On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Erica Ballard on the show to discuss how to optimize your health and performance through nutrition.  Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules. In this episode, we discuss: -The impact of optimal nutrition on performance -How to detect and remedy vitamin and mineral imbalances in your body -Mindfulness strategies to cope with quarantine stressors -And so much more!   Resources: Erica Ballard Website Erica Ballard Instagram Erica Ballard LinkedIn Pantry Essentials Playbook The Lies We've Been Fed Podcast   A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.     For more information on Erica: Erica is the founder of Erica Ballard Health – a wellness company that optimizes individuals’ energy through food. Erica started her company after realizing health looks way different than what she thought, bought into, and sold for decades. Now, an evangelical about helping people do better, Erica teaches working professions how to truly take care of themselves despite their busy schedules. Erica has her MS from Tufts University School of Medicine, got her CHC through the Institute for Integrative Nutrition, is a regular contributor to WTHR 13, and has been featured by Women’s Health, Lululemon, and the Young President’s Organization.   Read the full transcript below: Karen Litzy (00:01): Hey, Erica, welcome to the podcast. I'm so happy to have you on. And now, before we get into the meat of our discussion, I would love for you to talk a little bit more about you so that the listeners kind of know how you got from point a to point B to where you are now.   Erica Ballard: Sure. So for most of my life, I have been a public health practitioner. People pleasing go getting type of gal. And so because of that, I thought I knew what healthy was. And so I was always trying to get there through the traditional means of, you know drinking the shakes, eating the bars, following the guidelines. But the thing about it was I never actually looked or felt the way I wanted to, which was again, so confusing because rule following people, please are working in public health. Erica Ballard (01:02): You think that I would look the way that I wanted to given that I knew quote, unquote, exactly what to do because I had these huge desires to not only have the body I wanted and look like the women I saw on TV or magazines, but I also had this like deep desire to be happy. And I thought that health or fitness, because I equated the two at the time was the linchpin for me because externally I had everything that one would desire, but internally I felt unfulfilled. And so the only piece that was missing in my exterior, you know, look was my weight. And so I was like, okay, that's it. So I did what everyone does, who tries to get healthy? I like, I count calories. I followed all the rules. I tried to outrun every French fry or glass of wine that I would have, and I just couldn't get there. Erica Ballard (01:57): And that all changed though, when I moved from East coast to Indianapolis, which is where I'm originally from, I moved here and I went to the Institute for integrative nutrition, even though everyone said, don't do it because I got my master's at Tufts medical. I had still student loans, all those things. I was like, no, this is the thing. And it was like, it was the thing. It actually taught me that, you know, food sleep, stress. Those are the drivers of health. And when I figured that out, I went out and I tried to share this information with people. And when I did, they were like, no, that's not right. And so while I started to get results, I would hear them or I would hear society saying girl, no. And so then I would stop doing the thing that made me feel better. Erica Ballard (02:46): And it was this weird up thing that would happen until finally I decided now I'm the expert on me actually. And I'm going to let feeling good lead the way. And when that happened, it's like weight dropped. I was able to hold conversations and happy. My mom likes me again. Right? Like I wasn't the worst human being who was like constantly snapping and more. So I just figured out that, like I was in charge of my happiness. I was in charge of my health and I knew best. And so doing that journey is what has brought me here today to help not only continue to help myself, cause you never just arrive at health. Right. But also to help others who are really desperate to get healthy, do it because most of the people that I help are high performers are people that are willing to do the work and are just like, I am doing it, but I can't. And I'm like, I got you. I've been there. And so walk them through the things that they can do in order to really enjoy their lives while being healthy. Karen Litzy (03:49): That's incredible. And now let's talk about that. Cause I love that you work with kind of high performance people, high achievers, high performers feel like I'm the same way in New York. I don't know a lot of people in New York who aren't that way. I think that's part of living in that might be a requirement for living in New York city. But let's talk about how we can optimize our performance through food, right? I'm a physical therapist. So we're used to optimizing performance through strength, training, stretching, pro programs, plyometrics, but as a physical therapist, I also know that just what you said, sleep food are paramount to when it comes to being able to optimize your performance. So I'm just going to throw it over to you. And I would love to hear your take on what that means. Erica Ballard (04:42): Sure. So it was up to two things when I have this conversation because so many people will tell me all the time, Hey, I get so much done. Even though I don't eat the way I should or I'm drinking these Cokes or whatever it is. So like screw you Erica. And I'm like, listen, you're only in second gear. Like think about that. Like you're only in second gear, you get to fifth, you have to get your food. Right. And the first reason I think that I think it's so clear that we need to get our food right for this is Maslow's hierarchy of needs. So at the bottom of Maslow's hierarchy of needs is psychological and within psychological is food. So that means in order to get the self actualization, the top that, you know, essentially self fulfillment, you have to get the base, right? So without it, you just can't be. And if that's not enough, cause social science, isn't always enough for people. The hard data is starting to show that our brain and gut aren't connected. So we know that if what you put in your gut is not good, your brain will not function. And if your brain will not function appropriately or to the best of its ability, you can't optimize because a lot of your decisions are made with your brain. Karen Litzy (05:47): Right? Absolutely. Yeah. And, and you know, when we talk about that brain gut connection and you can correct me if I'm wrong, but we are really one of the bigger there is that Vagus, Am I correct? In that a hundred percent? Do you want to talk a little bit about that? Erica Ballard (05:58): Well, I think it's one. So for me, when I work with clients, I can, but where I always find it being interesting is that when I talk with people about how to get healthy every single time, I don't know, this is what happens to you when I get into the nuances. They're not, they're like, yeah, the Vagus nerve that matters, but I'm like, yeah. Breathing, putting things in making sure that like the fibers in your gut, they're all going up to your brain, making sure that that's, they're talking matters, but the nuances I have found people don't care as much about. Karen Litzy (06:36): I can definitely relate to that because I deal with a lot of people who have pain, more chronic pain. And so when I sort of go into kind of the neurophysiology behind pain, people like get it for a little bit, but then they just don't want to go that much deeper into the weeds with it. Like you said, like the nuances, but for the purposes of our discussion, I would like to, so let's pretend I'm like your ideal client and I'm like, Erica, tell me what does all this mean? Erica Ballard (07:10): So for me, when I look at our nervous systems and how they're connected, right, we have this nerve that literally runs through our body that connects these two entities and for it to be functioning appropriately, to make sure that the fibers around it actually work to make sure that it, all of the things that it's also then connected to work appropriately. It's really important that we put in foods and fibers and vitamins that our body need for those things to communicate and talk. And so what we typically do, right, is we're like, we'll put whatever it's in and it doesn't matter. And if I just drop weight, I'm going to be the healthiest version of myself. And it's like, no, you have, you have the Vagus nerve, you have your entire nervous system. You have your gut lining. Erica Ballard (07:58): You have these, like you have these different pieces within your body that need to appropriately absorb all of the nutrients in order to make sure that everything is communicating the way that they should. And so when I think about how to optimize and when I think about food and Vagus nerve and all of those pieces is I like where my head often goes is in order for these things to function appropriately, we need the right amount of nutrients and we need our body to be able to absorb them so that these things can talk. But we were like, we think that supplements work by themselves. And we think that vitamins and minerals work by themselves, but it's a payer to make sure the communication is appropriate. Karen Litzy (08:45): Okay. That makes sense. Yeah. And I think you do see a lot, I don't know about you, but I see a lot of people Hawking different kinds of supplements and vitamins and this and that. And then you hear research on none of it matters, right? Like, Oh, why take this? Why take that? Why take a multivitamin or take a plethora cocktail of vitamins that doesn't work. You should get it all from food anyway. So what do you say to that? Erica Ballard (09:11): So I think there is, I can understand where they're coming from. And I think that from a health perspective, if you're at the beginning and you're like, I'm trying to get healthy, I can't quite figure it out. Start with food nine times out of 10, or I would, should say eight times out of 10, start with food, making sure that you have of the highest quality items. But when I think about the importance, I used to really agree with that. But now I'm starting to understand the importance of supplementation or I have fully grasp it of supplementation because the soil in which our food grows does not have all the nutrients necessary for our body, for the plant to grow to the best of its ability and for our body then to take in all the nutrients that exist. Like as a society, we are magnesium deficient as a society. We are vitamin D deficient. And as a society, we tend to be omega-3 deficient and you can't often get enough magnesium through your food, especially if you're trying to make up and provide them in D like if you're in a Chicago or Boston or in New York, it is listen, it's cold outside. Like it is hard. Erica Ballard (10:22): To get those things in. So while I believe that food is medicine, I do believe often food is the first line of defense. If your thyroid isn't working appropriately, if you're in a lot of muscle pain, if you're not sleeping so well, those are, they're probably supplementations that you need to bring into your body to make sure that it's optimized. But, before going to experiment, I would always say consult with a practitioner or like PT health coach, like certified health coach doctor nurse practitioner, because you can't like you can't really OD per se, but you can get the wrong results from these supplements. Karen Litzy (11:04): And do you suggest people take blood work? Like if you're working with someone, do you suggest they get blood work taken so that you have a clearer picture or to see like, Oh wow, you really are deficient and XYZ. And then here's a way I can plan this. Erica Ballard (11:19): So when I work with people, what I always recommend is first start with your diet. So straight up, like most people are not eating enough vegetables. You know, if you're listening to you are like eat vegetables, try to also clean up your diet, take out where you can. And if you can organics pasture, raised grass fed really just up that quality and see what happens. But if you do that and in a month, you're not moving towards the results you want. Blood work, I think is, can be extremely helpful because like, for instance, going to like to the thyroid, the amount of hypothyroidism underdiagnosed in this country is, is pretty high. And when you also look at inflammation markers, even though you're eating a clean diet, like if we're having food, like we're eating things that we're intolerant to, maybe you can't get that exact number in, or that exact food item in the blood work. Erica Ballard (12:14): But I do think it helps really show same with magnesium, vitamin D cause there's different protocols, right? Based on different deficiencies that you have. And so to be able to task, versus just to think I provides a piece of mind that a lot of people want, especially going back to the high-performer piece, like your mind is always going, like you're going a thousand miles a minute, but if you can get paperwork that will show you what's happening and different ways to track, it can feel really nice. And it also can feel like an accomplishment.   Karen Litzy: Yeah, I agree. And I think that it gives you, like you said, a goal to work for, to work towards maybe like, I know I'm like a big numbers person, so I really like to see the numbers. So for me, if I had like a blood test, let's say I was vitamin D deficient, which I am by the way. And then I was like, okay, well let me change my diet or let me take this supplement. And then I got another blood test in six months and it was better than I would be like, okay, this is a little bit more proof for me. This is what I needed. And it would encourage me to stay on that healthy path. Erica Ballard (13:09): Yeah. And I think there's nothing wrong with that. I think that that's why there's such beautiful things with all the tracking devices and blood work and the availability of multiple different types of blood work now to test all these different things, because what I always find, and this is neither good or bad, it just is. It's not a lot of folks are sicker than they know that they are. And because they're so used to feeling a certain way, they don't even know that they're in deficient levels or dysfunction. Erica Ballard (14:00): And so that blood work can also, as a practitioner help us show that there are different ways to feel better. Because going back to the vitamin D example, I mean, vitamin D was all the rage. And then it was then were told it was a crock of, you know, stuff. And then now it's coming back in and it's like, if we could just show here's where it should be, that was conventionally what we said. Right. And here's where we need to be. It just fosters an easier conversation. Karen Litzy (14:53): Yeah. I think you get better buy in, you get people like, Oh boy, I don't think it's, and I don't think it's meant to scare people, but it's just meant to be like, Hey, you know, something may be some of your symptoms. Maybe they're correlated with this. You know, it may not be causative, but maybe it can correlate and let's see if we can change some and see, Do you feel different? And then retest, it's just a test retest, right? Erica Ballard (15:03): It's yeah. And if one scientific method, if you will, I'm all for that. And I think when it comes to supplier minerals, nutrition, like nutrients, things like that, it's really helpful. I think the only place I would say, and I would be interested in what you think that it's not as wonderful as doing the test on yourself is food intolerance. Because I find that the best model or the best testing out there is 85% accurate. Whereas the gold standard I have historically found is to pull it from your diet for three to four weeks and then systematically add it back in. Which you can do anything for three weeks. Karen Litzy (15:40): Yeah. Yeah. And I've done that in the past. And it was definitely very, very helpful. Like I took things out of my diet for a month and it's felt a huge difference. I had some autoimmune issues after getting the flu shot. So I had an auto immune reaction to that and it was quite painful and it lasted nine months. Yeah, it's called erythema nodosum it looked like somebody kicked me in the shins 500 times of the steel toed boots. Like it was swollen and red and purple. And I remember I was at the time dating this guy that lived in Baltimore and it was on one leg and it was like over Christmas. So it was in between Christmas and new year's and it was on one leg. I was like, what? And I remember I showed his mom like, what, what do you think this is? Karen Litzy (16:28): And she's like, she used to be an EMT. And she was like, I feel like you should just see a doctor. I'm like, why? And she's like now. And so I just went to like a ready care place, you know, like a city MD. And they thought it was like a staph infection, which I was like, this is I've seen or cellulitis. I was like, listen, I've seen cellulitis this ain't it. And then the next day I woke up and was on the other leg and I'm in Baltimore. And I said to my boyfriend, like, we gotta go to the ER. He's like, I don't know where to go in Baltimore, Johns Hopkins, Johns Hopkins immediately. And I went in and the doctor said, I'm in the ER. And he looked and he's like, it's erythema nodosum. I was like, what he's like, did you have any, like, do you get any shots lately? Karen Litzy (17:08): I'm like, well, I got a flu shot a week ago. He's like, yeah, it's the flu shot. Don't ever get a flu shot again. I was like, okay. So that was over Christmas. And then it finally, all of the symptoms went away in September. And, what I changed in September is I did an elimination diet and took a whole bunch of stuff out. So I don't know what it was, but I mean, I mean, I stopped sugar, gluten caffeine, which I didn't drink anyway. Dairy, everything, like just took it all out. Yeah. And then within a month I was like, and even like my boyfriend, he's like, you're so much brighter and you're back yourself again. And so that auto-immune really like knocked me out quite a bit. And so I do agree there is something to that pulling stuff out of your diet and just see what happens. I mean, it's the easiest thing you can do, right. Doesn't cost any money. Erica Ballard (18:06): I mean, there's so many now alternatives and just the auto immune piece of it. I work with a lot of folks who have auto immune disorders and gluten. I mean, whether or not you have an intolerance or not gluten, for some reason always seems to aggravate these autoimmune diseases. And so we're disorders. And so when you pull that out for a few months, it doesn't mean it has to be gone forever, taking it out and then allowing yourself to see if it works or doesn't is huge. And like you, like, it's the sugar and the caffeine. I know it can be really tough for people, but the rest of the stuff there are alternatives for all. Karen Litzy (18:39): Yeah, absolutely. And I mean, I don't really have a lot of sugar and I don't drink caffeine anyway. So that was easy. The other thing was no alcohol also fine. I can handle that. You know, the gluten was a little hard in the beginning, but then like you said, like I just had gluten free bread and gluten-free POS I mean, it's so easy. It's not like I was like Jones and for tea, like a loaf of French bread or anything, you know? So for me, I felt like, Oh, this was super helpful. And I have not had the flu shot since. Erica Ballard (19:09): I wouldn't either if I had to. Karen Litzy (19:11): Horrible. Anyway, so we're talking about optimizing performance through food, right? And so I think the listeners can now get an appreciation for how food should be the first line of defense. Then move into if you need vitamins or supplementation or minerals and nutrients and when these work together, your brighter you're quicker. Like you said, you're moving from second gear to fifth gear. Erica Ballard (19:37): Yeah. And the thing that always it's interesting for people when they do this is they never knew that they could feel this good. And now it's what makes continuing it so much easier. It's both a mix of like, I feel this good. And then being quite honest is when you start to eat better, like take supplements, do those types of things. When you put in things that your body doesn't like, man, does it fight back? Like you just feel the pain, you feel the grogginess, you feel the lethargy and you don't do it anymore. Because a lot of times people will say, well, you're healthy. It's easy for you. And it's like, Oh, it's either I feel horrible. Or I take care of myself because I've done enough. I find that the body always is trying to talk with you. It's always communicating and it will slap you in the face. If it does, if you do something, it does not like, and most of us can't feel it because we've put it in such a stressed out state. So that it's always feeling so bad that like, it's just hanging on because we're in survival mode. But when you get into that parasympathetic nervous system, when you get into thriving, it will literally have as many communications and conversations as it can that you move in the best direction for you. Karen Litzy (20:53): Yeah. And it sounds to me like what you're saying is the body would prefer not to feel like shit. Erica Ballard (21:03): Yeah. That's exactly in a nutshell. Karen Litzy (21:05): Okay. All right. That's what I thought. Okay. So you brought up briefly, they're talking about stress. So let's talk about stress. I mean, we're still as we're recording this, I'm in New York city, we're still on lockdown. We're in the middle of a COVID pandemic. So stress is a real thing right now. And when we're stressed, I think that's when people are like, I'll take that piece of chocolate, I'll take this, you know, so what can we do to help overcome the stress without falling back on those cravings if you will. Erica Ballard (21:39): That's a really good question. And I heard something this morning that I think was brilliant. So I'm going to share it here is when we think about stress, the idea is just, how do you get back into the present moment and how do you get back in to finding joy? I mean, it sounds a little corny, but that is that's it. And so in quarantine, what can be really helpful is identifying things that you could do that you would do on your vacation at your house. So whether you take naps on vacations or you take long walks, or you listen to music in the morning, instead of a podcast, doing those things that transport you into a state of calm is really helpful. And we can do those things in our house. We just completely forgot that we could, because we're so used to only doing them when we're out there. Erica Ballard (22:36): So that's the first thing that just came to top of mind when you were, when you asked that question. And I think the other pieces are just looking for moments of not solitude seems like the wrong word right now. But moments of peace, because while some people are not at the office, we're there were so available