Healthy Wealthy & Smart

In this episode, Managing Partner of XPAN Law Partners, Rebecca Rakoski, and Senior Account Manager at Contango IT, Schellie Percudani, talk about cybersecurity, especially for small businesses. Today, Rebecca and Schellie talk about business privacy and security practices, cost-effective steps that you can take to protect your business, and the importance of cybersecurity insurance. Why do small businesses have to worry about cybersecurity? Hear about ransomware attacks and how to react to them, data privacy laws and how they impact your business, and the value of hiring lawyers, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “What we all have in common between the small businesses and the large businesses is we’re all human.” “You’re only as good as your last backup.” “You can’t have privacy without security.” “You definitely don’t want to be fudging any kind of information. You definitely want transparency.” There are four basic things that you can do as a business owner: enable multi-factor authentication, provide security awareness training, monitor and patch your systems, and enable software and hardware encryption. “Encryption is your Get Out Of Jail Free card in most jurisdictions.” “60% of small businesses will go out of business within 6 months of a data breach without liability insurance.” “The first thing that businesses need to do is take a proactive posture.” “If you look at data breaches, if it’s not caused by an employee in the company, it’s caused by an employee at one of their vendors.” “Make sure you put yourself in a legally defensible position.”   More About Schellie Percudani Schellie is a Senior Account Manager at Contango IT located in Midtown, Manhattan. With 75 people, Contango IT services their clients through 4 key areas of technology. IT Service/Support - We offer unlimited onsite and remote support for all covered users and devices with up to 60-90 second response time. In that same fixed monthly price, we also include asset management, budgeting breakdowns, disaster recovery planning, compliance requirement review and planning, technology road mapping, and a lot more. IT Infrastructure / Cabling - Moving offices? Contango IT handles the technology side of the move through Cabling and IT setup. Cybersecurity - 45 people strictly in Cybersecurity keeps Contango IT on top of the biggest buzz In technology. Risk? Compliance? Reach out, looking to help in any way possible. Even if it is just second opinion or advice. Custom Programming - Front-end or Back-end development, Android, iOS, Web-based and much more. Winners of the Microsoft Best Use of Technology Award and the NYU Stern New Venture Competition Any technology questions, reach out! With hundreds of clients over 4 services, Contango IT has seen it before.   More About Rebecca Rakoski Rebecca L. Rakoski is the managing partner at XPAN Law Partners. Rebecca counsels and defends public and private corporations, and their boards, during data breaches and responds to state/federal regulatory compliance and enforcement actions. As an experienced litigator, Rebecca has handled hundreds of matters in state and federal courts. Rebecca skilfully manages the intersection of state, federal, and international regulations that affect the transfer, storage, and collection of data to aggressively mitigate her client's litigation risks. Rebecca is on the Board of Governors for Temple University Health Systems, and an adjunct professor at Drexel University’s Thomas R. Kline School of Law and Rowan University.   Suggested Keywords Healthy, Wealthy, Smart, Cybersecurity, Small Business, Privacy, Security, IT, Insurance, Legal, Hacking, Ransomware, Malware, Data, Technology, Data Breaches, Encryption   To learn more, follow Schellie and Rebecca at: Website:          https://www.contangoit.com                         https://xpanlawpartners.com Twitter:            @XPANLawPartners                         @RRakoskiesq Instagram:       @schellie00 LinkedIn:         Schellie Percudani                         Rebecca Rakoski, Esq.   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript Here:  00:02 Hello, Rebecca and Shelly, welcome to the podcast. I'm very excited to have you on to talk all about cybersecurity. So welcome, welcome.   00:13 Thank you for having us.   00:14 Yes, thank you. And   00:16 so this cybersecurity this for me as a small business owner, is brand new to me. Although it probably shouldn't be, but it is, but that's why we're talking about it today. But before we get into it, can you guys give a little bit more detail about yourself and what you do so if the listeners understand why I'm talking to you guys today?   00:41 So I, Rebecca McCroskey, I'm a co founder and managing partner of x Pam law partners, we're a boutique cybersecurity and domestic and international data privacy law firm, which is a really fancy way of saying we help organizations with their cybersecurity, and data privacy needs, right? I have been a practicing attorney for almost four years. I hate to admit that sometimes I'm like, I'm dating myself. But what's great is we really help businesses, small startups, all the way that big multinational corporations because right now businesses are it's, it's really a brave new world that we're facing today. And businesses are getting attacked literally from all different sides. And so we started x pant to really help businesses understand what their legal obligations are, and what their legal liabilities are. And I tell my clients, my job is to avoid those problems for you, or do my best or put you in the best position to address them if and when it becomes an issue. So that's   01:48 what I do in a nutshell. Great, thanks, Shelly. How about you?   01:53 Yes, my name is Shelly perky. Donnie, I am an account manager with contango it and we help businesses and our end organizations if I could speak, we help them manage their day to day it to help build a strong security posture. We also help them with cybersecurity, we have 45 people strictly in cybersecurity, we have 25 penetration testers, eight ethical hackers. So we have a strong, you know, posture to help businesses build a posture so that they at the end, I wouldn't say that they're not going to be attacked, but they are prepared for anything that could happen. And so we help them with that. Got it.   02:43 Well, thank you both for being here to talk about this, because we are seeing more and more things in the news lately about ransomware and cyber attacks. And so oftentimes, we think of that as only happening to the big businesses, right? So why should small businesses, which a lot of listeners that listen to this podcast, are entrepreneurs or small business owners? Why should we have to worry about this?   03:10 So, you know, from a legal perspective, obviously, anybody who's ever come into contact with the legal system knows, it's not just for large businesses. So from a legal perspective, you're going to be subjected to liability from your people who whose information you're collecting, call them data subjects, you can, you're going to have contractual obligations with your vendors and third parties that you use and share data with. So put that and then just put that aside for a moment, then you also have small businesses have a reputation. And in the small business community, I am myself a small business, I'm a small law firm, Chief law firm. And you know, your reputation is everything. And so part of your reputation nowadays is how you're handling security and privacy. What are you doing the data. And so it's really important for small businesses to realize it's not just the big guys, we hear about them in the news, the colonial pipelines and the JPS foods and the Equifax is of the world. What you don't know is that every single day law firms like mine are getting a call from small businesses going help. We just clicked on a bad link, we just got ransomware, what do we do? And that happens all the time. It really you hear about the big guys, but it's the little guys that are really, you know, bearing the brunt of it, I think.   04:32 Now, I would agree. And what we all have in common between the small businesses and the large businesses is we're all human. And like Rebecca said, it's human error. Somebody clicked on an email, and they didn't know you know, they weren't trained. Hey, this is a spoofing and phishing email. This is what they look like, this is what you need to look for. And so that's where we come in, and it's we're all human and we all make mistakes. It's just no Like, you know, you this is what to look out for.   05:04 Got it. And so what are some of the issues facing businesses today, when it comes to cybersecurity?   05:12 What ransomware is obviously one of the biggest issues, right. And for your listeners who don't know what ransomware is, it is, what happens is somebody clicks on a bad link, download the bad, you know, attachment to a file, and the ransomware is downloaded to the system. Depending on how sophisticated the hackers are, they can either deploy it immediately, which means your system starts to, they start to encrypt your files, or it can be that they sit in there and wait for Oh, I don't know, the most inopportune moment that your business has. And then they deploy the ransomware. I've had clients where they deploy ransomware, or they first delete backups before they deploy the ransomware to really add insult to injury there. So but so that's one of the big things and then the your entire system gets encrypted and you can't unencrypted it without the encryption key which you then have to pay for the ransom part of it. And, you know, we hear about the big ransoms, again, the 4.4 million from colonial the 11 million from JBS. But you know, I was speaking with a colleague the other day, and a law firm got ransomware for $50,000. Now, that's a lot to a small business, it's a lot to any business, but they try to make it it's almost like it's commercials with what they think that they can afford and pay and so that they'll pay because they want you to pay the ransom. So that's I think, I think that's probably the   06:35 number one I would say so too. And then you now you're on their list, because you've paid your   06:41 SIR now. Wow, they paid   06:44 from now you're on a list of this hacker of like, Well, you know, was easy to get in before. Yeah. So let's see how we can get in again.   06:55 Right? Oh, my goodness. Hang in and you know Rebecca's right.   06:59 And that's where you know, also patching and monitoring your systems having a good strong it. posture is important. Because they see that stuff, they see little inklings of, Oh, well, something's going on here. somebody's trying to get in, you know, so they can see that. And you know, you're only as good as your last backup, and where is your backup being stored? And you know, is that in a secure location? Because if not, guess what? It doesn't matter. Because your information is gone.   07:33 Oh, my gosh, yeah, that makes so much more sense. Now, even just explaining what ransomware is. I didn't realize so they hold the encryption key ransom. And that's what you're paying for.   07:46 Correct you in order to get your data back, you have to pay to get the encryption key. And people think Well, okay, so I'll pay the ransom. And I'll get the encryption. I'll get the encryption key. And it's like, like magic? Yeah. You do, to some extent, although there used to be honor amongst thieves. It's not always the case anymore. No. But the other thing is to keep in mind encryption is not perfect. So you're not going to get it back exactly the way it was before. And a lot of laws have been changed now. So the fact that you were ransomware, it is in and of itself, a reportable event for a data breach. So that's another aspect to it. I mean, we're talking more about the technical aspects with the ransomware. But this is the other part where you know, I always say like, ransomware is like three explosions. The first one, oh, my God, my computer has exploded, but yeah, my computer's, what do I do? And then the second one, which is how are we going to, you know, get back up and running. And then the third is really the legal liability that flows from it and holding it together.   08:55 Also to I mean, Rebecca, are you finding that now, too, they're not only holding it, they're selling the data? Yeah. So they're still older data copied it, they're giving you back access to it, but now they're gonna sell it?   09:12 Yes. So what it comes down to is yes,   09:15 there's a lot to do. At that point to now you've got to tell your clients, hey, I've been   09:23 hacked. And that's where that whole reputation part comes in, you know, where you're, you know, these are people who are interesting information to you data. You know, I mean, as a law firm, we obviously hold our clients data. But you know, if you're a business, you could be holding personal information of your clients and business partners. You could be holding sensitive data on your employees or social security, financial information, information about their beneficiaries, which could be kids and things like that. So it really is a problem that just expands exponentially. It's a rabbit Well, I guess you're falling down that rabbit hole for a while.   10:04 You're like Alice in Wonderland.   10:07 Right? Oh, my gosh. Well, now you mentioned Rebecca about laws? And does that? Could you talk a little bit more about like certain data privacy laws and how that works? And if you're a small business, what does that mean?   10:24 Sure, so different. So there are two sets of laws that you need to really be businesses need to be concerned about, right. So one of them are your your data breach notification laws, which won't really be triggered unless and until there is a data breach, there are 50 states, there are 50 different laws, it's super fun for businesses who have to deal with us, then you have data privacy laws, and because nobody can seem to get their act together to come up with a federal law, we are stuck with, again, a patchwork of laws. So different states have passed different laws. And that is in and around a data subjects rights, about the data that's being collected about from them. So for example, California has a law, Virginia passed the law, Colorado passed a law recently, I know there's a proposed one in New Jersey in New York, Pennsylvania, Texas. So you name the state, and it's probably considering Washington State has tried to have made several passes into data privacy law. And what's interesting about this privacy laws is it they're usually, there's usually a threshold, sometimes small businesses will meet that threshold, but you need to understand that and it's all about the data that you're collecting. So the data you're collecting is going to trigger or not trigger requirements under some of these laws. That same data is the attractive nuisance, if you will, to the hacker they want to, they want to so you know, I always say you can't have privacy without security. So they really do go hand in glove.   12:00 What would be like an app if you know this at the top of your head, but an example of data privacy law from one of those states that has them on the books like what would be an example.   12:13 So California has the California consumer Privacy Act, the ccpa, which was amended in November, when the good citizens of California had a ballot initiative to pass the California Privacy Rights Act or the cpra. And those types of so in and around that you have different rights, the right to deletion, the right to correction, or right to a ratio of three, you know, the right to be forgotten is what's commonly known as, or just some of the rights that you're entitled to. And so businesses that fall under the within the purview of the ccpa, which is in effect right now, the cpra, which will go into effect in 2023. And so if you are a data subject, and the business is is under those laws, you can, you know, say to the pay, I want to know what you're doing with my data, hey, I need you to correct or delete my data. And the business has a set statutory period of time to respond to that data subject Access Request. It's about transparency. So anybody who saw all those updated privacy policies online, that's all driven by privacy laws, there's one in Europe called the GDPR, the general data protection regulation. And it really is in and around transparency, and data collection, storage and sharing practices. So that's, I could go much deeper, but I don't want to put anyone to sleep as I talk about loss.   13:42 I think I think that's really helpful just so that people get an idea of like, well, I don't even know what that is, you know, and if you're a small business owner, you've got a million other things on your plate, because you probably don't have a dedicated IT department, you don't have a dedicated cybersecurity department, oftentimes, you're a solopreneur. Or maybe you have less than 10 employees, you know, so all of a sudden, all of this stuff has to come on to somebody. So I think just getting an awareness out there that it exists, is really important so that you can maybe look it up in your own individual state.   14:20 Yeah, and one thing I would say and I know that this is a problem amongst entrepreneurs and startup is within the startup community is that they think well, we can do this ourselves. We can like cut and paste the privacy policy online and somebody Shelley's laughing at me over here. But you know, the purpose of these laws is to provide information about what that business is doing with data. So if you're borrowing it from somebody else, you could be in trouble twice because you're now you're not accurately reflecting what your laws are, what you're doing with the data. And you've basically taken this information and maybe obligating yourself under other laws of regular So for people who are listening, I know nobody likes talking to lawyers. I swear we're not that bad. But hiring a dedicated privacy or security attorney who understands this is really important because you told what to, you know, have an Ono moment on top of it. Oh, no moment when you're you know,   15:19 exactly. You definitely were Rebecca Sade is absolutely correct. There are people that do that they try to manipulate it and do it themselves. What they don't realize is once you're hacked, it's not just, Oh, no, they've got my information. Now I have to pay this ransomware. But guess what, oh, if you weren't following those privacy acts, you're also gonna get fined on that data, too. So you definitely don't want to be fudging any kind of information. You definitely want transparency.   15:47 Yeah. So hire lawyer. I'm a big fan of lawyers. I hire lawyers for for everything, because I don't I'm not a lawyer. I don't know how to do any of it. And I want to make sure that I am protected. So I 100% get it. Now, what? So we're talking about the pitfalls of what could happen if you have a breach, or issues facing businesses. So what can businesses do to help with cyber security? What are some things we can have in place to give us some protection and peace of mind?   16:20 Well, I would like to answer that this is Shelley, I'm someone who's there for simple and very effective basics that you could do as a business owner. And they're very cost effective. In fact, you know, you already have some of them in hand, as far as like Microsoft Office 365, all you have to do is enable your multiple factor authentication, that's a huge one, it's like leaving your light on in your house, if you're going out to dinner, they're gonna move on to the next house, because you have that layer of protection. And then, you know, security awareness training, educating your employees, educating yourself a lot of spoofing and phishing email looks like, that's huge that you know, it, it makes them aware. And that also, you know, it shows your employees that you're protecting them, you're protecting your clients, you know, it shows stability. And then also, you know, monitoring and patching your systems, you know, making sure that someone has an eye on what's going on. I'm looking for those little ticks that someone may be trying to get into your system, because a lot of people that you can have websites, you can tell by is your website going slower, that's usually a sign that someone might be trying to hack into your system. You know, so it's little things like that. And then also, you know, software and hardware encryption, that's a huge one. A lot of people, I know we have all our devices, it's our fingerprint or face that opens it. But if your hardware is not encrypted, they could just steal your laptop, pull out the hard drive, plug it in somewhere else, and guess what the data is theirs. And it's just the simple things that can help a business.   18:10 Yeah, so So to recap, the multiple factor identification that I get, and I do security awareness training, what what are these emails look like? What not to click on? monitoring and patching systems? So when you say patching systems, what exactly does that mean?   18:27 Well, that's where someone is patching in and they're, you know, they're making sure that your system is secure. And it's going somewhere in that secure like firewall, everything like that. So that is exactly   18:39 the basic there. There are systems like so for example, the Equifax data breach was a vulnerability in an Apache struts operating system. And when they found this vulnerability, it was it was a problem. People write code, people make mistakes, you need to fix it. Once they discovered the problem. They went, they were like, Oh, you need to apply this patch. It basically fixes the code. Well, if you don't apply the patch, if you don't have somebody who can help you do that you're not you're leaving your back door   19:11 open or even Yeah, or even like software, like it needs to be updated. So they're patching and updating, they're constantly monitoring, updating any software so like have you ever had where your phone doesn't work and because you haven't upgraded your system? Well that's kind of like it is for monitoring and patching. They make sure that everything is up to date everything is to code   19:34 right because if you're not patching and updating like Shelly said, you can actually leave a hole Yeah, and you're not the it's a lot easier for them to get in because you would not that system isn't being supported anymore by the Microsoft's or the Googles because they've moved on. You got to move on with them. Otherwise, you're you're gonna have a problem.   19:52 Got it. Got it. Okay, that makes a lot more sense.   19:55 They could do that themselves. Like oh, I can do this. I can do this. But as they're growing Their business, they don't have time to focus on that. And that's how little cracks happen.   20:04 Got it? Okay, that makes a lot of sense. And number four was making sure that your software and your hardware was encrypted. Right? And does that. I mean, this might be a stupid question. But does it come that way?   20:19 No, that's not a stupid question. I mean, a lot of us think that because, you know, I mean, we're on a computer right now that if I shut it and locked it, I opened it again, I could put my finger on it, it would open it, I wouldn't have to type my password in. But if my hard drive wasn't encrypted, didn't have that same protection on it, where someone could steal it, and then just pull out the hard drive, because these people are very talented, plug in the hard drive. So you need to make sure that your hard drive has that same protection with your fingerprint of code that, you know that if they would have to, they wouldn't plug it in somewhere else, they're gonna have to know that code, because it's not going to work.   21:06 Keep in mind, too, that encryption, like we're always talking about is, in most jurisdictions, if you have an encrypted hard drive, if even if they get it, they can't access it. It's not a data breach. So I like to say encryption is your get out of jail free card in most jurisdictions, okay. There are 50 of them. There's a lot, but in most of them, that's your get out of jail free card. So it's one of the biggest, that multifactor I guess, are probably two of the biggest bang for your buck. There they are. And how do you   21:37 know if your software and hardware is in is encrypted? Again, perhaps another silly question, but I just don't know.   21:43 So first of all, I don't encrypt my own hard drive. I know a lot about technology. But I, you know, I don't go to my dentist for brain surgery. professionals, who are IT professionals, like Shelley's company, and I say, here, encrypt my hard drive, and they take care of it for you. So having it's really important   22:06 night. Yeah, I can. And does that literally mean you hand your computer over to someone and say, encrypt my hard drive? Not necessarily No, no, okay.   22:16 No, no, no, a lot of times what you know, like our text can do, they can come in, they can work in remotely in and you know, just like when they have when we monitor and patch, they do it remotely. You know, if you don't even know what's going on. It's just and it shouldn't, it shouldn't interrupt your day, it should then to wreck your workflow. It should be seamless. And usually, you know, it's something that, you know, our techs are very, you know, highly educated, I love text, I always think, Oh, my gosh, what they do is so cool, because they can just, they can fix everything, and they just go in and they're they're magicians.   22:56 Got it? Got it. Okay, how it should be you.   22:59 I mean, a lot of times, and this is true, too. I think Rebecca, a lot of rules now are making sure that you actually have a credible IT team. Because if you don't, you can now get fined. Or   23:14 Yeah, there are different laws where you can if you're not doing the things you're supposed to be doing, if you're not monitoring if you don't have your asset, you know, management, those kinds of things. I mean, one of the classic examples of that is is HIPAA. Now they don't say you have to have it on teaching but they do say you have to encrypt your heart you know, encryption, or they say you show it or they say you have to monitor monitor your devices and let's face facts, do you want to be I don't want to be monitoring my devices, I want my IT guys or gals to be monitoring my devices, I want to be practicing law. So that's the beauty of it is that it's it's Charlie says it's running seamlessly in the background, and you're doing what you should be doing much with running   23:55 your business. Got it? All right. Now let's move on to so let's say you have all of this in place. You've done your basics for cybersecurity. Do you have to have cyber security insurance? Or can you just say, Well, I did all this. So what do I need the insurance for? No,   24:15 that's like driving around without your seatbelt on. Like, you know, I, I frequently wanted to ram the car in front of me, but I don't I don't do that. So cyber insurance. When I will tell you this as when I started my own law firm. The first thing I bought was malpractice insurance. The second thing I bought was cyber liability, a separate standalone cyber liability policy. They are getting more expensive, but for a small business depending on the data you're collecting, they can be very reasonable. But I sleep at night because I know that if something goes horribly wrong, it's there. All of the things you're doing. me that all The good cyber practices that Shelly and I have been talking about that just means they're going to cover you when the when the stuff hits the fan. Because if you're not doing all of that, you've probably told they've sent you a questionnaire with your cyber liability policy and you filled it out and you're like, Oh, do I have multi factor authentication? Oh sure. I encrypt my hard drive. If you lie to them, they don't cover you. But if you're doing all these good cyber practices, and you have insurance, it's you know that every single one of my clients first thing I ask, Where is your data? What is it doing? Where is your cyber liability policy? Those are the   25:35 those are the big three Yeah. Okay. To help you too, because how are you going to get that money out? Right, how do you get that money back? How do you recoup your business? I mean $50,000 is a lot Oh yeah. And you know, you're a small business and yeah, you you could take a hit you can take a loan but wouldn't it be better if somebody covered it for you it's kind of like you You get a car accident you know, it was like that rental car where your car is getting fixed. You would like to get a new car that new car smell   26:11 Yeah, cyber liability insurance is absolutely critical for small business every this statistic might be a little bit old, but I will pull it out anyway for just as an example 60% of small businesses will go out of business within six months of a data breach without live liability insurance. So that's an I know that statistic has gone up it's a it's a little stale, but I think that's about a year old and every year they put out new stats I just haven't brushed up on my statistics today. But   26:41 well that is true because as many business owners as I talked to in everything, you would not believe how many of them I've had friends that had successful businesses and everything was going great. They got hacked, and they just couldn't recoup the money that they need it breaks my heart because they never thought it would happen to them because they weren't trading money they weren't doing anything like that. It was just common goods like e commerce that they were just like, yeah, and then something happened.   27:09 I mean, I get a call at least once a week from a crime business person literally tears I don't know what am I going to do? I have a little bit of a policy or something. It's like a rider on my my general liability policy, but now it's going out because it runs out like that and so quick, and they're like now what do I do? I don't I don't have an answer for them. They're gonna have to you know, they have to pay for it out of pocket. A lot of them can't It is really heartbreaking.   27:37 Yeah. Oh my goodness. Well, so you know, we talked about some issues facing businesses today. basics for cybersecurity, the need for cybersecurity liability, which I am in the process of getting after speaking with Celli a couple of weeks ago, so I'm there I'm doing it I'm in. You don't have to I You don't have to tell me twice when it comes to important insurances, I will get it. So is there anything else that you guys wanted to let the listeners know when it comes to cybersecurity for their businesses?   28:14 Um, I think the first thing that businesses need to do is take a proactive posture. So doing the technical things that Shelley's talking about, shoring up some of their legal obligations, like I'm talking about with, you know, appropriate privacy policies, contract language and things like that. The other thing is, they have to also be aware of their vendors, which I think is another big issue facing organizations if you look at data breaches, it's not caused by an employee in the company it's caused by an employee at one of their vendors. And so you know, it's a big issue and so I would say that for all small businesses, all of the technical aspects and then make sure your your legal, you put yourself in a legally defensible position because unfortunately, these things are going to happen. And you want to make sure that you not just survive but thrive after after an event like this.   29:09 Yeah, and I agree with Rebecca, those are the key things that you need to do as a business owner, but it's also helping yourself to educate been growing your business and I know at times it can be scary because like, Oh my goodness, I got to talk to a lawyer. That's more money. Oh, I gotta have someone you know, outsource it person. When I've had my cousin, he knows computers, he knows everything. You know, everything's going but if you're looking to move your business to that next level, and you're looking to flourish, you really just like anything else, you need to make sure you understand and you are doing what is required of you to do to help your business flourish.   29:53 Got it. Well, this was great. I mean, hopefully people listening to this, it will set a match under them. To get them to really take a look at this in their business because like you said when you're a small business owner you've got a million things going on. But this is super important and I think something that people really need to focus on so I thank you for bringing this topic to me Shelly and for bringing Rebecca on because I think this is really great and I do hope that all the listeners out there will now start to take a better look at their businesses and are they protected Do they have the right things in place so thank you thank you now where can people find you? if they have questions? If God forbid they have a breach and they need a lawyer or they need someone to help do an IT assessment of their business so where can people find you? So   30:47 I obviously have a website expand law partners com Also you can follow us on Twitter and on LinkedIn please connect you can connect connect with me personally and my business we put out for small businesses out there who have a lot of questions we are constantly pushing out different topics raising issues bringing attention to different ones so please act x Pam law partners connect with us and hopefully will will provide you with some of that information that Shelley was talking about   31:23 excellent Shelly Go ahead.   31:24 You can reach me at contango it calm is our website I can also link in with me you know I love to meet new people and I always like to offer any kind of advice or second opinions I can help with if I if there's anyone I can point you into the direction to you know help your business I would love to do that.   31:46 Excellent. Shelley is a great super connector for sure. So definitely reach out to them now ladies one last question and I asked everyone this is knowing where you are now in your life in your career. What advice would you give to your younger self?   32:01 see somebody asked me this I'm gonna have to steal from my prior answer was start my law firm earlier. I wish I had done it earlier. I cherish the time I spent at a large law firm but I love what I do now. I love helping businesses so this I would do it earlier. So amazing. I would become an ethical hacker. Love that. I want to change my answer. That's a great answer. I love it.   32:35 I love it. Well, ladies, thank you so much for coming on the podcast sharing all this vitally important information. I do appreciate it. Thank you so much for having us. Pleasure and everyone. Thank you for listening. Reach out to these ladies if you are a small business because you may need some cyber help. Thank you for listening, have a great couple of days and stay healthy, wealthy and smart.

In this episode, Physical Therapist and Educator, F Scot Feil, talks about understanding and eliminating student loan debt. Today, F Scot talks about the different kinds of student loans, his different revenue streams, and the value of having a diverse set of skills. How does the debt-to-income ratio affect student loans? Hear about eliminating student loans, managing multiple revenue streams, and get F Scot’s most important piece of advice for students with debt, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “The debt-to-income ratio is the amount of student loan debt you have over your current income.” “The best way to learn about this stuff, and what’s right for you, is to talk to a certified financial planner that knows about student loans.” “The biggest thing to try to do, if possible, is not to privatise your loans. Try to keep as many of your loans federal as possible.” “You make your own luck. You have to work hard, and you have to network and leverage with the right people at the right times about the right things, and then you’ll start to see those opportunities open up.” “The one key takeaway that I’ve had with all these revenue streams is you’ve got to do one at a time, and you’ve got to get it flowing, and then you can step on to the next stream of revenue.” “The money is nice, but the time-freedom is really what you’re looking for.” “You don’t have to work as hard, you can scale back, charge what you’re worth, and make a lot more money in a lot less time.” “Your career just has to be the tip of your iceberg.” “There’s a whole lot more out there than just going to an outpatient clinic every day and seeing your patients.” “Don’t worry as much. Just leverage the heck out of your career and your degrees. Use them to do what you want to do and what you enjoy doing.”   More about F. Scot Feil Dr F Scott Feil is a husband, a father, a physical therapist, a professor, and, most recently, an amazon best-selling author. F Scott is also a business coach and mentor, despite starting his journey as an English major before landing as a Physical Therapist. He is one of three co-hosts of the Healthcare Education Transformation Podcast, which aims at breaking down the silos between healthcare professions and trying to find best practices in teaching and learning throughout healthcare academia. His goal is to help at least 222 professors (one from every PT School at the time of publication of his book) and clinicians pay off their student loans quicker by using multiple revenue streams. If he helps some others with terminal degrees, or other healthcare clinicians, along the way, then it’s a bonus!   Suggested Keywords Student Loans, Student Debt, Financial Planning, Education, Skills, Income, Revenue, Profit, Opportunities, Physiotherapy, Healthy, Wealthy, Smart   Resources: FREE PT Educator’s Revenue Idea Generator Professors Of Profit Facebook Group PT Educator's Student Debt Eliminator: Multiple Streams of Revenue for Healthcare Clinicians and Academicians   To learn more, follow F. Scot at: Website:          https://pteducator.com Podcast:          Healthcare Education Transformation Podcast Facebook:       PT Educator Twitter:            @FScottFeil_DPT Instagram:       @PTEducator LinkedIn:         F Scott Feil YouTube:        PT Educator   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the full Transcript Here:  00:02 Hey, Scott, welcome to the podcast. I'm happy to have you on. It's great to see you and to speak with you.   00:09 Yeah, Karen, thank you so much for having me. I'm a longtime listener, first time caller here. So this is exciting. I've been waiting to do this for quite some time now.   00:17 Yeah. And I'm happy to have you on. And today we're talking about a topic that is near and dear to many, many physical therapists. And that is we're talking about student loan debt, and not only talking about it, but how to maybe understand it a little bit better, and how to eliminate it. So let's start with some definitions. And what is the debt to income ratio? And how does that affect your student loans.   00:50 So, you know, I'm not a student loan expert, by any means. I'm more of an elimination expert. That's that's where, you know, my specialty comes in. So I've had to learn this stuff, too. And, you know, one of the best ways that I've gone about doing this is going to certified financial planners, especially once you understand student loans, and talking through, you know, where I'm at what what plan looks like, it's going to work for me, what are my plans in the future? What is, you know, my vision look like? You know, do I want to start a family, buy a house, buy a car, all those things kind of factor in to your big plan. And then from there, you've got to come up with a foundational blueprint or a roadmap that you're going to follow based on what your student loans are. So the debt to income ratio is very simple, you know, it's the amount of student loan debt that you have, right? over your current income, and you just, you know, do the math and divide, right? So, realistically, the highest that you would want your debt to income ratio to be is approximately 1.01. To one, right. So if you had $100,000 worth of student loan debt, you're making $100,000 salary. That's not a terrible debt to income ratio, right? Unfortunately, especially in the field of physical therapy, we're finding that students are graduating with 150 175 200,000 plus worth of student loans, and they're coming out and they're getting jobs at 65 75,000 a year. And those are some pretty risky debt to income ratios, right? those, those get a little heavy, because, you know, if you don't know anything about it, and you you have all this debt, and you've accrued this debt, that's just massive, your payments are going to be massive, right, your student loan payments, if you just do the standard repayment, mine started out at 1700 a month, right. And I only had 140,000, when I graduated, that was with two doctoral degrees. So you know, it was one of those things where I got a little nervous at one point, because I didn't even know that I wanted to use the doctoral degrees, the way they were kind of meant to be used. But then I kind of settled down talk to a couple people both both on the business side of things, and on the Certified Financial Planner side of things, and created that roadmap, I went from the generic, you know, repayment plan at 1700 a month down to the income driven repayment plan, which for me, looked like about 700 a month. And then again, after really doing a deeper dive with the Certified Financial Planner, where I was at in my life and how I was planning on attacking my student loans, we've finally got it down on the repay plan or the revised Pay As You earn plan. And that's about $135 a month. And that stretches it out over 20 years now. So the difference that I'm making between the, you know, 135 a month and the 700, I was paying, I can now take that and have more liquid assets to do something with right I can have more cash in hand to invest or to start a new project or, you know, to make payments on other stuff, you know, so it's taken me some time to kind of learn this stuff. And again, like I said, I'm by no means a student loan expert, but I am learning through the bumps and the bruises and going through it and being in the thick of things there. And realistically, like I said, the best way to learn about this stuff and what's right for you, because it's going to be different for everybody is to talk to a certified financial planner that knows about student loans. So that would be my first recommendation.   