzy (12:19): Yeah. And I think we also hear the word implicit bias thrown around quite a bit. So do you want to define that and where that comes into play within this conversation? Jennifer Hutton (12:29): Yeah. So the official definition would be attitudes and stereotypes that affect your understanding, your actions and your decisions in an unconscious way. And I talked about thought viruses. And the way that I give a great example is the older person who only saw whites only signs and colored only signs everywhere that they went can, do you really think they couldn't have made some type of decision or thought about how black people are, how white people are based on what they experienced in their environment. So everything that you were taught and the things that you saw, the things that you heard, it forms your biases and that's on all sides and it mobilizes you. And it's how you act. So if you were surrounded by people who were racist, even if you think of yourself as a good person, you still may have things that were thought viruses that were planted that you have to check. Karen Litzy (13:28): Yeah. All right. Great. Okay. Now let's get into the stages of allyship. So stage one awareness. What does that mean? Does that just mean, Oh, I'm an ally. I'm aware. I'm sure it's much more complicated than that. So I'm just trying, I'm pointing out like the total ridiculous side of it, because that might be like what people think like I'm aware I watched the news. I know what's going on. I'm going to be an ally done. Yes. Jennifer Hutton (13:57): So awareness is that you see that there is a problem. You see the problem and you acknowledge the problem. You also acknowledge as an ally, your privilege in this world, the fact that you are viewe…

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498: Laura Rathbone, PT: ACT in the Clinic Jul 06, 2020

Show notes

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Laura Rathbone on the show to discuss Acceptance and Commitment Therapy. Laura Rathbone is a Specialised Pain Coach and Advanced Physiotherapist that works exclusively with people experiencing persistent pain and conditions such as chronic back pain, pelvic pain, fibromyalgia and CRPS. Much of her work is virtual as she coaches people all over the world in the service of their pain, but she also has a small clinic in the beautiful town of Weesp, just outside Amsterdam, the Netherlands. In this episode, we discuss: -What is Acceptance and Commitment Therapy (ACT)? -How the ACT framework compliments a biopsychosocial approach to patient care -The importance of promoting active over passive interventions for patients with persistent pain -Why clinicians should integrate psychologically informed physical therapy into their practice -And so much more! Resources: Laura Rathbone Website Laura Rathbone Twitter Laura Rathbone Instagram Laura Rathbone Facebook Laura Rathbone LinkedIn The Association for Contextual Behavioural Science A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020! For more information on Laura: Laura Rathbone is a Specialised Pain Coach and Advanced Physiotherapist that works exclusively with people experiencing persistent pain and conditions such as chronic back pain, pelvic pain, fibromyalgia and CRPS. Much of her work is virtual as she coaches people all over the world in the service of their pain, but she also has a small clinic in the beautiful town of Weesp, just outside Amsterdam, the Netherlands. She understands the need to see people from a 'whole-person' perspective and integrates modern, evidence-based physiotherapeutic and psychologically-informed approaches. Laura is a UK chartered Physiotherapist and has a Masters Degree in Advanced Neuromusculoskeletal Physiotherapy from Kings' College London. She is part of the Le Pub Scientifique team which organise regular live learning sessions exploring the science of pain and produces a small podcast called "Philosophers chatting with Clinicians". She runs her own courses on ACT and mentos clinicians regularly. Read the full transcript below: Karen Litzy (00:01): Hi, Laura, welcome to the podcast. I'm very excited to have you here and today we're going to be talking about ACT. So thank you so much for being on the podcast. Laura Rathbone (00:12): Well, thank you for having me. I'm excited too. I like talking about something. Karen Litzy (00:17): All right. So now let's talk about ACT first, two questions. What is ACT and how did your interest in ACT come about? Laura Rathbone (00:32): So ACT stands for acceptance and commitment therapy. I suppose, you know, sort of efficiently, the way we talk about it is that it's a third wave cognitive and behavioral therapy. So it's born out of the behavioral movement and it's a psych it's essentially, it's a psychology framework. It came out of the world of psychology. And the aim of it is to recognize that when we are experiencing, you know, difficult unpleasant and invasive stuff, there's often a lot of all the aspects to that experience that add to the struggle and add to the suffering. And what we're working with from an ACT perspective is often can we compassionately and you know, empathetically and appropriately work with some of that, all the stuff that comes with the struggle and comes with a difficult experience. And does that help us manage our present moment experience? Laura Rathbone (01:38): Does