now. And at least we had these cutoffs, right? You go into the office, you leave the office like, and that was that. Now everyone knows we're not going anywhere. So we're getting the emails, we're getting the texts, we're getting those things. And if we could work our way in defining moments where we can shut down, whether it's the walk without the phone, whether it's actually closing your computer and not opening it back up, putting your phone away for half an hour, those things are really gonna help bring you down. Even though we don't think that they do like you feel it in your body, like 15 and another phone, you kind of, you're able to sink down into that couch wherever you're at and just be. Karen Litzy (23:40): Yeah. And you know, I've been hearing that from a lot of my clients who I normally see patients in their homes. And so at this, right. Nobody wants somebody coming into their home and I don't blame them. But they're also working from home and what everyone's saying, they're like, you know, when I'm at work and we have a meeting, I get up from my desk, I walk to a boardroom, I sit down, I go to the bathroom, I talked to other people. I come back, I walk to work. I walk home from work. I go out for lunch. I come back in or at least I go to the kitchen and I come back to my office. And now I said, you know, I'll have a meeting from two to three. And they're like, Oh, you're available at three. We're gonna have another meeting from three to four. Karen Litzy (24:20): Oh, you're available from four to five. She's like, so all of a sudden my patient, she was like, I'm not leaving my computer. Whereas when I'm at work, I do. And I also have the opportunity to get fresh air, but now I'm 12 hours. I barely have time for lunch. And I'm just, and I heard that again and again and again, so you're right. It's that, that feeling of, we all have availability and for some people, their only option might be a five minute break, you know? Like they might not be able to take that half hour break if they've got people sort of like breathing down their throat. So do you have any advice for those people to do like a five minute break or a three minutes something to help at least ground them a little bit. Erica Ballard (25:04): Yeah. So there's two ways to do it depending on who you are as a person. So I think standing up planting your feet from on the ground and just breathing in and out in a really calm, amazing fashion and like feeling the breath go through you is just such a great way to literally move yourself into a very present state. The other way is to move your body, right. It depends on who you are and what you need. When I have five minutes between meetings, I'm not even going to hide it. Like I, right now, I'm here for the Jonas brothers. You can judge me all you want. I turn on the Jonas brothers and I like dance in my house. Cause those songs are only like three and a half minutes. So I will literally put it on and I will just dance around my house because a music makes me happy. But also it like moves. My body moves. My energy moves like that stagnation. And so whether it's squats for you going up and down the stairs dancing, whatever it is, it's just shaking off what was for what is. And I find that that is very helpful when you're chained to your desk for 12 hours on end. Karen Litzy (26:10): Great advice. Thank you so much. So now before we wrap things up, is there anything that we didn't touch upon or anything like, what is the thing that you want the listeners to leave this discussion with? Erica Ballard (26:24): I would say that if you want to get healthier and you're not where you want to be really taking a look at your food and at your stress and seeing which one is holding you back. Cause I pretty much guarantee it's probably one of the two and then make a few decisions and change as necessary. Karen Litzy (26:49): Excellent. And again, the good thing about this is that doesn't take a lot of money, may take some time, but it certainly is not something that's going to break the bank. And, and again, because we're in these uncertain times right now, you know, people might be a little less wary of like, Oh, do I have to, you know, go and leave my apartment or my home and go and do this and go and do that. But if there are easy ways, like you said, look at your food, look at your stress easy. Now, if you are the kind of person that needs someone to help walk you through it, that's where someone like you Erica would come in, you know, at being a health coach, like that's where you would come in to kind of not hold their hand, but be their coach and give them the game plan. Erica Ballard (27:41): Yeah. And, that is why if you do need help, I'm so huge on working with a practitioner because like at the beginning, it's an N of one, you are actually the unique snowflake you think you are. And so helping you figure out the right things for you in a safe space is really important because health is so personal and you get a lot of feels when he's searching to move, try to move in the direction you want to move. And so I do really believe people can do it on their own with a little bit of support from online programs and things like that. But if you can't, asking for help is the best thing you can do. Karen Litzy (28:26): Yeah. And I know you have a free resource for the listeners. It's the pantry playbook. Is that right? So do you want to talk a little bit about that? And just everyone knows, we'll have a link to that in the show notes at podcast.healthywealthysmart.com, but talk a little bit about it and where people could get. Erica Ballard (28:43): Sure. So I heard from clients all the time, I want meal prep, I want meal prep. I want meal prep. And I was like, no, you don't, they don't want it. But it's what they kept saying that they wanted. What they really wanted though, was they wanted it to be able to make really quick meals on the fly that tasted good because three days into the meal prep, if throughout all of their foods, they're sick of it. So I said enough, that's like, yeah. I mean, I don't like five day old food either. So I get it. And so what I did is, I was like, well, I don't ever meal prep. I don't. And so I was like, why don't I meal prep? Oh, cause I have everything I always need on hand all of the time. Erica Ballard (29:25): And so I went to my pantry and started to look at, and then think about all what my clients do and me, and they're there, the special needs that go on and was like, Oh, I can create a list that if you always have on hand, it's going to be faster to make healthy meals than it is to go out and get takeout, because these are our options, right? We meal prep, we get take out or we make it home. And if I can help you make a fast healthy meal at home that cuts the meal prep and cuts the time it would take to get takeout. It works. So I have that resource for them and it'll be at https://www.ericaballardhealth.com/pantry-essentials-playbook. Karen Litzy (29:59): Thank you so much. And now onto the last question that I ask everyone, knowing where you are now in your life and in your career, what advice would you give to yourself after college? Let's say grad school Erica Ballard (30:12): That I love this question and I really, really wish I knew this, that you can do it your way. Karen Litzy (30:22): Mm, powerful. Erica Ballard (30:24): It's just with health. Like you go into people's homes. Like I go into people's homes via camp, like what, like, you know, zoom, you can do this thing. You were away. So don't follow someone else's rules. If it doesn't feel good inside. Karen Litzy (30:41): Excellent advice. And where can people find you social media website? Erica Ballard (30:47): Okay. So I play a lot on Instagram. So it's at Erica Ballard health. I'm actually on LinkedIn quite a bit. Website is EricaBallardhealth.com. And I had a new podcast that's actually dropping on June 2nd called the lies we've been fed. And it's an eight part series that walks people through the lies that we have been fed about food to give them a path forward. Karen Litzy (31:12): Awesome. It sounds great. I look forward to listening and thank you so much for coming on. This was wonderful. Thank you and everyone. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Dr. Kameelah Phillips on the show to discuss optimizing health during pregnancy.  Dr. Kameelah Phillips is a board certified Obstetrician and Gynecologist, wife, mother, and lifelong women’s health advocate.  Since high school, she has been involved in local, national, and international organizations aimed at advancing women’s health care issues through advocacy and direct patient care. In this episode, we discuss: -The impacts of COVID-19 on pregnancy and post-partum -Factors that impact the United States’ maternal mortality rates -Six ways to optimize your health during pregnancy -The importance of interprofessional collaboration -And so much more!   Resources: Calla Women's Health Website Dr. Kameelah Phillips Instagram Calla Women's Health Instagram   A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.     For more information on Dr. Phillips: Dr. Kameelah Phillips is a board certified Obstetrician and Gynecologist, wife, mother, and lifelong women’s health advocate.  Since high school, she has been involved in local, national, and international organizations aimed at advancing women’s health care issues through advocacy and direct patient care. Dr. Phillips graduated from Stanford University with a degree in Human Biology with an emphasis in Women’s Health and Human Sexuality. After graduation, she worked at the San Francisco Department of Public Health in the AIDS office as a Research Assistant on HIV vaccine studies.  She relocated to Los Angeles to attend the University of Southern California Keck School of Medicine. During medical school, she received numerous community service awards. She was privileged to travel to Ghana, Cuba, and Tanzania on health missions during this time. Upon completion of medical school, she attended a competitive OB/GYN residency at the New York University School of Medicine. She also served on an emergency medical mission in Port-au-Prince, Haiti to provide women’s health care during the 2010 earthquake.  Dr. Phillips is an educator, mentor, and expert in women’s health issues.   She loves to help women and girls feel comfortable with their bodies, so that they can be aware of changes or new developments.  Her interests include Minority Women's Health and health care disparities, lactation, sexual and menopause medicine.  Dr. Phillips is a member of the International Board of Lactation Consultants and speaks Spanish. She enjoys teaching residents and medical students. Her guilty pleasures include reality T.V.   As a Real World Alumnae, she has used this platform to travel nationwide to discuss domestic violence, smoking cessation, and other health-related issues.  She loves a good bargain, flowers, and deep-tissue massages. You can follow her on Instagram @drkameelahsays   Read the full transcript below: Karen Litzy (00:01): Hi, Dr. Phillips, welcome to the podcast. I'm excited to have you on. And this is the first time I'm having an OB GYN on the program. I've had lots of physical therapists who work with women's health and pelvic health. So this is really exciting to get a different point of view on women's health and on pelvic health. And now, before we get into the meat of the interview, we are still living in a pandemic, COVID-19 is still here. It has not mysteriously disappeared or vanished. And so there are a lot of women who are getting pregnant, who are living through pregnancy at this time and who might be a little nervous, a little concerned about what can happen during their pregnancy is COVID affected. So what I would love for you is any advice for those pregnant women in the time of COVID? Kameelah Phillips (00:58): Yeah, absolutely. You know, one thing I really try and impress on patients that is absolutely unique to OB GYN is despite what's going on in the world, whatever chaos is going on, women still have babies women still go into labor. Women still take healthy babies home. So for us in particular we've made some minor, not, I shouldn't say minor there there's significant, we've made some changes in how we deliver care and the hospital setting, but for us, it's really been, you know, not so huge of a change because you know, hurricane Sandy earthquakes in Haiti, I've been through both of those, we still deliver excellent care to women. So one thing I would ask them to do is just really take a deep breath and while things are going on around us remember that their primary concern is to take care of themselves so that they can take care of their baby. Kameelah Phillips (02:11): I have told patients that a little bit of their OB care is changing. So we might have fewer visits, but really the important things we will always make sure that we hit the important time points and hallmarks of a pregnancy. So you won't miss anything. I've been telling them that labor and delivery has changed a little bit. And I think this changes pretty much coming across country, but whereas it used to be a time where, you know, extended family was welcome. It's important that they recognize now that only one or maybe two people will be allowed to be present for labor and delivery. And our hospital in particular, both moms and support family are being asked to wear a mask. We do check moms for coronavirus. We use the nasal swab. The extended family is not tested, but they're expected to keep their mask on. Kameelah Phillips (03:16): And most of the time our moms are coming back negative, but if they do come back positive, you know, we have a discussion and education with them as to what it's going to be like, knowing that they're now corona virus positive and going to be taking home a newborn. So we talk about those things. But for all intents and purposes, women are coming in. They're having healthy, safe deliveries, both C-sections and vaginal deliveries. Their hospital stay we've shortened a little bit in New York, we're going back to keeping women two days or four days, but other places in the country are, are shortening. The hospital stays in an effort to get women home safely and so that they can use hospital resources for the people that need them. But we're having healthy and safe deliveries. There was a panic, I think, amongst the pregnant community at the beginning of the pandemic, and everyone wanted to have a home delivery that still continues to not be the best response to this. Kameelah Phillips (04:28): It is still safest to deliver in a hospital or birthing center, certainly not at home to have best outcomes. We still recommend that women breastfeed that's the best way to feed your baby despite Corona virus, even if you were previously infected. And when women go home, I just ask them to be considerate of the new immune system in their house, right? So limiting visitors, washing their hands. If people come over, keeping them not being afraid to say, Hey, keep your face mask on while you're with the baby or around the baby. And really using the technology that we have to their benefit. So while it's not what we're used to, the grandparents meet their babies over FaceTime or zoom now. And that's not going to be forever, but you know, if you have people who are unable to quarantine and can guarantee that they're negative, I asked them to defer visiting. Karen Litzy (05:29): Yeah. Thank you. That's all really great advice. And I should have mentioned in the beginning that we are both located in New York city. And so right now it's different.   Kameelah Phillips: Yeah. So obviously New York was the epicenter of the pandemic, certainly in the United States, if not the world at one point we have now our numbers have gone down, but the safety for the pregnant and new moms have, has not is right. Yeah. Right. So we are still on top of new infections, preventing infections in the hospital, the doctors, the nurses, the people who clean your rooms, we're all washing our hands, wearing gloves, keeping our mask on because it is our priority that you come in healthy and that you leave healthy. Karen Litzy (06:33): Yeah. Perfect. All right. Well, thank you for that. And hopefully if there's any pregnant moms or other healthcare practitioners that are working with pregnant women kind of give them a little bit more information to pass along or to kind of keep in their heads. So now let's switch gears slightly here. I'd love to talk about maternal mortality rates in the United States now in the United States. We know, unfortunately that we do have a very high maternal mortality rate amongst advanced countries, or what's the best word for that advanced countries? Is that the right developed countries, industrialized countries, like we know what you're talking about, you get it right. So the questions that I have are what populations are most effected. And then what, in your opinion, do you feel like needs to be done to improve those maternal mortality rates? Kameelah Phillips (07:32): I am firmly under the belief that we can as a nation, as a country walk and chew gum at the same time to make these rates better. So to answer your first part of your question we have plenty of data that show that black women, African American women in particular are most vulnerable during pregnancy labor and delivery. And postpartum times the rates of increased death can be anywhere from five to seven times higher than their white counterpart. And these rates are abysmal for a developed country to have such a discrepancy in healthcare is really saddening and frankly just discussing it's unacceptable. But there are other ethnic groups that are also at risk that, you know, we always talk about black and white and really this country is so diverse, but our native American population is also significantly affected by maternal mortality rates that are poor as well as Alaska. Kameelah Phillips (08:57): We always forget about Alaska. So African American women, native American women and Alaska women, and it's complicated. It is a combination of access to care. It's unfortunate that we seem like we're talking about the same things over and over, but access is a big issue. We live in the biggest city in the United States, but you know, Manhattan alone, what the Island of Manhattan has four hospitals there used to be more, there used to be more can you imagine? But some of our outlying communities that are more ethnically diverse or Latino or African American have far fewer hospitals. And certainly in those hospitals, the resources aren't comparable to anything that you would see in Manhattan. So along with, you know, access there's hospitals, there's doctors there's birthing centers, all of these are less often found in lower resource places. Kameelah Phillips (10:06): So access is a big one education both on the part of the health field and of patients themselves is a problem. I think we're starting to really get some traction on the African American population, helping them understand that this is a very critical time in their life. And so they have to be hypervigilant about blood pressure, weight gain, diabetes, all of things, all the things that can be triggers for issues in pregnancy. Those are the big things that stand out access and education.   Karen Litzy: And do you also find that, and I find this in other aspects of healthcare especially when it comes to feeling pain that oftentimes women are not believed as much as men are. And, that is in other parts of healthcare, certainly true. Do you find that women maybe during pregnancy or even post pregnancy, like maybe that the day they gave birth, if they're there trying to explain things that are going on and perhaps they're not being believed and are just yeah brushed to the side so that I think is absolutely the case for a lot of the issues that women experience around the maternal period. Kameelah Phillips (11:22): And it's not limited to women. It also crosses ethnic and socioeconomic boundaries. We have a real issue and I'm part of the establishment, right? I'm part of the medical community. So I feel free to air up our dirty laundry, that we have a real issue with bias and medicine and we talk about racial bias and how that can impact black people. But we have a bias against women. We have a bias against women and, you know, she's being hysterical, she's being dramatic or pain's really not that big women in our discomfort in our needs are routinely downplayed and even by other women, because we've sort of ingrained in our head that, you know, women tend to be more dramatic, whatever. Kameelah Phillips (12:30): We downplay the needs of poor patients who come in, Oh, you know, she's just being loud for no reason or, Oh, that's just how they're. So this isn't just an issue of women. It goes across class, it goes across ethnicities. But for us, when we're pregnant, it has to be addressed and highlighted because when a woman is saying something isn't right. Something isn't right. And that should be taken seriously because in the postpartum period we get lucky a lot of times because women are generally young and healthy, but when things go bad in obstetrics, they happen quickly and then its big. So for example, if a woman was like, my bleeding is kind of heavy and say, maybe she just delivered a baby, a woman could easily lose one to two liters of blood in like a few minutes. So we had a really bad postpartum hemorrhage the other day. And I was like, this is impressive when you see what the body can do. Especially in labor, it happens quickly. And so it's incumbent upon us as healthcare providers to take women seriously. Karen Litzy (13:27): And then I would also think there is, and again, I don't know if this is true or not, but I know kind of where I come from more looking at the pain world and from my own experiences, as I personally would downplay my own pain. So as not to bother someone. Right. And do you feel like in the world of OB GYN, if you're going for pregnancy, like, do you have to kind of really educate those patients to say, listen, if you're feeling something doesn't feel right, like you need to speak up, right. Well, like you're bothering us. Have you encountered that?   