04:15 Yeah, and that is great advice. Great advice. I've been working with a certified financial planner myself. And it really, it's really great to have an outside view of your finances and everything that surrounds them by a professional who can go in and not be emotional about it, and not have biases built in because we all have emotions around our money and around our debt and our loans. And so it's great to have that outside perspective. Yeah, you   04:45 hit the nail on the head there, you know, especially when it comes to business and money. We tend to be very emotional beings and you really have to be objective when it comes to that. And that was that was you know, a big takeaway that I found when when starting up businesses and you know, figuring things out. I've had a bunch of deals in the last couple months kind of crumble and fall through and it's like, Man, that's a bummer. But at the end of the day, you realize it's just business like, it's not a big deal. Not personal, that, you know, can't get emotional beat up over, you just got to move on it's business, you know?   05:15 Absolutely. It's it. But I mean, it does suck.   05:20 It does. It does. And it's okay to kind of recognize that, you know, you know, exactly, but at the end of the day, okay, it's business. What's my next step? How do I pivot? How do I recover? What comes next? You know, I think that's really what entrepreneurs are doing these days is trying to figure it out, you know, just keep rolling with the punches until they, they get it right. Yeah,   05:38 absolutely. And now, you spoke a little bit about those different kinds of student loans. And so I'm assuming there are different approaches one can take, can you speak to that?   05:50 Yeah. So you know, again, like I said, I'm not exactly a student loan expert, there's several different kinds of student loans out there, the biggest thing to try to do, if possible, is not to privatized your loans, right, try to keep as many of your loans federal as possible, because the federal plans are the ones that work with you a little bit more, there's a little bit more give to them, right? You can restructure them a little bit. Like I said, I went from just basic repayment plan to income driven repayment plan, which is based on, you know, the amount of income that I would make as a new grad, down into the revised Pay As You earn plan, which, like I said, that one kind of starts you at a lower bracket. And year over year, as you make a little bit more, it creeps up a little bit, you know, but it also, again, it stretches it out over a longer period of time. So you know, they're their differences are time dependence, you know, how quick you have to pay him back. But you know, things happen, like COVID, right, and all of a sudden, the Federal plans have all kind of stopped, they put a, you know, a pause on them until the new year. So, you know, that's one of the ways that they can give you grace, you can go into a deferment plan, if you need a month or two, you know, though, they'll work it out with you, and they'll tack it on to the end or whatever, you know, there's just a lot of forgiveness. And then at the end, there's a big forgiveness. But with federal loans, you just have a lot more grace, right? Once you privatized the loans, you're stuck, that's it, they are what they are, and you've got to pay him back, there's, there's no getting rid of them, right. Because, you know, student loans are loans that we just, we can't go bankrupt on we can't, you know, get out of there just gonna be there forever until you pay them off. So, you know, it's super important to recognize the difference between a private loan and you know, a federal loan. So big takeaway there is try to keep as many of your loans federal as possible for as long as possible, because those will have the most options for payoff and forgiveness and forgetting, you know, you know, any sort of programs that are available that may come and go, right, there's the one program where if you work for a nonprofit for 10 years, right, X amount is forgiven. Now, there's been kickback on that saying that, like 99% of people don't get approved for it at the end, they cross the finish line, then all of a sudden, the finish lines moved, right. So you know, there's some fine, fine print, you've got to read there with all these. But you know, at the end of the day, most of the federal loans will give you a certain time period. And as long as you make your payments all along that time period, at the very end, there will be some form of forgiveness. Now, the only caveat with that is the way you're forgiving those loans is you get taxed on the amount of forgiveness as if you made that income that year. So, you know, for me, it'll probably be a 20 year repayment plan, at the end of those 20 years, I'll have $100,000 left, it'll be forgiven. And then it'll be like I made that extra 100,000 on my salary that year, so I get taxed on it. So in those 20 years, I have to come up with some sort of plan to save up and to make money to repay that one year, when I have that influx in salary, even though it wasn't there. It was a loan forgiveness. So just something to think about there, too, when you're planning out your loans and your repayment plan.   09:04 Yeah, yeah, I don't think people realize that you have to pay taxes on that loan that is left. So each year, you want to make sure that you're putting money aside and putting money aside so that you're in an account that maybe you can't touch so that when it comes you're not like, Oh my gosh, where am I gonna get this money from, but you're like, Oh, I know exactly where I'm gonna get it from. Because I have this account of money I haven't touched for 20 years, you can pull it out from there. And that can be like, it doesn't have to be a savings account at the bank. Exactly. That could be an account that is actually generating, maybe, you know, 4% or something like that, right? So you're making money on it, especially if your loan is only like 2.3%. So you could take that money that you would be paying toward that loan, put it into an account that's maybe making even if you're making 4% You're still making money on on that money in there so that when the time comes to pull it out to pay your taxes, is number one, you're not penalized. So it's not like you're putting into a 401k plan or an IRA or something like that, but just putting it into some sort of an account that can make you some money on the way.   10:12 Exactly. And that's where a certified financial planner comes in, because they can set you up with a savings plan over those 20 years that can get 810 12%. So you're actually saving a ton more money, and you're paying way less when it comes to it. And the you know, the rate the APR is, is even lower. So I don't, I don't want to throw out a bunch of like, you know, terms and, you know, definitions and stuff that are just kind of boring and not very sexy, to be honest with you. But we do have to kind of know a little bit about this stuff. You don't have to be an expert. Again, I'm not. But I know enough. Now I'm educated enough, because I took the time to talk to that certified financial planner and figure this out and sit there, it only took maybe an hour or two, to sit there with them and go through the plan and look at it and say, Alright, here's where I am. Here's my goals and plans. Which program is best for me. Okay, great. Let's get on that program. And then you know what, now let's figure out how we're going to pay it out. You know, and there's several different ways to do that, too. Right? You just have to come up with that number at the end of those 20 years. So how do you want to do that? And, you know, that's where my expertise kind of comes in? Is the elimination part of it? Yeah.   11:17 Yep. So let's talk about that. Let's talk about how do you eliminate that debt. And I know one thing that you speak about is having multiple income streams, I'm sure that's part of this conversation, but I'll throw the mic over to you. So you can talk about the elimination part. What does that mean? Yeah, so   11:33 originally, when I wrote my book, right, peak educator, student debt eliminator, I thought I could just start a side business or to write and make a bunch of money, and then throw all that money that I made toward the student loans and pay them off in a year or two and be done. That was my plan. And realistically, I probably could have done that, I probably could have knocked them out in about three to five years total, and been done. But that's kind of what the banks want you to do. Right? That's what these loans, processors wants you to do. They want you to pay all your loan off as quick as possible. So they get all the money and make all the interest, right? Well, after talking to the Certified Financial Planner, I said, Okay, well, if my loans are gonna go down from you know, 700 a month and 135 a month, that leaves me a good extra chunk of money that I can do stuff with, right? And he's like, Yeah, absolutely. He's like, in truth be told, as long as you're putting your a lot of money every month into your savings plan, or whatever, you know, investment plan, if you will, to pay off that 20th year, you can do anything with the money, right? So I figured, okay, well, could I invest it in stocks? And he's like, yeah, you could do that. I said, What about crypto? And he said, you could do that? What about real estate? Can I do that? Yeah, absolutely. So that's been kind of my plan is like, Okay, let me start a couple of side businesses that generate income and revenue for now. So that I can put it toward investments that don't kind of take me on the long term. Right. And I think realistically, you know, I think almost every millionaire has several different streams of revenue, right. And I think that we need to start thinking about that, as soon as we either enter grad school, or immediately after we finish grad school, you know, what is our plan for long term wealth? Right? How are we going to take care of ourselves, as well as our family, you know, that might not even exist yet. As well, as, you know, future generations, you know, we're talking generational wealth here. And it's not like, you've got to be a millionaire, right? But you know, a couple of six figure incomes, that can help a lot of people, right? I mean, you can take care of a family, or two or three down the line, even, you know, making several six figures over the course of many, many years, you know, and then if you invest it, right, you can put it in places, like we talked about, like rental properties, or something like that, where, you know, once those pay off, the mortgages are done on those in 15 or 20 years? Well, now you're going from making two or $300 a month in rent, up to, you know, 18 or 2000 a month, per per house, right? And that's where you get into that generational wealth. So, you know, for me, it started out as a simple mobile PT practice, right? I was by myself in a car with a table and some sheets and a bag with some equipment in it. And I was just driving around, you know, Waco, Texas, just kind of helping people in their homes or their offices or the gyms. Because I knew I could do that. I knew I could start that business, right? I had enough expertise in the physical therapy world to be able to run a small practice on my own. And I didn't really want to be tied down to the brick and mortar. I didn't want to have a high overhead. I didn't want to do any of that, you know, so I just started my own little business. And it started out with a crossfitter, too, you know, and that was not my demographic. It was just people in the community that I knew that asked if I can help, and so I did. And then Luckily, one of the women that I worked with, her husband had some shoulder and elbow issues and he was a big tennis player. So she said, You treat the arm in the elbow and choice it. Yeah, absolutely, I can do that. So once I started talking with him, he's a CEO of a small business in Waco there. We got him better, we got him back in the tennis court, he was feeling great. And so then he started referring me to all his other CEO buddies, and the CEO buddies and C suite level execs, right, and all these busy businessmen and business women. And it was great because I was I was selling them time, right, it wasn't so much about the physical therapy, or whatever it was, it was, I was buying them back time because I could come to their home or their office or their gym, and they love that. So it was just the right niche for me in the right, you know, they had expendable income, most of them because they were, you know, own their own business. So it was a really good group to get into, and a really good niche to break into. And, you know, word of mouth spread. And that kind of took off? Well, once that kind of happened, I really started having to figure out how to like market myself better, and how to do some, like digital marketing, you know, Facebook ads, Google ads, stuff like that. And I just didn't know that I didn't have that skill set, you know. And so I had to take a course in that and learn from it and kind of invest in myself. But once I did get better at that, you know, I even took a copywriting course and read a bunch of copywriting books as well. And once I started getting better at that a bunch of my buddies that I graduated PT school with saw what I was doing with Facebook ads, and they said, Hey, could you do that for our business? And I was like, yeah, I'm sure I could probably figure it out. They said, We'll pay you and I was like, Okay, great. That sounds awesome. You know, and that's where my agency kind of started, right. But one of the second pillars of revenue for me. You know, I kind of started a little bit of a digital marketing agency unintentionally. And so I did that for you know, that a year or so. And that even brought me outside of the field of physical therapy as well. I did it for a couple local businesses, some home renovations, some roofers, pool builders, stuff like that. And it was really working pretty well.   16:58 And then, you know, COVID, started hitting and things kind of got a little crazy. And I was still working full time in the clinic, too. And so with my wife being a type one diabetic, and already being immunocompromised, I had to kind of step back from that a little. And I stepped away from the clinical side of things. And that same week, the head of the program at university, St. Augustine emailed me and said, Hey, are you still interested in teaching because I spoken to him at the ETD graduation in 2018. And, you know, I said I wasn't, but now it's actually looking like a pretty good option. So I stepped out of clinical work, I headed into academia. And while I was doing that, you know, it really became a good fit for me, because, you know, I talked online most of the time, and then I had to go up and be there for labs. But it also gave me a lot of free time to work on my side hustles, and my side businesses, you know, and that's kind of how I fell into the consulting gig as well, like, that wasn't something I ever thought I'd be doing either. But I worked for workman's comp company as well up there in Waco. And I said, Hey, we should be educating these businesses to injury prevention and wellness and how to properly lift and ergonomics and all that. They said, Oh, no, we're not going to do that, you know, that's gonna eat into our PT numbers. And I said, No, it won't. Because I can't stop somebody from running over someone's foot with a forklift, it's gonna happen, accidents are gonna happen, you know? And they said, Well, no, we're not going to do that. So I said, Alright, fine. I'll do it myself, you know. And so I just went around to all the companies locally there that were sending us workman's comp people. And I said, Hey, would you like to lower your workman's comp numbers? And they were like, Yeah, sure. And so I go in, and I educate the workforce. And, you know, you can charge good money for consulting. I mean, I was able to charge you know, 1000 bucks to 1500 bucks an hour for two hours worth of work. So now it becomes a matter of, Okay, do I want to see patients at $200 an hour, which is a pretty fair rate for physical therapy, right? Cash pay at a network? Or do I want to work two hours and just, you know, educate these people and use my add my education background combined with my PT background, to kind of help them with injury prevention and wellness. Right. So again, it just kind of one of those things that fell into my lap, that wasn't ever something I thought I would do it just the opportunities were there. And I just kind of sees, you know, it was like, seeing like these opportunities out there and just realizing that holy cow, this is where I knew I was fine. Having a PT, you know, DPT and an add, not necessarily wanting to use them even though now I am, you know, more traditionally. But being able to leverage those degrees into other opportunities. You know, I'm not a huge believer in luck, I kind of feel like you make your own luck, you have to work hard and you have to network and leverage, you know, with the right people at the right times about the right things. And then you'll start seeing those opportunities, you know, kind of open up and you have to be ready to jump on those opportunities when they present themselves. So, you know, that's, that's kind of where a lot of these streams of revenue started from. It just kind of happened, you know, and I fell into them and I got better and better and better at it. I went, and then I was able to help more people with them as well.   20:04 Yeah, it sounds like you've gone from one to the next to the next to the next, which is, which is good. You're sort of keeping yourself open and you're learning and, and understanding like, Hey, I don't know how to do this. So I'm going to educate myself and learn a little bit more, and be able to do things that may not be at face value, what you went to, quote unquote, school for, but yet they are.   20:32 Yeah, I mean, we learn so many amazing skill sets throughout grad school, you know, whether it be the DPT program, or the ed d program, systems, right processes, standard operating procedures, things like that, like clinical development, and, you know, clinical thinking skills, critical thinking skills, all these things that we learn, are a lot higher level than a lot of the general public already know and deal with. So we can help by kind of bringing those things down and simplifying them, just like we would talk to a patient, right, if you're using layman's terms, you know, and I think the key here is to realize that we have a lot of these skills already, you can keep one foot in the healthcare boat already. Or you can diverged and go a different route. And you know, some of these skill sets, you're gonna have to learn because not everybody's, you know, born a natural with a lot of these skill sets. And that's okay, I've done that. But it's a good combination of taking as much as you already know, and pushing in on that. And then adding and supplementing a little bit here and there, when you find that you need it. You know, and that's where I think taking courses and paying for mentors, and doing all that stuff speeds up your timeline a little bit. You know, and that's why I'm a big believer in that I've had many coaches, many mentors over the last couple years, and they've totally sped up my timeline and showed me mistakes that they made and made sure I didn't make the right, you're still gonna make your own mistakes, there are a lot of them are going to be different than what your mentors went through, right? That's totally normal. But it's, it's realizing that they're not failures, they're just learning opportunities, you know, and I think we as pts are really good at being lifelong learners. And so it really shouldn't be a problem to dive into a skill set you're not familiar with, and just, you know, put your ego aside and being like, Alright, I don't know this, I need to learn it, here's a good resource, here we go, you know, just keep kind of attacking it until you get it right. You know, and I think at the end of the day, these multiple revenue streams now that are kind of growing are great, I love them, I'm very passionate and energized about them. They're definitely like passion projects for me, you know, and zones of genius for me, but it's a good way for me to get an outlet of creativity, I think, because I was an English major before I was a PT, right. So, you know, that to me was was a big transition in itself. But that's also helped me monetize blogs, monetize my book, right? monetize, SEO, and email sequences and copywriting. So, you know, again, all those things kind of fall into that consulting, revenue stream. But, you know, I had to learn how to adapt that English major into copywriting or into email marketing, or whatever it may be, you know, and I think the one key takeaway that I've had with all these revenue streams, is you've got to do one at a time, and you've got to get it flowing. And then you can step on to the next stream of revenue, then get that up and running, then get that flowing. And then step onto the next one. And again, you know, if you don't do that, you're going to fall for that shiny object syndrome, right, and you're going to be kind of chasing around, Ooh, that looks cool, that looks cool. I could do that, oh, I could do that, oh, that person's doing that, Oh, that looks really good. They all work. And you can do all of them, for sure. But you've got to get one down first, and then move on to the next and there's going to be you know, arguments and debates over what number is the right number to walk away from the first one and go on to the second one. I don't think it matters, I really don't just get it up and running, make sure it's making you some money, make sure it's profitable. And then when you're ready to step on to the next project, you're still gonna go back to the first one, you know, you're still who knows, you may even hire somebody to take over that portion for you. You know, but just knowing that there's multiple opportunities out there for physical therapists for healthcare providers, I think it's a great stepping stone for you to kind of open your mind a little and get out of that nine to five clock in clock out clinician mindset, you know,   24:15 and where are you now with? How many streams of revenue Do you have at the moment? And if you could put it in a pie chart, what is what makes up what? Because I think people would really be curious as Jeff, you mentioned a whole bunch. So where are you now? And what does it look like?   24:32 So I essentially what I teach, you know, all my students, I have what's called the feelgood method, right? Which is not just a clever play on my last name. It's also you know, how I make my students feel good about staying organized with their streams of revenue, right. So there's an umbrella on top and that's your holding company, right? For me, it's feelgood industries. pllc. Texas recommends if you have a professional license that you get a pllc it's different for every state. But, you know, doctors, lawyers, dentists, they all have pllc Alright, so since I started as a mobile clinic, I started as a pllc. then underneath that I had about four or five different revenue streams or tubes of revenue, that each of those was a DBA, or doing business as underneath the pllc. Eventually, I'm probably gonna have to turn some of those into their own individual LLC and make the pllc an actual holding company, but I'm not there yet. So, you know, with each stream of revenue, like I said, I have a couple little numbers next to each stream. And those are the checklists, things that you have to get done in order for that stream to start running. So I made a shift recently, because of my changing career, you know, like I said, the goal is to try to, you know, kick the bucket of the nine to five and do your own thing, you know, and go all in on entrepreneurship and your own business eventually, right? That's the hope. For me, my story's a little bit different, because my wife is a type one diabetic. And we need not just medical benefits, but good medical benefits, right? My nine to five might always be there. And I'm okay with that. I've learned how to kind of find the best possible job with the best possible benefits. and academia has afforded me that right now. So I'm able to do that, you know, at a little bit lower rate of like 32 hours a week instead of maybe 40. And that gives me more time then to work on the businesses. So while I was doing a lot of the mobile PT at first, that's kind of decrease now, because like I said, it's like, do I want to treat patients for $200 an hour do I want to do consulting at 1500? An hour, right. So I would say overall, you know, I've got the mobile business, I've got my online business and PT educator Comm. And then I've got my consulting, business, FTI consulting, and those are kind of the three main revenue streams. Now in those revenue streams. There's probably, I don't know, three or four different services, if you will, that are offered. You know, the consulting can be anything like injury prevention and wellness, because I've got that systemized. And I've got templates for that now where I can just come in, do the tour, see what's what, and then put together a presentation overnight. And then that also will have my copywriting little digital marketing. It'll have you know, Facebook ads, Google ads, it'll have copywriting, email, all that stuff underneath the consulting. And those I can charge, you know, for just one little piece, or put together a package where I'm like, Hey, here's what you need, here's what I recommend, you can go ahead and do it based on my outline, or if you need my help, here's my price, right, my fees. And then PT educator comm is just like I said, my online site where I do a lot of my blogs, I have a lot of the courses for sale and stuff like that. And that's just really to kind of keep me up to date on my writing. And, you know, my blogging skills and stuff like that just recently passed them the mark for 1000 subscribers and 4000, watch hours for YouTube. So I cannot monetize that as well. So the vlog cast, which I do one episode a week of an interview with somebody who's done that particular side, hustler side gig, starts out on YouTube, and then eventually makes it to the podcast in audio form. And that actually, the podcast hasn't even come out, that'll start September 1. With the first few episodes, I'll probably release three or four and the first one, and then do one a week after that. So if you want the new fresh content, you go to YouTube and watch the video if you want to catch up, you go to the podcasts. But if we're if we're giving it a breakdown, you know, I would say we're probably at about 60% of consulting at this point. And coaching, I kind of put coaching underneath that as well. And then I would say, you know, the the online business is probably about 30% at this point. And then treatment is just at this point, word of mouth, close family and friends here in the Wimberley area, you know, 10%? If that?   28:54 Yeah, got it? Yeah, I think that's really helpful for people to hear so that they're like, wait, I don't understand how, how is someone doing all of this at one time? Do you know what I mean?   29:03 Yeah, and let me make this clear, too. So 32 hours a week is still dedicated to my full time job and Right, right. So that gives me maybe eight hours extra to get to a 40 hour week, and then I work 50 or 60 hours a week, there's you know, I love that stuff, though. I would do that for free if I could all day every day, because that's what gets me excited, you know, the passion projects, helping people figure out a business model. So you're, you know, figure out what they can do for side hustles and side gigs. Even if it's just making an extra 500 bucks, you know, a week or something like that, you know that that could be huge for somebody who's having to pay 2000 bucks a month for student loans, right or 1500 bucks a month for student loans. So if we can figure out a side hustle or side business to get you started, at least, maybe you grow it big enough to the point where you can walk away from that nine to five and that's great if that's what you want to do. You know, but but I'm also to the point where I was working 60 or 70 hours a week for someone else and trading time for money and just wasn't cutting it. So I've scaled back, I've been able to, you know, increase my value on certain things and, you know, raise the prices on things enough to where I'm working less time and making more money. So it's like PRN rates don't even, you know, don't even cut it for me anymore. It's not even something I would look at. It's just not worth my time, because the money's nice, right. But the time freedom is really what you're looking for, I think, you know, I think people are, are looking to claim back a lot of that time with their family, not having to work weekends, not having to stay, you know, all hours at night at an outpatient clinic, doing notes and trying to, you know, stay on top of things. So, I know I've been there, man, it's a grind. And, you know, it's nice to be able to use my add and teach and to use my DPT and use that knowledge toward you know, something as trivial as a fantasy football injury course, right? That was one of the first courses I ever made. And then, you know, video gamers eSports, I did an Esports ebook on injury prevention for gamers, right? Like, that stuff is just fun to me, you know, I love that stuff. And we can use our knowledge to help those people and solve those problems. So why not do that? Right? Why not find a hobby or something you like? And just go all in on it, you know, and use your knowledge to help people. You know, so that's been a big a big finding for me over the last year or two, it's just that, you know, you don't have to work as hard. You know, you can scale back, you know, charge what you're worth, and make a lot more money in a lot less time. You know?   31:29 Yeah, that all makes sense to me. And what would be your says, we kind of come come to a close here, what, what is your biggest, your most important piece of advice for people listening, if they could take one, if you were like, oh, man, if you just took one thing away from this talk, this would be it.   31:51 Yeah, I think physical therapy or your profession, your career just has to be the tip of your iceberg, right? I mean, again, like I said, we as physical therapists can do so many things, we can help so many people, and it's like, if I go and treat a patient, you know, one on one, that's great, that one person gets better in that hour, maybe times eight hours a day, there's eight people, right? If you want to have a bigger impact, and you want to affect more people, right? Then maybe you coach somebody or teach somebody, you know how to start their own business. And now that person's treating, you know, 50 people a week. So now you're impacting 50 there, and the few that you were teaching, then you coach somebody else on something else, and they're helping, you know, 20 businesses, you know, with their patient intake model, and they're, you know, they're doing things, you know, at a higher rate. So now you're helping 20 businesses with 50 patients each, right. And so I think more impact can come if we realize that we're more than just a physical therapist that goes in and treats eight people a day, or 20 people a day, or 30 people a day, or whatever you're treating, right? Like we can do so much more. And we just need to think outside the box a little bit, you know, and be a little bit more than that nine to five clinician that clock in and clock out, you know, and then again, by having a bigger impact by helping more people, right, and then coming at it with a servant's heart. Money is just a byproduct, you can then take that money and pay off your student loans quicker if you want or invest in things that are going to make you more money down the line so that you can pay off the student loans, should you want to do it over a longer period of time. Either way, you know, it's just about opening your eyes and seeing that there's a whole lot more out there than just you know, going to outpatient clinic every day and seeing your patients.   33:29 Excellent, excellent advice and great takeaway. Now, where can people find you if they want to learn more about you what you're doing and how to get in touch with you?   33:37 Yeah, sure. So all of my tags are pretty much at p key educator on all the social medias. And then the book is on Amazon. It's available in softcover. And in Kindle, it's called PT educator, student debt eliminator, multiple streams of revenue for healthcare, academicians and clinicians. definitely have a second edition coming out pretty soon. So check it out, out while you can. You know, I'd love to see people hop on the second edition as well, because there are a couple of key changes with all the stuff that's going on nowadays, with cryptocurrencies and, you know, all sorts of investing strategies and stuff like that. So I'm still learning, you know, lifelong learner for sure.   34:13 Absolutely. And last question, what advice would you give to your younger self, knowing where you are now in your life and in your career? Yeah.   34:22 Don't Don't worry, as much, you know, just leverage the heck out of your, your career and your degrees. You know, use them to do what you want to do and what you enjoy doing, you know, leverage the heck out of it, you'll be fine.   34:37 Excellent, great advice. I've heard that many times on this show. So, Scott, thanks so much for coming on. This was great. I think you really gave people a lot to think about and some inspiration on maybe how they can use their passions and and think outside the box a little bit. So thanks for coming on.   34:57 Absolutely. Thank you, Karen. It's been a pleasure.   35:00 Absolutely and everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, Physical Therapist and Owner of Healthy Phit Therapy & Wellness Consultants, Dr. Lisa Folden, talks about diet culture. Today, Lisa talks about the pervasive nature of diet culture, how to reconcile diet culture with physical therapy recommendations, and how to support patients who are on their weight loss journey. What is diet culture? Hear about weight biases and phobias and how to deal with them, the Health At Every Size movement, and get Lisa’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaway “Diet culture is this pervasive thought process that we’re born into, that fosters the belief that we’re never enough – we’re never thin enough, we’re never healthy enough, we never got it right.” “Diet culture is the constant reminder that something’s wrong - you need to fix it all the time.” “Even if weight is causing some of the issue, the reality is, the research shows that weight loss doesn’t really work for most people. 95% of people who lose weight gain it all, plus more, back.” “Weight loss is a by-product that some people will experience, and other people will not.” “We think in our society that no one should be fat, and if they are fat, it’s because of poor health choices.” How to challenge the weight bias: Unlearn the idea that people in larger bodies are inherently unhealthy. It’s not going to help you make them feel better, and it’s not true for many people. Think about accessibility. Considerations are made for people with various degrees of mobility, so ensuring that there’s appropriate furniture is a consideration for those with larger bodies. Reassure patients. Especially when dealing with patients who have dealt with the weight stigma, it’s important to reassure patients that size variation isn’t a problem. “I assume that their condition is caused by something other than their weight, and I treat them based on that.” “We’re supposed to be different sizes, and we don’t have to lose weight to be healthy. You can be healthy at any size.” “Stop telling your patients to lose weight, offer people in larger bodies the same treatment options you offer people in smaller bodies, and don’t shy away from manually and physically examining them because of their body weight.” “It’s going to be okay.”   More about Lisa Folden Dr. Lisa N. Folden is a licensed physical therapist, mom-focused lifestyle coach, and the owner of Healthy Phit Physical Therapy & Wellness Consultants in Charlotte, NC. As a body positive women’s health expert and health at every size (HAES) ambassador, Dr. Folden assists women seeking a healthier lifestyle by guiding their wellness choices through organization, planning strategies, and holistic goal setting. Dr. Folden is a mom of three, published author, and speaker who understands the complex needs of the modern busy woman. Therefore, she considers helping busy moms find their ‘healthy’ as one of her of top priorities. Dr. Lisa is a regular contributor to articles on topics related to physical therapy, health, wellness, self-care, motherhood, body positivity, and pregnancy, and has had the distinct honor of being featured in Oprah Magazine, Shape Magazine, Livestrong, Bustle, and several other local & national publications. Additionally, she is a member of the National Association of Black Physical Therapists, the Association of Size Diversity & Health, The Know Women, Alpha Kappa Alpha Sorority, Inc., and serves as an expert panelist for H.E.R. Health Collective (2021).   Suggested Keywords Diet Culture, Weight Loss, Body Positivity, Acceptance, Stigma, Body Size, Fitness, PT, Physiotherapy, Symptoms, Healthy, Wealthy, Smart   Resources: Health At Every Size Community   To learn more, follow Lisa at: Website:          https://www.healthyphit.com Facebook:       Healthy Phit Twitter:            @HealthyPhitPT Instagram:       @healthyphit Pinterest:         @HealthyPhit YouTube:        HealthyPhit PT   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the full Transcript Here:  00:02 Hey, Lisa, welcome to the podcast. I'm happy to have you on today.   00:07 Thank you so much for having me. I'm so excited to be here.   00:11 Yeah. And today we're going to be talking about diet culture, in health care, and specifically in physical therapy, which is not something that I've ever spoken about on this podcast. And so I'm really happy to have you on to talk about this. And I remember speaking with Dr. Lisa van who's, and we were talking about biases in health care. And she said, one of the more accepted biases in health care is against overweight people. Yes. And so I'm happy to have you on and dive into that a little bit deeper. And so let's, let's talk about first diet, diet culture, you know, its impact on our not just our physical health, but also our mental health as well. So why don't we first start with what do you feel diet culture is? Let's define that.   01:13 Sure. So it's nuanced, of course, but essentially, diet culture is it's this pervasive thought process that we're kind of born into, that fosters the belief that we're never like enough, we're never thin enough, we're never healthy enough, you know, we've never gotten it right. And so it feeds into, you know, this multibillion dollar industry that says, you know, buy this tea, by this waist trainer, by this weight loss program by this because you always need to be getting smaller, shrinking yourself, doing something to change yourself, because, you know, you couldn't be healthy, you know, there's no way you're healthy, especially if you happen to be someone who was born into or developed into a larger body, there's no way you're healthy. So diet culture is sort of the constant reminder to you that something's wrong. You need to fix it all the time. And it's a deep part of our healthcare system. It's a deep part of, you know, like Hollywood and television, things we watch every day. So it's it seeps in without anybody really knowing that it's happening. And it's so common and so accepted, that we just look at it as you know, health, like a lot of things that are really diet culture, a lot of us would just look at as Oh, that's health, that's fitness. And it's and it's not, because it's actually corruptive. And it, it breaks us down. And it's not good for our mental health or for our physical health. It results in a lot of weight cycling and bingeing and restrictive in disordered eating. And so, you know, it's really bad. I mean, that I don't call a whole lot of things good or bad, but diet culture is one that I kind of just categorize is bad and unnecessary,   02:53 really. And so looking at that through the lens of a physical therapist, how do you reconcile that culture with what we do as physical therapists, because so often, if someone is, let's say, an example, someone is coming to us with osteoarthritis hips, knees, one of the recommendations is weight, weight loss of whatever that weight loss is, I don't think the recommendation is to be a size zero or two. But that recommendation is weight loss. So how do you? How do you kind of blend these two this diet culture, which knows very bad, but yet, in certain populations, it can be helpful to take off some weight to unload those joints. So how do you reconcile with that as a PT?   03:40 Yeah, that's a great question. And it's obviously something I've had to kind of deal with head on as a physical therapist still treating in the clinic. You know, like I said, in the standard outpatient practice. So here's the thing, there's physics, right? physics exists, when there's more pressure, you know, from gravity and weight, you can feel more pain. Like that's, that's a fact. But there's also, you know, this idea that we all have different sort of thresholds for our pain. And, you know, you know, like, I know, you can look at someone's, you know, x rays to people, and they can have identical things happening there, you know, at the structural level, and have completely opposite symptoms, one with severe symptoms and one with none. So, when I address the issues of pain that could be could be contributed to from weight, I just, I approach my patients from the lens that even if weight is causing some of the issue, the reality is the research shows that what weight loss doesn't really work for most people. 95% of people who lose weight, gained it all plus more back within one to two to three years, and they don't really have research beyond the five year point because nobody typically makes retains it. So the reality is, even if if you know if that is the suggestion, that's kind of what we've been taught as physical therapists, I know that it doesn't work. So I'm not helping my patients by saying, hey, you really should lose some weight. So I approach it from the lens of I'm going to treat them as if this osteoarthritis, this this issue, whatever they're dealing with, has nothing to do with their weight, and everything to do with all of the other possibilities in my toolbox as a physical therapist. So are we dealing with, you know, restricted, you know, soft tissue, tight muscles, you know, imbalances, muscle imbalances, are we dealing with, you know, just lack of flexibility and other things, can I do some manual therapy that can help, like, what other things can I do, because even if weight is a contributing factor, me telling them to lose weight is in the long run, not going to help them because for like I said, most people aren't going to maintain that weight loss any way, or if they ever achieve it in the first place. And it can be so daunting, when people in larger bodies go to health care professionals, and no matter what is going on with them, if they are in a larger body. The suggestion is weight loss literally across the board, not just you know, in our profession with, you know, things regarding the joints and osteoarthritis, you know, other things like that. It's literally everything, I'm having stomach pain, lose weight, I'm, you know, they literally here for everything. And so I just don't want to be a part of that. And I don't think I don't think that it helps our clients to get better in the long run.   06:28 Yeah, and it, might it add one more thing to this person's plate, so to speak to maybe, then they will say, Well, I'm not even gonna go back to this PT. Yeah, is there a way to meet people where they're at, and through exercise and other modalities, if they were to lose some weight great, not make that the singular focus?   06:54 Absolutely. And that and that's just what it is. Because, you know, adopting new health behaviors is good for everybody, whether you lose weight or not. And you know, just just just increasing the synovial fluid in the joint from, you know, more activity can be great, you know, so weight loss really is a byproduct that some people will experience and other people will not. And, and coming to terms with that has been a journey for me as a professional, and then in my own personal life and my own, you know, struggles from the past with weight loss and diet culture, but it's really freeing, and it helps people eat, I can just this year alone, I've had at least four clients, all of them were women, but they all had the same story, like severe trauma, from interacting with other healthcare professionals, like figuring out something's going on with them, and then being told, like, Oh, yeah, you just got to get that weight off, you just got to keep that weight up, and just kind of hearing it over and over again. And so coming to me was like a, sort of a breath of fresh air for them. It's like, you're the first person, it's like, not telling me I need to lose weight. And it's like cash. Like, I couldn't imagine that being the discussion. Every time I go to the doctor, every time something's bothering me, you know, as if to say, thin people, and people in larger bodies don't experience some of the exact same diagnoses and issues, you know, if weight were the problem, then that would be the situation then people and, and fat people would not have the same diagnosis. And we know that's not true. So yeah, you're right, it adds a whole nother layer of trauma that they have to deal with.   08:28 Yeah. And, and sticking with that theme, let's go into some of the the biases. So the weight bias, fat phobia and healthcare, we could talk about PT in general, like I said, and speaking with Dr. van Who's she sort of said, Hey, listen, this is apparently one of the accepted biases that you can have, you know, so let's talk more about that. Go ahead. I'll give the mic over to you and just kind of what's the situation on the ground here?   08:58 Yeah. And, and she's, she's right with that. It's like, it's like the legal bias. It's like it's okay. And, and even people, what's disheartening to me is interacting with people in larger bodies, they often will just accept it, because it is the norm. And they begin to believe that inherently something is wrong with them. They haven't figured out the magic formula, they're not doing something right. And so there's something wrong with their body. And they're almost Okay, in a sense being discriminated against or dealing with the biases because it's just so much a part of what we do. So it you know, it shows up in everything, like literally from the time you're born. You know, I had a great discussion on my Instagram with some people we were talking about, I did a summer body challenge. So I had everyone like, put on a sports bra and black bottoms and just show it and be proud of your body and we said it was the Being confident and proud of my body this summer and always, you know, not feeling like I gotta lose weight, two summers coming, you know, warmer weather doesn't mean I have to get to the gym and lose some weight or cut back on my calories. And a recurring theme in those conversations was just this idea that like, it starts at home, like my mom, you know, said, Oh, you're putting on a little weight, or you're getting a little chubby, or it's, it's this pass down fat phobia, it's like, do whatever you do, don't get fat. And it's like, oh, my gosh, we, we think we literally think in our society that no one should be fat. And if they are fat, it is because of poor health choices. So we create this hierarchy, where I'm better than you, I must make better health choices in you, because I am thinner, and you are fatter. And it just couldn't be farther from the truth. Because, you know, we, a lot of us like to believe we have a whole lot of control over the size, shape and weight of our bodies. But so much of that is genetic, you know, so much of that has a genetic component, we only have so much control. And even within the window of our control, without going into disordered eating patterns, it's still a very small, you know, amount of change that you can expect to see. So, you know, we hear it from our parents, we hear it at home, we see it on television, you know, when you get on a plane, and the seats are barely big enough for an average adult, you know what I mean? Like, barely, like we're squeezed in there. So imagine that humiliation, you know, as someone in a larger body having to either buy two seats or figure out how to squeeze into that seat. You see it in doctors offices, there's small seats and doctor's offices, even though we treat a huge variation of people in their body sizes, the lobby looks like everybody should be the same, you know. And so those are, you know, things that I want to see changed and considerations I want to see being made, especially in healthcare, because, you know, we we have the privilege of working with people, you know, from largely diverse communities, especially as it relates to their size. So, at the very least, that should be a comfortable experience, you know, you're going to your doctor should be a comfortable experience, you're going to your physical therapist, it should be a comfortable experience. So yeah, there's more I could say, but   12:36 I have a question for you that. So as a physical therapist, so let's say you're talking to you're talking to a group of pts about this, what advice do you have, that they can put into action to challenge these biases, and to make their spaces more inclusive?   12:55 Yes, that's a great question. So the first thing is to start within, and just avoid all of those assumptions that we like to make. So just you know, unlearning, that's where it starts like unlearning this idea that people in larger bodies are inherently unhealthy, or have inherently made bad decisions. Because one, it's not going to help you get them better, or make them feel better. And to it's not true for a lot of people. So getting rid of those, those preconceived notions about what someone in a larger body, you know, has going on, or what kind of health status they have. Also, if you're in a setting, where you have the privilege of sort of, you know, making decisions about the clinic setup, you know, thinking about the furniture, thinking about, you know, having things that are accessible, we think about this, and we're talking about people, you know, with varying levels of ability, if they're in a wheelchair or on crutches, you know, we think about making sure the doorways are wide and this and that, and height, adjustable seating and things of that nature, we should do the same thing for people in larger bodies, people come in different shapes and sizes, and we should do as much as we can within our power, you know, to accommodate them. The other thing is, especially when we're dealing with people who have dealt with the weight, stigma and all that trauma, we need to reassure them, we need to let them know like my patients are literally floored when I tell them like there's nothing wrong with you. You know what I mean? Like we have to abandon this thin ideal, like everybody is not gonna be thin, no matter how hard we work, no matter how hard they work, no matter how many calories we cut, everyone in the world will never be thin, nor do we need to be. It's okay to have variations in size. I truly believe in the concept of Health at Every Size, which is an excellent book by Dr. Linda bacon. But you know those things so I'm learning, reassuring your clients, you know, avoiding the assumptions. You know, there are people in large bodies that can do just as much as you can do or more, you know, but then when you do encounter someone in a larger body that is having trouble because of You know, their mobility issues or their body size, you need to be quick with the modifications, you know, we're good at that, like that. That's what pts do. So you know, give them the opportunity to try it full out. And if they can't, or you see them struggling, jump right in with a modification and you reassure them and you let them know there's nothing wrong with this, like exercise movement is for every body. And if you can't do it this way, well, guess what? I got another way you can do it, oh, that didn't work, I got another way you can do it. Or let's try this one. instead. It's, it's okay. And people need that reassurance. Because in the healthcare setting, especially if they've had that trauma, they're so nervous and so uncomfortable. And again, they feel like there's something wrong, you know, with them. And so, you know, we learn this in PT school, we treat the whole person, you know, we don't see a person and this is a knee, no, we're treating the entire person and all of that all of their preconceived notions, all of their trauma, all of their hardships that comes with them into the clinic. And so we have to figure out a way to work with them, ease their you know, their minds and give them the tools that they need to get better. And so I typically, I take weight out of the equation, I just, I assume that their condition is being caused by something other than their weight, and I treat them based on that   16:14 period. Now, here's the question, how about if you have a patient or client coming to you, who they want to lose weight, or they're in the middle of this weight loss journey, and they're committed to it, because they want to feel better? for themselves? Not for anything else. But you know, we're coming off of a really difficult year where a lot of people might have gained weight over COVID. And so how do you or how would you suggest PT support the patients that are coming to you, they're saying, Hey, listen, I, I'm on this journey, this is what I'm doing. I'm moving, I'm exercising, I'm eating better? How can you give them a little extra support? With out perhaps leading them into an extreme version of that?   17:04 Yeah, what I find in those cases, your role is more of a, I don't want to say a silent partner, but you're there for the supporting piece of it. But the goal is to not. Okay, I'll say it this way, I respect body autonomy. So essentially, I know the research, I don't think that, you know, chasing weight loss is a great idea, really, for anyone, despite COVID I know, people are like I gave the quarantine 15. I'm like, Listen, you're alive. That is such a blessing with the year we've had, you know, the year plus we've had at this point, so but I respect body autonomy. So if you believe like, this is not a weight I'm comfortable with I'm not, I don't feel good, I don't think I look good, I want to do something different, then by all means, go about, you know, the process that you feel comfortable doing, I am going to be here to support you by way of giving you evidence based solutions. So if you tell me, Hey, I'm doing this, you know, 30 day detox, I'm only going to be drinking lemon water. And shakes, I'm going to tell you, I don't think that's a great idea. And here's why. But ultimately, you are an adult. So you get to make all of these choices for yourself. Before I became you know, haze or Health at Every Size aligned and anti diet, I did, I did all kinds of things. And I would not have taken kindly to someone telling me, oh, you're wrong, you need to stop it. So people need to have the freedom to do what they want. And I just as a therapist, I just want to be there. And in my role as a health coach, I want to be there to support them, but provide them with the evidence that's out there. And then, you know, as they go through their process, I'm happy to fine tune, I love to give people workouts, you know, that's, that's what we do is PT. So yeah, I can give you some workouts. If you talk to me about like, I feel really weak in my glutes, I want to be able to do this or I want to be able to benchpress or daily, oh, I've got you, I can give you a great program, you can work on it, you know, we can follow up with me. But whenever you're talking about extreme dieting, and crazy restrictions and weighing yourself incessantly and you know, tracking your movement on your Fitbit all day, I'm gonna kind of bow out and give you the, you know, the freedom to do what you choose. But just let you know that I don't think that's going to really support your goals   19:26 overall. Yeah, and, you know, it's the same as as if we would talk about a return to sport after an injury. So we can help guide the patient through their rehab process. And when we get to that decision making point, it's a shared decision making point where it's you, the client, maybe it's a spouse, a child, a partner, the doctor, whomever might also be within that decision making framework, and exactly what you just said, You're giving the best evidence based information. You can to that patient, and then that patient can make an informed decision on what they can do next, or what feels good, what is the best decision for them? So I just want the PTS out there listening to understand that this is not unlike any other shared decision making that we would do. And it's not a you do what I tell you to do. Because we're biased against people who are fat. Yeah. Because you're overweight, you clearly can't make a good decision. Right? which is not the case. And it's maybe they need information to make a better informed decision, just like someone coming in after an ankle sprain or an injury or low back pain.   20:43 Yeah. And you know, and that that's a great point that you bring up because you're right, it comes up with injuries, people will Google it. And listen, I love Google, no disrespect to Google, I google things all the time. Know when somebody is coming in, and they're dealing with some type of injury or medical condition. And they're going solely based off Google. It's like, Yes, we have a responsibility as a trained professional to say, Hey, here's what I think you should really know. But ultimately, you're right, they they're going to have to make the call. You can't you know, get someone better in physical therapy, just you know, when they come to you, it has to be their follow through at home and their decision making. So that you're absolutely right. That's a great analogy, for sure.   21:27 Yeah. And now, you said this a couple times. But I just want you to talk a little bit more about the Health at Every Size movement. You mentioned it a few times tell the listeners exactly what that is, and what its significance is to diet culture.   