that help us reduce some of the suffering so that we can move forward with some of the realities that are in our lives? Like for example if you're experiencing pain, which is where I come into it, you know, in the absence of having a really good predictable, effective cure for things like persistent pain, things like fibromyalgia, CRPS even chronic low back pain, which we, what we don't have these predictable sort of treatments that's going to take that away once the pain has started to become resistant, but in the absence of that, are we able to support people with their pain so that they can thrive. They can be a person who has pain and has a career and has a committed family life and has a social function and role, and they're able to thrive with it. And that's really what we're doing with ACT there. Karen Litzy (02:38): And where did your interest in ACT come from? How did you get involved? Laura Rathbone (02:45): Yeah, there were two answers to that really. First answer I guess, is that I just sort of fell into it like so many people, right. I graduated from university. I went into my first job. I had a really difficult first job experience in a difficult company and ended up working, noticing, I suppose, and working with people that had persistent pain. And so I was constantly seeking for better solutions and trying to figure out how we can do better by these people. And then I guess I just sort of navigate it that way naturally. And yeah, so I was interested in mindfulness, mindfulness, you know, you study things like the MBSR. So the mindfulness based stress reduction start thinking about how you can incorporate bits of that into practice. And before, you know, it, you end up into accepted therapy. Laura Rathbone (03:41): And then I was super lucky because I managed to get this brilliant job in the national center for pain at st. Thomas' hospital in London, where I was working at input, which is the pain center. And I was working underneath professor Lance McCrackin in their embedded ACT unit. So I got this great opportunity to really further my training and understand how it functioned as a framework and how we as physiotherapists could really be maximizing our therapeutic alliances and relationships and really integrating this model to create, you know, a psychologically informed approach, if you want to call it that or a compassion focused approach so that we just do better by people who are vulnerable and in pain. Karen Litzy (04:26): Well, that makes a lot of sense to me. Thank you so much. Laura Rathbone (04:31): If I was to give you a second answer, is that, you know, pain is a bit of a personal experience. It's a personal journey for me. My mom had chronic low back pain when I was younger. And I guess I'm only just now coming to terms with the influence of that on my career. Something that I haven't talked about a lot. But I do get asked about quite a lot. And you know, it would be silly to say that those early experiences of somebody with chronic pain, you know, didn't have an influence on me and seeing her go through a biomedical approach to treatment and not be heard and seeing her struggles and thinking, well, you know, and the injustice has probably built in me as the second generation and thinking, well, how do we restore some of that justice? And then how do we acknowledge that there is an imbalance here in terms of privilege, like clinician privilege versus patient privilege, and how do we start to restore that and make sure that we listen to the people we work with and do better. Karen Litzy (05:36): What sort of experiences did you see your mother go through that kind of led you into where you are today, when you say so for a lot of people, they might not be familiar with the biomedical approach and what that looked like, but what did that look like for her? And then what did that look like for you as a kid growing up? Laura Rathbone (05:58): Yeah. Like I say, something that I'm still really coming to terms with then, and the memories of what I saw my mom go through was still quite like emotionally charged. They're still very close. And we're talking about it, me and my mama talking about this more and trying to open it up a bit more and explain that. And then what I remember, you know, being in the car and my mom being unable to sit in the chair and the sound of her voice when we went over a bump or the car stopped that, that Yelp for pain, that, that real yeah. Terrorist pain really. And I remember her spending hours in the bedroom, not being able to get out of bed but, you know, she also, she was an amazing woman, you know, incredible first role model as a strong woman, really, because, you know, she's a nurse, she was working in the pediatric units, she's done everything really she's done a and a pediatrics domiciliary, which is community-based working. Laura Rathbone (07:04): And like, she used to get up every day, even in pain. And she would go to work in paid and, you know, do all these and just push and push and push until she was exhausted. And when she would be like posted on the weekend and then pushing herself and through the day, and I saw her just be hopeless. That was, I think the overriding feeling, if I really reflect quite personally, was that feeling of, there is no hope there is no way out of this. This is the norm and resigning to that. And that's because, you know, she'd tried