Kameelah Phillips: I have encountered that. And it's really incumbent upon all of us to relearn these narratives that we've picked up just growing up in the United States of like not being the complainer or not being the squeaky wheel, not rocking the boat. Like those all have negative connotations right. Kameelah Phillips (14:47): In the obstetric space. When you don't speak up, we can have really negative, horrible outcomes. So part of my experience with patients is to listen to what they're saying really repeat back what they're saying, like, okay, I hear you're having X, Y, and Z. Did I get that right? And if it's something that is quote unquote normal in the space of a, you know, a growing uterus or a growing body part of my job is to really provide education, to help them manage their expectations for what they should expect. Growing uterus, growing weight gain, swelling, what they should expect from their body. If it's the first time they've been pregnant or the sixth time they've been pregnant, you know, all the pregnancies are different. And if we have a clear understanding her giving me her complaint, me giving her feedback on what I think she's saying, and then giving her the anticipatory guidance, I think she needs, and we still have an issue. Then it's incumbent on me to escalate it and really make sure that there's nothing there that's going to hurt her. Karen Litzy (16:01): Yeah. Great. That's perfect. And I love the kind of handling of expectations and monitoring expectations because that goes such a long way when, especially if it's your first time or not, like you said, your first or your six times, but kind of knowing what to expect at certain times is very comforting. And so then as if you're the patient, then you can say, Oh, you know, she said, this might happen, but I'm not, you know, it's not happening or it's going above and beyond what she said. So maybe this is time that I reach out and contact my physician on this, there are times where you may need to reach out to your doctor. And so knowing when those times might be, is really helpful. Kameelah Phillips (16:53): Exactly. So when a woman leaves the office and you know, it'll be maybe a month before I see her again, I tell her, you know, this is what I think might happen. It's okay. If it doesn't happen to you, but in the next four weeks, you might expect, you know, your pants size to change general discomfort in this area. You might feel something fluttering in your belly, like giving her those points to look out for. And again, managing those expectations and I'll get a phone call, Hey, this is maybe more I'm having this. Plus this is this in the realm of normal. No, it's not come in. You know, we can really help women out by giving them education cause it's empowering. And it helps us do a better job taking care of you.   Karen Litzy: Yeah. And it also keeps people away I would think from dr. Google or far down the rabbit hole of how many doctor Googles do you get? Kameelah Phillips (18:17): You know what, I can't anymore. Just so many doctor Google's with doctor said, I can't even more. Or my Facebook friend Sally said, Stay off. And it's funny cause when their partner comes with them, the partner inevitably just looks at him and like glares at them because they know that they're on Google or they're on these, you know, small chat rooms where everyone is on the T level 10 when the patient's issue is actually maybe a one or zero. And so it freaks her out. Yeah. I encourage patients to stay off of Google. Because yes, there are some times when it might answer your question, but really we're aiming for individualized personalized care and Google doesn't offer that to you. And so I really ask my patients to stay off of it. That's what their visits are for to write down the questions as they go. And honestly, it's so funny. They'll come in with like, say there's five questions just in the scope of time, given them the anticipatory guidance. Kameelah Phillips (19:17): Like by the time they actually get to the appointment, they may only have two questions because they're like, Oh yeah, she said that was going to happen. They know exactly, exactly. It helps to stay off Google.   Karen Litzy: Yes, yes, yes, yes. And now I think we've touched a little bit, I think on this, but let's see if we can delve into this more and that are what are ways women can stay healthy throughout their pregnancy so that maybe it can contribute to a decrease in the maternal mortality rate, even if it's just chinking away at the tiny little bit, because like you said, it's a big bucket with a lot of stuff going into it. But if there are ways that women can, like you said, empower themselves to stay healthy and give themselves the best chance, what advice do you give to women to stay healthy? Kameelah Phillips (20:04): Yeah. So in thinking about this, I have six points that I usually share with patients. So I'll go over them really quickly. But my first point is to find a doctor that you trust. I'm really big on that. I'm really big on that. I tell people to find someone that they trust because inevitably, you know, most pregnancies are fine, but if we get into some mess, I need to know that you know that I am your advocate and I am on your side. And if you hesitate or you don't feel like you can trust me a hundred percent, I'm going to ask that you explore other op, find another doctor because I want you to the best experience possible. And I even say this with my GYN patients, like if I tell a patient, you know, I really think you need surgery for this. Kameelah Phillips (20:56): I don't sign them up for surgery that day. I've let them go into the world, do their due diligence, meet with three other doctors. And I promise you, I have not had a patient not come back because they trust me. So that's a big thing. Find someone you trust. I think it's really important that patients meet with their doctor frequently, meaning that you come to your visits, you got to show up, right? So we can get data from you like your blood pressure, your weight how you're feeling, checking the baby regularly, blood work, this data that we're collecting at every visit. And it might not sound like a lot 15 minutes, but it actually gives us a picture of where we're going with your health. So that's important. I asked my patients also to stay active and exercise. I am not sure why there's this misconception that you should be sedentary during pregnancy first trimester. Kameelah Phillips (21:55): I get it that progesterone knocks everyone out there on the couch. They can't, you know, they're nauseous. They don't want to, I get that. But for the most part, when you feel healthy in pregnancy, I need you take care of yourself. And that means exercise and eating healthy and patients are, Oh no, but the baby really wanted the chili cheese fries. No, no she didn't the baby requests. Yeah. Did she send you a text message to get that? So really encouraging, like if you would feed your six month old, you know, a Coke and chili cheese fries for lunch, that's a separate conversation, but you know, trying to do as best they can. In terms of staying active and eating healthy education is a big piece for me. Every time they leave, I'm like, okay, we're entering this phase. These are the major risks for this phase. Kameelah Phillips (22:53): So I need you to go home and look at this website and read two minutes about diabetes, cause you're doing your diabetic test and this is why it's important. Being flexible is huge. Patients, I think often have the misconception that physicians or that I control their pregnancy. And really, I see myself as just like a tour guide, ushering your baby safely into this world. And so it's important that they're flexible to whatever the results come back as whatever the ultrasounds tell us, however, the baby is behaving in labor, that they're flexible. In my industry, I'm not sure what the corollary will be with physical therapy, but people who come in with very strict demands as to how they expect their process to be are the main people who have complications as opposed to just letting us do our job, to get you guys to the finish line. Kameelah Phillips (24:02): So being flexible is really important. And then my last one is to not refuse life saving treatments. We were, it was in the, I told you the other day I had a postpartum hemorrhage and I might back of my head. I was like, this woman's going to bleed. So as we were pushing or when she got admitted, I was like, you know, this is the type of situation where I see XYZ happening and when XYZ happens and she lost all that blood. When I came to her about needing a blood transfusion, she was already on board to not refuse treatment that could possibly save her life. So not refusing like blood products or blood pressure management, those are increased surveillance. Those are the big things that hurt and cause women to lose their life. So really not refusing important treatment. Karen Litzy (24:58): Yeah. And I think thank you, those are great ways that women can stay healthy. And you know, as you were saying, they need to be flexible. And I always go back to movies where they show the woman going in and she's got a birth plan and it has to be this and it has to be this. And there's no flexibility around that. So I could see how that could be really dangerous if you're going in with that kind of a mindset of, you know, I have to have this baby without any drugs and have to have it vaginally. When in fact there might be some complications where that's just not possible and it's just not possible. And, or advised or safe. Kameelah Phillips (26:00): And again, we don't decide that, right. The baby's position, the mom's uterus, the pelvis, like all of these things that are outside of our control decide that we're just here to make sure you both come out on the other side. Okay. And I can't underscore that. Cannot underscore that. Like I don't have anywhere to be there's this misconception that doctors always have like tickets. So like I have to be at the opera tonight. No, we don't have anywhere to be we're here for your baby, but you know, we have to have some flexibility, like let us just do our job and we'll get you through this.   Karen Litzy: Yeah. I think that's great. And then of course, I always love the third point, which is stay active and exercise and move during your pregnancy. And I think I'll give a quick plug for physical therapists. I think this is where physical therapists and women there are a lot of physical therapists who are pelvic health specialists and who work specifically with pregnant and postpartum women. And this is where I think we can actually maybe make an impact in that maternal mortality rate as physical therapists. Kameelah Phillips (26:54): Yeah. Yeah. I spent the first part of my career in a group dynamic and it was very hard for us to think outside the box with complimentary specialties that can help make this process of pregnancy, which is physically mindblowing. Like people, if you haven't necessarily been pregnant before or been in an intimate relationship with someone who's going through pregnancy, you can not imagine how physically difficult it is to have a baby. And so when I was bringing up the options of like physical therapy, no, no, no, she's fine. The body heals itself. I'm like, but it's not like, look at her walk. You know, I'm looking at her. Diane is like, like, let's think outside the box. So in my new practice, I'm making much more of an effort and actively establishing relationships with people that, okay, you're having this issue. Kameelah Phillips (28:07): Now let's connect with the physical therapist because you know, the hips give women the most trouble, the hips, maintaining flexibility labor and delivery, the act of pushing literally separates your pelvis. You know, it's not, of course you have issues with your pelvis afterwards. Lacerations, you know, women who undergo episiotomies that pelvic floor has literally hit the wall and back. So to not expect that pregnancy is a hundred percent, the most physical activity you can do with your body just really undermines and belittles the whole process. And so part of my process now is to send women to physical therapy, postpartum, even if it's just for one visit so they can have an idea of how to improve their core, how to keep their pelvic girdle in shape and engaged because most women have more than one kid. Kameelah Phillips (29:11): So that's a lot of, you know, trauma to the body. And we can do better. We know that it works, we know that it's available, but it's up to us to provide the education and the next steps for them to heal.   Karen Litzy: Yeah. Well said, well said I love it. And now as we wind things up here what would be, what would you like the audience to take away from our discussion today? Kameelah Phillips (30:29): I think that it would be helpful to really understand that most doctors do their best to provide women with excellent obstetrical and Gynecological care. I think that a good doctor is really open to receiving information from other specialties in this case PT, physical therapy as modalities that can compliment what we offer. That's not in opposition to what we do so that if we could somehow strengthen the relationship between obstetrics and physical therapists, everyone would win. Like it's for all of us, the patient the obstetrician, the physical therapist the patient's family. It's, you know, pregnancy is the deal. It affects literally you physically, emotionally, psychologically, and sometimes the physical impact of sometimes a lot of times the physical impacts the emotional and the psychological and your sense of wellbeing and health is so impacted by like how you physically look and feel. And you guys have a direct, you know, you have the keys to helping us, you know, improve women physically. So if we could strengthen that relationship and not see it as so oppositional, I think it's a triple win for everyone.   Karen Litzy: Yeah, I agree. And the last question I have is one that I ask everyone. And given where you are now in your life and in your career, what advice would you give to your younger self? Kameelah Phillips (31:41): So I'm out of residency 10 years, and I'm just starting my first private practice venture. And looking back, I probably should have done this five years ago. And yet I had a lot of other things going on. I was like birthing my own children and that kind of thing. But at the root of it, honestly, I was scared. I was scared of failing. I was scared of the unknown. I was scared of doing things that I'd never been taught before. Like formally I didn't consider myself an entrepreneur, all these like negatives, right? Negative, negative, never didn't have it. Shouldn't wouldn't, couldn't like, and I would give my younger self, like a kick in the butt to like, just get out there and you know, unless it seems so cliche, but you don't know unless you try. And when you're young, there's nothing to lose. Kameelah Phillips (32:53): Except the fear that's like this imaginary fear that's holding you back. It's a time to be brave and courageous and adventurous. And so I would probably give my younger self like the little push off the ledge the encouragement that I needed to have started this venture and experience earlier. And I would just tell her to be fearless. What do you got to lose? You can always, you know, move back in with your parents. That's what we're doing these days. Right. So like, why be afraid to fail like that just now it's so funny. Cause I think about it cause I'm in it now, but what did I have to lose? Nothing. Nothing. Yeah. Like time, but that would have been a learning, you know, you would have learned so willing to learn. Kameelah Phillips (33:52): So yeah, I would have jumped sooner.   Karen Litzy: Excellent advice. Thank you for that. And now where can people find out about you about your new practice? Where are you on social media? Where can we find you? Kameelah Phillips (34:57): So on social media? My main page is drKameelahsays, my practice page is Callawomenshealth, like the flower. I love the like beautiful erotic nature of the calla lily. So that's my practice Calla women's health. I'm on the upper East side of Manhattan, but also available for telehealth visits, physical visits throughout coronavirus. I've been on the grind in this office. So taking new patients of course also happy to see them.   Karen Litzy: And for everyone listening, we will have all of this information, one click straight to all of the practice and the social media at the podcast.healthywealthysmart.com. Under this episode, it'll all be in the show notes. So if you didn't get it, don't worry, you can get it that way. So thank you so much for coming on. This was a great episode and I think you've given a lot of wonderful advice to healthcare providers and to women who may be pregnant or want to be pregnant or maybe has already been pregnant. There's a lot of stuff here. So thank you so much. I appreciate it. And everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Susie Gronski on the show to discuss chronic pelvic pain syndrome in men. Dr. Susie Gronski, licensed doctor of physical therapy and board-certified pelvic rehabilitation practitioner, is the author of Pelvic Pain: The Ultimate Cock Block, an international teacher, and the creator of several programs that help men with pelvic pain get their pain-free life back.   In this episode, we discuss: -What is chronic pelvic pain syndrome/chronic prostatitis -Sociocultural barriers unique to men receiving pelvic pain care -Male expectations and reservations during a pelvic health treatment session -Strategies to increase patient self-efficacy -And so much more!   Resources: Susie Gronski Instagram Susie Gronski Facebook Susie Gronski Twitter Treating Male Pelvic Pain Course for healthcare practitioners Pelvic Pain: The Ultimate Cock Block Book In Your Pants Podcast Men's Online DIY program: use code painfree20 for $20 off! One-on-One Intensive Program   A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.       For more information on Susie:  Dr. Susie Gronski is a licensed doctor of physical therapy and a board certified pelvic rehabilitation practitioner. Simply put, she’s the doctor for ‘everything down there.’ Her passion is to make you feel comfortable about taboo subjects like sex and private parts. Social stigmas aren’t her thing. She provides real advice without the medical fluff, sorta' like a friend who knows the lowdown down below.   Dr. Susie is an author and the creator of a unique one-on-on intensive program helping men with pelvic pain become experts in treating themselves. Her enthusiasm for male pelvic health stretches internationally, teaching healthcare providers how to feel more confident serving people with dangly bits.   She’s determined to make sure you know you can get help for: painful ejaculation problems with the joystick discomfort or pain during sex controlling your pee without needing to be embarrassed... So whatever you want to call it, (penis, shlong or ding-dong), if you’ve got a problem ‘down there’, she’s the person to get to know. Dr. Susie is currently in private practice in Asheville, North Carolina specializing in men’s pelvic health.    Follow her on Instagram, Facebook, Twitter, YouTube and listen to her podcast, In Your Pants, for expert pelvic health advice without the jargon.    Read the full transcript below: Karen Litzy (00:01): Hi Susie, welcome to the podcast. I'm happy to have you on. And now as the listeners may know, I've had a lot of episodes about pelvic health, pelvic pain, but most of them were centered around female pelvic health and pelvic pain. And today, kind of excited to have you on Susie because today we're going to be talking about chronic pelvic pain in men. And I think this is a topic that is not spoken about a lot. I don't know if it's still considered taboo in many places. We'll talk about that today as we go through this podcast. But before we get into it, can you tell the listeners what is chronic pelvic pain syndrome or chronic prostatitis, which I don't know why I have a hard time saying that word and I'm looking at it and still have a hard time. But anyway, that's neither here nor there. That's my problem, not yours. So go ahead and just give us what is it? Susie Gronski (00:52): Well that's okay about the not able to say the word prostatitis because it is a bit of a misnomer when we're talking about male chronic pelvic pain syndrome. So it's okay. I wish that word wasn't used as frequently anyway to describe what we're going to be talking about. So the official definition that one might read in the literature is that chronic pelvic pain syndrome or chronic prostatitis is having recurring symptoms lasting more than three to six months without a known cause or pathology. And that typically results in sexual health issues, urinary complaints, and obviously a lot of worry to say the least. So that's the official definition of chronic pelvic pain syndrome. Susie Gronski (01:46): Now the NIH or the national Institute of health classifies, I put in bunny quotes here, prostatitis into four categories and briefly those categories are an acute bacteria prostatitis, chronic bacterial prostatitis, chronic non bacterial prostatitis, both inflammatory and non-inflammatory, which is the realm that physical therapist will work in. And then you have a category, interestingly enough, asymptomatic inflammatory prostatitis. And I think that's really important to stress that you can have quote unquote inflammation in the prostate, but you still have individuals who are asymptomatic. So when it comes to the word prostatitis and itself to describe male pelvic pain, I think it is a bit of a misnomer because a lot of cases are not bacterial related or infection related. And actually in fact 90 to 95% are not infection related or bacteria related. So I think we need to shift from using prostatitis as the main umbrella term. Susie Gronski (02:52): Because you know, it puts the blame on the prostate when we know that's not the sole cause or what we're dealing with in the long run.   Karen Litzy: Got it. So that, that can be a little confusing for people. Cause I'm assuming if you're a man and you hear that diagnosis prostatitis that that's gotta be kind of unnerving to hear. Right? For one you don't know what it is.   Susie Gronski: Yeah. It's like, well, and I don't want to stereotype, but I think when guys really hear prostate, anything, what's the first thing that might come to mind? Cancer, cancer. Right. And so now you're freaked out like what's wrong with my prostate? Am I going to have cancer? We know it's highly prevalent. And so yeah, I think it is a bit of a misnomer in terms of when you have pain down there especially without a known cause that leaves the fear of, well, they must be dismissing something. Susie Gronski (03:50): There must be something really seriously wrong that the doctors are not just finding.   Karen Litzy: And what are some common symptoms? I know you mentioned a couple in the beginning there, but if you can kind of repeat those common symptoms that people may experience with chronic pelvic pain syndrome and is pain one of them. Yes. Right?   Susie Gronski: Yes. Most often it is a sensation that is not typically pleasurable. It's painful. It may or may not be associated with urinary issues. In general. You'll have any sort of pain or discomfort in the abdominal or genital region. It could even be around the tailbone or even pain with sitting, sitting around, you know, around the sit bones in the groin. It may or may not be associated with sexual function. So for some men they might experience pain after completion or with an erection. Susie Gronski (04:46): They might feel pain with bowel movements. It might be testicular pain. It might be pain between the scrotum and the anus, typically known as the taint area. So there's a lot of overlapping symptoms that one might have. Again, everyone's so unique, but those are some of the common themes that one might hear in the pelvic health world.   Karen Litzy: And so if you're experiencing these symptoms, let's say for more than a month, I mean, will people experiencing these symptoms for, let's say a couple of weeks before they go see a doctor or go to look up their symptoms and see what's going on?   