21:43 So the health and every size movement is it was sort of tagged by Dr. Linda bacon. I don't really know the lifespan, how long it's been around, I don't think it's been before, like the 90s. But it's essentially a movement that believes in body respect, and body positivity or best body neutrality, and respecting and understanding that we're supposed to be different sizes. And we don't have to lose weight to be healthy, you can literally be healthy at any size. So it's it's really the antithesis to diet culture. It's everything that diet culture is not it's not a movement that is rooted in, you know, being sedentary and eating McDonald's every day. But it is a movement that's rooted in people making their own individual health choices, and and creating health habits that improve their health without any focus on weight loss. So the Health at Every Size movement sort of omits the idea of like, let me check my way, let me weigh in this week. Let me let me measure this week, let me see where I am. It's it kind of throws all of that out of the window. And so the book is actually Health at Every Size by Dr. Linda bacon, that was sort of my introduction to it. And it's been life changing for me again, personally and professionally. So I recommend it to essentially everyone.   23:03 Nice. And because I think oftentimes when people look at someone who's overweight, they think, oh, they must have heart disease. They must be a diabetic, they must have this, but you can have normal labs and be overweight. Yeah, yeah. So and I think that is one of the biggest biases not just in healthcare, but in society in general.   23:27 It is it is. And that is the premise behind Health at Every Size is recognizing that you can't look at someone's physical body and know what their health status is. And we're just so used to making those assumptions and it's so counterproductive to true health and it's so damaging, you know, to people, you know, I personally know people and my own personal story. I'm only 411 I know we've never met in person, but I'm very short.   23:55 A short and you come across way taller.   24:02 It's the hair.   24:04 The hair gives you an added oranges.   24:07 I am short. I've always been short. But genetically, my family my mom's side of the family, they're more like apples shape. So they carry weight in the stomach. They're usually just you know, they got big solid legs. My dad's family was a little bit more Hourglass OR pear shaped so very lower, larger lower bodies. And so literally my entire life here and I have never, ever, ever ever not been overweight. Ever according to BMI which is a whole nother topic but I believe it's trash. So I have always my entire life they considered in an overweight category. I have never had high blood pressure, high cholesterol. AB issues doing any physical activity I used to run once upon a time I ran 25 K's I've never had an actual health issue, but I have always been considered over weight, and that stigma because that you know, value was created by a mathematician, you know, that really even said that it wasn't supposed to be used to like actually measure health into BMI, the BMI. But because of that, being sort of what our healthcare system is run on in our insurance markets, kind of, you know, utilize for everything. I have never, for my whole life, I felt like something was wrong. It's like, I'm not running enough, I must be eating too much. Let me stop having carbs. Let me switch to this diet. Let me and that is it. You know, it's not just my story. That's a lot of people's stories, especially here in this country. And it's like, if we could just stop for one minute, and ignore the weight and ignore the BMI, and just focus on health activities, health behaviors that make you feel good. If it's walking for you, if it's running, if it's skating, if it's dancing, if it's height, whatever it is, for you know, joyful movement, that's kind of you know, that's a part of the Health at Every Size, mantra, it's like joyful movement. Eating when you're full stop eating when you're hungry, stopping when you're full, trying different foods and just living a life and, and managing the other aspects of your health, like your mental health, your emotional health, your spiritual health, if we could just focus on that, instead of the scale, or the measuring tape, BMI, we will be so much healthier. So so so much healthier. So yeah, I, like I said, I could talk about BMI forever, but I just I really, I love what health and every size stands for because it, it's really about valuing body diversity, that's what it is. Because the bottom line is, we're not all going to be the same size, we're not all going to be thin, we're all going to have different dimensions, and our bodies will change over the course of our lives, age, stress, hormonal things, pregnancy, you know, all kinds of stuff. And so we have to get more comfortable with that fact. And not try to create this, you know, there's the whole snap back movement with pregnancy, like, have a baby lose the weight. It's like, wait a minute, let's just be you know, let's adjust to motherhood and whatnot. Um, so yeah,   27:08 yeah, it's it. I can't even get into the BMI. Because I cringe when I when people start talking about their BMI is and what it should be. I mean, for my height for BMI. I am right now, like a tick away from being overweight. And I would if you saw me, you wouldn't think oh, she's overweight. But according to the BMI, I'm like, a tick away. And for me to be in that sweet spot. I would look emaciated. Yeah, exactly. You know, so, like, 100 pounds. Let's like, stop with the BMI stuff. You know, and, and I just had all my labs and I could not be healthier. Absolutely. So there you go. But yeah, I'm with you on the BMI. We could talk. We can go on about that for a while, but we won't. So let's talk about, you know, we talked a little bit about what, what can physical therapists do to look at their own bias and fat phobia in health care? Is there any Do you have any other tips for health care providers out there, when it comes to their bias and phobias?   28:30 Yeah, I would say, you know, in addition to what we talked about earlier, and then on learning practice, you know, we have to just stop telling people to lose weight, it's counterproductive, it's not effective. And again, most people aren't able to even do that consistently and maintain it. And then we have to offer the same treatment options we would offer offer someone who was thin, like it, you know, we just have to treat them with some, you know, equality or you know, equitably, and giving them the same options. And then I know in physical therapy, this has come up before and that's one of the sort of issues that the fat acceptance community has expressed in dealing with with healthcare professionals, is they are less likely to be examined to be physically examined, because of their body fat. And I get that, you know, when you go to physical therapy school, and we learn all these manual techniques, oh, it's much harder to try to palpate things, you know, when there's more adipose tissue, of course, but that doesn't mean you don't do it. You know, so my advice is to do it, it might be uncomfortable, it might be awkward, it might be challenging, but guess what, you grow as a professional and then you at the very least give that patient the the decency and the respect of trying what you know best to do, you know, in that you know, situation. So, um, you know, just being being supportive and not being demeaning that playing into the weight biases. And first really acknowledging that you have them that that's that's the first part because a lot of people don't think that they have until they're put in a situation where they have to face them head on. So recognize them. And then stop telling your patients to lose weight offer people in larger bodies, the same treatment options. You offer people in smaller bodies, and then don't shy away from manually and physically examining them because of their body weight.   30:19 Yeah, great advice. And hopefully people listening to this podcast will take that advice to heart. Now, where can people find you on social media websites? All the good stuff? If they want to reach out to you they want to work with you. Where can they find you?   30:37 Yes, well, my favorite social media is Instagram. I'm pretty much on everything. But if you really want to reach me, you can find me on Instagram and I'm at healthy fit. And that's h EA l th y pH it. I'm also again on YouTube and everything else. But I live there. I'm on the peanut app, which is kind of new. If you're a mom, and you want to have talks about body positivity and changes to your body through motherhood. I'm on that app. You can find me there Dr. Lisa folden. And then my website is www dot healthy fit that calm.   31:10 Awesome. What is this the peanut app? Yeah, this   31:15 is really cool. It's like club friends, but it's for moms. And so they have tons of discussions on there. But um, I was requested by the I think the creators to serve as like a professional and do talks on things in the health realm. So yeah, so I go on there every, every other Friday, and I host talks on things related to body positivity, Fitness, Health, Exercise, things like that.   31:38 Fabulous. Congratulations. It's awesome. Thank you. Now last question. It's out when I asked everyone is knowing where you are now in your life and in your career? What advice would you give to your younger self? Maybe like fresh out of PT school?   31:53 Oh, yes. Oh, fresh out of PT school that changes things, let's see, or high school or undergrad or whatever you want somewhere in there. I think you know what I think the best advice I would give to myself is it's going to be okay. That's really it. Because I was one of those like type A planners, like let me figure everything out. And I just remember being stressed all the time, like wanting my life to work out a certain way. And so it would have been nice. If you know, my older self this Lisa could reach back to that Lisa and just pat her on the back and say it's gonna be okay, honey, you're going to be fine. You can calm down. I just Yeah, that would that probably would have helped me relax a bit more during that process, you know, going through PT school and like, I felt, I just felt this heavy, you know, weight on my shoulders to like, get through and pull through and be great. And so if I could say anything to myself, it would be to just you know, relax. It's going to be okay. Enjoy the ride. You know, for sure.   32:51 Yeah. It's a very common piece of advice from a lot of people on this podcast. Obviously not hard to believe. Right. Right. Right. Lisa, thank you so much for coming on the podcast. It was a great discussion. And, you know, my hope is that people will take away from this all of the great tips to really examine your biases, and just start treating everybody like the people they are. Absolutely. Thank   33:18 you so much for having me.   33:20 Anytime. Anytime. You want to come back. You are welcome. And everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, CEO of CS Thrive, Kirsten Franklin, talks about mindset. Today, Kirsten talks about what mindset is, why we should care about it, and how it affects our outcomes, results, and everyday life. How can we leverage mindset to change the results of things we don’t like in our lives? How can we change our core beliefs? Hear about Kirsten’s four questions, her stopwatch strategy, and get her advice on how to manifest as a conduit, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “What you deeply believe will always play itself out for you.” “Sometimes just the awareness of the thing makes the thing go away.” “When you’re really in the moment, just throw a big red stop sign in your head. What you’re doing is actually stopping the subconscious chatter. That alone can elevate you.” “If you’re still trying to get to that next level, then you have to pay attention to what you’re saying to yourself at this level. You have to hear what you’re saying, because it’s dictating your reality.” “It’s the ‘taking action’ that’s the hard part.” “None of it is a big deal. Relax.” “There’s two ways to manifest. There’s the manifest by force versus when you open up and let the universe and all of its power flow through you.”   More about Kirsten Franklin Kirsten is a world-class rapid transformation coach who has helped change the lives of over 1000 individuals. She is the brains behind the unique MVP method that is responsible for helping her clients rapidly transform their Mindset, raise their Vibrations, and modify their Processes, so they can achieve their dream lives. She helps people overcome fears, adversities and traumas while improving their clarity, focus, performance, communication, relationships and thinking, so they can fulfill their ambitions. Many of her clients are seen as being highly successful and seek her out to help them define and achieve their next-level. She has spent over sixteen years studying mindset, positive psychology, behavioral science and neuroscience and she is a master of techniques such as Neuro-Linguistic Programming (NLP), Strategic Intervention (SI), Cognitive Behavioral Therapy Coaching (CBT), Timeline Therapy, Mindset, Mindfulness, Meditation and more. Kirsten received her Juris Doctorate from St. John’s University School of Law in 2001. Now retired, she owns multiple companies and is the CEO of CS Thrive, a coaching and consulting company that helps executives, founders, small business owners and athletes become unfu*kwithable in their business and lives. In free time, she is the host of the podcast Girl on Fire; writes for “Mind-Flux,” a publication she created on Medium.com; writes fiction and non-fiction books, and hosts live events. She has been featured in Thrive Global, NBC, CBS, and Fox.   Suggested Keywords Mindset, Mindfulness, Fears, Psychology, Behaviour, Therapy, Awareness, Manifest, Conduit, Abundance, Action, Reality, Subconscious, Liberty, Results, Outcomes, Positivity,   To learn more, follow Kirsten at: Website:          https://www.kirstenfranklin.com                         https://www.csthrive.com Podcast:          https://bleav.com/podcast-show/bleav-in-girl-on-fire Facebook:       Kirsten Franklin Instagram:       @kirsten_franklin Twitter:            @CSThrive LinkedIn:         Kirsten Franklin Clubhouse:     @kirstenfranklin   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the Full Transcript:  Speaker 1 (00:01): Hey, Kiersten. Welcome to the podcast. I'm so excited to have you on. So thanks for joining me today. Thanks Karen. It's great to be here. It's nice to see you again. I know, just so everyone knows I was on Kirsten's podcast a couple of weeks ago, and we will talk all about that podcast and where people can find it a little bit later, so you have to wait to get the good stuff. But in the meantime today, we are going to talk about mindset. So I feel like mindset can mean a lot of things. So what is it really? Yeah, so that's a great question because it's one of those words like coach or like this, or like that, that we hear all over the place and for me in the way that I use it. So it was actually originally coined by Carol Dweck and she was talking about eight thought process, like being fixed or growth mindset, meaning you believe that you were given a certain sort of limitation and that's the highest you can go and that's fixed. Speaker 1 (01:04): Right? And that no matter what you do, you'll never going to go and surpass that level of ability. And growth is one where you feel as though, you know, you have the ability to change it, right? You can, you can go beyond the quote limitations. There are no limitations. And the way that it's sort of been more used frequently is in discussing the subconscious mind. And that's something she references back to because that's actually where all the magic happens. And you know, the way I use it is really talking about that subconscious language. It's about the core beliefs that you hold about yourself. It's almost like the rule of law that you have decided is true for you and you're going to live by it no matter what, Hey, even though you don't really know, you kind of created those laws. So it gets a little tricky in that people understand the difference between conscious and subconscious, but as you talk to them, they really believe many times that they know what they're thinking. Speaker 1 (02:02): And the funny thing is is you don't until you catch it and you really kind of latch on and you're like, oh, why did I say that that way? Right? And, and you kind of have to dig into it, but you can, you can understand your deepest core beliefs by the language. And actually just take a look around you. Is there something in your life that you don't like, or maybe you're kind of feeling attracted towards or repelling against, then there's something out of alignment in those core beliefs, because whatever you believe is what you're going to see in your reality. And so when we use the term mindset, is that dependent upon our core beliefs? You know, or is this, I mean, obviously mindset is something we can change, but if people say, oh, well I have these core beliefs and they're not going to change. Speaker 1 (02:51): So then how can the mindset change? Does that make sense? Yes. And actually there's a perfect example. So a lot of times I like to ask for questions when somebody is in a certain emotional pattern, right? Let's say, oh my God, I have anxiety. I can't drive over bridges. Right? Like, or, or whatever it is. So I'll ask four questions and I ask the first question, like, could you let that feeling in like, are you willing to just feel it? Because if you're not willing to let it in and you're constantly pushing it away, well, you can't get rid of it because you're, you're, you're not willing to work with it. Right. The second question I'll ask is, do you believe it's even humanly possible for you to eliminate the feeling of anxiety? Could it ever just go away? Right. And these are just yes or no questions. Speaker 1 (03:35): And if the answer, yeah, I think I could get rid of it. Like that's totally possible for me. Right. The next question I would ask is, would you let it go? Are you willing to let it go? Okay. And again, it's a yes or no. The reason I ask these questions is a yes or no fashion is at any point when you say no, no, I'm not willing to let it in. Then you can't let it go. No, I don't believe, I don't believe it's possible that I could just eliminate it then. Guess what? You will not eliminate it. Right? No, I don't. I, you know, I'm not really willing to let it go. Okay. Well then, you know, you're going to keep it for some reason, right. Or if you say yes, all the men in the last one says, okay, well, when, when are you going to let it go tomorrow? Speaker 1 (04:15): Okay. There's a reason why you're not today. Right? So, so the thing about what you had just said is that whatever you believe is going to be true. So if you believe it's not possible, it's not going to, it's not going to, it's not going to be possible for you. Right. And so, so it's a, it's a, it's a tricky little thing, you know? And so how can we, how can we change our beliefs? How does that work? That's a, that's a long process and a short one. So you can actually just change them. That's the fastest way to change them is to literally just change them. What is it that you wish you believe? What is it that you hoped you live? How is it that you would hope things would be, and then just believe them? And it's actually that simple. Now I know a lot of us thinking like, yeah. Speaker 1 (05:06): Okay. You're funny. I, I that's. I'm like, yeah. Okay. Yeah. Right. But I want you to think of the moment. There has to be a moment in your life where you're so off. So fed up, so done with something that it was done. You're never going to take that, do that, see that, feel that again, and you walked out on it. Like it typically happens in relationships. I'm never going to have that. You don't, you're done, never happened again. Right. Because you're done because whoever you were that got yourself into that situation, you were done with it and you were not willing to accept it and you won't ever accept it again. Right. Whether it's like somebody who speaks to you in a certain way or does something or whatever, or even the way the grocery bag of groceries, you know, bags of groceries. Speaker 1 (05:47): You're like, yo, you like it. You know, it's just done. That's the same thing in our head. Sometimes we can just be so over something that we're done with it. And it changes right there in an instant. Right. and then more typically it's we think a lot about how we wish it could be how we wish it should be, should be as a, as a dangerous one for me, because it's a comparative thing. Oh, I should be here, but I'm not, oh, like, I shouldn't be married, but I'm not, oh, this should be this way. And that starts a spiral of depression because your life doesn't look the way you want it to, then it's no good and it's all wrong. And then it comes down. And as you know, when we have these stressors and emotional things, they come out physically. Now you have neck pain. Speaker 1 (06:33): Now you, now you get headaches. Now, all of a sudden, your knees hurt. Right. If it's not a physiological difference, then it's typically coming from an emotional space it's coming from inside. Right. So how do we change them? I mean, look, I'm going to be totally honest. You can like, go, am I allowed to swear? I'm going to try not to sweat. You could like Google this stuff. Okay. Like there are affirmations, there's hypnosis. There's, self-hypnosis, there's positive cycles. There are a million different ways. And I don't believe in one size fits. All right. So I could lay down some techniques right now. And you know, a third of y'all will get it, do it, try it. It'll work. A third of you will be like, yeah, I'm not even bothering. And a third of you will try it and it's not going to work. Speaker 1 (07:13): Right. But even that is in your head. So if you are someone who doesn't believe that talking things out helps anything. Then if my method is talking things out, then it's not going to work for you. So that's the power of our brain. Let me tell you how powerful our brain is. I was just having this conversation. So, you know, I was talking to somebody and there's a blind spot. So meaning your eye, witness identification, all stuff, all bad. Why? Because we interpret things so differently and we can create blind spots. So you ever had that moment where you're like, oh, can you get me that book on the shelf? Right. And the person's like, I don't feel like getting you up, but you're standing right next to the shelf. Just grab it to me and give it to me. Okay, fine. What's the book it's not here. Speaker 1 (07:55): Right. And all the fighting goes back and forth. You finally get up from your seat. You walk over to the shelf right in front of the space is the book he or she literally couldn't see it because somewhere the command was given no book. You don't have to get it. You don't want to get it. It's not there. This is stupid stuff. Right. And so it literally happened. And so it's kind of crazy. Like, I can't tell you all the science behind it because we're studying it every day. In fact, you and I, before this, this packets were just talking about how they figured out. They think the, the place in your brain that lights up when you're deciding whether something is going to get stored in your subconscious mind. Now that's a really interesting place to play because I mean the magic that we can make happen right there, who knows. Speaker 1 (08:40): Right. But you know, it's, it's many different techniques to change it. You know affirmation again, you can Google that, you know, but it's really important because what you deeply believe will always play itself out for you. So I always tell people, take a look around your life. If there are areas or places that you are just simply unhappy, you really need to dig into your beliefs about yourself, the way it's supposed to look how it's supposed to be, and you'll see how that's playing out. Yeah. So I, it sounds to me that you're saying not, there's no one size fits all for this. And I think that's the realest answer. You know, like you said, I can tell you this or this, and it might work for some and not others. And so it sounds like you need to figure out what is going to work best for you and then seek that out. Speaker 1 (09:42): Yeah. And it's a testing thing, right? I mean, you really do have to go through things. Like I have a mindfulness email that I send to everyone it's 52 weeks. And why, because it's literally 52 different ways to practice the same thing. Right. Mindfulness. Right. But the goal is, is that okay? You try it one week. Some people get bored with stuff really easy. Right now it's a new thing they could do every week. Right. But the goal is that at the end of it, it doesn't matter whether you picked up or found your thing, you just did it for an entire year, 52 different ways, but you did it. So at the end of the year, you still have the result, even though you didn't realize you were kind of doing that, you know, here I'll, I'll tell the audience one thing that they can do that works for everyone period. Speaker 1 (10:23): And it's only if you do it. So just remember you have to do it, actually do it. And it's something I do with all my clients. And it's called no negative and try it for a week. Try for a few days, it's really about awareness. And what I started them off doing is I literally have them take their phone, their stopwatch feature on their phone. When they wake up, they started the very first instance where they feel, say, or do something in the quote negative. They have to hit the stopwatch button, record the time, write down kind of what it is. They were doing, what it is, they're feeling what it is or how I was saying. So you wake up, you hit this, do you start the thing? Like, oh crap. I got to go to work. Gosh, 12 seconds, 12 seconds elapsed. All right. Speaker 1 (11:06): Oh crap. I have to go to work. All right. Start the button again. Okay. Brushing my teeth, got to pick out clothes. I got dressed. All right. Hit the button. Right. And, but that's it because you'll see, even by the end of the first day, people are shocked at how many, how many, but also how often and frequent things come because you live your life on autopilot all day. You don't realize that you're living sometimes in this hugely negative space. You think you're fine and you can't figure out why you're grumpy by the end of the day. Well, if you're telling yourself, oh, every five seconds, this isn't good. That's bad. Oh no. We've got to think about this. Yo of course, you're going to bring your vibration down. And your day is going to suck by the end of the day, every day. You know what I mean? It just is. So, so that's a technique I like to do. And that's only part of the technique, but that, that, that level of awareness, just as eye-opening most of the time. So that's a fun one to do. Oh, that's great. I'm going to try that. Oh gosh. Look, I'm already negative. No, no, no, no. Speaker 1 (12:08): Yes. All my new Yorkers let's do it. We all know how we are. We think we're funny. We're really like sarcastic and negative. Yeah, exactly. Oh my gosh. Yeah. I'll try that tomorrow. And we'll see what happens. I will report back to you. So, so obviously we know mindset is something that can be altered. Can't be changed. It can be positive. It can be negative. So how does that affect our outcomes and in how we live our life every day? Yeah. So, so let me give you an example. I call it the kindergarten story because I think it's kind of common for a lot of us. So I want you to imagine that you're in kindergarten. If you're listening to this outside of the country, it's a one year about four or five years old. It's the first level of school you go to here in the United States. Speaker 1 (12:58): And we have this thing called Valentine's day. And at the kid level, we just, you know, get a bunch of candidates together, throw a bunch of cards and give one out to each member of the class. But sometimes there's that special Valentine. Right? So, so let's say little care. It's kindergarten. And she's all excited. Turned her mom made all the little Ballantine things she's handing out. But Joey, her best friend, well he's has the special Valentine. And she's going to ask him to be his, be her beer Valentine. Right? So Karen goes up to Joey, we made a special bone. That'd be, will you be my Valentine? Joey loves comedy. He says, oh my God, Kimmy just asked me. And she's super cute. I'm going to totally be here Valentine. Now little Karen's like, wow. Now little Karen's had picked up this message, but it wasn't said, but this is what you heard. Speaker 1 (13:46): You're ugly. You can't get the guy. Oh, and Kimmy with brown hair and purple eyes. She's that's that's that's the ultimate cuteness. Like that's that's it. Now she's four. She goes home cries. Mom, mom fixes it. Everybody has dinner next day. You're for you, Joey and Camy. By the way, you're all besties. You're hanging out. Like nothing happened. You, you feel like you don't feel it. It was a split-second. It was a moment it's gone. It's not really gone because let me tell you what happens now. She matriculates she's in middle school and Karen has to ask a boy to a dance. It's one of those Sadie Hawkins thing. So the girls have to ask the guys. And so her and her bestie and most people at this age have faced some kind of rejection, whether it's in the girlfriend, boyfriend, lover section or, or any other part, like not getting the baseball, you know, position, whatever it is. Speaker 1 (14:34): So we understand rejection. So we're fearing a little bit and we're nervous. So it's natural. Right. And everybody will tell you that. Oh yeah. It's natural. Don't worry. Just go ask anyway. So you and your Bessie, of course, it's Kimmy go. And you're like, okay, all right, we're going to ask our guys. So Kimmy goes first. Can we ask the boy? And he's like, yeah, sure. What out? Right. So Carrie was like, yeah, I'm going to ask Tony. She goes up to Tony. She asks him. Tony was like, man, I wish I could go. But I can't. Now what Karen doesn't know is that Tony is a son of the local preacher and he's not even allowed to go to school dances. Tony is secretly actually in love with her. But he has to say no anyway, but all Karen hears, not consciously, but subconsciously because she doesn't remember five years ago, she all she hears subconsciously is yo dumb. Speaker 1 (15:19): Don't you know, you're ugly. Why you try to do this? That making a fool of yourself. You know, you can't get the guy just stop. You are not pretty. You are not enough. You can't get him just up. Okay. Underlying, underlying thought the overlying crunch thought, oh man, I can't believe it. I'm so to the point and maybe he doesn't like me, right? Like, why is it so easy for Kimmy? Why isn't it the same for me? Like, it becomes that now you can't leave Karen out. Karen's like, all right, she's going to high school. She's like, you know what? I don't even care anymore. I'm bringing to the new high school, new me, everything. She goes out, she becomes a head cheerleader. Everybody loves her. She's popular. She's gorgeous. She's smart. She's funny. She's nice to everyone. And so she's, she's the girl, there goes Joey from kindergarten. Speaker 1 (16:08): He's the captain of the football team. And you guys are of course still talking. So Hey, what up? You start dating on the outside. It it's like the ultimate thing. Like, you know, you've made it right. You've arrived. Like this is it. Like, this is everything that everybody dreams of. Right? Prom, king prom queen. We're going to do it. You know, Joey's all happy. But Karen Karen's like, dude, Tom feels weird. Why doesn't it feel right when you think he's cheating on me? Like you think like, what's going on? Like, like I know we, we look so good together. It looks, it looks like it should be perfect. This is actually everything I ever wanted since kindergarten. But I dunno. I think, I think, I think he talks about, look at, look at him, smile. Look at him, smile at that girl that just walked by. Speaker 1 (16:51): Look at him, say hi to everybody. Right? She starts going, yo crazy lady. I take taken his phone, looking at his text messages. Eventually poor Joey. Now she's creating damage and Joey, but you always like, all right, forget it. I can't, I'm done. Right. And then Karen thinks, oh yeah. That's because you're right. Your cheater, you're doing something right. And she has to solidify in her mind. What's going on? So now Karen gets smart in college. She's a psych major. She's not going to play this game. She thinks she's good. She finds herself a man, they get married. They have kids. But again, something's not right. Like it feels wrong. Like it doesn't feel good. It's supposed to feel amazing. Right. But, and then she starts picking on things like, why can't you take the garbage out? Why can't you take it on time? Why can't you put it in the bin? Speaker 1 (17:36): Right. Right. And all this weird things has nothing to do with the garbage in the bin. And it has to do with this internal, emotional strife that she can't release because she's not quite sure why she doesn't feel right. But the truth is it's because she's too ugly to get the man, this man she doesn't deserve. It's not right. He couldn't possibly be there for the right reasons because she's not good enough like that. And it plays out in this way. That's why it's important. Because every day when you wake up and you have those negative thoughts and you enter these scenarios and things come crashing into your universe, it's usually in your head, that's created it at some point or is receiving it in some way. Right. And you're being reactive, like a five-year-old to it. And you don't even know you're doing it. Speaker 1 (18:18): So if you want to have a nice, happy, easy, joyful life and wake up bounding out of bed, like if a kid on Christmas, this is the head game you got to play with yourself. It takes work. Right? No. Yeah, yeah. Yeah. I mean, you know, just like anything else, it does take, it takes consistent effort in, in getting it done. And actually to be honest, sometimes it doesn't sometimes just the awareness of the thing makes the thing go away. But you have to remember, you have been imprinted every second of every day, since before you were even born in utero with an impression and emotion, something okay. To date. So if your brain decided to take all those impressions and make a big deal out of them, well, you're going to be undoing a lot of stuff. And that's why it's layers. That's why it's kind of like, you know, when I'm working with CEOs that are, you know, in multimillion dollar companies, and now they're about to go into something and like close to a billion and they have all this stuff going on. Speaker 1 (19:13): Or, you know, I was just talking to an athlete who started a business and he was like, I should have been so much further. And you know, and you know, we broke it down that the work that he did to become an athlete, to become an MMA fighter is not the same level of work he's doing in his business. Right. He, he, he practiced every day. He, you know, ran, kicks every day. He had people watching him, critiquing him, helping him, mold him. He spends like three hours a day in his business, but he wants it to be a superstar rocket, you know? And it's like, well, you didn't get into the octagon and fight and win your first fight by, you know, being around for three months. You've been in this business three months. But you think you should be like a millionaire, like where is that coming from? Speaker 1 (19:54): Right. So it's, it's, it's all it's, it's it's in your head. Yes. I, I understand. I get it. I get it. I do. Now let's talk about, if you have something let's say in your life that is not going maybe the way we want it to, which let's be honest. I think that happens too. Can we say everyone at some point? Oh, of course. How can we leverage our mindset to change this so we can change our results? Okay. So I'm gonna, I'm gonna, I'm going to go a little woo on you here. So it's a combination of your thoughts and your energy, right? And so you know, just to, to focus on the mindset aspect of this, you can really dig into, you know, how would I deal? You have behaved, have responded, have done something. And how did you, you do it. Speaker 1 (20:55): What's kind of the difference. And how do you step into ideal you? How do you make decisions from that higher place? Right. just taking business, you know, let's say you're going to go into, I don't know, marketing and you have to pay marketing people. Well, you, you might say yeah, that's really expensive. I'm not doing that, but higher, you might say, Hey, actually I understand the long-term game. I'm willing to wait it out to six months. It'll probably take for me to recoup money back and let's go for it. Right. I would ask the right questions and it would know the right information and it would make the right decision. Right. So, I mean, when it comes to mindset and looking around your life and finding the things that you don't like, that's the start, but now what are you kind of leaning towards and what are you pushing away from? Speaker 1 (21:41): What have you settled for? Okay. Like notice that, because a lot of times in our lives, we settle for certain things. We want this ideal image, but then we're like, oh yeah, it's okay. You know? And so look at all these things because they all add up. I mean, there's a, there's a bunch of questions you can ask yourself, but I would really just start with, where are you, where did you want to be? Why did you want to be there? That's a big question. Okay. So, you know, think about all the people that go to college at, went to college and pick a major that had nothing to do with them. Right. you know, I wanted a big house in New Jersey when I first became a lawyer because I grew up and that's what everybody had. I didn't realize I don't even want to live in New Jersey. Speaker 1 (22:25): And I don't think Jesus, you know, I mean, like it, but because it was so familiar to me, I thought that's what I should be doing. And I wanted nothing to do with it. And so it caused every time I wanted to go look at property or do something, it always fell through, it always didn't happen. Well, it was the universe saying peace woman. Like, what are you doing? Just stop. But in the, my reality in that moment, it was frustrating. Like I tried so hard trying so hard and it's not working out. Right. And it was just like but you do get the signs. I mean, I think the biggest thing is, you know, again, with no negative, you start to look at your stressors too. You start to see the common themes of what you're saying to yourself, what you're hearing and really stop. Speaker 1 (23:08): You know, one of the, one of the, another thing that I love doing is when you're really in it in the moment. And when you're super about to be reactive, you know, about the Chuck that, that coffee across the room, just throw a big red stop sign in your head. It's called a pattern. Interrupt to stop, throw the sign in your head, just see it and just stop, stop, stop, stop, stop, stop, stop, stop, stop. And just stop. Because what you're doing is actually stopping that subconscious chatter. When you do that, and that's like an immediate thing that you can do that you don't have to deal with everything that's going on around you, because sometimes you can't because it's so in your face. But as long as you stop, as long as you stop that thought pattern, stop, stop, stop, stop, stop, stop, stop, stop, stop, stop, stop. Speaker 1 (23:49): Right. That actually just practicing that alone starts to stop the mental pattern that you have going on. All you have is a mental pattern, a little talk pattern, a little, you know, little repeat on loop, right? That's what you're stopping that alone can elevate you like everybody listening to this, you know, if you think of your life right now on a scale of one to 10, 10 million, like, oh, yo upper rockstar, one being like, dude, am I still alive? Like, how am I even still here? Didn't I like do something last week. That caused me to not be here because it's so miserable, right? Like that level. Okay. So on a, on an overall one to 10 rate yourself, then do no negative and stop just the pattern. Interrupt. Stop yourself every time. You're when the, when the bar reset. Isn't fast enough. Stop. Stop, stop, stop. Speaker 1 (24:33): Stop. When the dog just, you know, somebody else's dog ran across your foot. Stop, stop, stop, stop. Stop. When a door closes on your dress, your skirt, and you're about to get stop. Stop, stop, stop, stop. Just stop. You don't even have to think any further, just stop that's at the top. Move on, do it for a week. Now again, one to 10, how do you feel rate yourself? Your number is going to go up and then your brain is going to start with this. Oh, but nothing changed. Why do I feel? But, and then you're gonna question it don't it just is. And it's actually just that easy. So excellent. That's a great exercise and very, very easy. Anyone can do that. It takes nothing. You just have to stay, say stop. Yep. And those, when that those thoughts start rushing in and we all have them every single day. Speaker 1 (25:24): Yes, we all have them. I think that's great. So now, as we start to wrap things up, what do you want the audience to take away from our conversation around mindset? Well, I mean really just the basics. I mean, the fact that it is important, you have to pay attention to it. The reason you're here, wherever that is in your life is because you didn't, maybe you didn't know, maybe you didn't care to, maybe it wasn't as bad yet, but if, if you're still trying to get to that next level, then you have to pay attention to what you're saying yourself at this level. And I don't care what level you're going to or where you're coming from. That's just it, you know, where they're coming from, coming off the streets to your next level, or you're coming from your, your $50 million company and you want to make it a hundred million. Speaker 1 (26:10): It's the same thing. You have to hear what you're saying, because it's dictating your reality period. And so it's really important. And that there's a lot of resources out there. I mean, I can give you some resources as well, but you know, there's tons of stuff out there and it really is simple. It's just, it's, it's simple and taking action and everything changes and it can change in minutes. Yeah. It's the taking action part. That's the hard part, right? Everybody can read. You can understand the action that has to happen. Let me tell you, let me just really quickly tell you that that's my too. So you have to live into the being. So let me just give you an example. So I was very athletic when I was younger. You know, I didn't work out at all. When I had my child, my child is now 12. Speaker 1 (26:52): At the time that I had to do this to myself, she was 11. And I was like, oh, I'll kind of get into that place where you still look good with clothes on, but not so much when you take them off. So I was like, maybe I should work out. And I thought, oh, this is second nature. I'll just go work out. I live on central park here. So I'll just now. And I did everything. The micro habit, the be dressed in your sleep thing, the sneaker girl, if I tell you that at some point I felt proud that I got out the front door and want a cup of coffee to come back. And that was my workout. And I had to do my own techniques myself, which is what is it? I believe like what happened? I obviously no longer believe I'm an athlete because if I did, I mean, this is easy. Speaker 1 (27:30): Right? And that's what I thought I believed consciously. Well, when I dug down to it over the past, you know, 10 or so years, my friends had been getting a little snappy with me saying things like, oh, you eat like an a-hole, you still look good and I didn't work out. So then they knew that like, how do you not work out? And, and we work out 10 hours a day and what's going on. And there was part of that, that seeped into me that was like, oh, that's right, girl, eat whatever you want. Look good. You don't, you don't need that. Right. And well, it worked for 10 years, but obviously I needed to change. And the second I realized that I was letting those things come in, that it was easier to hang out in bed that I always had tomorrow that, and I changed that core belief. Speaker 1 (28:11): And I, and I really had to dig down into why, like, I want to be the grandma who like flies through the trees on zip lines with her grandkids. I can't do that in 10 years. If I don't exercise now. Right. I had a drill into my head. Oh my God, I love running by the way. Don't really, but I love running. I love running. I love running the second I did all that stuff. Right. And it actually took overnight. That's all I did. I did it one day. I wrote down the thing. I said it to myself again and again. I said it to myself in the mirror and I was like, yo, you, you have this, like, what's wrong when you have this right now woke up the next morning. I actually ran a whole mile. Now it doesn't sound like much, but 10 years sitting on my. Speaker 1 (28:47): Pretty good. That's great. Yeah. That's nice. So it's really convincing yourself that you are the person who does the thing. If you are the person who loves to do all this weird, you know, personal development stuff, and you'd love to say stopped yourself and you've loved it. Guess what you're going to do. You're going to do it. That's it? It's that simple. Yeah. Yeah. Oh my God. That's such a good example. Thank you for that. Now, speaking of resources, where can people find you, your podcast? Talk about the podcast, your resources, everything else. Yeah. Awesome. I mean, you guys can go to just my name.com. So it's Kiersten franklin.com. And I don't know if you're able to put that in the description. And then the podcast is just girl on fire. So if you want to just Google girl on fire, it's unbelief B L E V network. Speaker 1 (29:36): You can find it anywhere, apple, iTunes, all that good stuff. Yeah, that's it. Yep. And D and we will have links to everything, to all of her information at podcast dot healthy, wealthy, smart.com and the show notes under this episode. And we'll have your on social media. Do you want to give a shout out to your social media handles really quick? So someone can find you really easily. That would require me to know what they are. Well, it's all on your website. Yeah, we got it. We got it. No problem. We will have, I will put them all in the show notes individually. We're good. Don't worry about it. Now, the last question I always ask everyone is knowing where you are in your life and in your career, what advice would you give to your younger self? Speaker 1 (30:29): I would tell myself that none of it is a big deal. It's not as big a deal as you think it is, you know, all that lost time on stressing out and trying to make things happen and living by force, as opposed to living as a conduit where everything's flowing through you. Massive difference. My whole life has been lived by force winning, winning, winning, getting by force. I probably could've gotten the same exact stuff, Ben, the same that, and just nice and easy, you know, massive difference in life. Let me tell you. Yeah, I was relaxed. I love it. And I've heard that several times from people guests on this podcast. So there's clearly something to that. So for all of you, new new grads out there, college kids listening, relax. And I love, can you say that again? You want to be sort of a conduit versus a forest. Speaker 1 (31:25): Can you repeat that one more time? I mean, I, you know, listen, there's two ways to manifest, right? There's the manifestor force, right? Like, like you're going to get it. You're going to get it. You're gonna do everything class. We're going to fight, fight, fight. It's by force and you're gonna get it versus actually when you open up and you let the universe and all of his power flow through you, you're going to get the same things only. It's nice and easy, right? When, when something doesn't happen or someone candles or it moves when you know that it's okay, that it's all just going to be fine. It's your life flows through you. You are a conduit. I it's true about finances, about love, about anything, right? If you, if you're having financial difficulties, right. And this is going to sound crazy, I know it's gonna be painful for some, but if you open up and you just let it flow through you, all of a sudden you're going to just have more and more and more money, right. Speaker 1 (32:15): Because it's not about you getting money. You're the conduit. So the university saying, all right, I'll throw money at you because you're giving it here. You're helping people there. You're doing this. Right. And it just, just like, love like energy. It's just things you're, you're, you're a vessel it's supposed to come through the gifts that God gave. You are not for you. They're supposed to float through you so you can help others. If that makes sense. Yes. It, and thank you for that. I love it. So Kiersten, thank you so much for coming on the podcast and spending the time with us today. I really appreciate it. Absolutely. Thank you so much for having me. It's so fun. I always love seeing you. Yeah, my pleasure, my pleasure, and everyone tell the listeners out there. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