physical therapy or physiotherapy in the UK. And, you know, she'd tried like acupuncture and she'd gone around the holistic meds you've been in and out of the doctors and things like that. And just really been told there's nothing that they can do, but yet also she had this image of why she had pain. So she was told that she had back pain because her Coccyx had dislocated during labor, which was my labor. So there's a bit of personal guilt as well. Laura Rathbone (08:07): And really those things where, like, she always felt that that image had stayed with her forever. Even now, probably if you talked to her and ASCO, which we were working through a little bit, which is hard to do an issue, mom, I, you know, trying to figure out what, how she views her body and her back is becoming a much stronger image, but she really had to find her own way out of that. And it was years later until she found a solution that she could, she felt she could predictively start to acknowledge and manage her pain. And, you know, it's not the traditional method that she found a kind of like a kind of massage tool, which is everything we wouldn't say right now, but it worked for her and it gave her a freedom. She felt all of a sudden I have something I can do when I have pain. And that was the most important moment for her. And it wasn't, you know, acceptance and commitment therapy or mindfulness. It was, it was a tool that gave her strength. It was a kind of extended part of her own ability to self manage. And she did that and it worked for her and I don't advocate those kinds of mechanisms and those approaches, but it worked for her. And there's something in that. There's something important in that. But yeah, I remember I remember her pain and yeah, it's still very personal. Karen Litzy (09:27): Yeah. And not easy, but thank you for sharing that. Cause I know that sharing personal experiences from my personal experience is not an easy thing to do, and it's not easy to put that out there where the world is going to hear that. So thank you. But I'm glad that you shared it because I guarantee you, there are going to be people listening to this podcast who are going to say to themselves, that's me. That was my mom. That's my sister, that's my friend, that's my patient. And so I think it's really important to allow the listeners to understand the magnitude of hope and of finding something that works for you, even if it's not physiotherapy or it's not XYZ doctor or whatever framework you're using. Because like I said, somebody out there is going through that same exact thing. And just to kind of hear that story and to hear how, not only did it affect your mother, but it affect you and your family and growing up and I think that's a really powerful share. So thank you. Laura Rathbone (10:35): Welcome. And thank you to my mom who continues to be an incredible voice in my growth as a person and who went through that journey and who still goes through that journey. Although she doesn't identify now as somebody who has chronic pain and that's a great moment for her, like she's now able to do so much more and really doesn't have back pain very often anymore. So, I guess the, you know, yeah, it's hard for me to share, it's not my story. Karen Litzy (11:11): Yeah. Yeah. Well, and we're going to get back to pieces of that story in a little bit, but I heard you say in the beginning of this podcast, talking about ACT as a framework, I would like to kind of bust a myth because I think a lot of people look at it as a tool to put in the toolbox. So what do you say to someone who's like, Oh, ACT, this is a great tool. I put it in my toolbox. I'll take it out when I need it. Laura Rathbone (11:45): Yeah, this is, Oh, I'm glad, I'm glad we're talking about this. Cause this is something that this is probably my personal opinion and there's probably people out there are acceptance and commitment therapists. You may disagree with me and that's absolutely fine this space resolve, but I do not think that ACT is a tool that we pick up when we think it's appropriate. First of all, how do we know that? That's certainly another thing, isn't it? You know, we don't, you know, and what I would say that acceptance and commitment therapy is how we are. It's a way of being with your clients and the people who choose to work with you in the service of their pain. It happens. It's how we make decisions. It's how we think about and how we facilitate those decisions and how we are part of, you know, the next step in that person's journey. Laura Rathbone (12:37): It's not something that we say, Oh, we've exhausted the biomedical approach. Now we're going to pick up the ACT approach. And it's a bit later the biopsychosocial approach that it just doesn't work like that. This is just another way of, you know, clinicians getting out of doing the hard work, which is listening to people's stories and empathizing and putting themselves in somebody else's shoes and trying to, you know, trying to get more of their life experience as opposed to showing off what they know about a particular joint. Like this is not how we work in pain. Pain is a very personal, it's a very unique experience. It's built off of life experiences, as well as memories and, you know, learning and worries and fears and all of that plays out in our physiology. Karen Litzy: And what can a clinician who's working with someone in pain