Susie Gronski: I think that varies on the person and their personality in terms of like their health and healthy behavior in terms of men health seeking behavior. We know that when you compare it to, for example, women, they don't tend to kind of seek out the help of doctors as women might do. Susie Gronski (05:50): Right. and I think that's across the board in terms of international standards as well in terms of the seeking behavior, health seeking behavior. I don't think I can have like a, I don't have a stat or factored on that, but I do think that men tend to kind of like watch and see what happens or you know, I think many of us do. Like if you feel something you're like, well that'll just pass. Right? I don't know if I gave an answer that fully. I just know that sometimes people wait and sometimes people go right away cause they're afraid or whatever the case may be. But I do think that the sooner that you can get reassurance for what you're experiencing in term, and I mean reassurance from not just take these antibiotics and come back and see me in six weeks, it should go away. Susie Gronski (06:42): Because that's typically what will happen when a guy will seek help. And I think the main one of the main barriers too is that where does a guy go get help from when something like this happens? Cause for females we have a gynecologist or a woman's doctor, right. But guys, like I know my husband just, he's like, I would have no idea where to even go. Who do I seek for help for this kind of thing. And so I think when we're talking about barriers for seeking help, that's one of them. I just don't know where do I go. And then you'll go to your primary care physician who may or may not be familiar with, you know, chronic pelvic pain or being able to differentiate, you know, whether it's an infection and what tests to do. Susie Gronski (07:26): A lot of times men are given antibiotics without even having diagnostic tests to see if there's an infection, which is unfortunate. And they'll do this for several rounds too. And so I think the longer that happens, the more that we're making the situation worse in terms of, you know, we know we've got microbiome, we'll plan to those pictures. Well it may or may not have been an infection that triggered this. We know the immune system plays a role in chronic pelvic pain. So, you know, I think having a well versed, fuzzy healthcare professional who can really help this person say, Hey, this is what could be happening. We know a multifactorial and multi-modal treatment approaches is very helpful for what you're going through and that, you know, these symptoms shouldn't last forever. Here go see a pelvic therapist if we know that's not happening. Susie Gronski (08:23): And I see guys several years later or years later before they even have an appropriate diagnosis, which I guess brings me to say that chronic pelvic pain syndrome is a diagnosis of exclusion. So, before they even come see or get a referral to see and see if they're lucky to get a pelvic health referral, they'll go through a lot of invasive tests. Cystoscopies colonoscopies. I mean, you name it. So I just think that by the time they do get the help, the right care that they need for the issues that they're experiencing, they've gone down a really dark rabbit hole by that point.   Karen Litzy: Yeah, and that's sort of looking at, I mean, it's not that they're healthcare providers are intentionally doing them wrong, right? They just don't know. Right. So we're talking about, I guess this more traditional view of a medical process for men who are coming in. Having these complaints is saying, well, let's check this, this, this, this, this, and this. Like you said, a diagnosis of exclusion. And then years down the road they come to see you and I can't imagine, forget about their physical wellbeing. I can't imagine their mental and emotional wellbeing is doing all right either. And now the pelvic physical therapist has a whole lot of comorbidities to deal with. Susie Gronski (09:21): Absolutely. Absolutely. And with any type of persistent pain, not just chronic pelvic pain syndrome in men, but I think with any type of persistent pain, we really have to be looking at the psychological and sociological aspects of that person's experience. Because at this point now we're dealing with an emotionally driven process versus a purely nociceptive in nature. You know, it may have started that, but now we're dealing with this like this cat yarn, I don't have cats, but a kid, I know they like to play with yarn and you have this big ball of yarn that you're really just taking one strand out at a time to really unravel and everyone is so unique and very different. Susie Gronski (10:30): So yeah, I think that's where we're dropping the ball with getting quality pain care for these individuals. Number one, just getting rid of some of these barriers of a lack of education on the practitioners, you know, perspective of what do I do in this situation? Why do we need to have all these invasive tests done? In my opinion. I don't think we need to do that, but they're really not getting the referral to see qualified, you know, pelvic therapists who can really rule out, you know, biological triggers and even work with the psychological and sociological aspects of that person's experience. Just to, again, calm things down. And to reassure that person that things are going to be okay. And to that extent, I think this would be worth noting as well is some men do not have positive medical experiences in that they're not being validated, often being dismissed. Susie Gronski (11:23): And no one's really actually looking at their genitals. To this day, I still have men say it's all about just finger, finger in the butt, checking out the prostate, and no one's really addressing like, take a look at my testicles, look at my penis, like treat it like any other part of my body. And then you're then that kind of plays into the blame and shame of one's body. And just again, not knowing, no one's really looking at it. I want somebody to look at it to tell me I'm okay. And I think that's really being missed as well in those early encounters with medical providers. I think that's so important.   Karen Litzy: And you know, you had touched on it a few minutes ago talking about not just what we see from a physical standpoint, but a socio cultural standpoint as well. So what are some common barriers that are unique to men from a sociocultural standpoint when receiving care for chronic pelvic pain? Susie Gronski (12:25): Well, the first one that I touched base upon as you said, was having an outlet to get medical care. So there isn't a, you know, male gynecologist per se for men. And so I think just having a lack of that awareness of where does a guy go get help for these types of things. Where would be the best physician, let's say for health urologist or urologist. But that isn't usually the first line of the encounter. It's usually an internist or primary care physician. And sometimes it could be even other healthcare professionals like a massage therapist or a chiropractor, an acupuncturist who's hearing these the symptoms or men feel comfortable enough with the trusted provider that they trust to talk about even what they're going through. Cause I think that brings me into the second, I think barrier is I think if I can say this, the masculine side of culture, right? Susie Gronski (13:33): Like, what should men like mentioned man up and not have these issues and what if something is going on down there? Like, you know, guys aren't really talking about their private parts in the locker room per se. And I speak, again, I'm speaking for the heterosexual male, but like, you know, I think it's just uncomfortable in terms of how the society that we live in to even have that conversation be brought up so that being one of the barriers is just, we're not really talking about sexual health issues and what could go wrong unless it's like, you know, erectile dysfunction. Right?   Karen Litzy: Well, that's all over TV, so you can't miss that one. Right, exactly. Here's a pill for that. We know how to fix that. You know, you got Snoop dog talking about like male enhancement products, Pandora. Yeah. And I think, I think in terms of, you know, what are the conversations that we're having around men's health and really comes down to what's selling and what's not selling, unfortunately. Susie Gronski (14:38): But yeah, I think that that's one of the biggest barriers as well as just we're not talking about it outlets. There are no you know, taking a stand for men's health essentially. And the second thing too, or the third thing is when a guy has pain down there and they look it up on the internet, cause that'll probably the first thing we do. Absolutely dr Google will be first they're there and to get help, everything is women's health, women's pelvic health, a women's clinic, baby and mom, you know, like things like that that are coming up where that in itself is like, wow, this is a quote unquote woman's issue. Why am I having it? What does that mean for me? Because again, guys and everyone, I think unless something is going on down there, like we really don't talk about our pelvises or how things work and we're not taught, we're not really taught about like you know, what to expect and how things work and that you have actually pelvic muscles down there. Susie Gronski (15:39): So until you know, something goes South literally and then you have to like look things up and there's enough of crap out there to scare anybody. And so I think, you know, again, I think Google is helpful but it also can be harmful because we know, we know that anything can really shape someone's prognosis when they're seeking treatment and you have scary forums and you have people talking about how I'm living with this for several years. And then you have this person who's just starting to experience these symptoms, reading through these forums and looking at, you know, it could be cancer or it could be this or that. You know, it's like a life sentence. And that's really scary. And that I think is what part of the picture that takes things from acute to chronic in my opinion.   Karen Litzy (16:48): Yeah. And you know, when people are involved in, and this isn't across the board, but oftentimes in those kinds of forums, it's people are writing about their experiences that have gone wrong, right? Or that you said, I've been experiencing this for years or I tried X, Y, and Z and it was horrible. So when you read those kinds of forums, cause I've gone on those, I think we, you know, a lot of healthcare practitioners should go on some of these forums to see what's being spoken about. But I've gone on them for like chronic neck pain and you're like, Oh my God, goodness. Right. This is, this is frightening. It's really scary. And so I can't even imagine someone going on there who is experiencing, like you said, some of the symptoms that you had mentioned before. Maybe they've been experiencing these symptoms for a couple of years or a couple of weeks and they look on these forums, they're like, Holy crap. Yeah. Like this is what my life is going to be now. Susie Gronski (17:35): Right. I mean that is really scary. Exactly. Exactly. And that we know, doesn't matter what body part we're dealing with, right. Tends to make the situation worse. Yes. Just cause of that. And so I think I'm a huge proponent of, I don't think I am a huge proponent of having good information knowledge. And like I said, reassurance for this group of people to say like, Hey, this isn't forever. This is what you can do about it. We can really work with this. It's more common than you think. And, it happens in this area, just like any other part of our body, you know there's muscles down there, there's nerves down there, there's everyday function that happens, like pooping, having sex, you know, all these things are quite normal. And I think just even experiencing some discomfort down there, just like you would have some back pain once in a blue moon is not, you know, something that needs to be perpetuated I think for many, many years. Susie Gronski (18:41): But I think we're talking about is that it's unfortunate because they will go down a rabbit hole of, well we've checked everything, we've done every scan under the sun and there's nothing that's showing up on scans. I just don't know what else I can do to help you. And then at that point the conversation is, well now it's all in your head and then, and I'm a goner. Like I'm doing. Yes, I'm doomed. Like and then, yeah. You know, when we talk about the interpersonal context of pain for that individual, it's am I going to be able to have a family, you know, if they don't have any, you know, or be in a relationship or to have kids or how about my job, I have to sit for my work. I can't do that. Or what about my sport that I want to play? Susie Gronski (19:27): Does that mean I can't do that anymore. I mean, there's so many like what ifs and uncertainty and that's one of the themes that men will talk about it's this uncertainty, this roller coaster ride of the symptoms that they experiences. It's fine, you know, one week and then it's terrible the other week and they just don't know what to expect because there's no rhyme or reason for it, for their triggers. And that's really, I think that's a really hard mental, yeah. How do I say that? Like a lack of words. It's really hard. Mentally. It is.   Karen Litzy: Yeah. You know, you're absolutely right. And now let's say one of these guys they've been having these symptoms, they've gone to their doctor and miraculously their doctor said you need to go see a pelvic health therapist. Right. Yay. The doctors know what's up. So what are some reservations men might have before seeing that pelvic health therapist? And then we'll talk a little bit from the therapist background point of view after that. But let's talk about the men's point of view first. Susie Gronski (20:26): Yeah. So, the point of views that I'm going to be talking about are actually from the people that I've worked with. So I'm just reiterating or paraphrasing from their experience. But the number one thing is what is it? Cause the doctors aren't really telling them what to expect. So again, they'll go on to Google and they'll find like, you know, this is a woman's health issue and why am I going here? And you know, again that psychological aspects of I guess gender in general of what that means for me as a person. And that experience in itself might be one reservation. Susie Gronski (21:17): Like you know, this is a women's health issue. Like I don't want to go there. And so they might put that off. Which is common as well. I think the second thing is the actual procedure of having internal work or an internal examination. And this is one message I'd like to kind of get across to people is that you don't have to do internal work to get better. And I think there's this huge misunderstanding of like pelvic therapy being like, well, it's all about moving the genitals out of the way and just going for internal work and chasing trigger points. That's not really what it should be an in fact, I think unintentionally of course, I think that's more harm than good because we aren't really asking. Like if you ask the guy in front of you like is this something that you really like? Susie Gronski (22:06): First of all, what would be the purpose of doing internal work? Or even having that assessment, like why are you doing what you're doing? And number two is that in alignment with what that person wants, is that a goal of theirs? Is that functional for them? You know, why are we doing these things? Because we don't want, as for me, I'm speaking for myself, I don't want it to be another person to create medical trauma. I don't want to be that person that says, well this is what you need. When in fact like they're sitting up there on the table, you know, cringing and guarding and tensing. And I think it's funny for me, like it's not funny for the person on the table, but I think when they're pissed we'll say, Oh, you're really tight. You know, you're really tight. Susie Gronski (22:51): It's like, yeah, this is tightest I've ever seen. And I look at me and I'll tell my patients, cause they'll be told that. And I say, well, how did you feel on the table? Were you comfortable with what was going on? And they're like, no, you know, no. And I said, well, no wonder your muscles are tensing. And that would happen with anyone, you know, I'm like, but that doesn't mean that you're broken or that there's something wrong with you. And I think that's the message that's going across, not for every therapist. And I'm not speaking for every therapist, but it's just a theme that I see with men who come into my office who've had therapy in the past. And that's something that I think might be a huge reservation for someone seeking care as well, is having to have an internal assessment done. Susie Gronski (23:36): Although it is common, it doesn't have to happen. And if you're doing an internal, so now let's kind of go into the pelvic health therapist point of view. So this patient comes in, they've had chronic pelvic pain for, we'll say several months and why might you do internal work in or an internal assessment if the patient was okay with it, obviously. So what would a therapist be looking for? So if the person is agreeing to have this done, number one, I think it's, they want to have a thorough evaluation by a professional who works in this field. So that's reassurance. So you would do that because they're asking you to do that, to rule out whatever's putting their mind at ease, right? Again, if that's what they so, so want, I think that's the first thing that we're doing. Susie Gronski (24:35): Number two, if there's like pain with bowel movement or let's say that person's sexual preferences or pleasure has to do with anything anal that would also be applicable in order to just map out areas of tenders, tenderness, and then see if we can change that. So we're not, they're looking for golden nuggets, trigger points. We're there just to see, okay, can we change what you're feeling and can we give that person an experience of, Hey, it doesn't always have to hurt this way. And there are things that we can do to change things and essentially giving them back a sense of control of their own body. But I like to preface that it is a very awesome teaching opportunity for the person because you can say, well, how does it feel when somebody else touches you versus when you try to do this yourself and right then and there during the assessment, I will actually have, we'll compare, I'll say, okay, I want you to touch those areas at home and tell me what you feel. Susie Gronski (25:39): And then I'll say, if it's okay, I'm going to do the same thing and that might be my own individual hand. It might be hand over hand with that person's hand. It just depends on, you know, again, their comfort level. But essentially I'm just there to see if we can change their experience in their body and to prove that you don't have to hurt all the time and that things are changeable. So I love those moments. So that's the reason that I would do any internal work or any external work for that matter, is to see if we can change that person's experience in their body to create more safety and less danger. And so it makes sense. That's what I would do. So yeah, that's essentially why do that and it's not an hour long treatment session of you know, internal work. Susie Gronski (26:31): But, men do appreciate that you take the time to actually talk to them to address their body just like, or this part of their body just like any other part of their body. And that's a theme across every single man that I have worked with. I came into my office, you know, they'll say, I really appreciate how you just worked with me and worked with my intimate parts of my body but just considered it just like any other part of my body, like my nose. And they just felt like the sense of like they can feel vulnerable, they can be safe. They feel heard and validated because somebody is actually taking the time to work with them to ease their essential suffering around what it is they're experiencing.   Karen Litzy: And I think that's really important. And so if you are working with a patient with this diagnosis and they are not comfortable with internal work, cause like you said, you don't have to do it. So what might be some other evaluative procedures you might do as the therapist to help this patient? Like you said, feel more comfortable in their body and get a better sense of understanding of what's happening. Susie Gronski (27:45): So the first thing is really just getting to know their story. So going back to giving them time to talk about what's going on for them. I think for men, having an outlet to be heard is really important because men don't typically kind of talk about these things. So once they know that you are accepting and you're there to offer that space for them to express themselves and the difficulty that they're going through with this, I think that's therapy right there. Just to give them that opportunity. So, having a supportive outlet. And the other thing is just if it's movement related, if it's an activity that they're having difficulty with, for example, sitting as a very common one. I have all sorts of like gadgets and toys in my office and I just bring some playfulness into the conversation. Susie Gronski (28:39): I have them sit on various different surfaces to see what would be something they like would actually explore, you know, again, I'm trying to see if we can violate the expectancy of, well, it always hurts and it's constant. I can't change anything. And so my role is really to see like can we change things and if we can, let's do more of that. So I try to bring a little fun into it. I try to incorporate like the passions, their hobbies that they once had done but have stopped since because of all this happening. Sometimes we don't even do any hands on work or any, even a formal assessment on the first day because we're really going through the story and we're reestablishing a sense of that person, a sense of what that person, who that person is. Because a lot of times you lose who you are. Susie Gronski (29:38): You know, when you have pain, persistent pain, you've gone through something. So life changing. So I think, you know, for me and for that person is establishing, well, what would life look like? What would life look like if this were no longer a problem? Who do you want to get back to being? And so I do vision boards. I'll do some sort of visioning exercise of where we can get to like the why, you know, why is this important for you? What do you want to get back to doing? How do you want to feel in your body? And then that becomes essentially the treatment plan or the plan of care. Anything that we can do to collaborate together in more of a coaching relationship to help you move forward, to attain I guess living in a way that you see yourself living, but also a values based type of approach. Susie Gronski (30:28): In terms of treatment. So I know that was like a mouthful, if it's the Bible, you know, I'm doing a bio-psycho-social approach, but I'm really, really having a being patient centered and patient led and I'm just there guiding them. So for some people it is really more of this, I need to figure out who I am, I need to start doing something. Well we figure that out before we go on the table. Cause there might be a lot of fear with that or they might have had certain traumas associated with, you know, medical experiences that may have had that may be negative. And so there might be a lot of reservation.   