In this episode, CEO and Founder of Practice Freedom U, Jamey Schrier, talks about creating success by changing mindsets. Today, Jamey talks about developing a growth mindset to achieve greater success, what the biggest problems are that owners face, and how to ‘fix’ those problems. What’s your goal for the next 30 days? How do you keep your energy tank full? Hear about the different growth mindsets that owners get wrong, reacting versus responding, and get some valuable advice on how to grow and become more successful, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “How someone thinks determines the actions they take, and the actions they take produces results.” “The eyes only see, the ears only hear what the brain is looking for.” “You have got to look at a yourself as the owner, the CEO, the entrepreneur, the head honcho.” “Being busy is not an owner mindset.” “You have to slow down. You have to pause. You have to spend more time getting out of the immediate present.” “The biggest problem with the overwhelmed operator is there’s not organisation in place, there’s not systems in place, there’s no control over one’s time.” “The more you can bring people in an organised, systematic way, the less overwhelmed you’ll be later on.” “The best is yet to come. The future is brighter than the present and it’s brighter than your past.” “Business is all about trying things, failing, learning, and trying again.” “What you focus on, what you pay attention to, grows.” “You don’t know what you don’t know, and you never will no matter how smart you are.” “It’s not enough to be busy - so too are the ants. The question is, what are you busy about?” “Keep your tank full.” “Reacting is an emotional response. Responding is a rational response.” “When things get busier at the office, there’s one thing that you sacrifice more than anything else - that’s your self-care.” “You don’t strengthen the weak by weakening the strong.” “Overcome your ego. It’s okay you don’t know everything. Enlist some help. Invest in your business. It will pay off dividends in your future - not only to you, not only to your family, but for everyone that’s around you.”   More about Jamey Schrier Jamey is the founder and CEO of Practice Freedom U, and the best-selling author of The Practice Freedom Method: The Practice Owner’s Guide to Work Less, Earn More, and Live Your Passion. He is a sought after speaker on systems, marketing, and elevating the patient experience. Over the past decade, Jamey has helped hundreds of physical therapists, occupational therapists, speech therapists, and mental health professionals build their highly successful practices and create more financial security without working longer hours.   Suggested Keywords Owner, PT, Physiotherapy, Business, Entrepreneurship, Purpose, Mindset, Success, Actions, Thoughts, Leadership, Freedom, Productivity, Busyness, Progress, Reacting, Responding, Self-Care,   Jamey’s Book: The Practice Freedom Method: The Practice Owner’s Guide to Work Less, Earn More, and Live Your Passion.   Discovery Call: https://www.practicefreedomu.com/discoverycall   To learn more, follow Jamey at: Website:          https://www.practicefreedomu.com Facebook:       Practice Freedom U Twitter:            @jameyschrier LinkedIn:         Jamey Schrier YouTube:        Practice Freedom U   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the full transcript here:  Speaker 1 (00:01): Hey, Jamie, welcome back to the podcast. I am happy to have you back. I always love having you on, well, Speaker 2 (00:08): Thank you Karen. I am so happy to be here. Speaker 1 (00:12): And so every time you come on, we talk about some aspect of the physical therapy business, which is great because I know a lot of the listeners want to know more about how to run a business, how to be successful, what's going on in the market. So let's kick it off with what is in your opinion, the biggest problem facing physical therapy, practice owners today, Speaker 2 (00:42): Karen, you're just going, you're just right out of the gate. Like you're just like, you know what? We're not messing around. Hey, Jamie telling me about yourself or, or give it. It's just, I'm going fast ball down the middle either. You're going to hit it or you're going to strike out and we're going to be done. Speaker 1 (00:57): Yeah. They, they, they know who you are. You Speaker 2 (01:01): That's a good sign though. Right? what's the biggest problem facing practice owners today? That that's a really great question. And the answer may not be what people might think the answer is. The biggest province, really what, the topic that we're talking about simply put it's how we think it's just that simple. There, there's a, there's a simple formula that, that I've been following for years now, years and years and years. And basically it's just says how we think, how someone thinks, determines the actions they take and the actions they take, including their communication and their stuff. They do produces results. And too many times I've heard people that are not happy with their results, whether it's referrals, whether that's revenue, whether it's profit, whether it's hiring, whether it's retention, whether it's time, God forbid, people want time and control. They don't have that. Speaker 2 (02:03): So if you reverse engineer the result back to, well, why isn't the result we want? Is it some strategy? Is it some technique and answers? No. It's how an owner thinks. I mean, let me, let me give you an example. We went to school, right? All your listeners went to school. We are highly educated, very smart people. Now who educated us, right? We had professors in school and we, and, and, and PT school. We had professors who were educating us on what they were educating us on how to be a clinician, more specifically, how to pass the boards, because that is what schools do. They help you pass the boards. So then you can become a licensed clinician, licensed physical therapist. So you do that, whatever one year, you're five years, 10 years, and you have this urge, you have this thing inside you that says, I want to be a business. Speaker 2 (03:07): Now I want to run my own thing. So do you go back to school? Most people do not go back to school care and they don't get an MBA. They don't get any kind of, maybe they read a book, hopefully my book, right? The practice, freedom method, plug, shameless plug, but they, they just signed the dotted line. And now they're an LLC. And what are they doing? They are making decisions with the brain that was built and created with all of the information of how to be a talented clinician, which they are. But now that same brain is making decisions around business and there lies the problem. Speaker 1 (03:48): Okay. So you just described most physical therapy owners. So how do we fix this? How do we, what do we do if this is, if this is our mindset or if this is where we are, this is where we're thinking. And you know, everybody gets, I think people start their own practice because they want to help people. They want to see patients the way that they feel they should be seen, et cetera, et cetera. Right. So how do we take off the clinician hat and put on the owner hat? Or, or do we split it into, how does that work? How do we fix it? Speaker 2 (04:27): Yeah. So there's a great quote by one of my mentors, Dan Sullivan, and it says the eyes only see the ears only hear what the brain is looking for. And we've seen this, right. You know, you're, you're thinking about buying a car. You know, the last car I bought was a Jeep. Right. I bought a Jeep. I've never seen Jeeps on the road. Oh my God. I feel like the whole world has a Jeep. Right. You're seeing them everywhere. Did they magically all of a sudden become more Jeeps in Maryland? No, because you started your, you started to tell your brain Jeeps, Jeeps, Jeeps. So it really starts with recognizing that this is an issue and you don't know what you don't know. And Karen that's, that's hard for a lot of people that was very hard for me because I'm a smart person. Speaker 2 (05:24): I did really well in school. So did you, so did everyone, I haven't really made a million mistakes in my, at least academic life course. We wouldn't have been through school, but then you get in the business and you realize that, you know what, I, I don't necessarily know how to do this. Maybe I should get help, whatever that means. Like, I think it's just recognizing that I shouldn't be an expert at all this business stuff, because I'd been taught. I've never been trained. I haven't done self-development and work on that. I think that's one of the biggest things we just need to recognize. We'll get into, you know, I have some specific things that people can do, some tangible things they can do. But I think I just want to get people just to recognize that that's the issue, because if you don't think that there's a problem, even though you're working 50, 60 hours a week, you're not making the revenue you want your, your staff is coming and going, or you can't get them to actually do what you want them to do. Speaker 2 (06:30): So you're taking on some of their job, all those things that we complain about, if you don't actually say, look, you have created this model. So the only way to uncreate this model is to start to change how you're thinking about the business. And that starts with how you think about yourself. You have got to look at yourself as the owner, the CEO, the entrepreneur, the head honcho. You have to see yourself like that. That's scary, right? I don't think myself, I'm just a PT. The problem is that's how everyone else is looking at you. And you have to own that. Now you are playing multiple roles here. I've said one time, multiple personalities. It's not really multiple personalities. It's multiple roles, but your role as a clinician own it when you're treating treat. But when that ends, you have got to shift your mind to perhaps the role as the director, and then you have to shake. Speaker 2 (07:36): It shifts your mind. The role as the owner, the mindset you have for each of those three is so different, especially between the clinician and the owner, how you see your business, how you see your staff, how you communicate to people. That's very different than a clinical mindset. So I think that's the first thing we have to own it. The, the, the other big thing is success is 90% preparation and 10% perspiration people may have heard that they may have heard it in different types of things. 99%. This 1% that I've heard that before, never really understood what it meant. What does that mean? It means that we are by human beings. We are naturally doers. We do do, do I call up the home Depot model, you know more savings, more doing we're here to help the doers. So doers like to do they get off on doing stuff. Speaker 2 (08:38): And then those people like to be busy, busy, busy, busy, which is, seems to be the mantra of everyone nowadays, what are you doing? I'm really busy, but that is very different than being productive. That is very different than being efficient. So being busy is not an owner mindset. An owner mindset is how can I be more productive? How can I run things more efficiently? How do I utilize my time? Better? That alone will change what you focus on and how you start putting your business together. So this 90% preparation stuff is all about. How about having time to think about your business. If you're busy all the time, constantly filling your schedule with patients, with meetings, with putting out the fires in your business, just constant stuff. Where's your time Karen, to just think about what is it, where's my business going in the next month or three months or week. Speaker 2 (09:39): You don't have that time. You're just on the hamster wheel of doing, doing, doing busy, busy, busy, and the results don't really significantly change or worse. They start to improve a little bit, but they improve only because of the effort and the work that you're doing. So now you're trapped because if you shift that all of a sudden the results will, will go down. So you get trapped by that. So that, that, that motto of 90% per preparation and 10% perspiration and having this shift of you have to slow down, you have to pause and you, we have to spend more time getting out of the immediate present. And that is my first mindset shift. Speaker 1 (10:30): Yeah. It's hard to sometimes get out of your business so you could work on it, you know, and how, if you can make that mind shift, I think you still, so you can make the shift of like, Hey, I'm the owner. I need to not just work in my business, but work on it. Be creative, things like that. So what advice do you have for people to, let's say once they've gotten that mindset, okay. I am a business owner. There are other things I have to do here. What, what can they do to get to that, that area of creativity and of, well, let's look at how we can streamline things and be more efficient if you're always like, well, I have to treat patients because if I don't treat any patients that don't have any revenue coming in and that's not good because I don't have a business. Right? Speaker 2 (11:26): So unless you bought an existing practice, we all come in as what we call it at practice freedom, you a committed clinician, right? Your solo preneur, that's it. Maybe you have an, a, maybe you have a part-time PT PTA or somebody, but it's really just you. Okay. That's how we all come in. That's how I came in. That's how you started your business. We all do that. Now committed clinician. The biggest challenge, because the challenges are different between the two examples I'm going to give the challenges with that person is, well, you got to get busy and most of your bills, dizziness is going to, or you got to get busy, meaning you got to generate more work referrals and get your schedule busy. So your job is to start delivering great care, maybe going out, meeting some different referral sources. That's what most of us do. Speaker 2 (12:17): And your schedule will get busier. It always happens. Then there's going to come a point where you're like, I'm running at a time. Every time I start to mark it by place gets busy. And when I stopped play starts to go down. So we call that kind of, that role of poster. And you start teetering on the next slide level of business ownership. And the next level is called overwhelmed operator. Love that term. I coined that term years ago because it just describes that type of owner. This owner has hired people. And when you start hiring people, you probably don't have a lot of organization and systems in place. You just kind of doing it. You're trying to, you know, I got some good people. I know how to judge people, but you're you still have your schedule. You're still doing your stuff. When you hire people, now you're responsible for them. Speaker 2 (13:12): So now all of a sudden this whole HR there's human resources stuff comes into play. Ignorance is an excuse. It doesn't matter if you're ignorant. Like I broke the law department of labor, reached out to me and say, Jamie we got to investigate you because you're doing some illegal acts. What? Well, you're supposed to be paying overtime to certain employees. I'm like, I didn't know that. I thought they were a exempt from that. Like, no, these are exam these. I mean, then all of a sudden I'm like, well, I didn't know that. And I'm like, well, you're going to find out, cause we're going to find you. And I'm like, okay, from now on, I will make sure I have someone on my team that knows that stuff. So what happens with the overwhelmed operator? You start bringing in staff, not only do you have your job now, Karen, but you start taking on other people's jobs. Speaker 2 (14:01): Maybe not the whole thing, but you're taking on a little bit of it. Right? And there's reasons for that. The biggest problem with the overwhelmed operator from I call it crossing the street crossing well sometimes. So it's a big, big, huge river crossing over to more of this idea of practice freedom, which I'll get to that in a minute is there's not organization in place. There's not systems in place. There's no control over one's time because you're busy, busy, busy. That's why I started with the idea of the problem is we're not thinking like an owner. You are still an overwhelmed operator thinking like maybe not only a clinician, but you're probably playing the role of clinical director is not an owner director. So leadership position in your company, but it's not where the practice owner needs to be. Right? If you're a director, you need to remove yourself from that position. Speaker 2 (14:58): That's where people are. They're in one of those two categories. So if you're, if you're a committed, if you're an owner, if you're a committed clinician, your job is to start bringing people in. But the more you can bring people in, in an organized systematic, having some things in place way, the less overwhelmed you'll be later on, there's still going to be somewhat overwhelmed. It's just kind of part of growing a business, but there's a way to do it where it's not so much. So one of the things that we that, that, that I want to share with the group, one of my mindset shifts that nobody spends any time on. I never did. Cause I thought it was a waste of time, whether you're committed clinician, whether you're a overwhelmed operator is the mindset shift of the best is yet to come. Speaker 2 (15:52): The best is yet to come. I won't get into the story around this, but really what it means is the future is brighter than the present. And it's brighter than your past. The future is brighter. You have a vision, you, you have something that you want. Is it written down? Have you taken the time to describe it? John Lennon CRA wrote, imagine, right? Talking about peace and unity. Martin Luther king has I have a dream, not, I have a project plan. I have a dream little kids go to Disney world and Disney land. But when you get older, you think that's stupid. Why? Because you're too busy doing it, doing it, doing it, doing it. You don't step out of the fray and say, where is this all leading to you? And I, before this call, we're talking about you know part of, part of the program that you're taking is focusing on, well, what are your personal goals? Speaker 2 (16:58): What's your purpose about what are you about Karen? See, we all have something we're about. And when you start to create that and develop that, that gives you your north star, that starts to give you direction. That's a shift. We all have to have to make, you know, I love Bruce Springsteen like the next person, but let's not have glory days. Our favorite song. Cause that means the best is in the past. So we have to shift that. Why is that important? Because it gives you a a plan. It gives you kind of like the horizon to know the direction you're moving the company. What, it also does, little known secret. What it also does is let people that you're hiring, know what they're a part of. Most of us, most of the owners, at least I can share my own story. Most of the owners I've talked to Karen. They don't have a clue, dental have anything written down a lot of a plan. They don't have a vision. They don't even have, they couldn't even articulate just a dream. Like the, you know, I just imagined the place being like this. It's usually a half a sentence of kind of, sort of, because they're just overwhelmed and busy and that's the place we have to start. Speaker 1 (18:17): Yeah. And, and I think getting, making that shift in the beginning, I know I can speak, well, I can speak for myself. Is uncomfortable of like, well, wait a second. I'm not in the, in this role. Speaker 2 (18:34): So Karen, why I agree with you, but is it uncomfortable? Speaker 1 (18:39): And, and again, I think it's, it's I, and again, I'm just speaking for myself. It's hard to like, let go of that control. It's hard to step away from being the clinician because part of my identity as a person and an owner is wrapped around being a really good physical therapist, not an entrepreneur. Speaker 2 (19:01): So what you're really saying is a there's some fear there. And the fear is, and this has been my experience working with hundreds of practice owners. What if I'd only achieve it? Yeah. Karen, I'm not used to failing. What if I don't achieve it, then I'll feel like a failure. I'm already overwhelmed. I'm already feeling bad about myself. I'm already feeling ashamed that I didn't deliver what I said to my spouse and my friends, what I would do when I opened my practice. See, I think it's more about that fear of failure. And that's one of the things we have to learn to embrace because this isn't school, business is all about trying things, failing, learning, and trying again. That is business. And if we want to protect ourselves in a little too Kuhn, you're going to be miserable. And I hate to see that I was miserable for so many years. Speaker 2 (20:03): You'll never hear anyone say it because I've been there. I've been in the private practice section. Now for 10 years, I've never heard one person ever telling me they're not doing well. Even though the odds are 85% of them are, how is that? Because it's pride and you don't want to tell people that stuff, but it's really happening. So by writing it down just for you, this is the exercise. Just write it down, create what's your vision. I don't care if you use six months, a year, two years, something reasonable, but just write it down. If anything was possible. And remember anything you want to do has been done a hundred million times before. There's nothing you're going to want that some other company hasn't created. So it's not like it can't be done, but anyone that helps you, you come to me, first thing I'm gonna say is, well, what do you want? Speaker 2 (20:58): Well, I don't know. Then how can I help you? I don't know what you're trying to keep. If you're going to hire someone, a good somebody, a good person that is going to work for you, better ask you. So what's your vision? Where are we going with this? Because they're looking at themselves as what is my growth opportunity here. So it is your duty as an owner. And to your point, yes, we as practice owners have an identity crisis. We actually don't know who we are. We have to embrace the fact that we are in owner. I know I'm going against what probably people have said before. You will always be a PT. Yes, you will always have a license. You always be a PT, but mentally you have to embrace it. You're an owner because you chose to go into business ownership. You didn't have to, it's a free country. Speaker 2 (21:49): You chose it. And there is more that you want. So how about we embrace it? And when you embrace it, it's amazing what you're going to be able to achieve. And you're going to make this whole process a lot more easier right now. You're making it difficult because you are battling these two kinds of brains. You're battling that clinical brain, that kilt brain that I don't know who I am. I'm just a PT and all, but I want this. I want to go on vacation for three weeks. Oh, I want him, I want to make money so I can put money away and write a check for college or, or have this or buy this. I want to help more people than I'm doing right now. And right now I'm not helping enough people. So it's your purpose. Your impact has to be the keys to this. Speaker 2 (22:32): So that's one thing. I do want to share a, another one. If I may. The other a growth mindset shift is focus. First one is the best is yet to come. The next one is focus. What you focus on, what you pay attention to grows. Now here's the caveat. It includes crap. You focus on a flower. You cultivate that flower. You put that little seed in there and you water it and take care of it. You're going to get a nice blooming flower. You cultivate that piece of crap and make it really nice. That maneuver is going to wreak real good. So whatever. So what does that mean? What's the manure stuff. It's the stuff that you're doing. That's not moving the needle in your business and in your life. It's the things that, although may be important. It's not what you should be doing because you can't do it all. Speaker 2 (23:42): And having the mindset of, I gotta do it all. I'm a great multitask. If I get one more person, tell me how great of a multi-tasker they are. Do you realize we are all researchers and science people? There's no, it's impossible for the brain to multitask. It can only focus on one thing at a time. All you're doing is focusing on a lot of one things really, really quickly. And then there's this thing called residue. This delay, right? If you're focused on something for a while and you focus on something else that delay, that thing stays with in your brain for a period of time, come on. You're not going to have a badge of honor saying what a great multitasker you are. Now. I'm not talking about the moms out there. And I, yes, yes. That's a whole nother world and I've seen it with my wife, but I'm talking about business owners, oh, I'm doing this, I'm doing this. I'm doing this. When they do that to me, they do it like they're bragging. And I go, why, why, why would you want to do that? You don't even like half the stuff you're doing. Why can't you get rid of it? And then we get back to the identity crisis. Well, I can't let it go. And there lies the issue. So focus having laser focus is like taking a magnifying glass to your business, letting the sun come in and dialing that energy. That is so strong. It can burn through wood. Speaker 2 (25:07): You have to have as an owner. And I've never met a successful business owner, entrepreneur, CEO that didn't have laser focus, never in any industry. Never because they couldn't be in that position. They couldn't have the level of success. I've met CEOs that their company wasn't great. Oh, they're all over the place. I've seen that plenty of times. So I don't necessarily what I had my practice. I didn't call myself the CEO. I couldn't get around that day. Those two corporate is it doesn't matter what you call yourself. Just think of yourself as you're the leader. This is your business. This is your thing. But it doesn't mean Karen that they have to do it all. No one said to dude, do it all. You're making this up. You're taking it all on. And it ain't working. If it was working, I'd be like, keep doing more, do more. Speaker 2 (26:07): Don't worry. We'll add more hours to the day. Do more. We'll take more time away from your family. Do more. It's not working. So focus. How do you, do you ever see the video? The invisible gorilla talk about focus, type invisible to grill. It's also called monkey business illusion. So here's what it is. There's six people, three in black shirts. I believe three. And white shirts. They're passing a basketball, right? And the, the, the exercise is count. How many passes? The white shirt? People throw to each other. That's it? That's all the directions is. I've seen it before. The first time I saw it at the end, the person goes, did you see it? And I'm like, see what? That was 18 passes. Yes. The number of passes were 18. Did you see the gorilla? And I went gorilla fricking no gorilla. There was a gorilla that come out. Speaker 2 (27:09): I'm gonna ruin it for people, but you have to see it. There is a grill that comes through the screen that starts dancing around and then walks off the screen. 50% of the people that see it, don't recognize it. Gorilla. This was a psychology experiment by, by the person that who the psychologist who did this. So being the smart Jamie, I just watched this the other day too. I've watched another version of it. Here's what's crazy. Of course. I saw the gorilla cause I was looking for the gorilla, but you know what? I didn't see. I didn't see the background completely changed colors. I didn't see one of the people that were passing the ball leave, like it's wild. What the brain is looking for the brain will see. So we have what's called and I don't want to get too technical here, but we have, what's called a bias. Our brain has a bias. Every single one of us, more specifically, it's called a negative bias. No matter how much we think we know, we can't think outside of our own bias. Speaker 2 (28:17): So the way you can kind of play with this a little bit is getting very clear at what you are focused on. Thinking through what you're focusing, then executing the plan. That's the only way to get through the bias except to have. And this is what I absolutely recommend. Someone else, someone else that's mentoring or coaching you, you don't know what you don't know and you never will, no matter how smart you think you are. And that's one of the problems we have because we are very smart people, but intellectually smart around physical therapy and anatomy. Yeah. That's great. But that's not going to help you with your business, right? So what you focus on, what you pay attention to grows. If you want more referrals, if you want more time than focus on the things that are going to help you do that. Speaker 2 (29:17): But the mindset shift is you have to be very honest with yourself. You have to ask yourself, do I like the results I'm getting? Do I like the income? Do I, I know we feel really weird about money and income, but it does pay the bills. Right? Can't pay the bills in likes, right? Oh, I got a thousand likes. Okay. Well how much you make nothing. Okay. You know, it does take money. It's okay to make money. What about time? Do you have control of your time? We call it freedom of time. Are you controlling your schedule? You're missing your kids' games. Are you missing events with your friends? Are you doing notes on the weekends? And so I was talking to someone yesterday, say, Jay, man, I do notes until 12 o'clock at night. I go, this is your business. And he goes, yeah, I'm working for a lunatic right now. Speaker 2 (30:06): Right. But that was kind of funny. So so that's, that's the thing. So I like to break it down for most of the committed clinicians and overwhelmed operators out there. 30 days, we, we have, we have a tool called a 30 day sprint. You can use that to 30 day goals. What's your goal for the next 30 days? Not 90, not a year, 30 days. What does it do you want to accomplish and choose one thing. Karen, just blend it because it's going to be hard for you to choose one because you're used to doing 20 and not achieving really any of them at least completed. So that's, that's an exercise that everyone can do. What area do you want to improve? Like I said, I gave you, I gave a bunch of examples. There's one, there's one code. I'm not monopolizing this conversation about, you know, that you're like, this is great. I have Jamie on 32 minutes. I'm like, thank you. Speaker 2 (31:06): I'm still answering the first question. Right? Henry David Thoreau. Great, great quote. It says it's not enough to be busy. So two are the ants. The question is what are you busy about? So by focusing more, you change your busy-ness to being intentional with what you're doing, that moves to being productive. The difference between productive and busiest productive is moving towards something that is desire busy. It's just activity. And there's a whole dopamine thing that we all have in our brain that, oh, but when I'm busy and I, I, you know, I take a post-it note and I throw it I feel so good about myself. I'm like, I know it's that quick dopamine hit that you achieve something. But the reality is you throw all of them away. You keep creating new ones and then you step back a little bit and you realize you haven't moved anywhere. Speaker 2 (32:02): You're still kind of doing the same stuff you were months ago or even years ago, you know? There's a, there's, there's, there's one more thing that we have, do we have time? Are we good? We're good. There's one more thing I wanna, I want to leave your audience with a growth mindset tip. And that is and this is probably now not probably it's the most important one and that is keep your tank full. And when I re referred to the proverbial gas tank, I'm referring to your energy level. We have all been in places where we are exhausted. Our energy is zapped. Our brain is fried and we just want to be left alone. If you have kids, you've been there many a times. If you have lots of patients, you've been there many a times. If you are running a business, you've been there many a times. If you've got annoying friends, you've been there many a times. Speaker 2 (33:05): And if something happens when you are in that state of just exhausting fed up, what's happening is your energy take low, near empty. A problem happens. How do you see that problem? Well, according to research in our beautiful little amygdala or my daughter calls it, the Amy, the gala, when emotion is high, such as when you're exhausted, fed up too much, intelligence is low. Your brain is hijacked. This goes back millions of years ago. When the Tiger's coming after you, you're not going to rationalize the tiger. Your body's going to go into overdrive and start running. However, what hasn't changed, even though we've transformed and we've we've, we've, we've, we've got all this new way. And in the neocortex, this is all old school brain stop. Something can happen. And you'll still get that feeling. You'll still get that emotional, like, oh my God, I got to react to something. Speaker 2 (34:12): And when your energy is low and your tank is low, you start to make really bad decisions. And when you make a bad decision with your friend, you yell at her, right? You yell at your friend, you yell at your kids, you yell at your spouse. You yell at your boyfriend and girlfriend, whoever you yell at people. And then later on you say, I wish it ends. I apologize. I shouldn't have said that. But when you make a bad decision in your business, oh boy, this is a decision that will, that could cost you thousands of dollars or tens of thousands. I've seen hundreds of thousands of dollars with literally one decision. It can cost you employees. It can cost you culture. It can cost you time and it can cost you a hell of a lot of frustration. Now imagine you're making these types of decisions, some grander than others, all the time, that's what's happening. Speaker 2 (35:10): Karen, we are making way too many decisions when our tank is well below halfway, and we're doing nothing to bring our take back up to full. What is a full tank? A full tank is your highest, most creative, innovative place. It's the place that you just feel on top of the world. It's the place of the highest level of confidence. It's the place that your friend says something stupid. And you're like, oh, you're foolish and come on. But that same person says something. When your tank is empty, you're going to bite our head off in business. You have someone asking you a question or someone coming to you for the umpteenth time that so w w if I want to take off next week, what do I have to do? And you just blow up on the person next day. You're like, yeah, yeah. You know, I'm sorry, whatever that person doesn't forget. Speaker 2 (36:09): Something like that. And when you start doing that and you start reacting, there's a difference between reacting and responding. Responding is what we do when the tank is full. Reacting is what we do when the tank is near empty. Reacting is an emotional response. Responding is a rational response. So what can we do? The fastest thing you can do when your tank is down is evoke physiology. What we do. So what's going to turn around deep breaths, count to 10, take 10 deep breaths. I guarantee whatever the problem is, it will subside. And you will think differently about it. Exercise. I know for me, when I exercise, God, I feel great, right? Anytime. And I've, I've, I've infused as I'm not perfect at it, but I've infused as, especially the last few years, especially last year during COVID when I think I might've come on here. Speaker 2 (37:20): And you're like, Jamie, what's the secret to dealing with. COVID pause. Just pause. Just stop. Just take care of yourself. Take care of your team. Like just personally. So I'm a great thing to do is don't make any decisions until after you exercise. I don't care if it's a walk. I don't care if it's, you know, basketball, I'll give it a round of golf. If you consider that exercise whatever it is running, you will think differently about the issue. If you have a problem with an employee, take some deep breaths and pause, do not address it in a high level of emotional state. This, if you just stop doing this so often, I will promise you, your business will get better. I promise because you'll just stop making these decisions that you don't even realize. We don't even realize we make these decisions, but then all of a sudden problems happen. Speaker 2 (38:16): And then we justify why. And I guarantee, at least with me, the justification was well, Jamie it's because you're in a high emotional state. That's why this problem. No, I started looking for someone to blame. I look for the prop, the answer to the problem, somewhere outside of where it really came from, that gets expensive. That causes you then to hire people you shouldn't hire to pay. I mean, I paid so much money in marketing and stuff like that. Why I was in a really bad emotional state. And I was just trying to solve it, writing a check on it. Wasn't it, it wasn't, it, it wasn't a rational thought through issue. And I did that again and again, and I did that with a lot of other problems too. So you know, when emotions are high intelligence is low. Karen, this is an opinion. Speaker 2 (39:09): This is a fact. We like facts as PTs. This is a fact. So pause 10 seconds, 10 deep breaths exercise before decision. And you don't have to wait for your, for your tank to get low. I know we do that. Like I'm, I'm one of those. Not only does the light come on, but that, that thing gotta be at the line. Or even below the line for me to go to the gas station. We can't do that with ourselves. When that thing gets around half, half full it's time, start, start doing some things, put this into your regular routine. Here's what I've learned over the years. I didn't realize this. So I started talking to a bunch of people around this particular point of keep your tank full. And I don't know the exact number, but it's overwhelmingly more than I would say, 80%. When you, when you get busier, when things get busier at work in the office, there's one thing that you sacrifice more than anything else. That's your, self-care you exercise. Normally you stop going to the gym, right? You do yoga, you stop it, you meditate, you stop it. You go, you stop. The thing that actually is keeping you sane and keeping you mentally strong and mentally fit. That's when you have to pause and saying, I'm the most important person in this company, my thinking and how I think about this business affects everyone in the business, including the staff and the patients and the community. So when I'm feeling like that, I know it's time to do some serious take care of me time. Speaker 1 (40:57): Yeah, absolutely. So now, if we start to, we'll start to kind of wrap things up here. So I just want to review some of the things that you said that physical therapy owners can do to kind of change their mindset around them being clinician, a PT an owner, to help them be successful. So you just talked about not making decisions on an empty tank or a near empty tank. We talked about changing we talked about some little like mindset tricks and tips and things like that. What else? Speaker 2 (41:40): Well, the, the three things that specific thing could be talked about, cause a lot of them have to do with that is growth mindset tip number one, the best is yet to come. The exercise for that is take 15, 20 minutes. You can, you can, you can handle that. Write down what the heck you want one year from today, one year from today, if you and I had a conversation and we were going to look back on to this moment, what would happen for you to feel happy about your business, about your bank account, about your family, about your personal life, what would you, what would have to happen? Write that down. I don't care if it happens or not. No, one's going to call you on it, but I want you to go through what it feels like to actually put that down on paper. Speaker 2 (42:27): Don't type it out on the computer. There's something special about writing it out on paper, right hand to paper. That's number one, that's number one, number two, focus, growth mindset. Number two, focus. What we focus, what we pay attention to grows. So what are you focused on? One thing for the next 30 days? What is one outcome? One goal that you want once you do that reverse engineer, that and then say, okay, in order to achieve that goal, what happens? What do I have to achieve this week? Say that exact line. What do I have to achieve for this week? Do that four weeks in a row. And I promise you, I promise you, call me out. If I'm wrong, you will be either hit the goal, go way past the goal or make significant progress, which you won't be is where you are. Excellent is the 80 tank. Speaker 2 (43:28): Keep your tank full. If you get into a high level of emotional state resist making decisions, or if you have to make a decision deep breaths count to 10 exercise, something that helps you increase your energy level. And then of course the second part of that is incorporate that on a regular basis every day, maybe a couple days a week, three days a week, but on a regular basis. And for whatever you do, no matter how busy and crazy life gets, do not sacrifice your time, your self care is the most important thing. There is you are not a hero by killing yourself. You don't strengthen the weak by weakening, the strong you killing and sacrificing yourself is not helping anyone. You don't need to do that. And then of course the overarching thing that we've talked about is, you know, some of the ideas around really thinking of yourself and considering yourself and talking about yourself as a business owner, right. If you're treating tree, that's great. But other than that, you own a business. Speaker 1 (44:49): Yeah. Perfect. All right. Where can people find you? Speaker 2 (44:55): Yeah, learn more. You can just go to my website practice freedom, U the letter u.com. I got some goodies on there. You can download my book on there. What I would recommend if people want to dive in deeper with me and, and just kind of, you know, you want to have a conversation. I am offering a, what we call a discovery call and we'll see kind of where you are mentally. We'll see where your mindset is. We'll see where your business is and we'll see if there's ways we can help you. We do have programs. We'll see if it's a, if it's the right fit for you, if not definitely give you some things that you can do in the meantime, maybe point you in some other directions. So you can go. I'm sure you'll put that in, but you can go to practice freedom, u.com/discovery call. Speaker 1 (45:41): Perfect. And yes, this will all be in the show notes at podcast out healthy, wealthy, smart.com under this episode. So last question, Jamie, what advice would you give to your younger self? Speaker 2 (45:53): Oh my God. Overcome your ego. Jamie it's okay. You don't know everything enlist. Some help invest in yourself, invest in your business. It will pay off dividends in the future. Not only to you, not only to your family, but for everyone that's around you, including your staff and community. Speaker 1 (46:15): Excellent advice. I love it. I love it. And I feel like you've given different pieces of advice each time you've been on very impressive. Cause I've asked this question before and the advice is always different, so well done. You so thanks so much for coming on and sharing. This was great advice for anyone who is a current owner or who's maybe thinking about becoming an entrepreneur. So I thank you very much. Speaker 2 (46:41): You're welcome. Thank you so much, Karen. Speaker 1 (46:42): Yeah. And everyone who's listening. Thanks so much for tuning in, have a great couple of days and stay healthy, wealthy and smart.  