and they are taking the ACT framework into the clinic. What does that look like? Laura Rathbone (13:41): Good question. Yeah. I mean, I guess it depends what your setting is, doesn't it really like if you're setting is first line, so people are coming to see you and they have never seen anyone else with that problem, then of course, we're going to be thinking, okay, where is that person in the journey from that injury or the onset of their pain? Are they two years down the line? And this is the first person they see, or are they two weeks down the line? Cause that always is going to affect your approach to assessment and monitoring really. So it would make a difference in terms of where you start, but you're always thinking about okay, so if this person is two weeks from injury, then you're going to be doing your injury based assessments, your pathoanatomical approach to assessment. Laura Rathbone (14:34): And we want to want to make sure that this person hasn't done any serious injury. And we…

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496: Anne Stefanyk: How to Optimize Your Website Jun 29, 2020

Show notes

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Anne Stefanyk on the show to discuss website optimization. As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs, and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions. Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp. In this episode, we discuss: -Why your website is one of your most important marketing tools -The art of simplicity in branding -How to track the customer lifecycle -The top tools you need to upgrade your website -And so much more! Resources: Anne Stefanyk Twitter Drupal Anne Stefanyk LinkedIn Kanopi Website HotJar Google Pagespeed Accessibility Insights WAVE Web Accessibility Google/Lighthouse Use user research to get insight into audience behavior How to make your site last 5 years (possibly more) A big thank you to Net Health for sponsoring this episode! Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020! For more information on Anne: As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions. Anne fell into the Drupal community in 2007 and admired both the community's people and the constant quest for knowledge. After holding Director-level positions at large Drupal agencies, she decided she was ready to open Kanopi Studios in 2013. Her background is in business development, marketing, and technology, which allows her to successfully manage all facets of the business as well as provide the technical understanding to allow her to interface with engineers. She has accumulated years of professional Drupal hands-on experience, from basic websites to large Drupal applications with high-performance demands, multiple integrations, complicated migrations, and e-commerce including subscription and multi-tenancy. Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp. When she's not contributing to the community or running her thoughtful web agency, she enjoys yoga, meditation, treehouses, dharma, cycling, paddle boarding, kayaking, and hanging with her nephew. Read the full transcript below: Karen Litzy (00:01): Hey Anne, welcome to the podcast. I am so excited and happy to have you on. Anne Stefanyk (00:06): Nice to see you. Thank you so much for having me. Karen Litzy (00:09): So before we get into what we're going to talk about today, which is kind of how to use your website as a marketing tool, and that's putting it lightly, we're going to really dive into that, but I want to talk about kanopi. So for a lot of my listeners, they know that I'm a huge proponent of female entrepreneurs of women in physical therapy. We have a whole conference for it every year. And I love the fact that kanopi is a majority female company. So can you talk about the inception and kind of the journey that you've taken with the company over the years? Anne Stefanyk (00:47): Sure, I'd be happy to. So I founded kanopi kind of off the side of my desk and it actually came from meeting a need that I needed to take care of with my family. My family became quite sick and I had to stop working and as a result it forced my hand to pick up some contract work. And that contract works. Certain cuts soon kind of snowballed into, Oh my goodness, I have actual projects. I probably should hire some people and get out of my personal email to run the business. But it did come from a place where I needed some lifestyle flexibility. So I built a company that is fully distributed as well. And as a result of the business model that we created, it allowed us to really attract and retain really great talent. Outside of major cities. And I have a lot of single moms or a lot of moms and I have some single dads too, but we really are able to, with our business model, attract and retain a lot of top talent. Anne Stefanyk (01:39): And a lot of those are girls. So we're over 50% women and there's only really two men in our leadership, a team of nine. So there's seven girl bosses out of the nine that run the company. And we really have focused on helping people with their websites and making it really clear and simple and easy to understand. We find that there's always too much jargon out there. There's too much complexity and that we all are just craving simplicity. So building the business was twofold, was one to obviously help people with their websites. What was also to