Karen Litzy: And I think we as therapists need to recognize that that person might say yes, like yes, that's okay for you to do all these things like with touch. But we should also be responsible of actually paying attention to what their body is doing, what their autonomic nervous system is doing while you're touching them. Because they might say, yes, and I'm guilty of this too. I'll go for a massage and that person's touches firmer than I'd like. And they'll ask me, you know, how's my pressure? And I'll be like, Oh, it's good, it's good. Susie Gronski (31:37): That's my point. Exactly. That's what the person that you're working with is going through the same thing. And I think it takes a sort of a bit of a skill to recognize or to be more mindful of, you know what, this isn't necessary. I noticed that you're sweating a little bit more, that you're tensing up more. I see your facial expressions, what are your eyebrows doing? And then I'll say, you know, we don't have to do this. I don't think this is right. You know, your body is saying one thing and I know you, you know, I know intellectually, yes, they want it. They want to make you happy. They want to please you, they want to make you happy. And I think part of the treatment too is giving them permission. That's self-efficacy, that's giving them a sense of agency to make that decision for themselves. Susie Gronski (32:21): Do I want, you know, I want to be able to say no. You know, and I tell them right off the bat, you know, that may know I have a lot of tools in my toolbox and if we try something where you're willing to try something and it doesn't work for you, just let me know cause there's many other things that we can do and try out. It doesn't have to be this one size fits all, which we know never works. So yeah. Anyway, I guess in the long run it just depends on the person who is sitting in front of me and essentially what they're telling me they need. And they'll actually, I have a very long intake form, but it's more reflective, very open-ended. And so I'll know from that of like what they're telling me. It's just so it's this awesome cause you can see it like they actually write it out. Susie Gronski (33:04): Like this is what I need. So I think is happening. Great. Well I'm going to facilitate this process and we have a conversation around that.   Karen Litzy: Yeah. And I think that's great. And I think it gives the listener, certainly other therapists listening have a better idea as to what a session treating someone, treating a man with chronic pelvic pain might look like. And now you had mentioned self-efficacy and we all know that as physical therapists one of our biggest jobs is to give people a sense of self efficacy and control over their body. So do you have any helpful strategies that you give to your patients for them to increase their self efficacy and to be able to manage their care when you're not there? Susie Gronski (34:02): Hmm. I love that question. So as you know, it probably depends on the person, but everything that we do together in a session, I make sure that they walk away with, well, here's what you can do for yourself. And it's really just a suggestion for them. I really want them to take it to experience it. So for example, I might say, you know, let's do some pleasure hunting. Probably if they've had experiences with you know, having an erection or participating in sexual activity, that was painful. We know that it's like all it takes is one time for things not to work and for things to be bad, to have a bad experience, to be worried about the next time and the next time and the next time. And unfortunately that's really strong for men and their, I guess their penis function, you know? And that's not uncommon to experience when you have pain down there. You know, the last thing you want to do is be like, yeah, I'm ready for sex. You know, it's a threat. Absolutely. and I think it's just educating, educating the person about like, this is completely normal what you're going through and it's common and it's not forever and let's see what we can do to start getting you to feel comfortable in your body again. Susie Gronski (35:05): And so, yeah, I think just having that kind of conversation, not being afraid to ask the questions and then asking them, well, what is it that you'd like to do or start with? Cause there's so many things we can do. What is it that you think is the most important thing to start with onto your recovery? Like I said, it could be sensory integration. So touching one's body, touching oneself and not being afraid and then having a recovery plan or a flare up plan. Cause we know that's common as well. So having some sort of structure around if I experienced this discomfort well what can I do next to help myself in this situation? Whether that's breath work a stretch you know, talking to a friend meditating, whatever it is for that person. Then we kind of put that into a plan to say, okay, next time, you know, if you try this cause you can't really, it's really hard to just, I think applied graded exposure techniques or graded activity to sexual function. Susie Gronski (36:08): Like you know, erections and having an orgasm and you're ejaculating. You can't like stop halfway. Like coming back from like, once you hit that climax, you know, and I think just letting them know that this is the process that happens in your body when you're having an erection and when you're ejaculating and here's what you can do to help yourself post. So, you know, I usually give things like recovery plan, but it's really collaborative with that person cause you know, everyone has their own way of living and their own lifestyle and whether or not it depends under relationship dynamics and sometimes we have to have a conversation around that. And then, you know, if any of those things are kind of coming into play, then we have to reach out to other, you know, a network of team members to help with all those dynamics that might be contributing to that person's experience. Susie Gronski (37:01): So, you know, like sex therapist or couples therapy or, you know, that sort of thing. So it just, you know, again, it depends on the person. So I actually want to do, I do want to make a comment about, you mentioned you know, so what is it that you give to your clients or to your patients? I think the other thing that I want to mention is that for therapists not to be afraid to address the genitals, this is one thing that I think is still common where female therapists will want to I think move male genitalia out of the way and just go to internal work. I think it's really important not to be afraid of, you know, addressing, we're touching a testicle or touching their penis. Because for them it's really important that you're doing that and then you're showing them what exactly, you know, showing them techniques or sensory integration techniques that you can do that they can do for themselves. Susie Gronski (38:03): So you don't have to do things. You're just showing them and then you're saying like, this is all completely normal or you know, or this is what we can work on. And having them experience, have an experience in their own body that's completely not sexually related at all. But I think as female therapists, we're afraid of like, well what if they have an erection right in front of me? You know, or like, and that's happened. You know, that does happen. I think that's one of the reservations is like, and speaking of reservations for the guy on the table, they're also afraid, maybe more so than you, that they're going to have an erection. Oh my gosh. You know, and then I always, I'm very candid about that too. I'm like, you know, we're touching parts of your body that have nerves and sense things and physiological reaction may occur. Susie Gronski (38:47): No big deal. If you need some time to yourself, I'll walk out of the room, you know? But you kind of address it before they even have a question about it. To put things at ease. So, sorry, I went on a tangent with that. Karen Litzy (39:20): I think that's important. That's really important to mention for sure. No, this is great. I mean, what great information. And so if you were to kind of take this conversation from let's say from the point of view of a man suffering from chronic pelvic pain syndrome, what would be your big takeaway for them? Susie Gronski (39:23): Big take away. How can I put this in one sentence? The big takeaway would be that this doesn't have to be forever. Like that this isn't permanent. That if there is something going on down there, don't be afraid to talk about it. I know you may not be surrounded by people who are very candid about talking about poop pee and sex. Like, you know, us as physical pelvic therapists. Anyway, we're so comfortable talking about that, that we forget that people, other people have reservations about talking about private parts. But yeah, not to be afraid to just, you know, reach out to a professional who understands what you're going through and who can relate to you because it doesn't have to be a lifelong sentence and a death sentence per se. Susie Gronski (40:27): You can get help for it and there's help for this. And yeah, I just, I guess that would be the main thing, just making, you know, having support and having that outlet for them to just be themselves and know that they're not alone.   Karen Litzy: And what about to the physical therapist who, let's say you, if you are a pelvic health therapist, you're probably a little bit more informed about this, but what if you're not a pelvic health therapist and someone is coming to you with these symptoms, what advice would you give to them? I mean, outside of, I have some that I could refer you to, who is more well versed in the treatment of this, but what advice would you give to the physical therapist?   Susie Gronski: You might be seeing a patient with chronic pelvic pain syndrome. I think just having more knowledge about what it is and what it isn't just as a practitioner so that you can have a conversation with this person who is experiencing pain because it in fact, you know, if the person you're working with has groin pain or the tailbone pain or sit bone pain, I think just being aware of like, there are other things that might be involved and asking questions, really not being afraid to ask questions. Susie Gronski (41:48): Maybe you put it in your questionnaire. I think there used to be Oswestry used to have a sex question in it. They took it out. So get the original one, keep the original one. But, yeah, just not being afraid to ask those questions and really just asking the person like, you know, I know asking permission without giving advice to, you know, just saying like, you know, I know a little bit about this. It's not within my scope, but how do you feel about having a consultation with a colleague of mine who works with men? Or who works in this field that can really help you out, we can really work together. It really is just opening up the conversation to say, Hey, you know, you're having these symptoms. There's something that we can do about it. Susie Gronski (42:36): It doesn't have to be, you know, it doesn't have to be like, well I don't know what to do for you, you know? Exactly, yeah. I think that's what it is. Like, you know, give them a resource or give them a website. There's so much free stuff out there. Like my website, I have all sorts of like blog posts and many others who work in this field have a lot of great literature on here's some things that you can do to just open up the conversation and what you can do to help yourself. So I think that's really the key. I think for PR professionals who are not pelvic health therapists but working with people who have pelvises that make a difference, you know, and you know they might be coming to you for low back pain but we know that low back pain and pelvic floor dysfunction and pelvic issues are correlated, highly correlated and in fact you know a lot of testicular pain can or can't originate because of low back issues and vice versa because of the connection there. Susie Gronski (43:31): And so just I think just having that conversation with your patients of saying like this is why it's all connected and this is what I think is what else is happening. How do you feel about getting, you know, getting a consult from so-and-so related to this because they might be, that person might be having many other struggles down there but not talking about it. Right. The first and foremost thing to do from a therapeutic perspective is let's have a conversation because we don't know what else might be going on for that person. And we can certainly be that gatekeeper, that liaison that says, Hey, I know I can get you to see so and so to help with these things issues. You don't have to just live with them.   Karen Litzy: Yeah. Great. Great advice. Thank you so much. This was such a good conversation. I think from the standpoint of the therapist and the standpoint of a man maybe experiencing some of these chronic pelvic pain symptoms. Thank you so much. And now last question is one that I ask everyone and that's knowing where you are now in your life and your career, what advice would you give to yourself as a new graduate out of PT school? Susie Gronski (44:52): Oh, that's a good question. Okay. So what advice would I give myself as a new graduate from PT school? Hmm. You don't have to be so serious. I think that would be the advice of knowing that we're humans are all very different and we're built differently. And what we thought was once quote unquote true is always evolving and just use your own experiences to make those determinations. Like you don't always have to be, I don't know, taking word for word when everyone tells you, experience it for yourself and then make that decision. Karen Litzy: Excellent advice. So now let's talk about what you have coming up. So you've got podcasts, books, courses. So tell the audience where they can learn about what you're doing so that they can in turn help their patients or help themselves. Susie Gronski (45:52): Well, thank you for this opportunity to have a shameless plug. Here I am. Well, I'm currently working on the second edition or revised edition of my book, pelvic pain, the ultimate cock block, which is written for, you know, the average Joe who is suffering from pelvic pain. I have a podcast called in your pants that's also on YouTube. And I have several programs support programs for men who are suffering, who suffer from pelvic pain. Some are online DIY programs, others are support programs where myself and a psychologist and sex therapist have collaborated on. And I also have a course that I teach. It's called treating male pelvic pain eight bio-psycho-social approach. So I'm very busy. I have a lots of things go. It's awesome. But where can we find all of it on my website? drSusieg.com. I'm on Instagram @drSusieG. I'm also on Facebook and Twitter. Same handle. Susie Gronski (46:54): Awesome. Yeah, and we'll have the links to everything at podcast.healthywealthysmart.com under this episode. So one click will take you to all of Dr. Susie's really helpful information, whether you're the person living with a chronic pelvic pain syndrome or you're a health practitioner that wants to learn more. So Susie, thanks so much for coming on. This was great and I look forward to your revised book and all the fun stuff that you have coming out. So congrats. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Jennifer Hutton on the show to discuss Anti-Racism & Allyship. Dr. Jennifer Hutton, aka Dr. Jpop, is a pediatric physical therapist from Nashville, TN. As a Black woman, Jennifer knows what it is like to identify as different, and it has helped in her quest to be an ally for children with disabilities inside and outside of the clinic. Now she is educating others on how to be effective allies to BIPOC and furthering her desire to create a diverse and inclusive space she calls Dr. Jpop’s Neighborhood. In this episode, we discuss: -How racial trauma impacts the biopsychosocial determinants of health -The difference between an ally and a white savior -Implicit bias in healthcare -The lifelong process of Allyship -And so much more!  Resources: Jennifer Hutton Facebook Jennifer Hutton Twitter Jennifer Hutton Instagram Jennifer Hutton Website Anti-Racism & Allyship for Rehab and Movement Professionals   A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!   For more information on Jennifer: Dr. Jennifer Hutton, aka Dr. Jpop, is a pediatric physical therapist from Nashville, TN. She became interested in PT when her youngest cousin was diagnosed with cerebral palsy. Jennifer spent time observing him in different therapies, and subsequently determined that she would work with children in a similar capacity. She graduated from Loma Linda University with her Doctorate in Physical Therapy in 2008, and moved back to her hometown.  She spent two years treating in an ortho setting before finally transitioning to her dream job with children. Jennifer enjoys treating the developmentally delayed population, as well as children with neurological and orthopedic diagnoses, both congenital and acquired. While the world reminds children with special needs of their limitations, she believes they are all capable of the impossible and helps them see that their special gifts will help them be their best selves. Jennifer loves to showcase her “pop stars” and share creative treatment ideas on Instagram. She is also an instructor for RockTape and is currently working on her own educational content for pediatric movement specialists. As a Black woman, Jennifer knows what it is like to identify as different, and it has helped in her quest to be an ally for children with disabilities inside and outside of the clinic. Now she is educating others on how to be effective allies to BIPOC and furthering her desire to create a diverse and inclusive space she calls Dr. Jpop’s Neighborhood.   Read the full transcript below: Karen Litzy (00:01): Hey, Jennifer, welcome to the podcast. I am so happy to have you on. And now for those of you who are, maybe don't know you by your full first name on Instagram and social media, she is Dr. J Pop and last week you gave a wonderfully informative thought provoking webinar, and we will have the link to that in our show notes. Cause people can still watch the replay to that, correct? Yes, the replay is up and it will be for the foreseeable future. So what I'll have you do quickly because I don't want to put words into your mouth, but I would love for you just to tell the audience a little bit more about what that webinar was about and why you did it. Jennifer Hutton (00:58): Yeah, so it was anti-racism and allyship for rehab and movement professionals. And I went through from the beginning, literally started with the history of white supremacy in healthcare, through slavery. The Jim Crow era talked about racial trauma and the effects that it can have psychologically and physiologically. Then I went through the stages of allies and all of the things that you can do in each stage. And then I have portioned it out for the examination phase and for the action phase and kind of let people know in their different settings, be it education, be it healthcare or fitness, the action steps and the questions that they can ask themselves to be a better ally. I just, I wanted to do it. It's been a passion of mine for awhile talking about cultural competency and diversity, and I could tell people were awake in a way that they've never been awake before, so they were ready to receive the message. Jennifer Hutton (01:57): So when everything happened with, you know, Brianna Taylor, I'm not arbitrary and George Floyd, it was kind of like the cherry on top that everybody now is ready to listen. And so I found this was a great way to just get my thoughts across.   Karen Litzy: And obviously we're not going to have you retell that entire thing because people can go and watch the replay. Like I said, there'll be a link in the show notes but for me after watching it and I also watched the replay, so I sort of like went through it twice. Just because, you know, I want it to be really clear on what I didn't know. And good. Yeah. And so we're not going to go through all of it, but what I do want to touch upon today is, and you mentioned it in your description just now is racial trauma. And I also want to talk about allyship. So what can people specifically in healthcare do to be allies to our BIPOC community in healthcare? Jennifer Hutton (03:00): Right? So we'll get to that. But first, what I want to talk about is racial trauma. This was a very, very powerful part of the webinar for me. And it is certainly part of our social determinants of health. And as physical therapists, if we are treating under a bio-psychosocial lens, social is part of it. We need to be aware of what racial trauma is and how that may affect a person mentally, physically, and emotionally. Jennifer Hutton (03:47): Racial trauma is basically the cumulative effects of racism on an individual's mental and physical health. And I thought it was really important to highlight because we do a great job of talking about healthcare disparities. We do a great job of, you know, singling out the races and what you will see in the trends and the diseases. But we don't really look at the root cause of why this may be something that is more prevalent in different communities. So I kind of explained that racial trauma is likened unto PTSD. The only difference is we cannot separate ourselves from that toxic environment. So you start to see the manifestation of that stress. The weathering is one of the terms that you will hear when it just breaks down the body because of all of the stress that you are feeling and seeing. So you start to have increased suspicion, sensitivity to threat you know, physiological symptoms using other mechanisms like alcohol and drugs, increased aggression no thoughts of future. Jennifer Hutton (04:54): And I also have looked at research that where they look at the Holocaust survivors and how they actually saw changes in their DNA from the stress that they went through. And that's what they're starting to look at with our DNA as well, seeing that we pass these things down through generations, which is why it's called generational trauma. So to just say, Oh, well this, the African Americans are most likely to have these diseases. It's like, well, what are they dealing with outside of your clinic walls? That would cause this. And it was funny cause the students loved that part. The most, those were actually in professional school. Cause they're saying this would be extremely helpful to relate to patients when I actually go into the clinic or healthcare setting. So I focused on that and I also kind of showed way that you cope with racial trauma and all of the ways that you'll see in the communities is racial storytelling. Jennifer Hutton (05:58): So being able to tell you some of the experiences that I've had in this America validation, naming the trauma, understanding that the microaggressions that you're feeling are a part of the racial trauma that you're experiencing it. And the problem they're finding, even with some of these coping mechanisms is great for the moment. But what happens when the next event comes around, they're going right back through those stages of grief and stress. So I think it's important to see in every facet of life, there are the effects of racism, the effects of white supremacy. And so if you're hitting that on every facet of your life, you're more likely to present with physiological issues. Karen Litzy (06:44): And as a, let's say, as a clinician who might be treating someone who let's say does have high blood pressure