In this episode, Co-President of the American Association of Pain Psychology, Dr. Rachel Zoffness, talks about treating chronic pain. Today, Rachel talks about the failed biomedical model, pain neuroscience, and effective non-pharmaceutical pain treatments. When is the right time to refer someone to a pain coach? What are some multidisciplinary approaches to pain management? Hear about the biopsychosocial nature of pain, how pain treatment in the US is actually about money, how thoughts and emotions affect pain, and The Pain Management Workbook, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “What science tells us is pain is not purely biomedical. It’s actually this different and more complex thing, which is biopsychosocial.” “Pain is complex, and doing one single thing over years and years that has not worked, is probably not the right way to go.” “Pain is never purely physical. It’s always also emotional.” “Unless we’re taking care of our thoughts and emotions, we’re actually not really treating this thing we call pain effectively.” “If it’s okay to go to soccer coach to get better at playing soccer, it is surely okay to go to a pain coach to get better at living with chronic pain.” “96% of medical schools in the US and Canada have zero dedicated compulsory pain education.” “Pain, by definition, is a subjective experience.” “Keep doing exactly what you’re doing and follow your gut. Trust your intuition, and know that following the path of the thing that you love is the thing that’s going to bring you to where you need to be professionally.”   More about Rachel Zoffness Dr. Rachel Zoffness is a pain psychologist and an Assistant Clinical Professor at the UCSF School of Medicine, where she teaches pain education for medical residents. She serves as pain education faculty at Dartmouth and completed a visiting professorship at Stanford University. Dr. Zoffness is the Co-President of the American Association of Pain Psychology, and serves on the board of the Society of Pediatric Pain Medicine. She is the author of The Pain Management Workbook, an integrative, evidence-based treatment protocol for adults living with chronic pain; and The Chronic Pain and Illness Workbook for Teens, the first pain workbook for youth. She also writes the Psychology Today column “Pain, Explained.” Dr. Zoffness is a 2021 Mayday Fellow and consults on the development of integrative pain programs around the world. She was trained at Brown University, Columbia University, UCSD, SDSU, NYU, and St. Luke's-Mt. Sinai Hospital.   Suggested Keywords Pain, Psychosocial, Emotional, Physical, Neuroscience, Treatment, Thoughts, Management, Healthy, Wealthy, Smart, Coach, Physiotherapy, Healing,   Dr. Zoffness Latest Podcast: Healing Our Pain Pandemic Dr. Zoffness’s Book: The Pain Management Workbook   To learn more, follow Rachel at: Website:          https://www.zoffness.com Twitter:            Dr. Zoffness Instagram:       @therealdoczoff LinkedIn:         Rachel Zoffness   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:                https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the full transcript here:  00:00 Okay, so whenever so I, you will know when we're recording because like I said, I'll do like I'll do a quick clap. And then I'll just say, hey, doctor's office. Welcome to the podcast and off we go. Okay, ready? Perfect. Okay. Hi, Dr. softness. Welcome to the podcast, I am excited to have you on today to talk about chronic pain and treating patients with chronic pain. So this is a real treat. So thanks for coming on. I think you are very cool. Karen Litzy. And I'm excited to be here. Excellent. So what I what we're going to talk about today, just so the listeners knows, we're going to talk about kind of treating chronic pain from a bio psychosocial standpoint versus a biomedical standpoint. So I know a lot of people have no idea what those terms mean. So doctor's office, would you mind filling in the listeners as to what a biomedical model is and what a bio psychosocial model is? to kind of set the tone for the rest of the podcast?   01:10 I totally Can I talk about this all the time, because it makes me so mad. Okay. So the biomedical model is the one that we all know the best, because it's the way we've been treating pain for many decades. And the biomedical model of treating pain and health in general, is essentially viewing and understanding and treating pain as a problem that is purely the result of bio biological or biomedical processes like tissue damage and system dysfunction, and on anatomical issues, and then throwing pills and procedures at it. That is how we've been treating pain for many decades. And of course, we know it isn't working, we have an opioid epidemic, the opioid epidemic is getting worse during the COVID pandemic. People are really suffering, chronic pain is on the rise. It's not being cured. It's not magically disappearing. incidence isn't even decreasing. So the way we're doing it is broken, and also very expensive for people living with pain. However, what science tells us is that pain is not purely biomedical. It has never been purely biomedical. It's actually this different and more complex thing, which surprises nobody, which is bio psychosocial, which is a big and complicated word, but makes intuitive sense, once we start talking about it, I think to people who have experienced pain, which means that yes, of course there are biological processes at work when we're living with pain, acute and chronic. And I can say what those mean to short term pain versus long term pain, longer term pain.   03:02 Yes, and there are also many other processes that work too. So if you imagine this Venn diagram of three overlapping bubbles, which I draw a lot, but I cannot draw right now, we've got the biological or the biomedical bubble on the top. And then we've got the psychological bubble. And that's the one that I struggle to explain to people the most, because I think there's so much stigma around this idea that cognitive and psychological processes might be involved in this experience we call pain because there's so much shame and embarrassment and stigma around anything to do with psychology, which is so unfortunate. But in this psychology bubble of pain, there's a lot of stuff that I think people know intuitively can amplify or reduce pain. So there's thoughts about your body and about your pain and just thoughts you're having about life in general. There's emotions, like stress and anxiety and depression, even suicidality. And we know that negative emotions amplify pain. And we know that positive emotions can sort of turn pain volume down, there's memories of past pain experiences. And those are stored in a part of your brain called the hippocampus. And we know research shows that memories of past pain experiences can change your current experience of pain. And also in the psychology bubble, we've got coping behaviors. So that's quite literally how you deal with the pain you have. And a lot of us who have lived with pain, and that does include me engage in a lot of coping behaviors that make sense in the moment. But actually, they can make pain feel worse over time. And a great example of that is the resting indefinitely plan or the doing nothing plan, as I like to call it which is totally, you know, normal and natural for those of us who pay into Engage in because when your body is telling you, you know that you're hurting, it's understandable that the thing you think you're supposed to do is stop all activity. But ultimately, what we know about that particular coping behavior is that it makes chronic pain in particular worse over time. So the do nothing plan or the stay home or rest indefinitely plan is a coping behavior that lives in the psychology bubble that can actually make pain feel worse. And of course, there's coping behaviors that can make pain feel less bad, like the counterintuitive things like leaving your house and seeing people and walking and getting out into the sunshine. And, you know, these things that we don't necessarily know can help pain. And then the third, overlapping bubble, and our bio, psychosocial Venn diagram, is the social or the sociological domain of pain. And that's what I like to call the everything else bubble. So it's socio economic status. And family and friends have culture and race and ethnicity and access to care, and socio economic status, and history of trauma and early adverse childhood experiences, and culture, and context. And environment, like quite literally, everything else your environment, believe it not changes the pain you feel. And in the middle of those three things, and I know that's a lot of things, is pain. So when we try and pretend that pain is just this simple biomedical thing, the treatments don't work. And I think all of us who have lived with pain know that our pain is much more complicated and sticky. I know that was a lot of words.   06:44 No, and, and I'm glad that you described everything in the way that you did, because I think that gives the listeners a really good idea of what's in each of those bubbles. Number one, and number two, how complex pain actually is. Exactly, it's not. So if I think if the listeners take away anything from this conversation, if pain is complex, and doing one single thing repeatedly over years, and years and years and years, that has not worked, it's probably not the right way to go.   07:15 That's right. And you know, the other misconception that we all understandably have is that, you know, the way to treat pain is just by going to your physician. And, of course, that makes perfect sense. But we have this misconception in western medicine, that either you have physical pain, and you see a physician, or you have emotional pain, and you go to a therapist, or a psychologist, someone like me, and the really fascinating thing about pain, and the reason I love studying it, and treating it and talking about it so much is that neuroscience tells us that pain is never purely physical, it's always also emotional, because the part of your brain called the limbic system actually processes pain 100% of the time. So pain is always both physical and emotional. But most people don't know that most people have never been told that. But the limbic system plays a huge role in the experience of pain. And we know that, you know, emotions are always changing pain volume all the time. So this idea that pain is either physical or emotional, is not actually a thing, you know, and the way we treat pain by going to a physician exclusively is not actually nine times out of 10, probably more than that going to actually, you know, be the answer for any sort of chronic pain problem.   08:37 And so I'm glad that you brought that up that yes, we know emotions play a role in pain. And as a matter of fact, the International Association for the Study of pain, change their definition of pain in 2019, I believe to include that it is an emotional experience. And I think that really set the stage for greater discussion and research, which I think is amazing. But when you say to someone,   09:05 let's see, can I interrupt the flow to say, they did change the definition, but the the word emotion was always in there? Oh, was it? It was? Okay.   09:16 Let me so when we talk about kind of the emotional part of pain, and I have had patients say this to me, which probably meant I was explaining it incorrectly, and I take full responsibility for that. And I'm sure you've heard this before his patients saying, so you're saying it's all in my head. Totally. And how do you react to that?   09:42 Yeah. I love that. You asked that question. I think probably the worst thing about being a pain psychologist is you know, you're the last stop on the train. You're the last person anyone wants to see nobody wants to go to a psychologist or a mental health professional for a physical experience like pain. And I know you can't see me, but I'm putting air quotes around the word physical. Because again, pain is not a purely physical experience. It's physical and emotional. But of course, no one wants to go to a pain psychologist for pain, right? You think you're supposed to go to a physician, and a referral to a psychologist means you must be crazy or mentally ill or the pain is on your head. And no, that's not what it means at all. And I find that the way that I most effectively target that is by explaining, believe it or not pain neuroscience. And I, I usually do that in the simplest way, I know how just by distilling down that, that, you know, it's easy to believe that pain is something that lives exclusively in the body, right? Like, if you have back pain, it's so easy to believe that that pain lives exclusively in your back. But what we know and what neuroscience has taught us is that actually, it's your brain working in concert with your body that's constructing this experience we call pain. And we know that because of this condition called phantom limb pain, wherein, you know, someone will lose a limb like an arm or a leg and will continue to feel terrible pain in the missing body part. And if pain lived exclusively in the body, no limb should mean no pain. So if you the fact that you can continue to have terrible leg pain, when you have no leg tells us that pain can't possibly live exclusively in the body. And I find that when I explain this to the patients who come see me, first of all, there's more buy in that the role of the brain in pain is really significant. And second of all, it sort of gives me some leverage to then explain that, again, one of the parts of the brain. And one of the most influential, influential parts of the brain that processes pain is your limbic system, which is your brain's emotion center. So unless we're taking care of your thoughts and emotions, we're actually not really treating this thing we call pain effectively, we're just treating one small component of it. So that's, you know, and I also always, by the way, validate that, of course, you have, you know, of course, it feels like someone's saying that the pain is on your head, or that it's a psychological problem. Because of this, again, this like false and ridiculous divide we have in western medicine between physical pain and emotional pain, when neuroscience has known for decades that that's not actually a real distinction, like your head is connected to your body 100% of the time, you know?   12:24 Yeah, absolutely. And as let's say, as a practitioner who's not a pain psychologist, a physical therapist, occupational therapist, maybe your yoga Pilates, and you are working with someone with persistent pain? How, how can we encourage our patients or recommend to our patients, that, hey, you might really benefit from seeing a pain psychologist, without them thinking that we're telling them they're crazy? Yeah.   12:57 I do think that taking 30 seconds, or maybe even 60, to explain, you know, this basic painter science thing. And the phantom limb thing is a really, really effective strategy. So anybody can use that. That piece of information. You don't have to be a pain psychologist. So that's thing one is just like taking a few moments to talk about how pain works in the brain. I think patients are so grateful to learn that no one's ever told them this before you're going to be the first person to ever let them know. And then the other thing that I always do is a trick that I learned from a really nerdy journal article I read years ago by a guy named Scott powers. And he said that one trick that we can use is to call pain psychologists or you know, therapists who are trained in things like cognitive behavioral therapy for pain, pain coaches, and I love that. So I usually tell physicians and other allied health professionals to refer to me as a pain coach. And the way I pitch that to families and tell other health care providers to pitch it to their patients is to say, if it's okay to go to a soccer coach, to get better at playing soccer, it is surely okay to go to a pain coach to get better at living with chronic pain. Because living with pain is so hard. And you deserve support. You know, and usually that removes the stigma and the stigma, especially when you present that in conjunction with some science that supports the role of the brain and the role of cognitions and the read the role of emotions and coping behaviors. In the experience of pain, I find that that really is super effective.   14:41 Yeah, that's really helpful and a great way to frame how to frame that recommendation to someone coming from someone like me coming from a PT because people often come to physical therapists I mean, it's in the name Because they want us to heal or to fix their physical problem, which in this case is persistent pain or chronic pain. And so then that leads me to my next question is, as a physical therapist or as someone who's working with the body, when do we refer this person to a pain coach or pain psychologist?   15:25 I'm curious to know what you're going to think of my answer. Ready? Here's my answer. I once had a friend who said to me, man, like, everyone's always going around talking about how many miles they ran today. And you know, how you like the Strava app, like, you know, how many miles they biked? And how many hours they did yoga this week? And can you imagine what it would be like if everybody, you know, came, came to each other and started bragging about how many hours they spent working on their shit? Like, what I spent three hours working on my anxiety today, or like my family stuff? Or like, my complicated relationship is, like, just why do we prioritize working on the body over working on our minds? You know, it's so strange. So my honest answer is if you're ever treating a patient who's living with chronic pain, and again, that's pain that's lasted three or more months, I think it's worth a referral to a pain psychologist or therapist who's trained in cognitive behavioral therapy. I just, I can't imagine any human being who wouldn't benefit from the opportunity to navigate the complicated experience that is living with pain and having someone in the role of support and coping behavior coach is just, you know, and partner and in processing, the experience of it just just seems to me like such a great gift to be able to give to patients.   16:51 And my answer to how I react to it is I agree. And, and again, this takes into a takes into account really this multi discipline, multi disciplinary approach to pain and approach to pain treatments and management. And so in your opinion, what makes that multidisciplinary approach effective for that patient?   17:20 I mean, what the research shows is that trying to approach and treat pain from just one angle is usually not sufficient, because as we were saying at the beginning, pain is such a complex, bio psychosocial thing. So if we're just looking at the biomedical components, we're not really doing our job, if we're just looking at the psychosocial components, we're not really doing our job. So, you know, a multidisciplinary team as a team made up of, you know, psychologists and pts, and OTS and physicians and nurses and biofeedback providers, and all these different people who are sort of coming at this complicated things from maybe slightly different angles and perspectives. And when we do that, what the research shows is, we have the most robust outcomes, the care is most effective, and the most comprehensive, and people walk away with a whole tool belt of tools to use when treating their pain, you know, across scenarios and across symptoms. So multi disciplinary is really like, how can we all come together as a team with our unique backgrounds and our unique training because, you know, as you know, trainings, especially in the United States, the disciplines are also siloed. You know, like, psychologists are trained in this one way, and pts are doing this thing over here. And OTS are over there. And anesthesiologists are over there as physiatrist. Or, I mean, it's just it's so fractured. So a multidisciplinary team is hopefully working together to target this complex animal that we call chronic pain. And what's really interesting is, you know, I have a private practice, where I see a lot of patients with chronic pain. But I feel like the bulk of my work sometimes is coordinating care with this really complicated treatment team. And I'm seeing a really complicated patient right now who has crps complex regional pain syndrome, which is a really tricky, chronic pain syndrome. And, you know, the way that we his case has been so complicated. It's been many years of treatment. And I think today as a team, we finally decided upon a treatment plan. And it really wasn't until we all were talking that that came together and jelled. So I think that's one of the most important components of treatment actually.   19:38 Yeah, I, I agree. And and when you're in private practice, like you said, sometimes it can be a little bit more difficult, but the more communication you have with people on that team, again, we're doing all of this for the person in the center and that's the patient and so being being able to provide vied so much coordinated care for that patient. Like you said, the research has shown that this is that this works versus a piecemeal, one person's doing this over here. And someone's doing this over here, and they're hearing, and then the patient's hearing contradictory treatment plans. And so it gets really confusing.   20:21 Yeah, it gets super confusing when there's, it's almost like too many cooks in the kitchen, if you're not working together, because they're getting all this different advice from all these different people. And oftentimes, and I'm sure you've seen this, too, they're on, you know, 40, they've tried 40 different medications by the time they've gotten to you. And, you know, I mean, I think what it leads to is like, this treatment, burnout, where like, our patients are just so burned out on all the treatments they've tried, and they have this sense of hopelessness, like, nothing's gonna work. Nothing's working. So far. I've tried all these things. I've seen 40,000 million doctors, and, you know, I've, yeah, I've tried herbs. And yeah,   20:58 I've heard that from people like, they're like, I don't want to go to one like I'm all doctored out, if I have to go see one more doctor, or take one more medication, or do one more procedure, or one more scan, like I'm done. I don't want to do this anymore. Yeah. And I blame them. Yeah, it's exhausting. It's totally exhausting. And you know, we've been talking about things that don't work. Right. So we talked about all that being on medication after medication, opioids, we know these, they don't work for people with chronic pain. So let's talk about non pharmacological treatments. And what does work or what can work for people with chronic pain, so I'll throw it over to you.   21:44 Yeah, so non pharmacological treatments, there's like a whole host of them, there's a wide range of them. And there's a lot of literature on a bunch of different things. So what I use the most in my practice, because I really love it and have found it to be so effective is cognitive behavioral therapy, or CBT, which is different by the way than CB, cb, D, that's something different CBT cognitive behavioral therapy. And an arm off of that is a treatment called Act, which is acceptance and Commitment Therapy, which is become very big in the PT world, which by the way, originated from CBT, and was adapted for pain. There, there's also Mindfulness Based Stress Reduction, or mbsr, which has a huge literature base for the treatment of chronic pain. And there's other things too, like biofeedback, I happen to really love as a treatment for pain. And there's a whole host of other things, too. But, yeah, God,   22:43 I was gonna say, could you explain briefly what biofeedback is so that people understand what that is? Exactly.   22:50 I'm so glad you asked. I've been doing this for so long that I forget. I just forget that. Certain things are not known entities. But I also did not know what biofeedback was when I first started treating chronic pain. And so I'll someone said to me, oh, you're treating patients with pain, you should refer them to biofeedback. And I said, You know, I don't refer my patients to things that I don't understand. So I did a buttload, of reading about biofeedback for pain, and I got a bunch of books. And then I found myself a biofeedback provider. And I went to this gentleman, his name is Dr. Eric pepper. Dr. Pepper is just a great name for any doctor. And He is a professor at the University of San Francisco and I admired him right away, he was obviously very smart. And he sat me down in a chair. And he hooked me up to this machine. And he said, This machine is going to read a bunch of your biological outputs, it's going to read muscle tension, galvanic skin response, your finger temperature, and a bunch of other things, your heart rate. And I was like, what that's really interesting. And he showed me which monitor was, you know, giving me feedback about which thing and hopefully you're picking up on the fact that there's biological processes that you're getting feedback about? And he said, and now I'm going to teach you to raise your finger temperature to 90 degrees, using your mind. And I said, Excuse me, sir. I am a scientist. And I do not believe in Voodoo. And he said, Well, how about you just try it out and see how it goes. So he did a couple of techniques with me had me close my eyes, he did some relaxation strategies, and diaphragmatic breathing, and he used imagery of like hot soup and hot air flowing down my arms from my shoulders into my fingertips, and autogenic training and autogenic phrases and that's when you say things to yourself that are suggestive like my arms are heavy and warm. My hands are heavy and warm. And as I was doing, as I was doing all these things, I noticed, because the machines were giving me feedback about my biology, that my hand temperature was going up. And within two sessions, I was able to warm my hands using my mind. And I am a person with chronically cold hands, because I'm stressed out all the time. And no one had ever told me that cold hands and feet, by the way, are a sign that you are stressed out. So I can now warm my hands on command, which is absolute magic. And when I teach it to my patients, they oftentimes say things like, Oh my god, I can make fireballs with my hands with my mind, what else can I do? And that's exactly what we want. For people living with pain, this idea that the mind and body are connected 100% of the time, and that you have more agency and control over your body than you thought you did. And you can make changes to formerly unconscious biological processes like skin temperature and muscle tension and pain. And biofeedback teaches you some skills to do that. Which is why I really like it so much.   26:13 Yeah, it sounds so like sci fi doctor who kind of stuff. Dr. Pepper. Exactly. Yeah, right. Exactly. Right. But yeah, it just sounds like Wait, what? But yes, I mean, I've never I have not done biofeedback myself, but it is something that I'm just constantly interested in for the exact reasons that you just said, like, Whoa, I can control what my body does. This is pretty cool.   26:41 It's worth it, I highly recommend it. It is so worth it. It's it makes you feel like, you know, it's this sense of like, if you almost feel like the Incredible Hulk like gotta have all this untapped power and potential that I just didn't even know about.   26:55 Yeah, it's, it's wild. Thank you for giving us that kind of definition of biofeedback, because I guarantee a lot of people who are listening did not know that at all. I didn't either, I totally didn't either. Very, very cool. So now, all of this, these non pharmacological treatments, CBT, a CT, biofeedback, we can maybe put physical therapy, occupational therapy into that as well. I mean, obviously, all of these things, cost the system money cost the patient money. But let's talk about the money aspect of treating pain, especially here in the United States. So what, you know, when people think about treat treatment of chronic pain, they often don't think about the money involved. So I will throw it over to you to kind of elaborate on that, and what does what that means for the patient and for the system.   27:52 You're actually making me realize that when you asked me about non farm approaches, I of course, immediately went to like, you know, like psychological treatments for pain. But yeah, of course, you're right, PT, OT, all these things, of course, are all the things and approaches. Yeah, absolutely. So yeah, it was a really sad day for me, when I realized that the treatment of pain historically has actually been about money. That was a really sad wake up call for me. So I used to be a member of this organization called the American pain society, it was very well established, very well known organization. And they went belly up after it came out. And I don't know if this is proven or not. But I should say, after they were accused of taking money from Big Pharma, to promote the use of opioids for the treatment of pain, despite the fact that it was known that opioids a were highly addictive, and habit forming and B sensitize the brain to pain over time and are therefore not actually effective. Because if you go off of them, as most people who have tried this, no, pain feels worse, your brain is actually more sensitive to pain. And so they went belly up, and they were, and then I read this book that was formative for me, by Anna Lemke. Le MBKE, who is now a friend of mine, called drug dealer, MD, drug dealer, MD, a very controversial and very compelling title. It is a thin, little book, I think it came out in 2016. If I'm not mistaken, I read it. Or I should say, I consumed it in a couple of hours. And I am not someone who writes in books. But I must have written on every page of this book. You must be joking. Oh Mfg. Like curse words and exclamation points. Because essentially, it's the story of how pain medicine has been about earning a buck off of people who are suffering and as we all know, with these lawsuits that are now how Like with the Sackler family and a lot of and also big pharma, you know, what we're learning is that despite the fact that these people and these companies have known for many, many years that opioids are highly addictive, highly habit forming not actually effective over time. And, you know, especially in high doses. Yeah, it's sort of this story of like, you know, follow the money. It's sort of horrifying. So, you know, I also have had conversations with physician colleagues who say things to me, it's a true story that, you know, it's clear that pain psychology plays a huge role in pain and pain management, and would be hugely helpful as with all of these psychosocial treatments, but that a lot of the times because insurance doesn't reimburse these treatments, they either don't get recommended, or they don't get integrated into pain management programs, even at hospitals sometimes, because insurance reimbursement is so crappy, which is just like another eye opening moment like we wait. So you're saying that, you know, these things work? You say that, you know, they're effective, but we're not recommending them and we're not hiring pain psychologists, because insurance doesn't reimburse. So again, it's a money thing. What? So the effective treatments are out there, they're known entities. But, you know, big pharma has billions of dollars to, you know, promote this idea that pain is a purely biomedical problem that requires a purely biomedical solution. So as long as you believe that you're going to buy into that model, and you know, as long as insurance companies are not reimbursing non farm approaches to pain, then you know, we're going to say stay stuck in this loop of treating pain, like a biomedical problem when we know it's a bio psychosocial one. So it's really complicated. Just this discovery that pain medicine has historically really been about the dollar. And it's sort of nauseating and horrifying.   31:56 Well, I mean, I think you can take away pain from that and just say medicine.   32:00 Yeah. Insert health condition here.   32:03 Yeah, yeah, I think it doesn't matter what it is, right? Because it's always going to come back to following the money and where, where can you get the biggest bang for your buck? And unfortunately, that, like you said, Those non pharmacological treatments are oftentimes not covered. So you're getting zero bang for your buck. So as a business, which a hospital is, even if it's not for profit, or an outpatient clinic, are you going to do things you're not going to get reimbursed for? Right, you know,   32:35 no, you know, that's true. And like, I don't mean to sound on empathic. Like, of course, yes, hospitals are businesses, and they have to stay open, and they have to earn money. So so the question for me, like, as I roll along, in this world of this totally insane world of pain medicine, and build my own business, by the way, like, how do we change the system? Like, yeah, we really are patient, patient centric, and like our goal, actually, at the end of the day, is to help our patients get well, what needs to change first, like, does public perception and understanding of pain need to change first? Like, do we need to be training our healthcare providers across disciplines better, like in PT, school, and in OT, school, and in psychology programs like mine, where By the way, I was in school for 40 100 years, and I got zero training and pain, like in my undergrad, brown neuroscience class, we learned about pain, and I became obsessed, and then like, wrote papers and stuff, but but that was it, like not, I have two master's degrees never learned about pain. At no point in my PhD program, did we get training and pain? So? So like, do we need to go, you know, backwards and insert pain education programs in medical schools? Yeah, I know, I know, you and I have talked about this, like the statistic that I'm obsessed with, like 96% of medical schools, in the united in the United States and Canada have zero dedicated compulsory pain education. So it's like, where do we start with this problem, isn't it? Do we like go after the insurance companies and reimbursement rates? where like, where the it's the system is so broken, I sometimes get discouraged, like, where do we start? But I think I actually think what you're doing is a really great place to start, like educating healthcare providers, and the general public about pain, and getting enough people riled up and angry about the way pain has been mistreated, and the way we're Miss educating our health care providers are just not even bothering. Maybe that's the place to start. Like maybe if there's enough of a clamor, and enough people are pissed off about it. Something will change.   34:38 Yeah. And and I agree, I think education, education, education, it has to start there. And especially in medicine, in medical school, especially with the physicians who are oftentimes they are the frontline providers, right, your your regular, your local PCP, primary care physician is often your frontline person and But they're also the people who were traditionally prescribing opioids for everyone, when they would come in with back pain instead of saying, Hmm, maybe maybe you need to see a physical therapist or a pain psychologist, let's sit down and talk to you. How can we let's find out what your needs are, what your bio psychosocial needs are. And so I think if, as the practitioner if you're not getting any education in that you don't know what you don't know. So you're not going to do it. And then I agree, I think, and I think insurance companies need to reimburse doctors and therapists across the board to talk to their patients. Talking doesn't get reimbursed procedures get reimbursed. Right. Right. What's the most important part of diagnosis when you're with a patient? talking to them, understanding what's going on with them, like that is paramount, and that needs to be reimbursed. But insurance companies won't do that they won't reimburse you for talking with your patient. Especially if you're like a PT, we get reimbursed by codes. And and none of those codes are, I'm going to really sit down and try and get into the nuts and bolts of what my patient's problem is. So   36:20 yeah, we need to code for pain, education, community, healthcare provider to patient.   36:25 Yeah, yeah. And some people say, Oh, you could use like the neuromuscular, neuromuscular treatment code for that. But there should be a code for let's talk to our patients, there should be a code for the subjective exam. Yep. Yeah. Oh, yeah. Because how were you supposed to learn about their bio psycho social situation, if you can't talk to them? And ask those probing questions, ask those open ended questions, like you said, In the beginning, bio, psychosocial, a lot of things go into that bucket. And we as the practitioners need to learn as much as we can about all those things that go into that bucket, if we're going to treat this patient efficiently.   37:10 There's so many things in the bucket. And I think, when we assess issues that have to do with pain, we really are assessing the biomedical bucket like 99% of the time. And, you know, if we really are thinking about this as this Venn diagram with three bubbles, if you're only assessing or looking at the biological domain of pain, you're literally missing two thirds of the pain problem. It's just wild to think about it that way. Yeah, if not more? Yeah, yeah, exactly more right now. So like, maybe all of us should be assessing for history of trauma. And maybe all of us should be assessing for aces, the adverse childhood experiences, which we know there's like this slew of studies that show that aces impact, you know, the development of chronic pain and illness and adults, maybe we should all be assessing for, you know, abuse and, you know, poor access to care. And just like so many things that we need to assess for if we're actually going to, you know, do a workup of pain, and instead of just this, you know, tell me about your anatomical issues. And let me do some scans.   38:14 Right, right, on a scale of zero to 10. How would your pain? Oh, it's a 10 out of 10? Well, this is like my little soapbox is what I hate. I see this a lot in physical therapy, student Facebook groups, things like that. Yep. And you know where I'm going with this? They'll say, Oh, well, if someone comes to me, and they're 10, out of 10, I'm going to call the ambulance because they must need to be in the emergency room. Poor education, that therapist was not educated on pain. No, I've not. No, that's wild. Yeah, I hear this all the time. Or those similar Sam 10 out of 10. It's a really, because if like I chopped your hand off, that would be 10 out of 10. So what's your pain now?   38:57 Right? Like this? Right? This lack of awareness that pain, by definition is a subjective human experience. And whatever your patient says it is, that is what it is. And you you actually don't get to argue with them about it. You don't negotiate down someone's pain. Right. And I mean, I think what I've learned over time about pain is there's really valuable clinical information when your patient tells you, like I hear a lot of times like 11 out of 10 literally what your patient is communicating to you is I can't handle this anymore. It's beyond my capacity to cope with this level of suffering. That is what they're saying to you. And usually also, at least for me as someone who really, really likes and appreciates the pain catastrophizing scale, the PCs, which is a potentially controversial term, some people don't like the term catastrophizing, I happen to appreciate it. I think it's very valuable, but don't want to go down that rabbit hole. But the pain catastrophizing scale, but they're also telling me is that when people tell me their pains, Out of 10 or an 11 out of 10, there's a high likelihood that their thoughts around their pain are very intense and catastrophic, and that they're having very intense emotions around their pain too. So it's good clinical information. You know, like you said, You can't bargain with someone about their pain number. Yes, we don't pain haggle. Right. Right. It's not like being at the market. No, like a price price that you get on fish. But but there's rich clinical information in there, if you're willing to, like, Listen for it, they're telling me that they're having an emotional experience that's beyond their ability to   40:37 navigate. Right to cope. And, and that's where I think like, I'll ask that question to all of my patients, because for me, that's my window to crawl in, and really get down to maybe the psycho or the social part of their pain experience. So like you said, if someone says to me, oh, my pain is like, it's at 12 out of 10. Today, and I'll say, Okay, well, can you tell me a little bit more about that? You know, what are you? What are you? What are your feelings around that? Or what's going on at home? What are your responsibilities at home? How does, you know? How does that play into why this pain is? 12? out of 10? Today, right? Right, you know, so it is, like, I always ask the question, but it's a nice way to kind of get in and be able to ask more questions. And, and just because someone says their pain is 12 out of 10, it doesn't mean you call the ambulance, they shouldn't be in the emergency room, they probably worked all day have to go home and have two kids to take care of. Yeah. And they're doing all of this at a 12 out of 10. because like you said, they've reached the end of their way to the ladder. And our job as clinicians is to increase their capacity to handle that. And how and to do that, like you said before, through a multidisciplinary approach to pain management is really the way to go. Because now you have more people who can add to that capacity. Yep. So anyway, that's my soapbox. I will come down stepping down from the soapbox. I appreciate your soapbox. I think Kevin, I'm Sherif share box, but it drives me crazy. Okay, so we talked a lot about different treatments. And I want to talk about treatment that you have created the pain management workbook. So let's talk about that. And how this book that you wrote, can help people who are experiencing pain.   42:40 One of the nicest emails I got in the last couple of weeks was from someone named Karen Litzy, who responded to my email and said that she really liked the pain management workbook and was referring to her patients. And I happen to admire Karen Litzy. So I was really flattered by that. So so the pain management workbook isn't on its own, like some new fangled treatment plan. But rather, I got really frustrated by what I felt like was a lack of resources out there for people living with pain, and also for healthcare providers. In particular, you know, I am a nerd, like a real nerd. And I think pain is just so interesting, and complex and fascinating that I have like, amassed all of these books and journal articles and, you know, resources. But I felt like there really wasn't something that synthesized it in language that all of us can understand and easily give to our patients. So I took a lot of stuff that I loved and was reading, like there's a book called pain, the science of suffering, that I happen to really love. And there's all this work by Lorimer, Moseley, and Adrian low in the PT world, I happen to really love the way I love the language they use for explaining pain. And there's all this neuroscience literature out there that I think is so fascinating and so useful, like melzack, and walls, gate control, theory of pain, and all the things that have evolved from there. You know, and there's all these workbooks on cognitive behavioral therapy for pain, but I couldn't find something that, in my mind, put together all of it into one resource that, you know, anybody with pain can pick up and use right away and use have exercises and guided audio and handouts and all that stuff. So So I wanted to create something that was very user friendly, and I felt like especially during COVID, having accessible and affordable resources could not be more important because here we are talking about how pain at the end of the day is often about money and care is so expensive, and you know, cognitive behavioral therapy and these other things that are not easily or readily reimbursed, end up costing families and patients, sometimes many 1000s of dollars and it should Then be that way. So I literally took everything I was doing in my practice, and everything I was reading and stuck it in a workbook. So it's a lot of pain education. And I have to say, you know, a big thanks to Lorimer Moseley, and Adrian Lowe, who both of them were kind enough to agree to read through my pain education content and give me feedback and consultations and edits, which was like, so kind, and they didn't even charge me anything. And I offered to pay them both. And I wish they had taken my money. But yeah, I wanted them to vet the content. So there's this pain education piece, and then it's a series of chapters of tools. So, you know, again, affordable, accessible care isn't just, by the way, here's how pain works. It's now what can I do about it? So I wanted to make sure that I was offering, like a tool belt of options for healthcare providers to offer their patients like here are 17 different pain management strategies that have evidence of effectiveness that come straight out of the literature, you know, pick a few that work for you, whether it's mindfulness or using guided imagery, or, you know, cognitive strategies, or, you know, sleep hygiene and nutritional tips, like, how do we put this all together to create a unique pain management plan for each one of our unique patients who walk through our door with a unique profile of suffering. So that's how that happened. And I should also say that the book almost did not happen, because my deadline was in 2020, which, as everyone knows, was a shit show of the year. My, my bandwidth was zero, I would sit down to edit, you know, my lovely publishers would send me a couple of chapters, and they'd say, here are some edits, go ahead and make some changes. And I like, couldn't even read through the work I had written, I like my brain just was on overdrive. And I was trying to process what it meant that we were in the middle of a global pandemic. And I sent them an email, and I was like, you guys, I don't think I can do it. So the book almost didn't happen. But in December, it was actually shockingly painstakingly born. So I'm more proud of it than anything I've ever done. I don't know if anyone will ever read it. But I, I'm very proud of it. So I hope it's of use to health care providers to people living with pain.   47:21 Yeah, absolutely. And is this only for adults.   47:25 So the pain management workbook I wrote in language that's usable for everybody. I mean, it's not only for adults, it's. So the book I actually wrote first is called the chronic pain and illness workbook for teens. So it has a lot of similar content, but I wrote it for kids, because there just isn't anything out there for kids. And there's even less for health care providers who are working with kids with pain. So this is adapted from that it has like twice as much content, I would say and is expanded content. So the pain management workbook is sort of intended to be for everybody. And the chronic pain and illness workbook for teens is more specifically for kids in the health care providers working with them. But I've been told by people who just have that book that they have used it successfully with adult patients, too. So   48:14 yeah, so excellent. And where can people find all of this and find you if they want to get in touch with you? They have questions. They want the book, they just want to chat, where can they find you.   48:24 So the pain management workbook. And the chronic pain and illness workbook for teens are both on Amazon. And they're like 20 bucks, which is so much less expensive than around of cognitive behavioral therapy. But I do recommend oftentimes to healthcare providers that they offer the book to their patients, and then offer to go through it with them. Because it's just so nice to have a pain coach to be going through a treatment protocol with. But of course, it can be used as a self help book, you know, on your own. I   48:50 just like love that. I   48:51 love the supportive model. So yeah, there are those are on Amazon. And yeah, I have a really dorky website that has a ton of resources on it. It's just my last name. It's softness, calm. And there's a resources page with like, apps and websites and books and podcasts and guided audio and all sorts of stuff for people living with pain and their healthcare providers. And I also joined Twitter during the pandemic, because I don't know, it seemed like social media was where everybody was, and I couldn't see any of my friends and I couldn't go to conferences. I couldn't have conversations with cool people like you. So I joined Twitter and Twitter, my Twitter handle is at doctors office. That's been really interesting and fun. It's been a really interesting platform. That's I think that's actually how I found you. And then I'm also on Instagram where I post some pain education content too. And that's at the real Doc's off, because I couldn't think of a better name and I got really nervous because social media makes me nervous. So   49:49 well, at least now people know where to find you. How to get in touch with you where to get your book. So this is great. This was a great talk. I you know, I could keep going on and on and on too. about this, I could do like a 10 hour podcast, just on on pain alone. Because it's something I'm passionate about. And it's there's just not enough good information out there for people to access. So hopefully people listening to this will then access some of your resources and education, education education right. Now, before we end, I have one last question for you. And that's knowing where you are now in your life. And in your career, what advice would you give to your younger self?   50:33 What advice would I give to my younger self? Oh, wow, you know, the advice I would give to my younger self is keep doing exactly what you're doing and follow your gut. And trust your intuition and know that following the path of the thing that you love is the thing that's going to bring you to the place you need to be professionally. Like, I wanted to live at the intersection of medicine and psychology, and education and science writing. And I couldn't figure out how to do that. So I had all these different jobs. You know, I was like, a science teacher at the Wildlife Conservation Society. And I was a science writer at a Science Magazine, and I worked at the NYU child Study Center, and I got a PhD and I just couldn't, but but I think, you know, organically what happened over time, just from following my passion, my like, actual passion is that I was able to do all these things. So now I have a private practice. And I'm seeing patients, and I'm writing books. And I have a column in Psychology Today called pain explained where I do a lot of science writing about pain, and I'm teaching pain education at Dartmouth, and at UCSF, which I deeply, deeply love because I get to connect with physicians and other health care providers. And, you know, it's just sort of the it is sort of naturally and organically, exactly what I feel like I was called to do you put it out, you put it out into the universe, and it happened. Yeah, I mean, but not without a lot of trial and tribulation. But I think I would just tell my younger self to trust your gut and trust your instinct and you you actually are on the right path. If you're doing something that you love, you are on the right path, even if you don't know   52:09 Excellent advice. Well, Rachel, thank you so much for coming on the podcast and chatting today. I really appreciate it and I appreciate you. So thank you so much. Thank you for having me. Absolutely. And everyone. Thank you so much for listening, have a great couple of days and stay healthy, wealthy and smart.