really create impactful futures for my staff and give them opportunities to kind of grow and expand in new ways. So I'm really proud that as kanopi has formed our team, I'm part of our retention plan has to really been to take care of our families and put our families first. Anne Stefanyk (02:28): Because if we realize that if you take care of the family, the family takes care of you. And so we've extended a lot of different benefits to be able to support the family journey as part of the business. And we find that as a female entrepreneur, really recognizing and appreciating that we need flexible lifestyles to be able to rear children or take care of elderly parents or we have a lot of demands as females on us. I mean the men do too, don't get me wrong, but as a female I'm creating a space of work where we can create that space for everybody really makes me proud. And happy. Karen Litzy (03:03): Yeah, I mean it's just in going through the website and reading about it, I was just like, Oh gosh, this woman's amazing. Like what a great way to go to work every day. Kind of knowing that you're staying true to what your values are and your mission is and that people really seem to like it. Anne Stefanyk (03:22): Yeah. Yeah. We always say it's not B to B or B to C, it's H to H it's human to human. And what do we need to get really clear to speak to our humans to help them, you know, move forward in their journey, whatever that looks like for them. Karen Litzy (03:34): Right. And, so now let's talk about that journey and it's kind of starts with the website. So let's talk about how you can make your website an effective marketing tool. Because not everyone, especially when you're first starting out, you don't have a lot of money to throw around to advertising and things like that. But we all have a website or maybe we all should have a website and have some sort of web presence. So how can we make that work for us? Anne Stefanyk (04:00): Yeah, definitely. You need a website. It's like a non negotiable factor these days and it really doesn't matter. The kind of website you have, especially when you're just getting started. There's lots of great tools out there from Wix, Squarespace, even WordPress that comes with templates or pre-baked themes. And I think the most important part is to really connect with your user and figure out who your user is and what kind of website needs to support their journey. But yeah, definitely you have to have a website and you actually have to have a good website. Having a bad website is the non, like, it's really bad because it will detract people so quickly and they'll never come back. So you pretty much have that first impression. And then if you don't make it, they won't come back. I think there's a well known stamp that if your site doesn't load within four seconds or three seconds they'll leave. And if it doesn't load within four seconds, they will never come back to that URL. Karen Litzy (04:56): Wow. All right. That's a great stat. I'm going to be, I'm going to go onto my computer, onto my website and start my timer, you know, so there's some really cool tools. Anne Stefanyk (05:06): We can include them in the show notes, but the Google has a page speed test where you can actually put your website URL and see how fast it is and give recommendations on what to fix. Karen Litzy (05:15): Oh perfect. Yeah, and we'll put all those links in the website and we'll get to that in a little bit about those different kinds of tools. But let's talk about, you said, you know, you're human to human business. We have to know who are we putting our website out there for. So how do we do that? Anne Stefanyk (05:34): Yeah, that's a great question. So when you're first starting off, you probably all like if you're just starting your business, you're just trying to figure out who you serve, but you may have special things that you'd like to, you know, that you're passionate about or you specialize in. Like for example, maybe you really specialize in women's health or sports medicine or you know, one of those things. And just to kind of get clear on who is your best customer. If you've been in business for a couple of years, you probably have a pretty good idea who your ideal customer is and how they engage with you. So first off, it's really thinking about who your target audience is and what are their needs. So when we're thinking about a website and thinking about that user journey, you often identify them as certain people. So you may have like, Mmm you know, kind of creating different avatars or different personas so you can really personify these people and help understand their journey. Anne Stefanyk (06:27): And from there you kind of understand that if someone's coming to you for physical therapy, there's going to be different mind States that they come into you with. So when you first have your website, you're going to want to, of course, a lot of people just put up who they are. Like, you know, this is my practice, this is who I am. This is my credit, my accreditation, and my certifications. And maybe maybe here's some testimonials. And then we run and we go off to the races. And that's great to get you out the door. Once you started your business, you're going to recognize that you're people, when they call you, they're going to have a million questions and there's ways to answer those questions using your