or heart disease and is part of the African American community or BIPOC community, is it part of our job to then educate our patients on this? So cause they may say, well, you know, it runs in my family, right. I don't know why it runs in my family. So where does our job come in as the healthcare provider? What is our duty to those patients to address? Is it our duty to address that and to help with coping mechanisms? Or is it just a referral to someone else? Jennifer Hutton (07:25): Right. I think it's definitely our job to consider it when we are approaching different patients to consider that this may be something and a lot of times you'll hear it in their rhetoric. I think I had a student in the chat during the webinar say I have someone who said, he's afraid that if a cop actually comes and he can't put his hands up, that they'll feel like he's resisting. And it was because he couldn't get enough external rotation. Did you read that one? Karen Litzy (07:56): Yeah, I read that too. Yeah. Yeah. Jennifer Hutton (07:58): It was like, see that, that right there. That is something that probably wouldn't have come to your mind when you were thinking about his plan of care, but now maybe you need to change your approach because you're actually tapping into something that makes him feel outside. You feel something that just about the pain that outside and his wife. So I think we definitely have to keep it in mind and consider it. I also think we have access to and knowledge about so many different ways that we can take care of our body. So even if you were to start incorporating some of those into the treatment plan so that they can understand, these are things that you can use and you don't have to name it for them, you don't have to say this is because of racial trauma or give them all of the facts. But you, as a clinician recognize it might be something that's beneficial to them. So that's why I say to my Pilates instructors, to my yoga instructors, you know, you're a key to coping. You're a, something that could be helpful for them. And if they don't know that it, yeah, it is your job because you know about these things. So you can give them as a resource. Karen Litzy (09:02): Excellent. Thank you. And now, let's move on to the concept of being an ally. So before we start and get into how to be an ally certainly within the realm of healthcare, I would love for you to just, can you just define what an ally is? Jennifer Hutton (09:25): Yes. So an ally is a person group or nation that is associated with another group or others for a common cause or purpose. So that just means no, this is not something that affects your daily life personally, but you see that it does affect the way someone else's life is and you want to help make it better. So where you're using your privilege and your position to help further the cause. Karen Litzy (09:51): And how is that different than white savior racism? Jennifer Hutton (09:56): Yeah. So white saviors and still comes from the perspective that you are superior, that if you were not doing the work, then it would not be done and that you are absolutely needed. And I agree your voice is needed, but if you're still approaching it from a superior mindset, because you haven't done the work through those stages of allyship than it actually is a hindrance and it's not as effective. Karen Litzy (10:25): Got it. All right. Good, good change. They're good. Because I think oftentimes we maybe think we're an ally, but maybe we're not. And the concept of white saviorism, is that something that someone is consciously thinking or could that be an unconscious thing? Like you really think that you're there to help and you're trying to do your best, but you're may not be helping in the way you think you are. Jennifer Hutton (10:58): Right. And that's, to me, that's where the self-examination comes in. That's where those questions that you ask yourself about your upbringing, what you believed about black lives matter before all of this happened, what you thought about the killings that were happening in the people that were speaking out against them. How you viewed other races, the things that you said, the things that you've heard, because now you are able to see, yeah. Maybe you're not a racist, but you may have biases that are affecting your thought process, affecting your decisions. So I always say, check your intention. Like, don't just say, well, I intended to do good. Look at the impact that it had. If the impact does not measure the intention, then maybe we need to go back and do some homework on that intention. Because if you're doing something only to make yourself feel better, like, okay, I'm doing it. I'm that good person, not the best intention if you're doing it because like, Oh, they need me, like I talked about thinking that you have to give scholarships to all black people. Like they don't have the money to pay. That's why saviorism that is still coming from a bias mindset of, they are poor. They have less, they don't have the resources and I need to step in and save the day. But I don't think it's ever intentional. I still think it's just coming from your perspective and you really gotta check your perspective. Karen Litzy (12:19): Yeah. And I think we also hear the word implicit bias thrown around quite a bit. So do you want to define that and where that comes into play within this conversation? Jennifer Hutton (12:29): Yeah. So the official definition would be attitudes and stereotypes that affect your understanding, your actions and your decisions in an unconscious way. And I talked about thought viruses. And the way that I give a great example is the older person who only saw whites only signs and colored only signs everywhere that they went can, do you really think they couldn't have made some type of decision or thought about how black people are, how white people are based on what they experienced in their environment. So everything that you were taught and the things that you saw, the things that you heard, it forms your biases and that's on all sides and it mobilizes you. And it's how you act. So if you were surrounded by people who were racist, even if you think of yourself as a good person, you still may have things that were thought viruses that were planted that you have to check. Karen Litzy (13:28): Yeah. All right. Great. Okay. Now let's get into the stages of allyship. So stage one awareness. What does that mean? Does that just mean, Oh, I'm an ally. I'm aware. I'm sure it's much more complicated than that. So I'm just trying, I'm pointing out like the total ridiculous side of it, because that might be like what people think like I'm aware I watched the news. I know what's going on. I'm going to be an ally done. Yes. Jennifer Hutton (13:57): So awareness is that you see that there is a problem. You see the problem and you acknowledge the problem. You also acknowledge as an ally, your privilege in this world, the fact that you are viewed as different and sometimes better in your spaces. And then you say, I want to make this better. So the end of awareness is still an action step of committing and deciding and holding yourself accountable to learning and unlearning all of the things that have made you think this way so that you can be an effective ally. So the awareness, isn't just, yeah, I'm an ally. It's Oh, there's a problem. We got to do something about this. How do I help? Karen Litzy (14:52): Yeah. And could an action step in this awareness phase, be, you know, watching your webinar or watching 13th or reading a book or having conversations. And does that, would that fall into this category or is that sort of weave through?   Jennifer Hutton: I think awareness is probably the step that you will visit the most. That would, that's the thing because you, the more that you educate yourself, so webinars, podcasts, Ted talks, documentaries, those are part of your education. Just like any, I think I said, create your own curriculum. Just like you would learn anything. You have to go through all of the information, but as you learn, you'll start to see these things in other spaces and that seeing those things is still your awareness. So I always say, don't think that you're going to escape the phase I'd be done and not come back to it. You're going to start to see these things in all the facets of your life on it. So not just awareness on, like I took a week off and now I'm more aware it's being aware on a daily basis of what you're seeing in your community, within your family, your friends, your peers, your colleagues, and then just do so are you aware of it? And you just make a little mental note, or it's more of a high and it sticks because if you're educating yourself, then what you see will help you process. If that makes sense. The scenario that you are placed in the things that you watch, you'll be able to refer back to. Oh, I remember when I watched, Oh, I remember when I read, when I heard this person say, now you're connecting that after you've educated educator in the process of educating yourself. Karen Litzy (16:02): Yeah. Yeah. And then we sort of jumped the gun. So you've got awareness and education. Is that kind of second stage or do those just sort of inter sort of weave together? They can't have it. Can't have one without the other, right? Yeah. You cannot. Okay. And then next, so kind of moving through these stages here, here comes this, this is a tough one. Karen Litzy (17:00): Here comes the sticky one self interrogation. So can you explain that and also explain why it's sticky it can be difficult.   Jennifer Hutton: Yes, the reason self interrogation, this is when you really start to ask yourself a question, cause you're now trying to strip yourself or unlearn the things that have caused you to think the way that you have. So you really have to put your ego aside. And I always say, tell yourself, you're not a bad person. You just have thought viruses that you're trying to change. So you're asking yourself those questions. What were you taught about black people and people of color? Were there any times that you were in, you know, scenarios where there was racism and you didn't speak up or you feel like it was important to speak up? Have you allowed your privilege to mobilize you, but maybe not help someone else? Jennifer Hutton (17:56): Do you have friends of color? My favorite is, well, what were your thoughts about black lives matter 10 years ago in 2012, maybe when Trayvon Martin happened, what were you thinking about these same protests and these same people speaking out? Because if you can truly answer those questions, then you'll see that's where my bias is. That's where that was my blind spot. That is something that I didn't realize it was coming in, but it has affected me. So those were the personal questions and those are hard because it is really, you have to strip yourself of what you consider a part of you. A part of who you are a part of your upbringing. And if you're having those conversations with family members, I mean, I've heard people say, I didn't expect my parents to say the things that they said. Jennifer Hutton (18:47): I didn't expect my best friend to feel the way that she did about me posting my black square. And the conversation that we had was extremely uncomfortable for me and hurtful because I thought we were on the same page. So that's where the discomfort lies. And then it's in deciding, is this that important for me to continue? Even if other people don't continue with me asking yourself, that question is hard. Because you can't, you can't let go of family. That's not how it really works. I mean, of course, if it's toxic, I understand, but you really have to say, I might be doing this by myself and it is a tall task, so are you really ready for it? So that was the personal self interrogation. Karen Litzy (19:34): Yeah. It's sort of this cleaning out your cupboard, if you will, you know, and trying to see if you are ready to change your thoughts and your beliefs and what if you go through these questions and you're not ready. Okay. Jennifer Hutton (19:59): It's always comes back to the question. Once you get to that point of discomfort, you have to ask yourself why you're uncomfortable. You can't just escape the situation because you're going to end up coming back to it. If it was a part of your awakening, once you're awake, it's hard to not see things. It is really hard. So I always say, it's fine if you're not ready, but maybe the reason you're not ready is because you had an upbringing that taught you something that you can't shake. Maybe you need a therapist. Maybe you need to talk through some of those other things to actually help you get past this stage. Karen Litzy (20:34): And was there a point for you growing up where you had your first encounter with racism? Jennifer Hutton (20:50): My very first that I can recall it was mother's day out where you went like three days a week and I wanted to play with like, it's a daycare. It's kinda like daycare, but you don't go every day and you still learn things. So it's like a preschool thing pre K through year four or whatever you call it. But I wanted to play with the kids and I think there were two black kids and the entire mother's day out or my class. And I was told, no, we don't play with Brown kids Jennifer Hutton (21:29): I had another four year old. And so apparently went home. I remembered the act. I remember the kid. I could actually see his face even now, 30 something years later. But apparently I didn't want to tell one parent because I thought that parent would get upset and do something at the house. So I told my, I think I told my mom and that was when they first had to have that conversation of people are not going to like you because of your color and explain it. You imagine having to explain it to a four year old, like they're still processing how to count, pass a hundred, like, and you're telling them it's going to be a problem. Something that they identify with, that they see in the mirror everyday, they cannot shake is going to be a problem for people. So I think that was definitely the first time that I remember. Jennifer Hutton (22:24): And then I also remember the first time I said, Oh, this is unacceptable. And at that point I was like 14. And I had had an incident with a cop where I was profiled. And it was evident because I had white friends around me that were not treated the same for the same regulations I was given. And it was at that point that I said that I'm a fighter, it's time to go. I'm not going to accept this. And I'm not going to not be in these spaces because you don't like it either. I'm going to show up and you're going to see me and I'm going to speak and be loud about how I feel. Because I think my voice is extremely important. Karen Litzy (23:05): Yeah. Wow. I mean, I grew up in the most non diverse town in Pennsylvania and I went to a very non diverse school for college. It's much more diverse now. And when I moved to New York, so I'm in my twenties and it's the first time that I had a friend that I worked with. And he's awesome. But that's beside the point. And we were at work and he had said something about like he had to drive. He hated driving back out of the city at night. Sometimes I said, well, why I was like, is it, I was like, see, it wasn't a drinker or anything like that. It's like, he's drinking and driving. And I couldn't understand. And I was like, well, why wouldn't you, like, why would you worry about driving out of the city at night? Karen Litzy (24:05): And, and he was like, well, I wouldn't want to get pulled over. I'm like, why would you get pulled over? This is how like, night and I was not doing it. Like I was seriously wondering, why would you get pulled? Like, do you have a broken tail light? Did you do speed? And he was just looking at me and he was like, no, I'm like, well, why would they, why would the police pull you over then if you're doing everything right. And he was like, well, you know, when I was like, I don't, I don't know, like tell me why. And he was like, well, you know, because I'm black. And I was like, what? Yeah. And that was the first I was in my twenties. And that was the first time. And I was like, it's funny. I had a talking about, so that was the first time I ever had a conversation about that type of, about racism and how it affects someone who I only knew as like these. Awesome. I love him. He's my great, he's a great friend. He, to this day is still a great friend. And I just was like, I don't, Karen Litzy (25:08): I don't get it. I don't get it. Yeah, yeah, Jennifer Hutton (25:10): No, I didn't get in there. And I think part, my brother said it perfectly sometimes when you're in the same spaces with people, you think your experience is similar. So even if you had a black friend that was with you through all of those, you know, non diverse schoolings and situations, scenarios, and things that you were part of, you would still think our perspective has to be the same. Cause we're getting to do the same thing. So it kind of makes it harder for you to look outside of your experience. Karen Litzy (25:43): What a world. So that's a little bit on the self interrogation and what those questions when I asked myself those questions, I remember that incident. So clearly now and looking back on it, I was like, Oh boy. Yeah. I was just didn't know, I didn't know what I didn't know. And now I do. And now I do. Yeah. Period. Now let's go on. So we talked about self interrogation serve as a person, but let's talk about it now under the lens of being a healthcare provider. So how does that work?   Jennifer Hutton: So the self interrogation as a healthcare provider, to me, just like I said, we're educated on health disparities, but not with them. What was your professional opinion? How did you form your professional opinion based on the things that you were taught? Jennifer Hutton (26:44): And this can even a great example is when you hear the word Medicare, what do you do mentally physiologically? Do you grown? Because it's like another Medicare patient. If you're a clinic owner, or even if you are a clinician Medicare, Medicaid, workman's comp, like, what are your thoughts when you see that come through the door, chronic. So that kind of pain. What do you think about chronic pain? People like that? These are you've formed a bias. And how does that bias actually shape how you treat shape the way that you develop plans of care? Are you able to actually change things based on what you see? Just like that student said, well, how do I work on external rotation? There's a million ways that you could actually work on it without it triggering them. So those are the things that you really have to ask yourself and then privilege in outside of just the clinic. Jennifer Hutton (27:34): What is your governing organization look like when you are a part of these masterminds and part of these panels and these groups and discussions, do you see other voices? Do you see other people that don't look like you in the room? Are there ways that you could leverage your privilege to actually open the door so that there are more voices in the room? And then how do you view the table? Like there was one person I was talking to last week and she said, you know, even the thought of saying, let's give them a seat at the table said that you own the table and you don't, none of us do. So you want to create a diverse perspective or diverse group of people in all of your spaces. And so you really want to ask yourself, how can I do that? And then patients like nonverbal communication, when you are working with them, when they are hearing conversations that might be triggering or how do you respond? Do you want to just go in a corner and not say anything? Do you want to just ignore it and shift it to the side? How does discomfort in your coworkers look when you are talking about certain things. So that's some of the self interrogation you can do as a clinician. Karen Litzy (28:43): And, you know, you sort of mentioned, well, if you're having conversation with patients, what happens when let's say a patient in a clinic, whether you're one-on-one or you're in a gym with a lot of people, if they say something that's just not right. Right. And if they sit there talking racist talk, or even saying things that maybe aren't blatantly racist, but still you're like, yeah, no, that's not right. What do you, what do you say? No, we spoke about this a little bit before we went on the air. And we said, it's a little different because we can, we were talking about coronavirus before we got on the air and how, you know, cases are going up in some parts of the country. And it's not just because of more testing it's because more people are sick and you can point those facts and figures. So someone says to you cases, aren't going up, it's the testing you can say, no, no, no. Here are the facts and figures here it is. This is the truth with this. It's a little more abstract, right? So how do we handle those situations as healthcare providers? Jennifer Hutton (29:53): I think just like you handle your patients, it's going to be a case by case situation. I can't give you a cookie cutter copy and paste way because everybody, even if they present with an implicit bias, it's still going to be different from the next person. So depending on your position, if you are a clinic owner, then if this is something that is explicitly, someone's explicitly racist, then you have to make it clear what your business stands for. That is extremely important first. I think it's important to have procedures and policies in place. And maybe even we tolerate everybody like this. Isn't an open space. This is, we accept everyone as they are. And that's something you can give to them. The first time they walk in the door. Cause that lets them know, I don't know who's coming in here is clearly a diverse population and they are tolerable of everybody. Jennifer Hutton (30:48): So it sets the standard sets that precedence before you even get started. And then it's those simple conversations. No, you can't spend your whole session educating them on, you know, the history of healthcare. But you can say, you know, there are some resources that I've read that have helped change my perspective. And if they are open, then give them to them. If they are not, then you need to have something in place that says, Hey, I understand that everybody has different perspectives, but here we respect everyone. And we don't want to trigger anyone in how in our speech. So we would really appreciate it if you would respect that. And honestly, they're gonna be some people who don't like it. And that is this journey. This is literally the journey of being a black person and being an ally. There are not going there going to be people that don't agree with you. And you just have to decide what your stance is and continue to go inside for that every time you face these situations. Karen Litzy (31:48): And I love, and I want to point out that the responses you just gave did not, they weren't accusatory, they weren't aggressive. It was more, Hey, I found this for myself or this is what we, as a clinic, believe it wasn't you. Or how could you say that? Don't say, I mean, that is just the wrong way to go about it. Jennifer Hutton (32:12): Especially the clinician is not professional. Got to that point. You do, you might have to say, you know what, we might have to end our relationship and maybe able to give you some clinics that would be more suited for you. But this, if you are, if you continue to look at this as person against person, we're not going to get anywhere to me. If you look at it, as these are thought viruses, I'm trying to change, it's a lot easier to have grace for other people as well. Karen Litzy (32:44): Yeah. Excellent. All right. Now that was a little bit of an action step, right? So let's talk about a very, very important step in allyship and that's action. So that was one and that's a great action, but what are some other things that would fall into the action category? Jennifer Hutton (33:01): So I split them up into immediate action and longterm action. And mainly because we're telling you slow down, educate yourself, and that can be hard cause like, well there's stuff that needs to be done. So your immediate action is you're protesting, signing petitions in the emails informing yourself about, you know, the politicians that are statewide local, all of those. And then speaking up against remarks. If you hear them now, one thing I want to say do not wear yourself out in the comments section of social media, because I'm sorry that anyone who comes into those comments extras, they're really not looking to learn anything and you're not going to teach them. So you have to let the energy out of it. Karen Litzy (33:45): Energy vampires, it's not worth, it's not worth it. Jennifer Hutton (33:48): It's not worth it. So that's not the action I need you to take. I need you to take that off the dock. Long term action would be continuing to having those discussions in your clinics, in your gyms, in your educational setting, to see where your blind spots are and what you really would like to do to move forward. I think I said earlier, you may get stuck at a step. And if you feel like it's something deep, rooted, get a therapist to actually help you talk through these things recognize it's a learning process, encourage others to do that work that you are doing. And if we're doing it already as healthcare clinicians, we learn things. We believe things. And then we use them in our practice, whether it be something in the biopsychosocial model about chronic pain, about certain, you know, systems that we use, we do it already. And you just have to decide that this is something that's important to you. And that honestly will be your guide when you get to that longterm action. Karen Litzy (34:55): And something that you'd mentioned in the webinar that I want to bring up again, is that when you're talking about these, this longterm action that it needs to be authentic and then you don't want it to do, you don't want to subscribe to tokenism. So we didn't really define tokenism. So why don't you define what that is and why we want to be authentic and not subscribe to it. Jennifer Hutton (35:18): So tokenism, the long and short is you are going to get that one person to represent diversity. I think I said, when we were talking before we started recording about if you are in an all white community, don't just go get a black person and say, that's our representation that is not authentic and it's probably not comfortable for them. Would you need to be able to identify that? So if you're just picking the black person or the person who's Mexican or Asian to say you have that voice, that would be your tokenism.   