In this episode, CEO and Founder of The Bold Leadership Revolution, Tara Newman, talks about creating a better relationship with money. Today, Tara talks about Profit First, her EMS Framework, the common blocks that women face, and helping women feel more comfortable talking and thinking about money. How do you raise your rates? How do we shift our energy without losing money? Hear about startup burnout, improving your relationship with money, and get Tara’s advice to her younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways Profit First helps women make and keep more money. “I’m really passionate about teaching women to change the way they think, and even talk, about sales.” The EMS Framework: Energy. What is the energy in which you’re approaching sales? Mindset. What is your beliefs and attitudes around sales? Strategy. This is your sales process, and how you come at it with your energy and mindset. “When we feel good, good things happen.” “Shifting your energy and feeling good does not actually have to cost a dime.” “Selling is about empathy. Women are empathetic. Women are fantastic listeners. They ask great questions. These are all the things that being a good salesperson encompasses.” “The secret to sales is to keep going.” “It’s okay to be uncomfortable. It’s okay just to listen.” “Women think that they need to be perfect in order to make money.” “I hear from a lot of women that they don’t feel safe with money. We were never taught how to make it, manage it, keep it, and use it for growth reasons.” “There is nothing more frustrating than wanting to do good work in the world, and not having anybody to do that work with or for.” “Raising your rates is actually easy. Can you communicate the value and not the amount?” “Don’t take yourself so seriously. Be weird. Be yourself. That’s what people want. People buy from people.”   More about Tara Newman Through her podcast, The Bold Leadership Revolution, as well as her association, The Bold Profit Academy, Tara Newman is the Leader of Leaders. She supports leaders as they embrace their ambition and leave the grind behind. Using decades of entrepreneurial experience and a Master’s in Organizational Psycholgy, Tara is uniquely qualified to teach leaders to run businesses without sacrificing their health, relationships, or integrity by establishing behaviours, habits, and rituals aligned with their vision of success.   Suggested Keywords Sales, Leadership, Money, Income, Lessons, EMS, Energy, Mindset, Strategy, Profit First, Responsibility, Relationship, Communication, Expectations, Healthy, Wealthy, Smart   Revenue Goal Calculator: Profit First Revenue Goal Calculator   To learn more, follow Tara at: Website:          https://theboldleadershiprevolution.com Facebook:       The Bold Leadership Revolution Instagram:       @thetaranewman LinkedIn:         Tara Newman   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:                https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the full transcript here:  Speaker 1 (00:02): Hey, Tara, welcome to the podcast. I am happy to have you on. Speaker 2 (00:05): Thanks for having me, Karen. I'm excited to be here Speaker 1 (00:08): And I will say right when I got on the call. So you can't see this everyone because it's a podcast, but we both have the same rode podcaster microphone. So it's like, this is destiny, but I have a question Speaker 2 (00:23): Because I think I know why we have the same ones by any chance. Did Jason help you set up your podcasting stuff or did you ask him for it? Speaker 1 (00:32): You know, and we're talking about Jason van Orden, did he? No, no. I just did a lot of research and I went to be my gosh. Speaker 2 (00:40): He is like the King of podcast equipment. Yeah. So see, maybe he helped you. I know, I think I got my, this suggestion from him. Speaker 1 (00:48): Yeah. I think I just looked around, I went to BNH and I asked them like, this is what I'm doing. BNH photo is a big store here in New York city. And I said, Oh, I'm debating between like, what's the other one that everyone uses the Yeti. Yeah. The Yeti and the route. And they were like, no, you want the rode podcaster? And I was like, I'll spend the money. I'll do it. I'm going to do it. So so yes, when we came on, I was like, Oh my gosh. And then of course we have all these people in common as well. I guess just a New York thing. I don't know. I know, but you sound less new Yorker than me. Well, I'm originally from Pennsylvania, so that explains it. That could explain it. But I was telling Tara when Tara, when we got on that, I saw her speak at Tricia Brooks speaker salon a couple of years ago, year and a half ago. And I thought to myself, Ooh, I like her mental note, like reach out to her for the podcast. And then, you know, 2020 came and, well, we all know what happened there that we do. We all know what happened there. So I feel like I already know you, but now it's a chance for the listeners to get to know you. So let's get into it before we start. Can you give the listeners just a little bit more about you about kind of why you do what you do? Speaker 2 (02:13): Oh yeah, sure. That's like a, a loaded question. I feel like I could talk about that forever, but I really teach female business owners how to increase their sales so they can have more cashflow and they can have more profit in a way that's simple and without as much stress, because I know that, you know, when I'm working with women business owners, they're usually really amazing at what they do and they're experts and they love it. And they're passionate about it, but they're not as passionate about running a business and I'm actually passionate about the running the business part and the sales part. So it winds up being like a fantastic Speaker 1 (02:55): Partnership. And I will also add that you're also profit first consultant now in my business group that I ran with physical therapists. That was the first book. I said, you have to read this book. Right. And so now this is not a profit first based podcast or anything like that. And we're going to go into a little bit more, but what, what was that like to become a consultant from profit first? Did you read the book and it changed your business? How did that come about? Speaker 2 (03:26): So I actually read the book in 2014 when it first came out before, like right before I started my business, but I wasn't, it's not an easy book to read to be honest. And I think like when I read it, I didn't really read it. Like I dabbled, I think my husband read it. And, and so I didn't actually fully read the book until after I was certified, but I had implemented profit first ish in my business in 2006 teen. And it really changed everything. It made things so much easier. I used to have plenty of revenue coming in, but the cash wasn't there, like the cashflow was off. So I get really stuck. And I remember being in a mastermind and being in my hot seat and just being like, I have no money. So that's really why I love profit first is because it really helps women keep, make and keep more money. And I think that we don't think about that when we start out, we think about like, we have this great idea. We love what we do. And it's like gangbusters out the door and then it's like, Oh wait, like there's this money component. Speaker 1 (04:38): Absolutely. And especially with women, it seems like and I, I know I'm this way. I hear this from people it's Oh, well, it's, it's the charging part. It's how do you bring up to people? What your, what your fees are and, Oh, I feel weird about it. And that the money issue, especially with women can be really sticky. I'm sure you found that. That's why you do what you do. Speaker 2 (05:06): It is really sticky. And you know, we weren't, a lot of us weren't raised with the language for money, especially for me, I'm a gen X-er, I'm 44 years old. My mom stayed home most of the time. She didn't go to work outside the home until later. And, you know, I always say like, women, women come to me and they're meeting me like 15 years into my journey leading them. And so they don't realize that I started exactly where they started. You know, even when I first started my business, that was the first time I was really responsible for my own money. I always tell people, I'm like, I'm so embarrassed. But like, even from before my husband and I were married, I just used to hand him my paycheck and be like, just pay the bills and deal with it. So that was like a really rude awakening when I started my business and my own. And that's really why I've become so passionate, not just about profit, but about helping women sell. Speaker 1 (06:04): Yeah. And, and let's get into that because you have created a framework inside the bold profit Academy, which is part one of the offerings that you have to help women and their relationship with money. And it's called the EMS framework. So we know it's not emergency medical services. I Googled that. It's not it. So what is the EMS framework? Speaker 2 (06:31): I always joke around though and say it's equally important. So the Amis framework, I'm really passionate about teaching women to change the way they think and even talk about sales, right? The way we have absorbed sales and the framing and the lens through which we look at sales is, is actually not really in alignment for a lot of women. Right? And they, you mentioned some of the challenges that they have, like asking for their rate or understanding their value or not having the confidence to have those conversations, not knowing how to have those conversations. They've never been taught. And if you were anything actually like me and my husband, when we first started our first business, we didn't even realize we have to sell things. And what happened was, is we went out of business. Well, I guess we might make sense. And we went bankrupt. Speaker 2 (07:30): Right, right. And we didn't even realize we needed to sell. So ever since then we have made it kind of really a part of our mission is to help people learn from the lessons that we learned. So I've created the EMS framework and it stands for energy mindset and strategy in that order. So what is the energy in which you're approaching sales? Is it desperation? Is it fear? Is it, you know, tense and gripping what's happening with your energy and how can we get you to shift that energy before you even do anything else? And then it's like, what is your mindset around sales? Is it that you don't believe you can sell? Maybe you don't believe you have the personality of a salesperson. Maybe you don't believe that, you know, how any of those things, what are your beliefs and your attitudes is in the mindset piece. And then in the strategy piece, that's your actual sales process. And honestly, any process will work. They're like the same seven steps, all that jazz, but it's how you come at it from your energy and your mindset that makes that the strategic action that you're going to take in your sales process. So much more powerful and potent. Speaker 1 (08:47): And what are some common things that you're coaching your clients through? Let's start with energy, right? What are some common energy blocks that women have and how do you help them get over it? Speaker 2 (09:03): So I think it's one, and I wouldn't say it's necessarily a block. I think it's our conditioning. Do you believe you deserve to feel good as a woman? Like, do you like, do women have this belief that they should, Speaker 1 (09:15): And I have to think about it. So I saw you, right. Speaker 2 (09:21): Because when we feel good, good things happen. And when we feel good, we're more confident when we feel good, we have a better self concept. You know, Brian, Tracy, he's a sales you know, well-known sales trainer. And he just says like, can you just say in the mirror, I like myself, but that's so hard for people to do, especially women to stand there and be like, I actually liked myself. Right. But when you can do that with your self concept and how you see yourself in the energy and what you bring to things that changes everything. Speaker 1 (09:53): Absolutely. And it's, isn't it sad that I had to think about that. I'm like, yeah, I think I deserve good stuff, but it shouldn't be, I really struggle with it Speaker 2 (10:03): That w they struggle with like, feeling joy and pleasure and enjoyment and just good. Right. And it's not fake good. It's not coping in wishing good. It's like, and it's not even like, what's your morning routine, but everyday when you wake up, what are you doing for your energy? Speaker 1 (10:26): Is this a question? No, I'm just [inaudible] Oh, no. What am I doing? Well, what, one thing I do that actually does help with my energy is I get up in the morning and I make my bed first thing. And that actually helps with my energy Speaker 2 (10:44): A hundred percent. Right. And I think you bring up such a great point, because when I talk about this in the, in the framework, what I want women to hear is it doesn't have to cost to me shifting your energy and feeling good does not actually have to cost a dime. It doesn't have to take a long period of time. You know, you can do it at any point during the day, you know, depending on what you're feeling and where you're at. And so if you, if everyone can just wake up in the morning and think to themselves, you know, what am I doing to care for my energy? What am I doing to feel good today? Speaker 1 (11:20): And, and that's a big, that's a very powerful shift, especially in these times when everything there's like tension on top of tension on top of tension. And you know, a lot of people that listen to this podcast are physical therapists. There are health and wellness professionals, and it's, it's stressful, you know? And so being able to do one thing that doesn't cost any more money, it may cost you a tiny bit of time. Not a lot. It takes me two minutes to make my bed in the morning, but I feel like, all right, I've accomplished something. This is good. Speaker 2 (11:56): And Speaker 1 (11:59): When it comes to, so let's say, you've, you, you are working on your energy. And that obviously flows right into the mindset part of things. Right. And oftentimes, you know, you hear a lot of women say, Oh, I don't want to like sell things. Cause it just feels like icky. I don't want to be like that used car salesman, quote unquote. And that is a mindset issue, right? Speaker 2 (12:24): Yeah. I mean, those are your beliefs that you have around, around selling. And so what I like to do is I like to reframe things. So for example, I'll hear somebody say, Oh, I need to create this opt-in so I can lore people in yeah. Loring people. And these are human beings, right? Like you're welcoming people and you're inviting them in, you're sharing something with them that can help them. And the funny thing is, is like women, I think are so naturally gifted salespeople. They just do all the things that great salespeople do it. We just haven't been presented that like, when you think of, of amazing salespeople, I just mentioned Brian, Tracy, right? Like he's a dude in there. There are really great, amazing women salespeople, but there are fewer. And the ones that maybe we think of right off the bat, or like the used car salesman, I hate going a Bob's to buy a couch. No, like that just doesn't work for me. But I think too, like thinking about when you've been, when you've had somebody sell something to you and it's felt really good to kind of shift that perception and to reframe that is really helpful as well. So not looking for the reasons to believe selling is icky, slimy, sleazy, smarmy, whatever your words are for it. And, and finding the examples of it being done really well. Speaker 1 (13:50): And do you have examples of people doing it like women in particular who are doing it very well? Speaker 2 (14:00): So I can share with you the reason why I think women will sell Stu sells really well. So it's about selling is about empathy and that completely gets missed, especially in the online business space, or like as soon as you like flip open an app and there are all these internet marketers swarming about or anything like that, you, you know, you see it in the health, the health and wellness field, it's, it's gross. It's, flat-out gross. The way that people, and I think they just particularly happen to prey on people's pain, specifically women. So we tend to see it as not feeling good. But women are empathetic. Women are fantastic listeners. They ask great questions. These are all the things that being a good salesperson in campuses. Yeah. It's not so Speaker 1 (14:52): Much the sort of vomit all over the person. This is what I do, and this is what I can offer. But instead, it's you doing a little less talking and doing a little more listening. Speaker 2 (15:05): Exactly. Exactly. So from my perspective, when we have women in the bold profit Academy and we're teaching them how to sell, we're not teaching them how to do anything different than they're already doing. We're teaching them to leverage the things that already come natural to them. And they experience success so much more quickly because we're not actually asking them to change their behavior. Speaker 1 (15:30): Right. You're just, you're kind of putting this obviously into a framework, but almost into a, I don't want to say a script, but into an outline, is that the right or no Speaker 2 (15:46): Going to correct you slightly. So the way we do things in the bull profit Academy is through frameworks. And the reason why we pick frameworks is because it gives you a guideline and then you can take that and adopt that to itself. So I'm saying to you, energy is important. You, yoga might be it for you or like throwing around heavy weights might be it for you. Or, you know, I love my Peloton, but someone else might do something else. Right. Someone might not choose to do anything physical, you know? So because I love Peloton, I take Tuneday's classes and she always says she has, I'm giving the class of classes, the recipe, and then you season to taste. And so that's why we do frameworks, because like I said, in the beginning, women business owners, any business owner goes into business because they love what they do. Right. And they're passionate about being the expert that they are. And sometimes the business piece doesn't excite them as much. So we give them a lot of frameworks and templates for them to customize in their business to do that heavy lifting Speaker 1 (16:50): Yeah. Template. That's the word I was searching for. It was not coming into my head template. Listen, and I will tell you the people who listen to this podcast, we love that kind of stuff. We love that. Having a little structure around things, you know, we're, we're a little more kind of type a like, let, give me some structure and I'll run with it. And so how has this EMS framework, how does it impact daily sales habits for small business owners for these female entrepreneurs? Speaker 2 (17:22): Okay. So there's your secret about sales? I'm not one for telling secrets, but there's a secret. The secret to sales is to keep going. So the whole point of the EMS framework is to build resiliency because if you're taking care of your energy and you're looking at your mindset before you take the strategic action, that's resiliency. So when you wake up in the morning and tired and you think, what can I do for my energy to get me to feel good? Right? You're not just rushing into your strategic tasks, feeling like hell and then burning yourself out or, or feeling like poop, right? Like you're, you're actually feeling, you're always feeling good and you're always able to move forward. You're always fueled up and really taking care of yourself so you can keep going. And that consistency is what brings in what brings in the sales and fills your pipeline. Speaker 1 (18:22): And I think you hit on something really important and it's that burnout. And I hear that a lot, especially from women who are just starting their business. They're like, I don't, I feel like I'm already burned out and I haven't even started yet. Right. I haven't even gotten out there. I haven't done the sales yet. I haven't. And I'm already burnt out. So how do you coach those women? What do you, Speaker 2 (18:46): I'm sure they come to you, but that I just actually posted on Instagram. I want to be, I'm going to host be hosting a free conversation around women and business and what I'm calling a global crisis of fatigue among women. The number one reason why women come to me is fatigue, tired, feeling like poo, whatever it is, right? Because we have been conditioned to jump through every hoop imaginable for our success. Women's sex women and success. It hasn't typically come easy. We're the first ones to raise our hands were the first ones to volunteer. We are the first, you know, we do a tremendous amount of unpaid labor throughout our, throughout our lives. And we're exhausted. And then we get into our business and we think that we don't know anything. We think we're doing it wrong. We think that you know, we should be doing it differently. Speaker 2 (19:55): The marketing messages start to come in preying on the fact that women want financial freedom, but have the things like I'm not good enough. I don't see my value. I'm not con right. Like if you, if you really think it's insidious and it's gross. And so what happens is, is there's more hoops. Well, now I need to go take this training and now I need to go take this course. And now I need to go do more. And if it's not happening fast enough, I must not be doing enough. And if it's not right, all the time over and over and over again. And none of that is true. Speaker 1 (20:28): And I have thought that all the time, I still think that all the time, Oh, maybe I should take this course, or maybe I should do this, or maybe I should. And yeah, it's, it is. And it is gross, but it is, it's hard to get that out of your head, because like you said, we've been conditioned you and, and you'll find this really interesting as a fellow podcaster. Talking about that sort of conditioning of how we, we just don't think we're good enough. A, a, a physical therapist or a physio from, from Europe said, how come, how come? I don't see a lot of women as guests on podcasts. I don't understand if we're in a profession that's 60, some percent women. How come all the podcasts are men? How come all the podcasts are hosted by men? Where are all the women? Speaker 1 (21:23): And, and and so a pod, a male podcaster, I guess, sent she's like, well, we asked 30 women, 20 of them said no, and five never got back to us. And, and so I think to myself, this is a tough nut to crack. Is it exactly what you said? I don't know anything. Is it all, this is it. They don't have time because they're raising kids, they have to do this. They have to work. And then I brought up, well, maybe it's a way they were asked because I will ask people to come on and I have had women sad, and I don't know what I would talk about. And I said, well, I wouldn't ask you to come on the podcast. If I didn't think you had something to talk about. So I coached them through and we work on a podcast together. Right. And, and so, I don't know. What are your thoughts on this? I mean, you're a podcaster. Speaker 2 (22:11): So I think, I think that there's, there's a lot of, there's a lot of things that could be at play here. However, what I do know for sure is women who are experts, don't see themselves as experts, right? Women don't see their value, and that's why they struggle to make sales present themselves. And this is whether you're in your own business or whether you're working as a professional in somebody else's business. Right. And so I know that they struggled to see their value and they struggled to see their con like that they're good enough for that contribution. I, myself, when I was first starting out in my business, I turned down oppor opportunities that I was referred for, where people were like, no tower, you need to go and do this consulting gig. And so I do some corporate consulting as well. And I was like, Oh, that company's too big. Or the topic they're asking, I don't feel confident enough on. And you know, I think that's part of, what's keeping women in a, in a financial bracket. That's, that's not sufficient. Speaker 1 (23:15): And what do we, what do we do? What do we do? That's the big question, right? What's your best advice on that? What, like, what do you tell your ladies? Speaker 2 (23:27): So I think what's important about this is that I started a couple of years ago in the mastermind that I run, where we had a quarterly money date that we just got together and we talked about money and we do this in the bull profit Academy as well. And it's okay to be uncomfortable. It's okay. Just to listen, I have had women sit on these calls, looking like they were going to vomit. That's how uncomfortable they were. But I think you have to have these conversations with the right people who understand all that's there around money. And that it's actually not about your mindset, because that's what people get told that this is, Oh, this is your money mindset. You're in scarcity. Yeah. That's why. Yeah. Right. No, that's a marketing message. I mean, yes. Women feel scarcity, but you know, I think that there's a lot to unpack around how we think about money from a generational standpoint, from a societal standpoint, from a racial standpoint, like there are so many intersections when it comes to money, you know, you know, my dad, my dad, my dad's a business owner too. Speaker 2 (24:47): And he laughs at me sometimes when I start to get a little tight fisted, because he's like, you're just being a refugee Tara. This is like the refugee in our family. Like, cause my grandmother fled Poland and it like in 1920 and he's like, you're not in the shuttle anymore, Tara, like you can, you know, and I'm like, that's right. Like they do. I, I, you know, we, we feel that way and it's not always ours that we're carrying, like our parents have passed down messages or grandparents have passed down messages, society. We don't have the language for money. We feel shame around it so much shame around money. Women think that they need to be perfect in order to make money. They think they have to have the perfect family to be successful. They think they have the perfect marriage. They think. I mean they, the stories. Right. And I think that if you can find a safe environment to talk about that so much more and get that support as possible. Speaker 1 (25:42): Yeah. I think that's wonderful, wonderful advice for, for people out there and it doesn't have to be formal. I mean, you can have like a group of, of girlfriends or fellow entrepreneurs that you've, that you trust and that you feel, you can talk about these issues with, because it is hard and I'm gen X as well. And it's the same thing. My mom, wasn't working for most of my childhood and then went back to work a little bit later. And, and it is, there is this, Oh, I don't know if I deserve to make that much money or I don't know, Oh, this seems expensive. Or if I run things even by my parents or something like, Ooh, that seems like a lot, Oh, I, how could you charge so much? How could, and so those messages get stuck in the brain, you know? So it, it does take a lot of work to get that unstuck. Speaker 2 (26:36): I will also say, this is where profit first comes in really handy because it gives you language for money. And it gives you a system for money that if you just do the steps and you just do the system, it takes a lot of I find any system in any structure calms. My nervous system makes like literally my nervous system calms down. And so having that structure for my money calms my nervous system way down and allows me to approach my money from a much different perspective. Speaker 1 (27:10): Yeah. We, in the PT world, we would call that a SIM, which stands for safety in me. So throughout your day, you have Sims, which are safeties in me or dims, which are dangers in me and from a pain science standpoint it is hypothesized that the more dims you have during your day then Sims, you may feel more pain, especially if you're a chronic pain suffer. So we try and have those have more Sims introduced into, into one's life to outpace the dims. That's actually really good. Speaker 2 (27:40): Interesting, because I hear from a lot of women that they feel, they don't feel safe with money. They don't feel responsible with money. We were never taught how to make it, manage it, keep it, and use it to for growth reasons. Like those were things that were not, that were not taught to us. Speaker 1 (27:59): Yeah. And I, I will say like using profit first using that system, I started using that a couple of years ago and I was like, Oh, I do have money. Oh, I see how it works. Oh, when it comes to paying my taxes, I'm not stressed out. Like I turned my quarterly taxes up, it's right there and I just pay it. And it's so like, I feel like so light and I do have a history of chronic neck pain. And, and I will say, this is for me a big, it's like a super SIM for me, because I don't feel that anxiety and stress and around tax time, because I know it's there, I've already done it. It's true. And, and it just makes such a huge difference, but you're right. There is that conversation needs to be had for women around their safety, with money and with sales and with, with confidence around all of that. It's hard. And the thing that's so Speaker 2 (29:03): Interesting about women too, is that they do such a great job suffering in silence. I'm sure you see this. Speaker 1 (29:09): Yeah, yeah. Right. Yeah. Right. Speaker 2 (29:14): Bring in silence and not asking for help. You know, not wanting to receive support. I know a lot of women that I work with feel like they need to know it all or they need to get it all right. Speaker 1 (29:27): Yeah. No, you hit it. You hit the nail on the head before when you said it has to be perfect before I do something. And that was me for years and years, if I'm going to put a program out, it has to be perfect. I have to have, it's all planned out, needs to be perfect. And it doesn't not at all. And it doesn't. And just having, knowing that was very freeing. Speaker 2 (29:50): Yeah. I watch I watch women put a lot of obstacles in their way and, and I know I get that. We do that for self protection. Yeah. To feel safe, to, you know, to, to not fail to, you know, not look silly or foolish or whatever our stuff is. And at the same time we really need to get on with that. Yeah. And we need to find a way to be courageous and brave now more than ever Speaker 1 (30:25): Agreed. Agreed. It's just, yeah. And what would you say to people who are like, Oh, it's so daunting. I'm just not even going to bother. Speaker 3 (30:33): Yeah. Speaker 2 (30:36): Well, I mean, we can have a conversation around what's that costing you [inaudible], you know, and, you know, peel back the layers to that because I can guarantee you that, you know, that's affecting you in ways beyond which you're even able to conceptualize because you're, you're shutting it down and you're closed off. I mean, ultimately people have to be willing to do this and which is why, you know, around the work that I do, it's really important to me to always reiterate to people. It's okay. To be scared. It's okay. If a spreadsheet feels intimidating it's it's okay, like, please don't overthink this, please. Don't overcomplicate this. I am giving this to you the way it is so that all you have to do. I do, we do a lot, like a lot of it in the bowl profit Academy, we do a lot of calculators that like just takes all of the, all of that stuff out of it. Right? Like that charge that, all that charge out of it. If I could just remove all of the barriers and all of the obstacles, I will do that. Speaker 1 (31:50): Yeah. And that's what I think that's what women need, you know, it's what we need to feel good is to say, how can you take away using the analogy? So before, can you take away some of those hoops? Speaker 2 (32:04): Yep. Yeah. Don't don't you dare go into your money without checking on your energy first and your mindset. Do your EMS before you look at your money. Speaker 1 (32:15): Yeah. And that's, that is good advice because we we've all gone into our bank account when I did it the other day, which has happened. What's just happened here. And, and whether that be good or bad. Right. but, but you're right. You have to use that energy that in order to, to get into the sales process, to make money, to help more people, right. Like you said, women want to get into business so they can help people. Well, guess what, if you don't have a good framework what's going to happen. Speaker 2 (32:53): There is nothing more frustrating than wanting to do good work in the world and not having anybody to do that. Good work with her for I have been there. Yeah. Speaker 1 (33:06): And it's an, and then that can lead to this sort of demoralizing mindset. The, I failed. I can't do it well. Oh, well, I was, this is, this is, I'm done. Speaker 2 (33:17): Well, here's where women, here's where women go. I must be charging too much. Yes. So I'm just going to lower my prices. But the reality is, is we just need to up our skillset. Speaker 1 (33:31): Yeah. And, and I I'm guilty of that. I've certainly done that in the past. I'm like, Oh, I'll just, Oh, well maybe I'll just lower the rate. And that will get more people to come in. And it doesn't, it doesn't Speaker 2 (33:45): No, because then you're looking at perceived value of what you're selling. Right. People will be like, why is she, so why is she so cheap? Right. Speaker 1 (33:54): Yeah, absolutely. Absolutely Speaker 2 (33:56): Not know what she's doing. She must not be confident. That's Speaker 1 (34:00): So true. And, and I try, and you know, a lot of physical therapists now are, are sort of using an out of network model or a cash based model where the person pays you up front. And, and it is hard for women to raise their rates. Men are like, after six months, I raised my rate by $50. Oh, I raised it again. No problem. No problem. Women are like, so how do you, what do you say to someone who's like, I can't raise my rates. Speaker 2 (34:29): All right. So there's like the practical piece complex. I mean, it isn't, it's not, so I think there's a couple of things at play. I think if you think that you can't raise your rates, raising your rates is actually easy. You change the number, you put it on your, your chart or your website, right. I mean like the actual act of raising your rates is easy. Maybe we need to do some talking around like how much should you raise them to and whatever. But the reality is is can you communicate the value and, and not the amount, it's not about the amount, it's about the value. And it's about understanding how to talk to people, have a sales conversation and overcome whatever concerns they have around that. So it's, it's not actually a price issue. It's again, it's are you comfortable with selling issue? Yeah. Speaker 1 (35:27): Yeah. And that's like you said, where the listening and the empathy and stuff, that women are so good at any way that they're probably doing naturally, they just don't know it. They just need a framework. They just need a little bit of guidance. Speaker 2 (35:38): Think about someone who, who, or something you've just bought recently. And like, you just couldn't wait to buy it or you couldn't wait to give them your money. Right. Like why, what happened? What was that conversation like? And inspect that because someone is, is like excited and can't wait to give you their money, you know? Gosh, if somebody's back is bothering them. Or I had sciatica last year, that was like my worst hell ever. So, you know, I would have paid millions of dollars for someone to make that go away. It wouldn't have even mattered. I wouldn't even cared if you were like, I can help. You'll be like, awesome. Speaker 1 (36:13): Yeah. And, and I hear that so many times over and over again from people who are not physical therapist or not health and wellness professionals. And I think it's, I love that you said that because I think it will give the people a little more confidence. Speaker 2 (36:30): Yeah. I mean, if you're, if a lot of your audiences like physical therapists and chiropractors, I will tell you that, like I had, I've worked with a couple of chiropractors and they're like, I went to the chiropractor convention, I'm going to be facetious and silly. I went to the chiropractor convention and I came out with this 4,000 page manual on how to run my back office and my front office and all this stuff. And I'm like, great. So what are you going to do to actually stand out? Because the 5,000 other people that went with you got the same 4,000 page manual. And so I find a lot with health practitioners that I work with, they really it's beneficial to get outside of that health practitioner loop and, and, and look to find strategies from other industries talk to people who are outside that industry. Speaker 1 (37:23): Yeah. Yeah. Great advice. I Speaker 2 (37:25): Mean, that's with any industry, but I just specifically know sometimes that, you know, or, or in health industry too, you, you tend to have a lot of regulations and quote unquote rules. Right. So you'd get very stuck in like, well, the regulation, the regulation, the regulation. And so I sometimes come in and I'm like, Speaker 4 (37:47): Is that really the regulation? Speaker 1 (37:54): But yeah, it is that, that is true. There are some perimeters from which we have to work around, but you can still work around them and be successful and, and have a better relationship with money, which is all, you know, what we're talking about here today is just to how to have a better relationship with money and how to not be afraid of it and how to move forward with your business, knowing that it's, it's part of business. Yup. Period. When we take it personally, but it's business, it's business. Yeah. It's business. And now before we wrap up, is there anything that maybe I over or that we didn't cover that you're like, Oh, I really want to, I really want the listeners to know this. Speaker 2 (38:43): I think we really we really covered a lot. Actually. We talk a lot, we talked a lot about money and sales, which is so exciting to me cause I can talk about that forever and ever and days. Speaker 1 (38:56): Well, speaking of which, where can people find out more about you to learn about when you're, when you have events and learn about your programs and follow you on social media and all that fun stuff. Speaker 2 (39:08): Okay. So the first thing that I want everybody to do is I have a resource for your crew. So if they go to the bold leadership revolution.com forward slash resources, I have a revenue goal calculator that actually you plug in your personal information, it tells you based on how much you need to make to cover your expenses. It tells you how much revenue you need in your business. And it'll plot it out with profit first. It is nifty Speaker 1 (39:39): Amazing. And we'll have that link in the show notes. Speaker 2 (39:44): Yup. I like to hang out on Instagram. So I'm at the Tara Newman and I have a podcast, the bold money revolution. Speaker 1 (39:51): Awesome. So Tara, last question, knowing where you are now in life and in career, what advice would you give to your younger self? Speaker 2 (40:03): Hmm. Don't take yourself so seriously. I'm a serious person. Like I could be super serious. And I think like if I had to do it all over again, just like be weird, you know, be yourself. That's what people want is people buy from people, right? Like you're humans are out there and they want to work with you and they want to know you in all your weirdness and all the things like just be you it's, it's really that simple. Speaker 1 (40:34): Yeah. And I remember having this conversation with someone else on the podcast and said, you know, you want to be the Flamingo in a sea of penguins Speaker 2 (40:45): For sure. Speaker 1 (40:46): Because there's like you said, there's someone out there who's looking for you for you. And if you're like everyone else they're going to miss you. Speaker 2 (40:54): They, yes, there are people who are out there. And I think here's the thing when you beat, when you're more, you, you S like other people feel seen. And when you tell your story and you can connect with people, like just super quick, I just had a recent ADHD diagnosis at 44. And I, when I was like, Oh, I think I need to get an evaluation done. I went and we went to listen to the whole bunch of podcasts and I just typed in ADHD. And there were all these women podcasters with ADHD, and I would listen him. And I would cry because I didn't know how to, I was so normalizing what was not normal, but I lived with it my whole life. And I didn't know. And them sharing their story helped me see, like, what was normal, what wasn't normal, what I needed to talk to my doctor about places where I could be releasing guilt that I felt about things. And so I think it's just so important. Speaker 1 (41:59): Yeah. And thank you for sharing that. That's so, so powerful for for people to know that there are others out there going through the same thing and that yes, you're seen in your herd. And I think that's a great way to end the podcast. So thank you so much, Tara, for coming on, and I really appreciate it. And I can tell you that all the listeners do too. Speaker 2 (42:21): Thank you so much for having me Speaker 1 (42:23): And everyone. Thanks so much for listening in today. Have a great week and stay healthy, wealthy and smart.  