website. And as a solo entrepreneur, like I ran my business by myself for three years, which means I was everything and I wore all the hats. Anne Stefanyk (07:09): I was the project manager, I was the designer, I was all the things that was the marketer, was the, I know that feeling well. So it took me like three years to operationalize. And I think the first thing I did as a female entrepreneur, I hired an assistant. I would highly recommend that as being one of your first hires as an entrepreneur. And that's just someone who can do all the little itty bitty details and then move on to whatever that looks like for you. But when you're building your website, the next level you really need to take is it serving my humans? Is it serving my audience? So are they able to get the information they need? And I think this strange time that we're in, we're all, this is an opportunity for us to look at our own website and our own stuff and say, is this the best representation possible? Anne Stefanyk (07:52): Because no longer are they just picking up the phone and calling you because your practice is probably closed. You're at home right now, your phones, maybe you if you have them redirected, but either way they're going to your website first. So it's like having the right information there at the right time for the right person. And that really comes to the user journey and that's where you know, if someone is just broken their ankle and they're now told by their doctor, you have to go into physical therapy, that's their first stage as they now are going to Google and saying, you know, PT for San Francisco and interestingly enough as Google wants to keep you there, so here you are. You user is Googling for you or Googling for physical therapy wherever, San Francisco, San Jose, wherever, and up comes the Google listings. If you can get past that point, then they go into your website and they're going to click open a bunch of them. Anne Stefanyk (08:43): That's what we call, you know, your awareness phase. They're becoming aware of you. There's certain things that a user wants to see in that phase. So understanding of someone's looking for you, they're going to, Oh yeah, they specialize in ankles. And I really think you know, Oh, that's person's for me. Versus now they're in the consideration stage and now they've chose likely, but Sally over here and James and Jimmy and we're figuring out which PT to go to, then that's a different level of content and what are they looking at to compare and contrast. And then when they've actually decided to work with you, then there's another layer of content you have to consider. So, Oh, I've decided to work where they're located. How do I get there? Was there anything I need to prepare their forms I need to fill out in advance? Anne Stefanyk (09:27): And then you even have the persona of the user once they've actually gone through all your services as I imagine. And therapy. A lot of you folks are getting referral and word of mouth. Let's nurture that. Let's use the website to nurture the word of mouth and referral work. Let's give your patients a place to go really easily to provide feedback, which will then change, you know, getting those Google reviews up leads to a higher ranking on that Google page. So if you understand where they began and where they pop out at the end, kind of map it all together. You'll start to see your gaps. Karen Litzy: And is it possible to go through sort of a quick example of what that might look like? So if someone's there on Google, they hit Google, they click on your website, you just said if it doesn't load within a couple of seconds, they're gone. Anne Stefanyk (10:14): Right? So that's a good awareness phase situation, right? What else? Someone's there, they're just click, click, click trying to find someone. What is it that they're looking for in that awareness stage? Like what are they, what is going to be like, Ooh, I like this, this person. I'm moving them from the awareness bucket to the consideration bucket. Yeah, yeah. So they need to see themselves in the way that their problem gets solved. So when they look at the website, they can say, Oh yeah, that person had the same problem and they got help. And then, Oh, look at their results. Oh look, there's a picture of them, you know, back on their skateboard six months later as part of this patient follow-up log. Oh, we don't, you know. So that's the kind of stuff is that when users really want to just be able to see themselves, they crave simplicity. Anne Stefanyk (11:01): And so often I think that if we're too close to it, we don't actually see how complex our stuff is. And sometimes when we're really smart and we have degrees in specialized things, we use vocabulary that our users are not even aware of yet. So it's really when you're talking to getting them from that awareness into considering you, it's about using really basic common language. It's about guiding them through a bit of a story. People love to read stories. So showing them like, Oh, you know, I was really showing another patient and showing the patient journey that all, I considered multiple companies locally, but I ultimately went with Sally as a PT because this, and just sh…

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496: Anne Stefanyk: How to Optimize Your Website Jun 29, 2020

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