Karen Litzy: Yeah. And, I think that we certainly see that in a lot of facets of society. Definitely. Definitely. All right. Any other actions that you want to cover or do you think we've hit everything? Jennifer Hutton (36:20): I think, I think we've hit everything. I know I did a lot of steps for examining in the webinar, which if they wanted to see it by setting, they're definitely able to go in there. But my biggest takeaway from this is, I know we're in a manic period still where everybody is happening on this quote trend. So don't burn yourself out. It is a marathon, not a sprint. And so it will, it might be sticky. It might be difficult. It might be uncomfortable, but you have to decide whether this is what you believe in to keep going.   Karen Litzy: Excellent. Well, thank you. I was just going to ask what are your final thoughts and beat me to it. So thank you. Okay. Well on that, I have one last question that I ask everyone. And that's knowing where you are now in your life and in your career. What advice would you give to yourself straight out of physical therapy school?   Jennifer Hutton: Be patient be patient. I came out with the idea, I'm going to be a PT therapist and nothing's going to stop me and I'm going there and I'm doing this. Jennifer Hutton (37:18): And I had to take detours from the minute I graduated. My life did not look like what I thought it would, but where I am right now. I'm good. So it worked out how it was supposed to, so I would say, be patient.   Karen Litzy: Excellent. I'm still need to learn that one. I feel like things still need to be done yesterday. Thank you for that advice. And now where can people find your webinar?   Jennifer Hutton: Yes. So if you go to Instagram, dr. J-Pop, I actually have the link in my bio. I am probably by the time this comes out, it will be on my website as well.  That replay is there and it will be there until that platform doesn't exist. So hopefully forever.   Karen Litzy: Excellent. Well, thank you so much. I appreciate this. Like I said, I learned a lot, it was very introspective for me to go through your questions and to kind of understand the privilege that I came from, just for the fact that I was born with the skin that I have. Right, right. And it has nothing to do with, you know, just that one singular thing. It has given me privilege and listening to you and educating myself has really allowed me to, to see that, that very singular fact very clearly. So thank you very much for your webinar and for coming on. I appreciate it.  And everyone else. Thanks so much for listening. Have a great couple of days and stay healthy, wealthy and smart.     Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Laura Rathbone on the show to discuss Acceptance and Commitment Therapy. Laura Rathbone is a Specialised Pain Coach and Advanced Physiotherapist that works exclusively with people experiencing persistent pain and conditions such as chronic back pain, pelvic pain, fibromyalgia and CRPS.  Much of her work is virtual as she coaches people all over the world in the service of their pain, but she also has a small clinic in the beautiful town of Weesp, just outside Amsterdam, the Netherlands. In this episode, we discuss: -What is Acceptance and Commitment Therapy (ACT)? -How the ACT framework compliments a biopsychosocial approach to patient care -The importance of promoting active over passive interventions for patients with persistent pain -Why clinicians should integrate psychologically informed physical therapy into their practice -And so much more!   Resources: Laura Rathbone Website Laura Rathbone Twitter Laura Rathbone Instagram Laura Rathbone Facebook Laura Rathbone LinkedIn The Association for Contextual Behavioural Science   A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!   For more information on Laura: Laura Rathbone is a Specialised Pain Coach and Advanced Physiotherapist that works exclusively with people experiencing persistent pain and conditions such as chronic back pain, pelvic pain, fibromyalgia and CRPS.  Much of her work is virtual as she coaches people all over the world in the service of their pain, but she also has a small clinic in the beautiful town of Weesp, just outside Amsterdam, the Netherlands.   She understands the need to see people from a 'whole-person' perspective and integrates modern, evidence-based physiotherapeutic and psychologically-informed approaches.   Laura is a UK chartered Physiotherapist and has a Masters Degree in Advanced Neuromusculoskeletal Physiotherapy from Kings' College London.  She is part of the Le Pub Scientifique team which organise regular live learning sessions exploring the science of pain and produces a small podcast called “Philosophers chatting with Clinicians”.  She runs her own courses on ACT and mentos clinicians regularly. Read the full transcript below: Karen Litzy (00:01): Hi, Laura, welcome to the podcast. I'm very excited to have you here and today we're going to be talking about ACT. So thank you so much for being on the podcast. Laura Rathbone (00:12): Well, thank you for having me. I'm excited too. I like talking about something. Karen Litzy (00:17): All right. So now let's talk about ACT first, two questions. What is ACT and how did your interest in ACT come about? Laura Rathbone (00:32): So ACT stands for acceptance and commitment therapy. I suppose, you know, sort of efficiently, the way we talk about it is that it's a third wave cognitive and behavioral therapy. So it's born out of the behavioral movement and it's a psych it's essentially, it's a psychology framework. It came out of the world of psychology. And the aim of it is to recognize that when we are experiencing, you know, difficult unpleasant and invasive stuff, there's often a lot of all the aspects to that experience that add to the struggle and add to the suffering. And what we're working with from an ACT perspective is often can we compassionately and you know, empathetically and appropriately work with some of that, all the stuff that comes with the struggle and comes with a difficult experience. And does that help us manage our present moment experience? Laura Rathbone (01:38): Does that help us reduce some of the suffering so that we can move forward with some of the realities that are in our lives? Like for example if you're experiencing pain, which is where I come into it, you know, in the absence of having a really good predictable, effective cure for things like persistent pain, things like fibromyalgia, CRPS even chronic low back pain, which we, what we don't have these predictable sort of treatments that's going to take that away once the pain has started to become resistant, but in the absence of that, are we able to support people with their pain so that they can thrive. They can be a person who has pain and has a career and has a committed family life and has a social function and role, and they're able to thrive with it. And that's really what we're doing with ACT there. Karen Litzy (02:38): And where did your interest in ACT come from? How did you get involved? Laura Rathbone (02:45): Yeah, there were two answers to that really. First answer I guess, is that I just sort of fell into it like so many people, right. I graduated from university. I went into my first job. I had a really difficult first job experience in a difficult company and ended up working, noticing, I suppose, and working with people that had persistent pain. And so I was constantly seeking for better solutions and trying to figure out how we can do better by these people. And then I guess I just sort of navigate it that way naturally. And yeah, so I was interested in mindfulness, mindfulness, you know, you study things like the MBSR. So the mindfulness based stress reduction start thinking about how you can incorporate bits of that into practice. And before, you know, it, you end up into accepted therapy. Laura Rathbone (03:41): And then I was super lucky because I managed to get this brilliant job in the national center for pain at st. Thomas' hospital in London, where I was working at input, which is the pain center. And I was working underneath professor Lance McCrackin in their embedded ACT unit. So I got this great opportunity to really further my training and understand how it functioned as a framework and how we as physiotherapists could really be maximizing our therapeutic alliances and relationships and really integrating this model to create, you know, a psychologically informed approach, if you want to call it that or a compassion focused approach so that we just do better by people who are vulnerable and in pain. Karen Litzy (04:26): Well, that makes a lot of sense to me. Thank you so much. Laura Rathbone (04:31): If I was to give you a second answer, is that, you know, pain is a bit of a personal experience. It's a personal journey for me. My mom had chronic low back pain when I was younger. And I guess I'm only just now coming to terms with the influence of that on my career. Something that I haven't talked about a lot. But I do get asked about quite a lot. And you know, it would be silly to say that those early experiences of somebody with chronic pain, you know, didn't have an influence on me and seeing her go through a biomedical approach to treatment and not be heard and seeing her struggles and thinking, well, you know, and the injustice has probably built in me as the second generation and thinking, well, how do we restore some of that justice? And then how do we acknowledge that there is an imbalance here in terms of privilege, like clinician privilege versus patient privilege, and how do we start to restore that and make sure that we listen to the people we work with and do better. Karen Litzy (05:36): What sort of experiences did you see your mother go through that kind of led you into where you are today, when you say so for a lot of people, they might not be familiar with the biomedical approach and what that looked like, but what did that look like for her? And then what did that look like for you as a kid growing up? Laura Rathbone (05:58): Yeah. Like I say, something that I'm still really coming to terms with then, and the memories of what I saw my mom go through was still quite like emotionally charged. They're still very close. And we're talking about it, me and my mama talking about this more and trying to open it up a bit more and explain that. And then what I remember, you know, being in the car and my mom being unable to sit in the chair and the sound of her voice when we went over a bump or the car stopped that, that Yelp for pain, that, that real yeah. Terrorist pain really. And I remember her spending hours in the bedroom, not being able to get out of bed but, you know, she also, she was an amazing woman, you know, incredible first role model as a strong woman, really, because, you know, she's a nurse, she was working in the pediatric units, she's done everything really she's done a and a pediatrics domiciliary, which is community-based working. Laura Rathbone (07:04): And like, she used to get up every day, even in pain. And she would go to work in paid and, you know, do all these and just push and push and push until she was exhausted. And when she would be like posted on the weekend and then pushing herself and through the day, and I saw her just be hopeless. That was, I think the overriding feeling, if I really reflect quite personally, was that feeling of, there is no hope there is no way out of this. This is the norm and resigning to that. And that's because, you know, she'd tried physical therapy or physiotherapy in the UK. And, you know, she'd tried like acupuncture and she'd gone around the holistic meds you've been in and out of the doctors and things like that. And just really been told there's nothing that they can do, but yet also she had this image of why she had pain. So she was told that she had back pain because her Coccyx had dislocated during labor, which was my labor. So there's a bit of personal guilt as well. Laura Rathbone (08:07): And really those things where, like, she always felt that that image had stayed with her forever. Even now, probably if you talked to her and ASCO, which we were working through a little bit, which is hard to do an issue, mom, I, you know, trying to figure out what, how she views her body and her back is becoming a much stronger image, but she really had to find her own way out of that. And it was years later until she found a solution that she could, she felt she could predictively start to acknowledge and manage her pain. And, you know, it's not the traditional method that she found a kind of like a kind of massage tool, which is everything we wouldn't say right now, but it worked for her and it gave her a freedom. She felt all of a sudden I have something I can do when I have pain. And that was the most important moment for her. And it wasn't, you know, acceptance and commitment therapy or mindfulness. It was, it was a tool that gave her strength. It was a kind of extended part of her own ability to self manage. And she did that and it worked for her and I don't advocate those kinds of mechanisms and those approaches, but it worked for her. And there's something in that. There's something important in that. But yeah, I remember I remember her pain and yeah, it's still very personal. Karen Litzy (09:27): Yeah. And not easy, but thank you for sharing that. Cause I know that sharing personal experiences from my personal experience is not an easy thing to do, and it's not easy to put that out there where the world is going to hear that. So thank you. But I'm glad that you shared it because I guarantee you, there are going to be people listening to this podcast who are going to say to themselves, that's me. That was my mom. That's my sister, that's my friend, that's my patient. And so I think it's really important to allow the listeners to understand the magnitude of hope and of finding something that works for you, even if it's not physiotherapy or it's not XYZ doctor or whatever framework you're using. Because like I said, somebody out there is going through that same exact thing. And just to kind of hear that story and to hear how, not only did it affect your mother, but it affect you and your family and growing up and I think that's a really powerful share. So thank you. Laura Rathbone (10:35): Welcome. And thank you to my mom who continues to be an incredible voice in my growth as a person and who went through that journey and who still goes through that journey. Although she doesn't identify now as somebody who has chronic pain and that's a great moment for her, like she's now able to do so much more and really doesn't have back pain very often anymore. So, I guess the, you know, yeah, it's hard for me to share, it's not my story. Karen Litzy (11:11): Yeah. Yeah. Well, and we're going to get back to pieces of that story in a little bit, but I heard you say in the beginning of this podcast, talking about ACT as a framework, I would like to kind of bust a myth because I think a lot of people look at it as a tool to put in the toolbox. So what do you say to someone who's like, Oh, ACT, this is a great tool. I put it in my toolbox. I'll take it out when I need it. Laura Rathbone (11:45): Yeah, this is, Oh, I'm glad, I'm glad we're talking about this. Cause this is something that this is probably my personal opinion and there's probably people out there are acceptance and commitment therapists. You may disagree with me and that's absolutely fine this space resolve, but I do not think that ACT is a tool that we pick up when we think it's appropriate. First of all, how do we know that? That's certainly another thing, isn't it? You know, we don't, you know, and what I would say that acceptance and commitment therapy is how we are. It's a way of being with your clients and the people who choose to work with you in the service of their pain. It happens. It's how we make decisions. It's how we think about and how we facilitate those decisions and how we are part of, you know, the next step in that person's journey. Laura Rathbone (12:37): It's not something that we say, Oh, we've exhausted the biomedical approach. Now we're going to pick up the ACT approach. And it's a bit later the biopsychosocial approach that it just doesn't work like that. This is just another way of, you know, clinicians getting out of doing the hard work, which is listening to people's stories and empathizing and putting themselves in somebody else's shoes and trying to, you know, trying to get more of their life experience as opposed to showing off what they know about a particular joint. Like this is not how we work in pain. Pain is a very personal, it's a very unique experience. It's built off of life experiences, as well as memories and, you know, learning and worries and fears and all of that plays out in our physiology.   