In this episode, Physical Therapist in Detroit, Ted DeChane, talks about his experience living with Long Covid. Today, Ted talks about his Long Covid timeline (including attempts to return to baseline, his relapses, and his work), the Long Covid Physio group, and the mental aspect of managing Long Covid. How has Ted adapted his life and work around Long Covid? What is the most common question people ask him about Long Covid? Hear about the importance of peer support and shared experience, the role of Physio in managing Long Covid, and how cognitive and emotional fatigue can set off Long Covid, and get his advice to his younger self, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Long Covid in itself is not caused by anxiety, depression, and those things, but they certainly do exist.” “Finding the things that help you get through the day is really important.” “If you don’t allow yourself that pacing, that rest, you’re going to be forced into it.” “It’s so much more than just the physical aspect of having Covid. Emotional and cognitive overload can cause these physical symptoms as well.” “We [physios] can play a huge role in the Long Covid epidemic.” “Sometimes these symptoms can come days later.” “Helping them [patients] log what’s triggering their relapses is helpful.” “If youre interacting with people with Long Covid, just have a little sensitivity around some of these questions. They can be triggering, and they can be stressful, and can be something that can increase symptoms of Long Covid.” “10% of people who are diagnosed with Covid may have Long Covid symptoms.” “Don’t be so rigid in your box of knowledge. What you learn in PT school is great, but there’s so much more out there. Be open to things you haven’t heard of or things that don’t fit what you’ve heard.” “It’s okay to step outside your box and look at something from a different lens. Even if it doesn’t quite make sense yet, be open and willing to learn about something a little different.”   More about Ted DeChane Ted DeChane is a physical therapist in the Detroit area specializing in pediatric therapy. He covers multiple settings including school-based, outpatient, and acute care. Ted became ill with COVID-19 in March of 2020, and continues to experience persistent symptoms. As part of the Long Covid Physio group, he has contributed to podcasts, articles, and peer outreach.   Suggested Keywords Covid, Long Covid, Physical Therapy, Physiotherapy, Recovery, Mental Health, Support, Fatigue, Symptoms, Adaptation, Relapses, Healthy, Wealthy, Smart,   Resources: Ted - “Living and Working with COVID.” Uncharted: Patient Experience With Long COVID   Round Table Talks: Round Table Talks   To learn more, follow Ted at: Website:          https://longcovid.physio                         https://teddechane.wixsite.com Twitter:            @TedDeChaneDPT                         @LongCOVIDPhysio Instagram:       @longcovid.physio LinkedIn:         Ted DeChane   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the full transcript here:  00:02 Hey, Ted, welcome to the podcast. I am happy to have you on this month as we're talking all about long COVID. So welcome.   00:10 Yeah, thank you for having excited to be able to talk about it. Okay, so   00:15 let's start out with the basic question. What is your interest in long COVID?   00:22 Yeah, unfortunately, it's kind of been thrust upon me, it wasn't something I chose to be a part of. I became ill with COVID symptoms in March of 2020. right at the beginning of the pandemic, I work in an acute care hospital in the Detroit area, which was a early hot spot, so hard to say where how I contracted it. But regardless, I did, and I had the pretty classic textbook COVID-19, acute phase, cough, fever fatigue, lasted about probably two to three weeks, that initial acute phase, and I had recovered mostly so I thought, went back to work back to exercising back to running, living, all those things and just couldn't, couldn't quite get back to where I wanted to be and was pre illness. I had just been suffering from fatigue, and since some heart rate issues, inability to tolerate exercise, and it was beyond the kind of normal deconditioning. You know, I've been in and out of running for years. So I knew that, you know, when you first get back into it, it's not always fun or pleasant. But it wasn't that normal, fun or not fun or not pleasant feeling it was this, just complete debilitation, you know, laying on the couch in a dark room, couldn't even tolerate sitting up kind of thing. And that's when I initially knew that something was wrong and started reaching out to healthcare professionals. My own health care professionals couldn't really give me an answer. It was unheard of at that point, that early on. But I connected through Twitter of all places with some other people who were experiencing nearly identical thing that I was. And that's when we kind of realized that this was a bigger problem than it had seemed to be initially. So that's kind of where we, especially a group of physical therapists got together and kind of began bouncing ideas and symptoms and trial and error off of each other and realized what was working, what wasn't working. And it was through that, that we kind of became this long COVID physio group to try to help each other initially and then realized that we needed to start helping others as well. So that's kind of how I got involved in the long COVID. process.   02:50 And it must have been quite scary in the beginning, because like you said, the doctors didn't know no one knows. So very early on. Do you remember when that diagnosis of long COVID symptoms or you know, being diagnosed with lung COVID? When When did that happen? Like what was the timeline on that?   03:14 Yeah, it's definitely a fuzzy gray area in the beginning, you know, I was sick in March, God, quote, unquote, better April, May. And then June is end of May, early June, is when I really began trying to pick up the running, I was like, Okay, I have to get going. You know, it's time I've been down for a month and a half now. And that's kind of when my gears started turning that it wasn't right. It wasn't until probably October or November that for me the phrase long COVID really hit home and, and I kind of gathered that that's what was going on. So it, it took a long time for me to realize for others to realize that this wasn't right. It's not, you know, expected progression of what we thought was supposed to happen.   04:03 Yeah. And I think Daria echoed a lot of what you just said, in that she was like, I just wanted to get back to running. I'm a PT, so I'm just going to use graded exercise. And that did not work.   04:15 Yeah, it's, it was really kind of a mindset shift. When you when you really get down to it, you know, we as pts we know that we need to go or we think we need to go I should should correct myself. You know, we thought that's what we had to do. And we tried it and we we did not it didn't work. So yeah, that really clued me especially in that, you know, this wasn't right, you know, as pts where we're supposed to be the experts at monitoring Response to Intervention so that I just, you know, it's hard. It's easy to do in when you're monitoring a patient's response to intervention, but when you're kind of monitoring your own, it really was another hurdle to cross to accept that. You know, I Can't do these things right now. So   05:02 and you know, dari and I also talked about that mental aspect aspect of it, and how, gosh, so challenging? So what what have you done around your mental health and the mental aspect of living with long COVID that maybe you can give advice to others?   05:20 Yeah, that's a really important part of it is the mental health aspect. You know, we always stress that there is can be a lot of anxiety, depression, fear over a long coat COVID in general, but especially long COVID diagnosis. But we also want to emphasize that that is usually a secondary issue, you know, you know, long COVID in itself is not caused by anxiety, depression, those things, but they certainly do exist. And it's, it would be remiss to, to not mention them. For me, personally, you know, there was a long time where you kind of get that dark cloud over you, and you think, am I ever going to get better, and I still have those days, to be quite honest. But, you know, I think just focusing, and thinking about the positives, and the gains that I have made, personally, has really helped me. You know, I, I see it a lot on my Twitter and my Facebook history timeline coming up, especially this time, on my runs that I did, and all my failed runs that I did, and you know, even not going to work some days not getting off the couch some days, and those days are less than less than less now. So really looking back where I was, and where I am now is, it's been really important for me, to see that there is progress being made. It's it's not linear, it's not quick, but it's there. So that has helped me personally kind of get through that. But in addition, the peer support has been really instrumental, um, that we've created kind of through long COVID physio, there's a whole group of us who kind of have a very similar mindset, a very similar training, and a very similar experience. So we can all kind of commiserate and, and vent when we need to, but also pick each other up when we need to share resources, those kind of things. So finding that group has really been helpful.   07:09 Excellent. Yeah, finding that having someone who's gone through what you've gone through, or is currently going through, that peer support can be so so helpful. And we'll have a link to long COVID physio in the show notes for this episode for anyone who wants to learn more about what you guys are doing, and maybe they need the support themselves. So we'll have a link to that. And now you said something. Just before about some days, you can go to work, you can't get off the couch. So let's talk about how one can adapt to living with long COVID because we got to do things, right. I mean, most of us have to work or most of us have to do things around the home or with family and friends, etc. So can you talk about adapting all of that while living with long COVID?   08:04 Yeah, initially, that was really tough thing for me to do. And even still, it is a very tough thing to do, especially as pts, we have a very active physical job. Regardless of what setting you work in acute outpatient, you know, I'm in pediatrics, as well as acute care. So there's a lot of up and down moving, running, note taking cognitive, mental, emotional exertion that's going on, and all those things can trigger these long COVID crashes, relapses, post exertional malaise, whatever your name of choice is. So finding the things that help you get through the day is really important. Some of the things that a lot of us have found helpful. pacing is a big one. So you really have to look at your day, how can you chunk it up and kind of take things minute by minute, which is, again, hard to do when there's productivity demands and billing demands, and maybe you're a clinic owner, and you're, you know, relying on that income. So that is a really hard thing to do. But it's so important. And I always say that if you don't allow yourself that pacing, that rest, you're going to be forced into it. So it's better to do your best to plan around it rather than let the kind of disease process do it dictate it for you. So, you know, if I think I'm going to push through this week, and I'm, you know, going to make my productivity while the next week, I might have to take two days off work and then I'm not helping anyone. So, you know, really accepting the fact that you do have to listen to your body and rest when you need to and, and make the accommodations at work, whether it's building in an extra break, or maybe you need to do your charting in a dark room. You know, maybe there's a half hour in the day where you can just lie down on a mat table in a treatment room and have you know, 1520 minutes You know, no stimulation, it's really about finding those things in your day that make make it easier. So you can last, you know, through a day through a week through, you know, a month kind of thing?   10:14 And how would you suggest someone have this conversation with their supervisor, Boss owner of the clinic they work at, because you obviously have to have cooperation with the people that you work for. Now, if you're your own boss, I guess that's a different story, you can probably, you know, kind of set your schedule accordingly, maybe, but what advice do you have for people who maybe have to have these difficult conversations with their employers?   10:42 Yeah, it's, it's a really tough place to be in for the employee, and also the employer, you know, they have a budget to make to, I get why they, you know, set these demands, but at the end of the day, you really just have to be open and honest with them, and your co workers about what's going on, what your needs are, how you how you need the accommodations, you know, that's a struggle a lot of people are having, especially in the US, we don't have a lot of options, as far as you know, paid time off. You know, in the UK, there's, there's union representation, which we don't have in the US, generally speaking as a profession. So it's really important that you can connect with your boss and explain the importance of the, the needs for accommodation. You know, we do know of a few people who have been successful kind of navigating the, you know, short term, Long Term Disability here in the US under like a chronic fatigue type diagnosis. So that may be a route you have to take, if you're finding trouble getting these accommodations, obviously, try to find a, you know, physician who is supportive of your long COVID and the needs for the documentation that you might need for that. You know, but I, I'm fortunate enough that I have, you know, administration who has supported me, and I think that's do a lot in part A to them, thankfully, but also, you know, just to the open and honest dialogue that you have with them, and explaining the needs and how putting in these needs now can save you some time later. You know, so that it's beneficial to everybody.   12:26 Got it? Yeah, great advice. So just being open and honest with your communication with your supervisor, employer, etc, would be your best advice to people who maybe are living with long COVID and don't know how they're going to get through the week.   12:41 Yeah, you know, hopefully, that route works, obviously, there's going to be places where that isn't going to work, where you might need to escalate. In addition, you know, finding co workers who are supportive, you know, maybe you have a close coworker that you can confide in and kind of help you through the process. You know, I kind of had a funny story when I was kind of navigating my own long COVID process. I had a co worker who texted me and she said, Are you feeling okay, today? And I said, Actually, no, you know, how did you know because I thought I was holding it together. And she's like, Well, I can tell whenever you're not feeling well, because your voice gets deeper. And I just thought, Oh, that's really cool that she was able to notice that, because I didn't even notice that. So, so finding a co worker who you can lean on, and maybe they can, you know, help you through things, if you have a difficult patient you need help with or you say, Hey, I have to take the afternoon off, can you help cover some of these patients? So it's not, you know, such a burden on the clinic, kind of thing, just building those relationships, and being open and honest about it.   13:41 Yeah, makes perfect sense. And you sort of touched on something that I want to highlight. And that is when people think of long COVID and they think of pacing, they think of the physical pacing. Right. So moving your body pacing, but you also touched upon and I would love for you to go into a little bit more the cognitive and emotional fatigue that can also set off long COVID So could you explain that for the listeners?   14:11 Yeah, that's a really difficult piece to manage, because it's not as black and white as some of the physical things that happen. But a lot of us, including myself have noticed that with increased cognitive load, you know, we have the same physical symptoms that we would if we were to run a mile you know, just maybe we had a really hard case we needed to critically think through or or, you know, in my case, I was doing a lot of spreadsheets over the summer we were doing some budgeting things and normally that would not have been a problem for me but I just and this was before I even realized what was going on. You know, I was having struggling with these spreadsheets and and that kind of would set me back and and I would have to shut the computer off and and take a step back in a day off and Um, so those things we don't really realize are adding to the stress of our mind and our body. You know, the documentation and screen time, if you're doing a lot of notes on your computer, or you're doing virtual sessions kind of thing that can really fatigue your body and give you a lot of the same symptoms as physical would. Are you muted there, Karen?   15:25 Yep, sorry, I was just saying kind of unbelievable, right? Because it's like, it's so much more than just the physical aspect of having COVID. It's, you know, people talk about brain fog. And they, they talk about fatigue, but knowing that just emotional and cognitive overload can cause these physical symptoms as well. And I think that's something that a lot of people are not aware of.   16:04 Yeah, and I think a lot of people have set themselves back thinking they're doing a great job pacing and not realizing that they're still carrying the emotional load of their patients, or maybe there's something going on at home a relationship issue, you know, family stress, things like that can can add to your total body fatigue, and that's. So when you look at your, your work day or your home day, you also have to include that piece too. So like, for me, one thing that I found difficult was bouncing back between patient care and documentation, just the back and forth was like a lot for me to get my brain switched into like documentation mode, and then back to patient mode. So, you know, for me, what I found helpful is actually kind of, you know, doing a few patients in a row, and then then going and doing a couple notes at a time, rather than where I would normally do you know, a patient, a note, a patient a note. So everyone's different, that might not work for somebody. So it's really finding that balance of how you can navigate doing your job, but also not being a detriment to your own health.   17:15 Yeah, so it sounds like a little bit of trial and error until you kind of find that sweet spot.   17:21 Exactly. And that's kind of what we tried to learn from each other in this peer support group is, hey, what worked for you? Because I might like to try that. So   17:30 make sense. Now, let's talk about the physios role when it comes to long COVID. So where do we fit into this recovery in this puzzle?   17:41 Yeah, I think we can play a huge role in in the long COVID. epidemic, if you want to call it that, because that's what it will become if it isn't already. I am fortunate enough to not have to be treating these patients right now, especially in pediatrics, there is cases of lung COVID. In kids, it's not as prevalent. Unfortunately, I've not had to deal with that. But as physios, we are spending a lot of time with patients, more so than most, any other health care provider, you know, we have the knowledge of pacing and, and monitoring, medical status. And I think we need to use that. So being a part of the pacing process for patients I think would be good because that is a cognitive tool for someone to sit down and plan out their day. So if you can kind of help them be there to guide their day, just as you would a patient who has, you know, hip replacement or cardiac surgery, you would you would be the person to help plan their day out to make them the most efficient. So that's something you could also as a PT, and do for a long COVID patient being the one to help them through that. But But in addition, you know, as I kind of mentioned in my intro, that response to intervention is so important and what sets us apart from other providers is that we we can pay attention to what's going on. You know, and make sure that our treatment isn't a thing that's doing harm and causing the post exertional malaise or symptom exacerbation. And it's really important to look through that through a lens of not immediate either sometimes these symptoms can come days or later. So think of it more like delayed onset muscle soreness, you know, you might do a treatment on Monday, they may be fine Tuesday and Wednesday and then Thursday, all the sudden they flare up. Well, it could have been your treatment on Monday that caused that. So it's important to recognize and do a look back at each session, you know what happened kind of thing to kind of help help the patient progress because if they're going into these crashes, they're not progressing. They're regressing so it's important to progress rather than regress.   19:55 Yeah, so it sounds like it's a lot of on the physios part, certainly education. to the patient. And and I really love how you said you can help them set up their, their pacing schedules, you know, you can be the person, you You said you have the long COVID group to bounce ideas off of, well, you can be this person to help them bounce ideas off of right?   20:16 Yeah, exactly. They might not have a peer support group that they found, you know, or they might be overwhelming for them to go to a peer support group. So for you to be the patient, or the person to say, hey, let's sit down and say, Okay, so the shower is an issue for you. Well, how can we fix that maybe you need to sit down when you shower, maybe you need to shower in the evening, something like that, you know, trialing and airing with them. And you're helping them log what's what's causing and triggering their relapses is super helpful.   20:48 Yeah, I think that is great advice for any physio, who is going to be working with anyone with long COVID to kind of know that it's more than just giving exercise way more.   21:00 Yeah, absolutely. You know, you we have a huge role as far as physical therapists and it goes beyond exercise. You know, that is an important piece of, of our profession, obviously. But there's so much more that we can do and, and step outside of our, you know, musculoskeletal box and kind of really help these patients at the end of the day.   21:21 Yeah, I think that's great. Thanks for sharing that. And now I have a question. What is the most common question people ask you about living with long COVID? Because I'm sure you get questions, even if it's family, friends, if you divulge to your patients, hey, I'm living with long COVID what's what's like the main question you get from people?   21:43 Yeah, there's a lot of questions. You know, the biggest thing could be it could be questions, that's okay. Yeah. Well, the a lot of people always ask about, did you have the vaccine? Did that help you? And my answer is no, that's a big question. A lot of people did find relief from the vaccine I personally didn't. But then a lot of a lot of the times the question I just get is, how are you? And that's a really tough one. Because you never know that they want, you know, I'm fine. How are you? Or do they want the Well, today, I have to lay on the couch for an hour in the darkness. And so that that is a tough question to navigate. It's just the How are you? So if you are asking that question of long COVID of, you know, patient, someone who's living with long COVID, you know, be prepared for a full answer. You're actually intending that. So, because it can be loaded?   22:35 Yeah, absolutely. Yeah. I don't even think about that. How are you? Well, yeah, really want to know, or do you want me to write? Exactly, yeah, yeah, yeah. Yeah. I think that's a great advice for people to what's what's it a question that you wish people would ask you? Or maybe how to phrase that? How are you questions? You know, what I mean?   23:00 Yeah. You know, I don't mind that. How are you question? As long as it's coming with, you know, good intent, and, and all that. So, you know, I think it's okay to ask, but also know that maybe that can be a stressful question for for someone. So, you know, maybe, maybe instead saying, you know, is, you know, how, how are you feeling today? Is there something I can help you with kind of thing, you know, putting a more kind of purposeful spin on it rather than, you know, just kind of, for your own personal curiosity. So,   23:35 yeah, I love it. I love that. How can I help question? I asked that a lot. And it's Yeah. So nice for someone to hear that. Especially. I think people living with long COVID many of you don't look sick. You look fine. I'm sure people have said that to you. Countless times. And it drives me crazy. That's a tough thing to hear. Yeah, you look fine. It's one of those invisible diseases, and it's invisible diagnoses. And I think that can be very stressful. Yeah, you know, you do hear that. Oh, you look good today. Well,   24:15 I did a good job then. Cuz? Because I don't feel good. A lot of days. So yeah. You know, and I get where people are coming from, but it is, it is kind of just something that is a hard thing to hear. Yeah,   24:27 yeah. Yeah. So I think for people, if you're interacting with people with long COVID just have a little sensitivity around some of these questions, you know, because they can be triggering, and I think that they can be stressful and as we just spoke about stress can be something that can increase symptoms of long COVID. So we want to try to minimize that throughout the day, right? Hmm, yeah. Well, Ted, I have to tell you, this is great. I'm so looking forward to Our roundtable discussion at the end of the month with you and Daria and Darren, and maybe a surprise guest in there as well, time will tell. Because I just think, as we discussed before went on the air, it's timely, it's important. If the, if they're modeling out 10% of people who are diagnosed with COVID may have long COVID symptoms, it's a lot of people. And so if you're a physio, odds are you may be seeing someone come into your clinic with long COVID.   25:35 Yeah, and even that 10% number could be conservative. So it's, it's hard to say there are a lot of a lot of people out there and a lot of people who still haven't heard of long COVID, especially outside of the medical community, I've run across a few people who have kind of talked to me. And as they start to tell their story, I kind of have that little thought in the back of my mind that, you know, this was me 15 months ago, I can hear some of the things they're saying in myself. So   26:02 yeah, yeah, well, hopefully things like this will help get the word out to more and more people. So thank you so much for your honesty, and for sharing your own story here on the podcast now, where can people find you if they have some questions?   26:17 Sure. Yeah. So my main social media is my Twitter. It's at TED Duchaine, DPT. And then we also have just started long COVID we have our peer support long COVID physio group, but we also just started a page for people who aren't living with long COVID just for information. So that's on Instagram at lone COVID physio, and also on Facebook and Twitter at the same handle. So   26:45 Excellent. Well, thank you so much. And we'll have links to all of those at podcast out healthy, wealthy, smart, calm under this episode. And last question, knowing where you are now in your life and career. What advice would you give to your younger self? Let's say fresh out of PT school?   27:03 Sure, yeah. I would say don't be, don't be so rigid and you're in your box of knowledge, what you learn in PT school is great, but there's so much more out there be open to things that you haven't heard of, or things that don't fit what you've heard. You know, I can honestly say that have had I not been living with long COVID I would have had that little squint in my eye that a lot of pts probably have right about now listening to this. And, and that's totally normal, but it's okay to step outside your box and, and look at something from a different lens, even if it doesn't quite make sense yet. Be open and willing to learn about something a little different.   27:46 I think that is great advice. Thank you so much for that. And thank you for coming on today. It was pleasure. Yeah, thank you, and everyone. Thanks so much for listening. Be sure to catch us for our roundtable talk, and have a great couple of days and stay healthy, wealthy and smart.

In this episode, Physical Therapist at Pro-Activity, Dr. Daria Oller, talks about living with Long Covid. Today, Daria talks about the signs, symptoms, and causes of Long Covid, how to implement #StopRestPace, and how wearables can help guide your decisions. What are the considerations for athletes wanting to return to sport post-Covid-19 infection? Hear about the role of social media when it comes to Covid, the many mental health aspects of Covid, and get Daria’s advice, all on today’s episode of The Healthy, Wealthy & Smart Podcast.   Key Takeaways “Long Covid comes after an acute Covid-19 infection. The current definition is ‘prolonged symptoms after 4 weeks.’” “It’s multisystemic… Two people don’t present the same.” “We’re not in a lab. We can’t control for every possible thing. Just tweak one little thing and see what happens.” “Our energy is very finite.” “Learn how to pull back, do what’s really essential first, and find opportunities to rest when you can.” “Work with where you are that day.” “With any athlete who has had a Covid infection, you just need to be aware and monitoring for possible red flags… The fact that they’re able to keep going doesn’t necessarily mean that it’s safe.” “There are people who are committing suicide from Long Covid.” “There are lots of great peer support groups. Even if you’re not getting professional help, you at least have other people you can relate to.” “Looking for those little wins and victories, even if they’re small, even if they don’t seem like much, it helps.” “Do not try to push through symptoms… Stopping, resting, and pacing makes a really big difference.” “You don’t have to push so hard all the time. Things will be there. You know yourself, you know what you’re capable of doing, but resting is as important as pushing hard.”   More about Daria Oller Daria Oller is a physical therapist at Pro-Activity in Lebanon, New Jersey in both an outpatient clinic and on-site with employer clients. She specializes in working with dancers and athletes and in prevention and health promotion. She is also an athletic trainer, having worked in clinical, research, and education settings. She served as the PI for a study describing the injury and illness experience of youth campers at university-sponsored summer sport camp program. Daria contracted COVID-19 in March 2020. It continues to affect her daily life, including her ability to participate in and pursue her passions for dance and running. She is one of the founding members of Long COVID Physio, and has been sharing her lived experience on social media.   Suggested Keywords Covid, Physiotherapy, Recovery, Long Covid, Healthy, Wealthy, Smart, Symptoms, Relief, Pacing, Resting, Support, Energy, Mental Health, Sport,   To learn more, follow Daria at: Website:          https://www.pro-activity.com                         https://longcovid.physio Facebook:       @LongCOVIDPhysio                         Daria Oller Instagram:       @ontapphysio                         @proactivityus                         @longcovid.physio Twitter:            @ontapphysio2                         @LongCovidPhysio LinkedIn:         Daria Oller YouTube:        Long Covid Physio Twitter Accounts to Follow for more info on Long Covid:  @OT_Skiff @ahandvanish @PTOT4MECFS @PhysiosForME @ManeeshJuneja @itsbodypolitic @patientled @LongCovidPapers @AlyssaaErinn @ItsAngInLA @BreathewellPT @sunsopeningband @PutrinoLab @4Workwell @AHPLeader @SimonDecary @fi_lowenstein @MichelleBull4 @elisaperego78 @respphysio @Dr2NisreenAlwan @Dysautonomia @LongCovidKids   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:               https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the full transcript here:  Speaker 1 (00:03): Hey Daria. Welcome to the podcast. Happy to have you on this month, where we are talking all about long COVID symptoms and rehabilitation. So welcome. Speaker 2 (00:13): Thank you for having me. Speaker 1 (00:15): And now what's your interest in long. COVID let the, let the listeners know if they don't follow you on Speaker 2 (00:21): Twitter. It's a very public about this. I got sick with COVID last year in middle of March, 2020, and the symptoms never went away. And early on, we were told people recover in two weeks and after two weeks, I said, I'm not better yet. And I was young and healthy. I'm a distance runner, I'm a dancer, pretty fit, and I just wasn't getting better. And I didn't know anything about post viral illnesses at all. So being the good PT that I am, I just pushed exercise and pushed and pushed because that's what we do. And it made everything a lot worse. And then through Twitter some of the PTs who specialize in myalgic encephalomyelitis and chronic fatigue syndrome reached out to me when they saw my tweets and said, this is bad. You need to stop. We're gonna help you. So then it just snowballed from there. Speaker 2 (01:07): I started learning about chronic fatigue and the similarities that were coming up with long COVID. And so besides that, like just personally affects me, cause it really drastically effected my life and thinking if I wasn't aware of this and I'd been a clinician for 15 years, like how many other people don't know about this? Because it seemed like just as all the PTs with long COVID started finding each other. So many of us had no idea, and this is across all different specialties and settings, different ages. And we just didn't know, unless you somehow happened to wind up in the chronic, the peak space already. We had no idea and it seems really easy not only to make mistakes with ourselves, which many of us who got sick in the first wave did, but to then make mistakes for patients because you're going to do great at exercise. That's what we do. You're going to encourage patients to push a little bit, to push through all the symptoms and it's really dangerous. So I want to make sure, you know, that people are learning, that we're educating our colleagues and even they're trying to reach out to patients to and teach them how to advocate for themselves, teach them some of the basic information that's out. So yeah. So in addition to just affecting me personally, I've seen professionally how important it is to help educate and advocate. Speaker 1 (02:10): And can you, Darren and I spoke about this last week, but I feel like we can never say it enough. Can you define what is long COVID and what are some common signs and symptoms? Speaker 2 (02:26): Yes. So long COVID comes after an acute COVID-19 infection. So it basically, you don't clear the symptoms. You continue to have symptoms and they can change what the acute symptoms are in those first couple of weeks can be drastically different. What happens weeks and even months later, people are reporting new symptoms. So right now the current definition definition is prolonged symptoms. After four weeks, there are people who have it just for a couple of months. Many of us are on month, 15 month, 16, and some of the common signs and symptoms. Some like for me, example, seem to have carried over from the acute having shortness of breath, chest tightness, chest pain, all different kinds of chest pain. Dysautonomia is really common now. So we're seeing people who have really funky things happening with their heart rate, with their blood pressure, heat and tolerance, just a really poor tolerance to exercise. Speaker 2 (03:14): And so taking a term from chronic fatigue syndrome, there's post exertion mollies, or we've been saying post exertional symptom exacerbation. So whenever you can do not only exertion like exercise, heavy exercise, but just general physical exertion, you know, walking to the corner could have cognitive exertion, like going to work or emotional exertion that can set off a whole cascade and worsened symptoms. And that can range from just get small exacerbation to people, get fevers for me personally, like I can't get up off the couch. I can't speak really well. And it's multi-systemic so it's really interesting because two people don't present the same. Some people can have more neurological, some could be more cardio, some could be more cognitive respiratory. There can be a whole mix. We're seeing people who have mass cell activation syndrome and you're seeing allergic type things and rashes and changes in food tolerance and GI disturbances. It is really, really across the board. So there's no one set. This is what long COVID looks like. But if there are symptoms that are just continuing for weeks to months after the acute infection, terrible, terrible. Speaker 1 (04:18): And let's talk about from, so your physical therapist, athletic trainer, let's talk about the, some of the treatment parameters around people living with long COVID. So you had said, when you talked about why you're interested in long COVID it's because you are someone living with that and you said, I'm just going to exercise. I'm going to go harder. I'm going to put in a graded exercise program and that's going to get me all better because that's what we do. So tell me now, what should therapists or trainers be trying to implement into your patients or, or even you, if you are Speaker 2 (04:57): Someone living with them? Yeah. So it's, it can be such a different approach. I'll start with, there are some people that starting with the light exercise program can be appropriate, but there are things that you really need to monitor for. And nobody's like red flags. So looking at somebody has its own an again, seeing their heart rate blood pressure changes, just poor tolerance to even just moving from supine, to sitting upright, to standing poor tolerance to the heat, that trying to get that under control first so that it could be just working on breathing in their sessions, working in diaphragmatic, breathing, trying to get out of that, like very accessory breathing pattern because many of us hyperventilate and just don't even realize that we had adapted that pattern. I look at this tooth, I have one patient right now with it. I'm teaching people how to manage their symptoms, that these things are going to happen. Speaker 2 (05:45): And it tends to be very unpredictable and episodic. And that's, what's really frustrating. It's not that, oh, I just let me not do this. And then I'll be okay if I avoid this. Cause you could do something one day and be fine. And the next day it sets off a horrible crash. So teaching patients how to start recognizing those signs and symptoms and sort of like you can sort of tell sometimes and things are starting to go in a bad direction and what do you need to do if you're home, teaching them how to lie down, go through the diaphragmatic breathing. I've been sitting with my patient going through her day and like, where are there opportunities to rest? So this is very different than here's your theoretics program. It's where can you rest in your day? Where are, what are the things you absolutely need to do? Speaker 2 (06:21): Like eat, prepare food, order food, something like that. What are the things that, you know, are good you'd like to do with maybe aren't, you know, priority. And one of the stuff that like just don't even, it's not worth exertion that can set stuff off. So that's a really big part for me with the sessions is teaching people sorta how to figure out how to live with it. It's not a set plan. Like this is what you do, but here. So here's your life. Like I explained to my patient today, like we're not in a lab, we can't control for every possible thing and just tweak one little thing and see what happens. So here's your life? What do you need to do? And then how can we best set up to get you like that you're able to function that you were able to within reason control the symptoms. Like as an example, you know, right now it is incredibly hot in New Jersey, New York city. So we know that that can trigger symptoms. All right. So maybe we figure out if you have to have food shopping going early in the day, not going at noon when it's going to be really hot out. So there's not necessarily something set, but I look at it as helping people figure out how to live their lives right now while managing the symptoms. Speaker 1 (07:19): And that kind of takes me to the concept of pacing, which I think maybe a lot of people don't quite understand. So can you talk about what pacing is and how that differs from a graded exercise program? Speaker 2 (07:31): Yes. Hazing is so difficult. It sounds easy and it's not. So, and this is pacing, like say I'm a distance runner. So I understand how to pace, you know, over running, but to pace in your life is so challenging. So it might mean breaking something up. Pts will understand this. Some, some of us can sit at a computer for a few hours just to go through those notes, get them done. I can't anymore. So it's like maybe set a little chunk of time and then maybe you need to rest. Maybe you just need to get up and take a break. It might be cleaning your house that you can't do it all in one shot that you need to maybe do some in the morning and some at night, some today, some tomorrow is I look at it as like finding opportunities to slow down and opportunities to rest and something I've noticed as the world doesn't really set up for that. Speaker 2 (08:14): It is really, really challenging. You do your best and there are certain things, you know, you won't necessarily be able to pace with, but when you can just trying to spread it out because our energy is very finite and this is like literally at the cellular level, the energy is just not there. So you can't necessarily push through it. You could try, but that's going to affect you tomorrow. And then you'll be at a deficit for the next day and the next day. So it's learning how to pull back. Do what's really essential first, like really prioritize and finding opportunities to rest when you can, Speaker 1 (08:48): Yeah. Much, much different than a graded approach to activity or a graded approach to exercise is every time you do something, you increase it a lot, a little Speaker 2 (08:57): Bit more. And that's, what's interesting too, because yeah, that's just, that's what we do, but because symptoms can be unpredictable just because like, I'll use an example just because I could pick up five pounds one day doesn't mean I could do five or six pounds the next day. It might be the next day one pound. So it's really, really hard. You have to really listen to the patient and just go off of how they are feeling that day and let them know too that they're not doing worse because they can't do the same amount of whatever it is that they could do the day before. I mean, that's a hard thing. You look at it. You're like, but I just did this two days ago. Why can't I do the, why am I so tired today? It's so complicated. So yeah, it's trying to avoid that a little bit more the next day, a little bit more, a little bit more and just work with where you are that day, wherever your symptoms are at let's work from there, Speaker 1 (09:41): It's a much different mindset than what we're used to. And now, as, as we talk about that, I think that there's something important that we have to mention and that's athletes living with long COVID. So with athletes, we have to get them ready to get back onto the field, which means they have to be able to do a little bit more, a little bit more, a little bit more because they need to be able to compete. They need to be able to perform. So what are some specific considerations for athletes returning to sport post COVID infection or athletes with long COVID? Speaker 2 (10:19): Yeah. I look at this as with any athlete who has had a COVID infection and you just need to be aware and just be monitoring for possible little red flags that they might be going along COVID direction, because for anybody it's not always immediate, there are people who are doing okay in a couple months later, I had a flare up and we know with athletes in general. And I say this as one we push, you know, there are athletes who have plead while they have broken bones and concussions and all kinds of things. So the fact that they're able to keep going doesn't necessarily mean that it's safe. And an example for me, like I ran 10 and a half miles, two months after I got sick, which is insane, but I pushed and I did it. And then you could look at my heart rate and see why it was bad. Speaker 2 (10:58): So you're monitoring for, especially that post exertion L symptom exacerbation, if after they're working out, they're doing their practice, even watching film the cognitive demand for that, if it's a sport that has filmed, are they crashing? Not just the normal you know, you're a little fatigued or maybe have some dorms or something like that, but they're just completely done. It's really important to educate them and let them know because they might just think that it's just deconditioning. You need to get back in shape really important to monitor their heart rates too, because then they're going to push, especially getting back now after, after not being able to play sports from the pandemic, everyone's gonna be excited and have big adrenaline rushes and be able to push. And it's great to be able to look at some vital signs, to look at their heart rate, look at their blood pressure and see what it's doing, because they might not always be aware of what's going on to report it, but we know what you could look at as something objective like a heart rate and see, this is not the normal response from like what we would expect. Speaker 2 (11:50): So I know in the literature there's been some emphasis on clearing them for cardiac conditions, obviously super important. We see myocarditis and all kinds of things that is very important, but we're seeing many people in general on COVID whose basic lab work imaging is negative. But that doesn't mean that they're necessarily. Okay. So it was looking for the dysautonomia, particularly with sport, looking for the post exertional symptoms, symptom leaves after their playing, after their conditioning, again, after even cognitive exertion to see how they're doing monitoring for months, you know, don't assume because they were okay in the beginning because they're able to push through a couple of things that they're okay. Cause athletes will push through some pretty dangerous things to play. Speaker 1 (12:27): And can you just for the audience give a specific definition to the post-exercise malaise or post-exercise symptom exacerbation. Cause I really want people to understand that it's not just like, I'm a little tired and I just need to rest. So can you explain what that means? Speaker 2 (12:47): Yeah, it is. That looks like yes, it is actually physiologic reaction. So people will report an increase of flare up, increase in severity of their symptoms and you will actually see like physical, sick symptoms, like a fever is I think a really great example because no matter how hard you push exercising, a fever is not normally you know, response to that. And it is, it is so hard to explain when she experienced it, how crippling the fatigue is. It is something you cannot push through. Like you cannot get up. It sounds like I'm exaggerating, but I'm not. And I was talking to PT, Todd Davenport about this. And he, with his work in chronic fatigue was saying like, it's literally two energy demanding to talk like the amount of energy it takes for what we're doing right now is not there. So, and again, it can vary too. Speaker 2 (13:38): There are crashes. That's what I've kind of called them. Some other people too, that can be a little minor is not the right word, but not as severe. And some that are, people are literally bedbound and are unable to get up and it can vary to where the post exertional symptom exacerbation, those crashes can last for a few hours. They can last for days, weeks. Some of us, it takes us months to be able to bounce back from one. And even that, we're just trying to get back to that baseline of where we were when the crash happened. Not like a true, like pre-illness baseline. Got it. Yep. Speaker 1 (14:10): Thank you for that because I think it's really important to make that distinction for the listeners. Now let's talk about let's talk about the rule of social media when it comes to long COVID or COVID in general. I mean, we all know that social media is full of misinformation. As a matter of fact, I was reading an article where they said the long COVID misinformation, 80 or 80, some percent of the long COVID misinformation and misinformation on vaccine surrounding lung COVID was coming from 12 accounts. Speaker 3 (14:46): Can you imagine Speaker 1 (14:47): They just happen to have like a really, really strong presence and a really large following on social media. So what is the role of social media with long Speaker 2 (14:56): COVID? This has been fascinating. So we all people with on COVID found each other on social media pretty early. This part I didn't find initially, but body politic, they found each other really early in starting this whole launch. The patient led is another group too, but so this patient led movements. So people just coming together and saying, we're not better. We don't necessarily know what this is, but this isn't right. This isn't the two week recovery that we're hearing about. And at the same time people with chronic fatigue were jumping and they had been sounding alarms from the start of the pandemic. We didn't know about it. Cause you know, we weren't in that space. And then, so it's the people with lung COVID who named it. We gave it a name when we, you know, we weren't being heard initially because things, you know, being New York city, things were so severe that the focus was on the acute. Speaker 2 (15:40): We severely sick hospitalized people. So we on our own kind of came together and gave it a name and have gone from there. So that's social media has allowed for peer support groups and we have long COVID physio specifically for PTs, PTs, other allied health care professionals with it. I'm in a group for endurance athletes with long COVID. I'm sure there's plenty of other like specific groups where you can relate to each other because when you try to explain this to people who don't have it, they look at you like you're crazy because it just sounds so ridiculous. It doesn't sound like it's real, especially for those of us who were young and healthy and fit, you know, prior to COVID and then it's allowed us to get information out really fast where, you know, it takes a while to publish. It takes a while to do a study, but all of us, you know, we've been our little ends of one, like I'm going to report what I'm going through. Speaker 2 (16:23): You know, PT, Twitter was great. Encouraging me from the beginning, just report where you have. Cause that's, you know, that's one example we'll learn from. So we've been able to get that information out and papers have gone out very quickly. We have had some amazing webinars and just things that are, people are just producing so quickly and on their own, sometimes it was faster than having to go through a whole, you know, association and, you know, with the journal and everything. So that's been amazing and we find each other and I know which are the accounts that are going to put out like the peer reviewed articles when they're there. I know, which are the accounts that are going to have the great webinars and all the free things that are available on YouTube to watch. I know which are the counselors patient share and their stories. So you kind of find to what fits with, with what you need to know and whether you're at the, just the patient level or you're a clinician who needs information Speaker 1 (17:08): And can you, what are some of the accounts or, or if you want, you can send them to me and people listening can just that way you don't have to rattle through land accounts that no, one's not going to re no, one's going to remember anyway. So if you can send me some of the accounts of individuals and groups that people, if they're listening have long COVID, they know who to follow on where to get accurate information Speaker 2 (17:32): From. Yeah. Yeah. That's a great point that accurate that's been for better or for worse having clinicians and researchers with long COVID gives you people who know what they're talking about that you can follow them and I'll add for what you said. Cause I went, oh no, because one of the things that happens with long COVID is brain fog which is a broad term. And it sounds like not much, but the symptoms, the cognitive symptoms really, really range. And you'll see some of us just kind of get stuck finding words or trying to remember something, or I can picture people's Twitter profile photos. Couldn't tell you what the handle is on the list. Like actually see it, that's been a really challenging thing. I've been trying to kind of figure out how to work so I can send you yeah. Cause that's great. It is, it is so great to have other people to follow who are in the same boat or what we're calling, you know, allies, people who are sharing, they might not have it, but they're in a clinical space or research based to help. Speaker 1 (18:21): Yeah. Fabulous. Yes. So for all of you listening, Daria will send them to me. You can go to podcast dot healthy, wealthy, smart.com click on this episode and then you will click on whichever of those links you would like to follow. That would be much easier. Okay. So now let's talk about just this'll be well, we'll sort of finish up our conversation on a light note. Let's talk about the mental health considerations of those Speaker 2 (18:50): Living with Ms. Oh yeah. This is a whole big topic. So I'll start with it was pretty early on from when I had symptoms that somebody had first mentioned anxiety in me kind of implying that might be what the cause of my symptoms were. And I just say for me personally, I'm not an anxious person at all. So on one end, we're, you know, we're trying to say that it is virus driven. People can have mental health aspects a lot to get into, but that's not the root cause. So it's really important to tease out because people are told and I'm learning all about this from other people, chronic illness going in that direction and say, no, but psychological interventions can help, but that is not the underlying cause. But that alone, when people are telling you you're anxious, you're depressed when that's not what's driving. Speaker 2 (19:34): It is really frustrating. But because of all these symptoms, having this new chronic illness during a pandemic that has been politicized with false information is really hard because you'll talk to people who don't believe in the science of what this is, and they don't know that you have long content and you're just so that's really, really difficult. And it changes your life. You know, it's a complete change in your identity for all of us, particularly who are really active, whether it's exercise or as PTs, if physically demanding jobs. And you have to like figure out who you are now, if you can't do all the things you used to be able to do, you know, who are you? And then say for me, like running and dancing, that was my stress relief. That's my outlet. That's how I express myself, particularly with dancing. And now, you know, I'm not able to do that. Speaker 2 (20:23): Like I was before and it takes a toll and you're trying to find, well, what can I do then? What, what am I able to do to try to help cope with these symptoms is it is so frustrating. You are trying to figure out how to live with symptoms that are unpredictable and episodic. And like I mentioned before, you know, the world isn't adapting to what's going on in the world, just going on, like it was before the pandemic. So having the peer support has really, really invaluable to have other people to talk to that, understand it. And you can not only explain the symptoms, but you can be going through the symptoms and you know, they understand when you forget your word, when you stumble, when you're just too tired to sit up. So you're on a zoom, lying down. There's so many things like that. Speaker 2 (21:06): When you have people that to just, just to vent to or who, you know, they just understand what you're going through. That's been really big because the first for me, the first few months, I didn't know anybody else with it. And I obviously, there's plenty of great PTs who I was talking to, trying to help and my friends. But when you have people to talk to who understand that makes such a difference. It's just like, there's weight off of your shoulders. And like, oh, you understand you get it. I've met people. When we work with employer clients for my job who have long COVID and they start to explain the symptoms to me and I could see them kind of hesitating when they say that, it's like, no, no, I understand. I understand that you get really sweaty all the time. You're not crazy. Speaker 2 (21:41): That's a real symptom. That is a thing we can talk about that because this is something I didn't appreciate earlier. I work in orthopedics and it is, you know, there, there is a mental health aspect to it, but this is a whole other world there wasn't aware of. Yeah. As a PT, it's making sure you're listening to the patients that you're validating their experience and not say maybe if you're not familiar with this thing, well, that's weird. You know, that, that can't be right, that you're really listening to them. And that when you're, as you're listening, if you're hearing some of those red flags that maybe as a results of long COVID, or maybe they had anxiety and depression already, and this is exacerbating, it know that you're listening, you're ready to provide resources. If that's appropriate. And then now we're even taking a sad turn, but there are people who are committing suicide from long COVID. Speaker 2 (22:26): There was just a big case in the news because the woman was a writer. There's somebody who owned a chain of restaurants, it was pretty famous that had committed suicide. And there's more that are in the news, but that's really big too. And it's something that, again, I didn't necessarily appreciate until I was going through not only chronic symptoms in general, but symptoms where there's not a cure or treatment necessarily. So it's a whole new, a whole new world to learn about this. So as a PT, it's just really listening to the patients and under trying to, you know, understand, be open to what they're going through. That it's not just physical symptoms, but it's going to affect their entire being. Speaker 1 (23:02): Yeah. And you know, in Darren and I were talking about this, I said, you know, it reminds me or it makes me think of people with a headache, chronic headaches, migraines, maybe neck pain, back pain, where, you know, you're not walking with an assistive device. You don't have a limp. You're, you know, you don't have the symptoms of someone who's quote unquote sick. So it's one of those sort of silent silent diseases, if you will, or, or silent symptoms for a lot of people. And to have to explain to people why you can't meet them for dinner or why you kept it, it can just be, so how do you deal with that? Oh, Speaker 2 (23:49): This has taken a long time because I'm someone where you can look at me and assume I'm high functioning. Cause I go to work every day, you know, I, to a degree, kept up with dancing. But I'll explain to people and they're not getting it that they don't see what it takes for me to be able to do those things. The resting that I have to do, as soon as I get home from work or dance or something draining, I lie down I'm supine. That is like, if, as long as my schedule lets me do that, that's the first thing I do when I walk in the door. If I have to dry for a while, if I can I sit down when I get done or lie down even better. So there's a lot of strategies like that, that go on that you wouldn't see unless you're next to me. Speaker 2 (24:24): So I'll tell people about that. You know, I might look okay, but there are symptoms that are going on and I'll explain to a particular thing because I dance, you know, and the show must go on. I'm accustomed to ignoring symptoms and smiling and getting out on stage and spurt, you know, pretend everything's okay. So that's something that I've learned. It's not the greatest treat to have with long COVID because again, people, it just looks like, you know, we're okay. But it's, it's explaining, you know, what it takes to be able to just do basic things like food shopping. And what advice do you have for Speaker 1 (24:56): For people living with long COVID when it comes to their mental health? I think the advice that you just gave for therapists to really listen to your patients, not only listen, believe them. But what advice do you have for people living with long COVID? If they are kind of suffering their mental health is suffering. Speaker 2 (25:17): Yeah. A big thing is like, we've already talked about social media. If you can find, there are lots of great peer support groups. There are just general long COVID groups on Facebook. And then, you know, there's specific ones targeting you know, very specific populations. So at least even if it's not, you're not, you're not getting professional help you at least have other people you can relate to because I know that with long COVID clinics that are, that are starting on their wait lists. So trying to go through that referral system, you know, to try to get to somebody to help can be a little challenging. And I know for me and other people it's been having to just kind of accept that this is a thing going on and that it's, you can't push through it. You can't just kind of wish it away. Speaker 2 (25:59): You can't ignore it, it's there and you can, you can try to ignore it, but it won't let you, you're not going to get very far. And is this so much easier, seven number, just trying to accept the, how uncertain it is and just being able to kind of roll with it and know, you know, you might plan, have plans for a certain day and you wake up and say, Nope, that's not today. That's not going to happen. You know, I wanted to go to the pride parade on Sunday in the city and it was 90, whatever degrees, obviously very crowded. A lot of stimuluses Nope, this is, this is not a good idea. It would have been great to do, but not safe. So it's being able to, you know, recognize your limitations and something. I can't remember who told me this, but it's not only acknowledging the things you can't do because that is important to recognize certain things that are not right now, but something you did do that day. Speaker 2 (26:45): Like maybe I wasn't able to go food shopping, cause it was too much, but I didn't crash. I got through the day without a crash. So that's a positive thing. And it's hard again because it's not always in our control, but I that's something I've been trying to do as frustrated as I get, because there's so many things I can't do right now or I could, but I shouldn't because I've learned the things I shouldn't do. Just also recognizing there are still things that are not control maybe even on the worst day and you're not able to really get up and do much look at your heart rate and say, Hey, but I was able to keep my heart rate at a fairly low level because I understood that I was supposed to stay in bed. So looking for those little wins and victories, even if they're small and if they don't seem like much, if you're accustomed to doing a lot, it helps. It gives you just like a little bit incentive. So you can kind of look at the big picture and see that if you aren't making progress. Speaker 1 (27:30): Yeah. That's such great advice. And you know, Louis Giffords called that, looking for the pink flags. So looking for those, you know, cause we got red flags, yellow flags looking for those pink flags, which are those, those exactly what you just said those times where you're like, you know, I still have back pain, but Hey, I was able to sit through a movie, right. Or, oh, I was, I wasn't able to get out, but I was able to, to do some stretching. Right? So it's like, these are, you're really looking for those pink flags, those things that give hope that give a sense of accomplishment, however, small or big it might be. So I think that's really important. Speaker 2 (28:14): So now, so it's helpful two, because you don't know from day to day, what's going to happen. Which is just makes it so hard. That is the really frustrating part. And like you really have no idea. I can't remember. There's so many things that I've read. I always forget who, where I read what, but there was a physician who said with long COVID, it's like putting your hand in a bag of symptoms and pulling them out and say, this is me today, which is very accurate. That is a hundred percent accurate. So yeah, when you can say, all right, well today didn't turn out as planned, but I did something or at least, you know, things didn't get worse. Sometimes literally the accomplishment is that things didn't get worse and we're able to sort of manage it. It just really changes your perspective on how you look at things. But it's knowing that we don't know what's going to happen. We don't have a predictable, rough timeline on what to expect. We don't know that, oh, if you're in this age range, you're more likely to have this. Or if you were healthier, you're because we're seeing people who had no comorbidities I'm like, you know, with the severe acute infections. So just looking for those little wins can make a difference. Yeah. Speaker 1 (29:16): And, and living with that uncertainty certainly not easy. But if you have support groups, you have friends, family, peers, professional help. I'm sure that all of those things can help you kind of manage your life and manage where you are at this moment. Speaker 2 (29:37): Yes. I was explaining to my patients today that I, because she was, she was explaining friends who aren't understanding it and if it's going to happen and this, as soon as you have to, I think of the Mr. Rogers quote about finding the helpers. And in that case, you know, I had a friend who visited that hadn't seen our literally two years, but I knew she would understand. And there was a couple hours, one day I just had to lay down and I knew that would be a non-issue for her. She'd either take a nap or find something else to do. So I was looking for that, like knowing who the people are in your life that they'll understand. If you have to cancel last minute, that's fine. If you need to sit down last minute or, you know, slow down, you can do it, but that they will understand. And that's not going to be everybody not everybody's going to get it, which is fine. It's frustrating. But you know, it is what it is. But looking for those helpers who even if they can't directly help you, you know, cause they're not in healthcare, they at least will understand. They at least will listen to you. And they'll at least say, no, that's fine. This is who you are today. So we'll work with that. Speaker 1 (30:31): Yeah. That's so great. I think that does sound something like very Mr. Rogers E write something he would say. So now what would you really like for the listeners to kind of take away from Speaker 2 (30:45): This episode? A couple of things is the one is with anyone with long COVID, whether are living with it, or you have patients with it to not try to push through symptoms. I cannot stress that enough. You can use me as the example of why you should not push through symptoms. I have tons of data available from my garment and heart and crazy heart rate things. And it is just not something you can push through and it's not a failure on somebody's part. It's not that they're not trying hard enough. It's not that you're not strong enough. It's just physiologically. This is where you are right now and really doing your best to embrace. It's hashtag stop, rest pace, which is from the chronic fatigue community to really, really try to do that while there's, you know, like I said, there's no set treatment or cure. Speaker 2 (31:31): We know that that that helps it. Doesn't magically fix everything and everybody's different with how you implement it in your life. But the stopping resting and pacing makes a really, really big difference. And like as a PT, you just need to be open to the paradigm shift. It is so different than what we are taught from, you know, my mindset like so many people's it was, I gotta move. My dad's a respiratory therapist. He's retired now. But when I got sick last year in March, he said, knowing me, you know, you need to wait two weeks until you don't have symptoms before you start running is like, that's crazy. No, I got to move. And here's all the reasons why I can't be sedentary. Here's all the health reasons. And now I've had to like shift that in my brain a lot and say, okay, I know there's risks with bone health and cardiac disease and all these things, but the priority right now is trying to get the symptoms under control and really trying to prevent crashes as much as possible. So just being open to that, and yes, there are concerns about being sedentary, but right now preventing the crashes, supersedes that. Speaker 1 (32:23): Got it. Excellent advice. Now, where can people find you on social media, Speaker 2 (32:28): On Twitter? I'm on Twitter often. And I would say you can tell when I'm lying down resting, cause that's when I'm tweeting. Well, good to know it's at on tap physio two, number two, that is the best place to reach me on Instagram. I'm ONTAP physio. Excellent. It's on Twitter often. Yeah. Yes Speaker 1 (32:45): You are. And you get spread a lot of really, really good advice and, and we all appreciate your being there and being a voice of truth for people living with lung COVID and for clinicians who want to learn more. So we all thank you for that. Now last question I ask everybody this, where what advice not, where, what advice would you give to your younger self knowing where you are now in your life and Speaker 2 (33:15): In your career? I'm laughing because to not push so hard, which is crazy as a physical therapist or someone in healthcare in general, but to not push so hard. You know, I learned at my very type a all girls high school to push, like we just push you work as hard as you can. You grind got that in undergrad. And I was at the other training student, obviously I was in PT school and after that, and it has been to my detriment now that we're, you know, we look at that drive that that's such a great thing to have and look how resilient you are, look how antifragile you are looking all these great things, but we're seeing with not just lung COVID, but other post viral illnesses that can actually really harm you life in general. Yes. Yeah. And we get accustomed to not sleeping and illustrating caffeine and all that. So it sounds crazy to be saying to myself, knowing how I am, but it's to learn, like you don't have to push so hard all the time that things will be there. You know, you, you know yourself, you know what you're capable of doing, but resting actually resting, not doing things just resting is really, is as important as pushing hard and pushing hard can lead to all kinds of fun trouble. Speaker 1 (34:30): Absolutely. I think that is great advice. And one that I think any, certainly any PT should, should take and should live by. So thank you for that. And thank you for your honesty and being so candid during this conversation, because I think it will help a lot of people. So thank you so much for coming Speaker 2 (34:48): On. Well, thank you for having, like I said, finding the helpers, you are one helping to get all the information out to people on your, you have such an incredible platform where it's so important that we're reaching people wherever they are, and podcasts are definitely a way to do it. So thank you. Speaker 1 (35:03): I am happy to do it and I am learning more and more myself throughout this whole month. So thank you again and everyone. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.

In this episode the chair of Long Covid Physio, Darren Brown discusses the World Physiotherapy briefing paper on safe rehabilitation approaches for people living with Long COVID.  Today Darren talk about the Key messages for Safe rehabilitation from the briefing paper:  " • Post-Exertional Symptom Exacerbation: before recommending physical activity (including exercise or sport) as rehabilitation interventions for people living with Long COVID, individuals should be screened for post-exertional symptom exacerbation through careful monitoring of signs and symptoms both during and in the days following increased physical activity, with continued monitoring in response to any physical activity interventions. • Cardiac Impairment: exclude cardiac impairment before using physical activity (including exercise or sport) as rehabilitation interventions for people living with Long COVID, with continued monitoring for potential delayed development of cardiac dysfunction when physical activity interventions are commenced. • Exertional Oxygen Desaturation: exclude exertional oxygen desaturation before using physical activity (including exercise or sport) as rehabilitation interventions for people living with Long COVID, with continued monitoring for signs of reduced oxygen saturation in response to physical activity interventions. • Autonomic Dysfunction and Orthostatic Intolerances: Before recommending physical activity (including exercise or sport) as rehabilitation interventions for people living with Long COVID, individuals should be screened for autonomic nervous system dysfunction, with continued monitoring for signs and symptoms of orthostatic intolerance in response to physical activity interventions." More about Darren:  Darren Brown is a cis-gendered (pronouns he/him), gay, white man, of English and Irish heritage, living in London, UK. He is a clinical and academic Physiotherapist specialising in HIV, disability and rehabilitation. Darren leads the HIV rehabilitation service at Chelsea and Westminster Hospital NHS Foundation Trust; Europe's Largest HIV centre. He is the Vice-Chair of Rehabilitation in HIV Association(RHIVA), HIV/AIDS coordinator of World Physiotherapy subgroup IPT-HOPE, and steering committee member of Canada International HIV Rehabilitation Research Collaborative (CIHRRC). Darren was awarded an NIHR funded Masters of Clinical Research (MRes) in 2019 and continues to conduct both quantitative and qualitative research about disability and rehabilitation among people living with HIV in the U and internationally. Darren contributes to national and international programmes focusing on disability inclusion across all responses to HIV. Darren contracted COVID-19 in March 2020 and continues to live with Long COVID. He is a patient advocate for Long COVID healthcare and research, calling for the greater involvement and meaningful engagement of people living with Long COVID in all responses to COVID-19. Darren founded Long COVID Physio in November 2020, an international peer support, education and advocacy group of physiotherapists living with Long COVID. Darren is an invited expert contributing to World Health Organization Guideline Development Group on COVID-19. Suggested Keywords:  Covid, Physiotherapy, Recovery, Long Covid, Healthy, Wealthy, Smart, Symptoms, Relief, Pacing, Resting, Support, Energy, Mental Health, Sport To learn more follow Darren at:  Twitter https://www.hiv.physio/ https://longcovid.physio/ Long Covid Briefing Paper   Subscribe to Healthy, Wealthy & Smart: Website:                      https://podcast.healthywealthysmart.com Apple Podcasts:          https://podcasts.apple.com/us/podcast/healthy-wealthy-smart/id532717264 Spotify:                        https://open.spotify.com/show/6ELmKwE4mSZXBB8TiQvp73 SoundCloud:               https://soundcloud.com/healthywealthysmart Stitcher:                       https://www.stitcher.com/show/healthy-wealthy-smart iHeart Radio:                https://www.iheart.com/podcast/263-healthy-wealthy-smart-27628927   Read the full transcript here:  Speaker 1 (00:02): Hey, Darren, welcome to the podcast. I'm thrilled to have you on today. Thanks so much. Speaker 2 (00:07): Hello. And thank you for having me. My Speaker 1 (00:09): Pleasure. So this month we are talking all about long COVID. So people living with the long COVID symptoms and also what long COVID is at least what we know now, what we know at this present time. But before we get into all of that, and before we talk about the the world physio therapy briefing paper nine, which we will have a link to in the podcast notes I would love for you to let the listeners know a little bit more about you and why you are part of that paper and, and part of this world. Speaker 2 (00:48): Yeah. So thank you very much for having me today. So my name is Darren brown. I'm a, cis-gendered gay white man. I've mixed English and Irish heritage. I live in London in the UK. Hence my accent for anyone that's not where I am. I am both a clinical and an academic physiotherapist, and my background is in the area of HIV, disability, and rehabilitation, so specialized in that for a decade. So I'm kind of used to the chronic implications of viral diseases. And I also happen to be a person living with long COVID. So I contracted a coronavirus acutely in March, 2020. So as I sit here today, I'm of my 15th month after acute coronavirus and I am currently sitting here today in a really stable, good place with my long COVID I predominantly symptom free. Speaker 2 (01:45): However, it's been a 15 month journey and it's been a very episodic and up and down journey which I'll be very happy to summarize for you if you thought that was useful. So I, as I said, I contracted coronavirus last year. I went back to work pretty quickly actually, and I ended up working full time for six months, switched, included being redeployed to various sectors, including intensive care in response to the pandemic. Had some ongoing symptoms, but in September last year I crashed. And I ended up being off work for two months and the crash lasted for about six months where at my most disabled I was bed bound and flat bound and walking with a walking stick. And my symptoms were multi-dimensional episodic and unpredictable in their nature with profound exhaustion, fatigue, brain fog I've had some respiratory symptoms. Speaker 2 (02:37): I've had cardiovascular symptoms. I've had urological symptoms are neurological symptoms and I'm under all of those physicians for investigation still. I then had my vaccination, my first dose in January. I got better. I returned back to work. And then I was getting so much better. I started to do a bit more and unfortunately I had second crash. But then I had my second vaccination felt a bit better. And I've been continuing that journey since. So yeah it's been a very episodic journey but I'm also a co-founder of a group called long COVID physio. So long COVID physio was born out of the need for peer support amongst physiotherapists, living with long COVID, both in the UK and the United States, but now it's evolved, it's now a global peer support group that also provides education in the context of a long COVID disability and rehabilitation. And also acts as an on an advocacy level which kind of brings us round to where the briefing paper came in really. Because it was born out of a need for education and advocacy led by people living with long COVID. Speaker 1 (03:54): And you know, I think we spoke about this before we started recording, but your background working with HIV that has multi-system whole systemic bodily implications, you said, well, with these, the code, the symptoms of long COVID, you weren't, it wasn't like out of the blue, it wasn't a huge surprise for you, but is it safe to say it was a huge surprise to a lot of other people in healthcare and out? Speaker 2 (04:26): So in the context of HIV, we know that HIV can be controlled with medicines antiretroviral therapy. And when a person is undetectable, meaning you can't detect the virus in the blood because the medicines are working that well, people are on transmittable, meaning you can't pass it on. And when people are undetectable and they've been taking the medicines, people can live a normal life expectancy. But what we know with that is that people are growing older with HIV and the developing other complications and people living with well controlled HIV, still experience issues, including episodic disability. So when this pandemic came out, there was quite a few of us at work in the world of HIV, disability, and rehab that were kind of anticipating well, if people recover, there may be a risk that people will develop long-term consequences. So it wasn't surprising. I think what was surprising was that I was one of them and actually how severe the disability was. Speaker 2 (05:19): There are other groups of people that also were anticipating a post viral manifestation, particularly groups of people living with Emmy or my LJ can. And my lightest also known as chronic fatigue syndrome. And other people that have been living with post viral complications probably were anticipating there was going to be some form of complications after acute Corona virus. But I think mostly the world has been caught off guard by this. And maybe it hasn't been prepared for the critical mass of people globally that are going to be living with ongoing consequences after acute coronavirus, which is now commonly referred to as long COVID. Speaker 1 (06:00): Yes. And so now I think that leads us right into the briefing paper. So like I said, there'll be a link to this in the podcast notes, but when you look at this briefing paper, there are a lot of contributors to this. So before we get into the meat of the paper, can you give can you explain how you got all of these people together in order to write this paper? Speaker 2 (06:22): Yeah. So this brief briefing paper was specifically brought together communities of people from different experiences. So the idea started with myself and a few other people that had expressed some concerns that maybe there was lacking guidance and policies and standards around the utilization of physical activity, witching of all types, including exercise and sports in the rehabilitation of people who may have been recovering from coronavirus or living with long COVID. And so initial conversations were between some people that had already connected pretty much through social media. And when we got the kind of green light with world physiotherapy, that this might be something that we could work towards. We started to snowball our collective groups. It, this, this briefing paper is brought together over 50 different people from different geographical regions in the world, so that all of the five corners of the global four, four corners, but, you know, five weld, physiotherapy regions have been represented here. Speaker 2 (07:29): So we've got people from Europe, north America, south America. We've got people from Africa, Asia, and Asia specific. So we, we have huge diversity, not only in where people are from, but also in that backgrounds. We've got people living with long COVID. We've got physiotherapists, we've got physicians, doctors that specialize in a range of different things, including physical and medical rehabilitation. Also known as physiatrists. We've got occupational therapists, psychologists. We've got people living with M E the list goes on and we've got such diversity because what was needed was a consensus here. What was needed was a diversity of thought experience, both lived clinical and academic, but also geographical to come together to say non COVID is not just affecting one place in the world. And this experience is not singular to two groups of people or people in certain locations. This is actually a unifying global issue and the long-term consequences after acute coronavirus and affect people around the world. And that's why it was so important that we have that diversity, if the people that were contributing, but also diversity of experiences and thoughts, because not everybody comes from the same background with the same beliefs about all of this. And so we needed to bring that consensus together. And that's how we was able to develop the paper, though. It was not only recommending caution, but was also what can be done and also where rehabilitation is successful. Speaker 1 (09:00): Yeah. And I think, you know, for a whole systemic disease, that COVID is, and it being global, it is important to have a whole systemic group of people working on this. So I just wanted the listeners to know it's not only physical therapists or it's not only physicians, if this was a real collaborative world effort. So that being said, let's talk about what some of those key messages are, especially when it comes to safe rehabilitation of people with long COVID. So I'll hand it over to you. Speaker 2 (09:33): Yeah. So the, the way the briefing paper was written was to introduce T considerations when rehabilitation specific to physical activity in all of its forms. As I said, including exercise and sports, when those key considerations need to be taken from a safety perspective before we prescribe exercise and physical activity. And I purposeful in my terminology there because we are health professionals that do prescribe our interventions. And so therefore we do need to have safety at the core of what we do. We know that there is currently not enough evidence or any evidence on the safety and effectiveness of physical activity and exercises and intervention for people living with long COVID, but there's loads of indirect evidence. And there's also enough evidence in long COVID to give us the signals and clues as to which direction we could be traveling in. And so there was four key messages that came out in this. Speaker 2 (10:31): So the first was before recommending physical activity, as a rehabilitation intervention for people living with non COVID individuals should be screened for post exertional symptom exacerbation. Now, this is a term that's called different things. So post exertional symptom exacerbation is something that I quite like, but it's also used by other groups sometimes more commonly known as post exertional malaise, but can also be known as post exertional neuro immune exhaustion, basically, in a nutshell, when you exert yourself, whether that be physical, cognitive or social exertion, your symptoms get worse. So obviously before you get people to exercise, it would be quite useful to know whether they've got that because you can't exercise your way out of a symptom, which is made worse by exemption Speaker 1 (11:21): And, and from a physical therapy. Cause we're both physios from that physiotherapy perspective, how do we screen for that? Is it a simple questionnaire? Speaker 2 (11:33): So this is where the briefing papers really quite useful because obviously that's the first key message. And the way the briefing paper is designed is that you have the key message and the rationale for that key message. So if anyone's now going, why they brought that key message out in the briefing paper, there is an evidence based rationale for that. And then off the back of that, there's an action. So each key message has an action point where clinicians and also communities of people living with an effected by long COVID can utilize these action points. So as you rightly said, there are ways of screening for post exertion or symptom exacerbation. Now, one of the best ways of doing that is actually a narrative approach, which is having a effective communication between clinician and the person accessing the clinicians care. So one of the nice things about this briefing paper is it's also included the whole context of person centered rehabilitation and the therapeutic Alliance or relationship and how that's going to be an integral part of ensuring that safe rehabilitation is provided. Because if you can use a narrative approach to hear that people are experiencing this symptom, then it's a really good starting point. There are other tools though. Speaker 1 (12:47): So are you saying that we actually have to make the time in our evaluation to speak with our, the person in front of us to really get to know them and to ask more narrative questions, motivational interviewing, not just yes and no, and typing into a computer Speaker 2 (13:06): Now that's that's yes, that's leading, right? So, but you know, the average person probably listening to this, he's probably going, of course, I listened to my patients. Of course I communicate with my patients, but, but, but I think what it is, it's about providing space for people to feel safe, to provide the information that they can engage in. So if person centered care is going to be a key pillar of rehabilitation, we must make sure that our patients feel safe to open the engage in rehabilitation with meaningful connections that are established with the clinicians knowledge, but also the patient's belief and knowledge of their own lived experience. And I think this isn't new to many people, but I think it's a really vital skill that we can harness in terms of delivering safe rehabilitation. Speaker 1 (13:56): Yeah. And everyone deserves to be heard and acknowledged and seen and given the space to do that. So as physiotherapists, we should obviously be doing this with every patient. But when you're seeing patients who are living with long COVID, I think it behooves you to give them some extra space because I'm sure they have experienced people, not believing them. Like you said, just exercise your way out of it. You'll be fine. And because a lot of people with long COVID, unless you maybe are walking with an assistive device, they may come in and look, okay. Yeah. Speaker 2 (14:40): Th that's that's the key point, isn't it, you know, a long COVID could be classified for many people as an invisible disability. And certainly it's something that's experienced as, as not only, but also episodic in its nature and also unpredictable. So someone may look okay, one moment, but not another. And this is something that I've talked about from the lived experience of having the symptom of post exertional symptom exacerbation, which is that it's, it's wholly invisible to the majority of people because when I'm out and about, and I'm doing okay, people see that I'm doing okay, well, they don't see as the repercussions of that a day or two later where I'm laid up in bed because no, one's around me when I'm laid up in bed and no one can see that. So it is truly an invisible symptom and that's where people need to feel safe to talk about that. Speaker 2 (15:26): Because a lot of people may not understand it themselves and may be very confused by this because my experience was, I was totally confused as to what was going on with my body, when this was going on. And I was very lucky that people were able to guide me through what the symptom was and to understand it better. Yeah. And you're in the biz. So just people who aren't. Right. Yeah. I have a head, I have a level of health literacy that is probably different to the general population. And I didn't have a Scooby-Doo what was going on with my body. I thought I was doing the right things to try and rehabilitate myself by gradually increasing my activities. What I thought was dependent on my symptoms, but I had zero clue what was symptoms were doing because they were all over the show, but there are some tools to screen for this as well. Speaker 2 (16:14): And that's within the briefing paper. So there is a range of different questionnaires. And actually specifically within the, the, the briefing paper, there is a a box which actually has these 10 items that you can use. And it tells you how to score it, how it links it to the evidence-based research, which comes from Emmy and CFS. Hasn't been validated in long COVID, I'm sure that work will happen, but it's a tool that could be useful. There has been some research already that's come out of Calgary in Canada, which has used this tool specifically along COVID. And actually that was published as a pre-print literally the day after this was published. So it's not included in the briefing paper and that's a sign of how fast this research is moving, but a very high percentage of people are scoring as the threshold for experiencing post exertional symptom exacerbation when living with long COVID. Speaker 2 (17:07): So it's there, it's prevalent. It's an important consideration because what we know is that a graded exercise therapy program, which is incrementally increasing the amount of activity you do, irrespective of your symptoms has been shown to cause harm in other populations of people, particularly MEFs that experience post exertional malaise, and at our heart of what we do rehabilitation should be there to support people. It should be nourishing. It should be improving functioning, and it should not be causing harm. And that's where that narrative approach is useful because when we provide interventions, we need to provide the safe spaces for people to tell us that it might not be working and not allow people to feel that it's their fault that it's not working because they've got this symptom. Speaker 1 (17:57): Yeah. So, so, so important. We don't want to place the blame on someone for something which they have no control over. Right. And, and I think as, as physiotherapists, we have to check our biases. We have to understand that when this person comes in, I mean, we all have biases. We were, that's how we are, you know, maybe not as a four year old child, but certainly as you grow up, you acquire these biases and you have to know as the practitioner to be able to recognize that bias and push it aside, right. Speaker 2 (18:36): That's such an important point about implicit bias as well and unconscious bias. Because I think actually wholly as a profession physiotherapy has an unconscious bias, which is that the mantra exercise is medicine is within our bones. And I think as a profession, it's quite hard to hear that exercise can't cure everything Speaker 1 (18:58): Well. And, but I think you kind of said this earlier is exercise is prescribed. So we need to prescribe it just like you would prescribe a medication by dose. Right. So, and sometimes guess what that dose is zero, right? Sometimes it's zero, you're prescribing it. So again, it's that exercise is medicine. Yes, it's a thing. But you have to know enough about the person in front of you to know how to prescribe it. Exactly. Speaker 2 (19:29): And that's where physio therapists are. So ideally placed to take on board these messages, there's key message of screening for post exertional symptom exacerbation, because we all are good at prescribing physical activity and exercise interventions that are based within a rehabilitation model. And we are also good at knowing when not to prescribe. And I think that if we're given the tools to be able to identify the symptom, recognize that there might be an adapted approach that's needed that works with individuals and potentially takes a stop rest and pace approach because pacing is not easy to do. I'll say that from lived experience you know, there's, there's so much that can be done beyond the scope of just prescribing physical activity and exercise interventions. And I think that physiotherapists are so ideally placed to be working along those lines and working with our multidisciplinary team colleagues. And this is where the big shout out to the OTs go because pacing is their bread and butter. Speaker 1 (20:28): Yeah. Yeah. For sure. Absolutely. Okay. So we've got one key message is screening. Speaker 3 (20:38): Cause there were four, right? So what's number two, we Speaker 2 (20:42): Went on a topic, but it's important. Speaker 4 (20:47): [Inaudible] Speaker 1 (20:47): The most important part is to be able to screen and know the person in front of you. Yeah, Speaker 2 (20:53): Yeah, absolutely. So the second is about cardiac impairment. So what we know is that before we prescribe physical activity, interventions, including exercise or sport, we need to exclude cardiac impairments. Now there is enough evidence to demonstrate that's people that have had coronavirus and people that are living with the long-term consequences are long COVID can have cardiac impairment. And that can include things like pericarditis, myocarditis, even at mild levels. Now we know the opposite. There's a favoring for excluding exercise interventions for people that do have perio myocarditis for the safety implications. So reducing morbidity and mortality. Now, obviously this is a safety message. We don't have enough evidence yet to say what the true prevalence of cardiac impairment is amongst people living with long COVID what the safety implications are. But this key message is we must make sure that we are conscious of this because the evidence is indicating there's a risk and we need to be mindful of that risk. Speaker 1 (21:58): Right? So as a physiotherapist, if someone is coming to us with long COVID, who has not seen a physician has not seen a cardiologist has not had a cardiac workup, it would behoove us to say, Hey, listen I think your next stop should be, let's get you to a cardiologist to evaluate your cardiac function, Speaker 2 (22:18): But depending on symptoms, certainly. So, you know, people are having it disproportionate tachycardias on exertion. They are having strange cardiac symptoms, including changes to heart rate and blood pressure. They have chest pain, they have desaturations, you know, the classic cardiac symptoms that you'd expect. You're not going to try and push them through an exercise program. You're going to encourage them to see a physician first. And I think that there is going to be many people living with lung COVID that might not be going through specialist services for people designed for people living with non COVID. And there may be many that come through the doors of physical therapists and physiotherapists around the world first. And so this message is there because we need to make sure that we are aware that there is a risk. Speaker 1 (23:06): Perfect. Okay. What's number three. So Speaker 2 (23:09): We know that third one is around excluding exertional oxygen desaturation. So what we know is that COVID-19 can cause interstitial pneumonias. And so we have seen this in other diseases. So, you know, it can be things like pneumocystis, pneumonia, or PCPs. You see it in things like interstitial lung disease or idiopathic lung fibrosis with these they can cause these saturations on exertion basically, and as the most safest thing, you want to make sure that your patient is not hypoxic when you try to exert them. So it's a simple thing, but what we know is that this is often something that may have happened to people during acute COVID, but it doesn't mean that they can't have it ongoing. And we are seeing people that are having pulmonary impairments and sometimes these pulmonary impairments can manifest slightly later on as well. So it's just to be mindful of this. Speaker 2 (24:04): So the world health organization does recommend, you know, the pulse oximetry is used to measure that's and certainly in terms of long COVID services. So I'm based in England. So the long COVID services that are here do often utilize functional performance measures to determine if someone is exertion de-saturated and they might use something like a sit to stand test or a 40 step test to see if somebody is exertional desaturation, or having disproportionate successional tachycardias as well. But that needs to be finely balanced with point number one about posted exertional symptom exacerbation. Because obviously you don't want to put somebody through a test to determine if their exertion de-saturated, if it's going to cause them to end up in bed for a bit. Speaker 1 (24:49): Yeah, absolutely. Again, why point number one was so important. Let's go on to point number four. Speaker 2 (24:56): So point number four is about autonomic dysfunction and orthostatic intolerances. So many physiotherapists might not be aware of some of these conditions. So for example, there's something called pots or postural orthostatic tachycardia syndrome which is where people change posture. They go from lying to upright there, their heart rates go really, really high. And with that, they can have symptoms of presyncope or even syncope. And also other orthostatic intolerance is exists where people can have really significant drops in their blood pressure again, causing issues with precinct pain syncope. So these dysautonomia is, are actually being seen to be quite prevalent in many people post virally, potentially. When they're living with long COVID, I said potentially there, because we don't really know what's going on with long COVID. So so we are seeing there's a higher amount of that and the American autonomic association has already published some guidance on that specific to long COVID. Speaker 2 (26:00): So the key message with this is if you've got somebody who, when they change position may have a disproportionate dropping their blood pressure or a disproportionate increase in their heart rate, you probably don't want to be getting them doing a downward facing dog or sitting on an upright bike because the likelihood is they could find, or they could have a heart rate of 220. So we need to think about that. Now there are lots of existing research prior to even COVID existing about dysautonomia is including pots and there was all these protocols that existed. And actually some of the work that's come out of Mount Sinai in New York has been looking at adapting those protocols to develop something called autonomic conditioning therapy which that developed in the context of long COVID. But it's really important that we're aware of this because if we're going to be looking at whether a physical activity intervention, including exercise or sports is going to be safe and effective for our individuals sat in front of us in the absence of evidence, guidance, and policies and standards. We need to be aware that these things are happening and people are having strange symptoms including changes to their blood pressure and heart rates with changes in postures. And the, the briefing paper is really clear on what it is what can cause it, how to measure it and what to do if it's there. Speaker 1 (27:26): And so we've got those four key messages. We're not going to dissect every bit of this briefing paper, because that would be a whole weekend course, I think, but for people that are listening, what, you know, as being one of the authors of this paper contributors to this paper, what, what is that, that group's hope for people upon reading this paper? Speaker 2 (27:53): So I don't know that I can speak for everybody that was contributing to this, but I would imagine that the majority of people have the same opinion as me. It's the lead author of this which is that we hope that this supports firstly, communities of people living with an effected by long COVID when they are accessing care, which is they have a resource that they can take with them to their health care providers and have these open conversations and dialogues about what may or may not be right for me. I also think that collectively, we all really hope that this is going to support clinicians that are going to be providing care for people living with and affected by non COVID. Because we know that at the moment, a lot of people are looking for information and there's, there's a lot of information that's either direct or indirect, and sometimes it can be difficult to see the wood for the trees when there's that much information. Speaker 2 (28:48): And so we're really hoping that this has consolidated over 180 citations into one document and every single citation has got a PDF link. So you can access that literature yourself. You can do your own research around it, should you want to, but we're hoping thirdly, that this will be a starting point. We're hoping this is going to be a starting point for hopefully international collaborations to work on these messages, to develop guidelines, standards, and policies around that as the evidence continues to emerge, but also to guide the research agendas, because obviously there are going to be some people where exercise will work for them, but we need to know who they are. And we need to make sure that whilst we're doing that research, that we have the safety messages at the heart of delivering that research too. So this crosses communities, clinical practice policy and also research. Speaker 2 (29:46): So I think the hope is that this has wide reaching impact. Obviously we need to see how that is, but this isn't the end of the journey. This is going to have further interest iterations. This is a live document. This will be updated as more research comes out, but we hope as well that people will work with us as things move forward and looking at international collaborations because we know that it's interprofessional, but also multi-sectorial collaborations that meaningfully engage and increasingly include people living with an effected by the health condition that leads to much more positive responses in all of the responses to that health condition. Speaker 1 (30:25): Yeah. And, and last thing I'll, I'll touch on here. And that's, I think what you were getting at at that last little bit is really looking at the social determinants of health and of the people who are affected by long COVID. I know I can say here in the United States that we know that African-Americans and Hispanics within the United States much more effected by COVID than other other folks. And so can, might, might this also be with this international collaboration across a lot of different professions, a way to really look at our social determinants of health and what can we do as healthcare providers and researchers, and so on down the line to make sense of this and to to address this, even in, in a small way, I know it's opening a whole can Speaker 3 (31:25): Of worms, but you know what I'm saying? Yeah, I Speaker 2 (31:28): Do. And I think it's, it's a can of worms I'm prepared to go into. So so yes, we know that in different parts of the world obviously the people that are affected more by acute Corona virus has been disproportionately people of different ethnic groups. So for example, here in the UK, we are seeing it more amongst black, Asian, and minority ethnicity groups. And we're also seeing it amongst different populations of people in terms of employments, but also in terms of socioeconomic status. So we know that health workers and teachers are more likely and people that drive buses, people from black, Asian, and minority ethnicity groups and people that live in deprived areas in the UK. But what's really interesting is we're not seeing that same demographic appear in terms of who's presenting in terms of the demographics of people that we are collecting data on in terms of long COVID. Speaker 2 (32:16): So what we're seeing in the UK so with the office for national city plastics, which is probably the most representative and largest epidemiological studies on long COVID to date globally, it's actually disproportionately young white women that are have relatively different social economic. So I think the aims of maybe an unintended aim, but hopefully a positive unintended outcome is that if more people are aware of some of these key indications of awareness, maybe some greater awareness of lung, COVID the people that are probably more likely to get COVID are probably going to also be more likely to get long COVID, but we're not seeing that come out in the data or the people presenting to those services. So we need to think about health inequalities in terms of the candidacy of people to access these services, how permeable are they to access? Speaker 2 (33:19): How, how is the adjudication between the individual and the health care providers to be referred to that? What's the individual's candidacy to raise their voice, to say I deserve to access these services. And at the moment we know that structural racism exists, health inequalities exist, and people that experience structural racism often experience healthcare incredibly different to other groups such as white people. And so it's probably likely that many of these people may also be living with long COVID and not presenting to health services and not being counted. And this is a particular issue globally, which is that we're still not effectively counting on COVID. And so we don't know the proportionality of people affected by it and the need globally. So if this briefing paper has any way in contributing to more clinicians, more people being aware of some of the signs and symptoms of lung COVID and particularly those key recommendations in terms of safety, if they can say, well, maybe you do have long COVID. It might be a way of identifying people that are more at risk, but also are more vulnerable to not accessing services. Speaker 1 (34:21): Yeah. Perfectly said, I am in awe of your of your ability to succinctly and efficiently get big ideas across that allows people to understand better. So thank you very much for that. That was wonderful. Now, before we sign off here, where can people find you? They have questions. They want to know what's up. I love Speaker 2 (34:44): A bit of Twitter, so I'm on Twitter, I'm at Darren brown. Also we've got our long COVID physio group at long COVID physio on Twitter. We've also got a website long covid.physio. So they're probably the best way he's very responsible on Twitter. So yeah, I won't give out my email address, no need, Speaker 1 (35:02): No need to, no need to get that personal. But I do have one personal question before. So knowing where you are now in your life and career, what advice would you give to your younger self? Oh Speaker 2 (35:13): My God. So you warned me about this earlier, didn't you and I get to repeat what I said earlier. I was like, oh my God, this is like, RuPaul's drag race. Isn't it. There's going to be a picture of a five-year old Darren big helicopter. What would you say to baby Darren? Do you know what I would actually say? Whether I was on RuPaul's drag race or dot is the diversities of people bring out the strengths in others and I'm a man, and I know that Mo and I'm now a person living with an episodic disability. Those things have made me a better person and enabled me to have conversations with my patients and the people that come and access my care in a completely different way that because of the lens that I've seen society and life. So if I was seeing myself as a younger Damron, I would have said, be proud of who you are, be accepting of who you are and know that your diversity, your differences, your quirks, your geekiness, your diff, your things that make you unique are going to truly make you unique when you're older and give you advantages in terms of how you navigate life, society and your job. Speaker 1 (36:23): I love it. Thank you so much. That was so perfect. What a great way to end this podcast, Darren, thank you so much for coming on. Thank you for your time. I really appreciate it. Thank you for having me and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.