Karen Litzy: And what can a clinician who's working with someone in pain and they are taking the ACT framework into the clinic. What does that look like? Laura Rathbone (13:41): Good question. Yeah. I mean, I guess it depends what your setting is, doesn't it really like if you’re setting is first line, so people are coming to see you and they have never seen anyone else with that problem, then of course, we're going to be thinking, okay, where is that person in the journey from that injury or the onset of their pain? Are they two years down the line? And this is the first person they see, or are they two weeks down the line? Cause that always is going to affect your approach to assessment and monitoring really. So it would make a difference in terms of where you start, but you're always thinking about okay, so if this person is two weeks from injury, then you're going to be doing your injury based assessments, your pathoanatomical approach to assessment. Laura Rathbone (14:34): And we want to want to make sure that this person hasn't done any serious injury. And we want to make sure that we, you know, use the most appropriate and effective science that underpins our physiotherapy framework. Right. But you're still thinking, how is this person managing this injury? You know, even though we might be assessing the tissue in some aspects that tissue belongs to a person it's in a human it's in a much wider system. So we're always going to be thinking, okay, and how is this person dealing with the fear of an injury? Are they able to make sense of this in a helpful way, are their behaviors of management helpful or unhelpful? And if they're unhelpful, then how can we facilitate an experience that allows them to update that behavior into a more helpful way? Laura Rathbone (15:29): And that's what we're doing with that all the time. So I guess in my setting, when people have probably been through lots of healthcare professionals, then I'm going to that it would probably look quite different. I would use ACT maybe in a more intense way from very early on. Whereas if you're in a very acute injury setting, you're going to be using it as part of your assessment. You are still going to be satisfying, those more traditional approaches to injury assessment and management, which is not my area. So I don't want to make assumptions. Karen Litzy (16:24): Right, right, right. Of course. And what is, let's say a patient has come to you and they've had a long history of pain and you're sitting down, then this is the first time that you are seeing them. What are some questions? I know this is, I'm using this very broad net here. We're casting a very broad net because obviously the answer is, it depends on the person. And I want everyone to know it depends on the person, but it depends on the person, but for people listening to this and not really quite grasping, that sort of ACT framework is there. I don't want to say an outline, cause I don't think that's the right word for it. It's just escaping my head at the moment. But can you give examples of maybe how that conversation might go or what you're trying to, to get from the person in front of you using this framework? And again, we're talking about people with more persistent or longterm pain problems. Laura Rathbone (17:11): Yeah. So when somebody comes in and sits down and starts telling me, you know, what their lived experiences of pain and they start in their story, wherever they feel is the most important place to start. And we give space for that to grow. I guess what I'm looking for, what I'm trying to pay attention to is you know how is this person making sense and applying meaning to that pain what is it that they're coming to me for guess is the first thing, like, what is it that they're here looking for? Are they here looking for something that I can't give them, in which case I need to be really open and honest about that? Or are they coming here because they're looking for they're wanting to move towards a particular goal. Laura Rathbone (18:07): So it, usually people come in and they're telling me about that pain. And of course that's really, really difficult as a person. Sometimes it's really difficult to listen to, to hear somebody else's pain. So I'm mostly working with my own resistance, but also thinking well, okay, what is it that how we want to find out? What is it that would, would give this person that would help this person find more joy, more meaning, what is it, what is the value that they want to move towards? And what is the struggle that they are coming up with? So, so where are they getting stuck? Like, what are they battling all the time? And I guess that's where the idea of acceptance comes in and an acceptance here is really not resignation. It's really not just, you know, getting on with it's an opening up of the experience to accept that there are difficult and painful and hard to look at experiences happening in the present moment. And so we're opening that opener and sort of acknowledging that those things are there. And also maybe giving space for the fact that there are other experiences beyond those as well, that there's a wider spectrum of experience here. And trying to find a way to be with those experiences and also be with the important things in your life. This is what we see commonly. And what we hear with in the clinic is that people who have, you know, people who are experiencing pain are also missing out on a loss. Laura Rathbone (19:51): And that's really, really, I think what a lot of people find the hardest. And when I listened to it, you know, what the people who choose to work with me say, it's actually that they're just grieving that they're unable to be part of their family moments or their community or their society, or, you know, the things that they really believe in and that they really want to be part of. And it's hard because when they go into more traditionally biomedical models, the clinicians are saying, Oh, well, when we've done this surgery, your pain will go and you can do that when we've done this injection, when we've done this treatment and, you know, yeah, great. If that works, then that's an absolute lesson relief and fantastic. But what if someone's been doing that for 10 years and the clinicians are still saying, well, when we do this treatment, your pain will go when we do this treatment, you know, you starting to chip away at someone's life. Laura Rathbone (20:53): You know, this is a lifetime that easily limited, you know, we don't have infinite lives to live infinite moments to be part of our job and probably the most significant part of our job, especially in persistent pain is helping people and facilitating opportunities for people to be part of those moments. And to make sense of their life in a wider spectrum, rather than just, how does my life make sense in pain? It's more like, how does my life make sense in the whole bio-psychosocial sphere? Am I able to be part of that? And that's what we're looking for, or certainly what I use acceptance commitment therapy for. It's a way of creating opportunities and creating space for us to support someone as they take their pain into really, you know, meaningful moments and find that there can be joy as well as pain. And that is a really, really difficult thing to acknowledge and to allow for when you have pain, because it means that in one aspect of your pain journey, you have to allow yourself to take a step forward with it. And that's really hard if you really want to get rid of it. And of course we should always be working towards that. That has to be a big part of our approach, but it might not be the only thing we focus on. Karen Litzy (22:27): I'm glad that you said that because you sort of jumped the gun on what I was about to say, because when people come especially to a physical therapist or physio, one of the main reasons they're coming is because they have pain, right? And so they're coming to us to quote unquote, fix it, fix the pain. I don't, once I don't have this pain, what's your goal. Zero out of 10 pain, no more pain. And so I think from the clinician standpoint, when you have those people sitting in front of you, it's very, very difficult to have those conversations of, and you say, well, what if you still had a little bit of pain, but you can do XYZ activity, or you can still take part in all of this stuff. And you can expand those areas of your life, even though you have pain. Karen Litzy (23:26): Is that the wrong thing to say to someone is, should that be a goal to work toward, or should the goal to work toward if their goal is 100% no pain, what does the clinician do? What do we do with that person in front of us when maybe we may think, well, but you can X, Y, and Z, and you can have this full life. If maybe you have a little bit of pain, but the person in front of you is very adamant and their goal it's no pain or nothing, no pain or bust. So, how do we, as the therapist navigate that? Cause that's very tricky because like you said, we're working towards reducing pain, but what if that's not enough? Laura Rathbone (24:13): Yeah. So this is a really difficult part of the conversation, isn't it? And I guess what happens probably more often is we come up against our own reflex to save everybody in front of us and our own reflex to be sure we know we are right, right. Our own privilege that we are the experts, but we have no idea what is right for that person in front of us and what is enough for them. And, you know, in the first few sessions, when you meet someone, you’re still in the process of relationship building and trust building. So those early conversations may well be communication of, you know, I am really struggling with this pain. I am really suffering and I need you to fully acknowledge that I am really suffering with this pain. And it may be a way, you know, and that might be that that's where that person is. Laura Rathbone (25:14): And it might not be that we can change that. And I put that in quotes because you know, what we're doing here is where we're with a second sense and commitment therapy specifically is we're coming from a place of no judging. So, what the behavior, the thoughts, the meanings of that person's coming off of, I have no idea if it is right or wrong for that person to keep seeking, you know, a hundred percent cure. I mean, I looked to my own, my own experiences and see how far people I love and in my direct family have come in their chronic pain journey and think, well, you know, I have no idea if it's going to be a cure or if it's not, if there is such a thing, I mean, we're thinking of cure. The word cure is almost decided that we know what the cause is. Laura Rathbone (26:00): And we don't fully know that yet. So we don't know what the end point of that person's journey is. All we can ask is right now, is this helping you in this moment as we take a step in this part of your journey. And if that's unhelpful, because it's not helping us to take a step in the direction that we've highlighted is a good one that you've decided you want to take, then we need to work with that urge that keeps coming in to go for a curative treatment, potentially curative treatment. If we've got one. Laura Rathbone (26:36): But I guess what I would suggest in that moment is that we as clinicians probably need to do the most work because our urge is to jump all over that and be like, no, no, no, no, no. The science says that you're never going to get that. And that's a cruel message and it's not accurate. We have no idea. You know, our urge is to educate the shit out of that person and make them feel better. Right. But we don't know. We don't know that. So maybe we need to sit with our allergies a little bit more. Maybe we need to pull ourselves back a little bit more in that moment and just hear what that person is saying and listen and acknowledge it and bring it into our decision making, bring it into our understanding about, you know, what that person is going through. Laura Rathbone (27:19): What in our experience might be a helpful step. And then we have that collaborative discussion. Do you think it's going to be a helpful step? Would you like to go in this direction and see what happens? See what comes out of it? It's hard because we are trained to know the answer. That's what that biomedical model is all about. Those, you know, assessment tools. We can tell you if you've got an impingement and you know, that the idea, the whole point of that is that we had an idea that we knew what was causing pain. We knew it was the musculoskeletal system, and we knew it was the nervous system. Then now we're starting to think, well, maybe it's the neuro immune system. And, you know, it's all this idea that we know what is the cause of a human beings pain. And I'm not sure I have seen any evidence that we're much closer. And that's just my opinion on what I see. So maybe in those moments, we need to check ourselves a little bit. Karen Litzy (28:27): And thank you for that. That makes a lot of sense. And you know, it brings me back to this idea that are we doing the best we can for the person in front of us at this time with the knowledge that we have and that has to be enough at that moment because that's what we have. Laura Rathbone (28:53): Yeah. And I think that's really an important thing to remember is that we are both two humans interacting on a human issue, which is the human experience of pain. And, you know, we are healthcare clinicians, not heroes, right? We're not the saviors, we're not in the, you know, the people that come to see us, they're not victims. They are humans trying to live their lives. And we are people who have studied physiology and people who have studied rehabilitation and people who hopefully are studying sort of communication and behavior change theory and the philosophy of just like a human experience. And, we're hoping that when those two things come together, something happens and the person who is struggling to come to terms with their pain, manage pain and find ways and solutions to their pain, right. We're hoping that the combination of these two things or these two people, these two worlds and worldviews come together and we can find and facilitate a way for that or the person, the person in front of us to move forward. Laura Rathbone (30:03): So, you know, yeah. We have to sort of remember that we are only doing our best and that has to be recognized on both sides, right. That there is also a responsibility for the people that choose to work with us to remember that we are people, we are humans. We do sometimes get it wrong. We are able to look back and say, Oh, that was not necessarily the thing that I would do now. And were able to change and update and evolve. Yeah, I guess that's where I come, that our job, our role is to make sure that we are reading the literature, that we are going to the podcast that we are listening and learning and evolving and evaluating our messages to say, is this still the best I can do? You know? Laura Rathbone (30:52): And to that end, I would say, I've had this conversation a few times with sort of new graduate clinicians who say, Oh, but you know, this person, I educate, I gave them the education and they just didn't get it because education has also been one session. And I say, okay, so you gave him the education. How did you deliver it? What was your approach to education delivery? You know, what training have you done in educating? And they touched, they took a weekend course, but if they've even done that, that's the point, isn't it. I try the CBT approach. Okay. So how did you train in CBT? What is the CBT approach? Yeah. You know, Oh, I've done mindfulness. Okay. So how do you integrate mindfulness since you're into your practice? And we say that we think that we know how to do these things, but we're not putting in the time and the effort to really fully train and upscale, you know, acceptance and commitment therapy is an entire psychological framework, right? Laura Rathbone (31:53): It's not a little bit that we just add in, it's an entire framework of being with the people that means you never finished learning. Right. I'm still learning. I still have people call me at my clinic and watch me. I still do peer review and make sure that people, people are listening and helping me understand how I apply ACT. And when I may say, or when I get it wrong. And so I can keep evolving, you know? And, that's the thing, isn't it, you know, we have to make sure that we are fully invested in our communication strategies, not just superficially, because otherwise we're not doing the best by the people that we work with. We're giving them a half-assed attempt at education, blaming them for not understanding what we were trying to say. Karen Litzy (32:40): Well, we don't even understand it. And, also being very cognizant of the fact that people communicate differently and people learn differently. So if you're giving quote unquote giving the education, well, I told them all about it. Well, maybe they're visual learners. Maybe they need to hear things in small chunks, not vomited all over with information, maybe they need follow-up. Maybe they need to watch videos. Maybe they need to take a test. Maybe I know I'm the kind of person who I like to take a test. It's a very weird thing. I took a continuing education course the other day on child abuse. And at the end, you know, they tell you to evaluate the course and I do. I'm like, well, where's the test, where's the test. How do they know? I know that I read. And my boyfriend was like, are you advocating for a test? Like you want to test? Karen Litzy (33:32): I'm like, yes, I want to test because I want to make sure that what I read that I understand it at least superficially right. So when you're talking, like I have had patients where I have explained things, explained pain, used a pain education approach to them. And I always try and follow that up with, you know, I'm going to send you a couple of videos. I'm going to send you some you know, and ask them like, do you understand? Can you kind of give me the highlights? What did you take away from that conversation? So you may educate them, but if you don't ask them well, what do you think? What did you understand from that? Does it matter what you said to them? If they can't understand a word that you just said? Laura Rathbone (34:20): Well, that, I mean, that is like one of the basic basic principles, isn't it of how do we communicate it? Does the other person even understand what we're saying? Are we using it an appropriate approach to communication? But I guess the other thing is, you know, the beauty of the ACT is that it came out of, you know, this struggle that we had in real time, behavior change, you know, like we can help people change their thoughts and they can change. They can, they can find a new narrative, but when pain comes, what do they do? What do we do when something difficult shows up, you know? And the skillset, in fact, the hex of flex, all the processes have changed at all. Within the hacks effects are there to be navigated and to be utilized in that moment, when pain comes, what do I do? Laura Rathbone (35:19): Is this helpful? Is this in service of something that I am working towards and not working towards, but that's, whatever the person in pain says it is, right. That's not all saying, Oh, we're in rehabilitation. Therefore we need to rehabilitate you to action. Or, yeah, I have no idea. You know, it might be that in that moment, the most important goal for that person is self care, right. That could be, I mean, and that's very legitimate and very, very valuable, you know, it's not, well, when pain comes, how do I push through it? It's what we're trying to figure out is okay, when your pain comes for you, what do you do? And is that helpful? And if it is, then all we want to do is facilitate that and to validate it. And if it's not helpful, then that's when we might say, okay, so how do we start opening this up? Laura Rathbone (36:11): How do we start finding a helpful thing? What do you think could be helpful? And our job is to facilitate that conversation so that the other person doesn't feel they are making all of the choices on their own. And they've all of a sudden, they've just had been dumped the responsibility of their own care on their lap. Our job is to compassionately titrate that conversation, what might be helpful, and to take our time, to explore it in a way that people feel they're able to meet in a way, not that people feel sorry, that isn't the right word in a way that people are able to make their own choices. And we are able to support them. That's it? And that's what ACT is. Karen Litzy (36:55): And to that end, I want to go back to the story of your mom and how you said she found this massager that really helped. And you know, you and I had a conversation the other day, and we had this conversation about the passive versus the active modalities and passive bad, bad, active, good only thing we should be doing. So let's talk about that within the ACT framework of your mom found a massager or whatever it is. And boy that really helped. So from an ACT framework, how do we make sense of that when we are supposed to be only advocating for active, active choices, not passive modalities, not a tens machine, not a massager. Laura Rathbone (37:47): Okay. So I would say this is probably the part of the podcast where I will, it's the most controversial part. Because if you are a person that advocates hands off therapy, then actually fit very nicely into your framework and you might be using it very X and you know, and doing great work. And if you are a hands on therapist, then you may have already decided the ACT is for the hands off people. So you're not going to go near him. And you know, my opinion on this probably changes quite often, but I would say that if a person is making an informed choice about how they, their pain that is helpful for them, that is active treatment, that is an active decision, but is that person and saying, this is helpful. So, I guess if we're going to use the way I would use ACT in that moment as somebody who typically doesn't use a lot of hands on therapy or a treatment delivery devices. Laura Rathbone (38:58): So we say, you know, I did my masters in sort of neuromusculoskeletal therapy. We did all the manual therapies stuff. I would say, okay, how much does it help? Let's talk about that helpfulness, because that's important because my job is not to make you feel bad about using something that helps you in your life. My job is to facilitate that and to support that and to see value in the bits that you might not be using, or the bits that you might not be doing. So if that person is able to say this right now is the only thing that is keeping me going, then we say, okay, it's helpful right now, helpful right now doesn't mean helpful forever. Right? Helpful right now means in this moment, in this context, with the knowledge that you have the skills that you have, the relationship that we are developing, this is very helpful. Laura Rathbone (39:58): So I'm not going to take that away because that's cruel, right? That's not nice. What we're going to do is we're going to work with that. I'm going to keep checking in and seeing, okay, is this still very helpful? If it's, and at some point it might not be, and it was, we're going to keep working on all this stuff, I would say, okay. So let's say, you know, a TENs machine, quite often, people that I work with are using tens machines, because it helps them to do something of value. That's it, that's what we're working for. But if they're saying I go to the physiotherapist or a particular physical health therapist, whatever, and they give me, let's say core exercises. That just for it, just rotate through their active therapies, right? These are hands off therapy, call exercises to strengthen my core. Laura Rathbone (40:47): And I do them. And I have worked with these people where they are doing them four or five times a day. And they're in pain when they do it. They're in pain after they do it, they're in pain the next day. And they've been doing it for months, some of them. And you're saying, well, actually, is that helpful? There's an active treatment. That's an active treatment in a way, that's the person doing it, but that is a passive approach to receiving therapy, right? Because they're not thinking and not enough. And don't feel like they're able to have the space for their own opinion on whether this is working for them. It hasn't been created in the therapeutic alliance. So, so that they're doing this in the hope that they get to the goal of the therapist that they're going to get, but they're not necessarily getting there, but they're still doing it cause they haven't the safety and the relationship hasn't been created. So that person can go back and say, actually, this isn't helping me. So we can say, okay, that's not helping. We can change. You don't need to do stuff that's not helping. If this is making your pain worse, then it's causing pain. Why are you doing it? Karen Litzy (41:51): Yeah. And it's so funny. I had that conversation a couple of weeks ago, the gentleman with chronic low back pain, it's been six months of low back pain. And the doctor said, we'll read this book and do these exercises. So he was doing press ups and press ups at an angle and press ups. And, and I said, well, how long have you been doing that? And he said, I've been doing for a couple months. I'm like, Oh, well, how does it feel? He's like really hurts when I do it. But you know, the doctor said to read the book and do what's in the book. So I'm just doing what's in the book. And I said the same thing. I'm like, well, there might be ways that we could alter this, or there might be other things that might be more helpful if you're doing this particular exercise. Karen Litzy (42:38): Exactly what you just said. Well, it hurts when I do it. It hurts more after I do it. And it hurts the next day more after. And I said, well, okay, let's explore this because I think there might be ways that we can make this work. And lo and behold, we found ways to make it work, but it's just, yeah, it's just that exact example of what you just said. And having the conversation was maybe a little uncomfortable at first, because this was something the doctor said to do. And so we had to do it. Laura Rathbone (43:14): Yeah. But I mean, that is a typical example where a clinician just has not invested in their communications strategy or their compassion for the person in front of them. They haven't even created a dialogue. They've just given somebody a book and said, your problem is so common that we've written a book on exactly how to get out of it. You just need to follow this. There is no dialogue that, and the thing is pain. Pain makes us very vulnerable, right? Pain creates a huge vulnerability in us. And we know that when we have pain, we are vulnerable and it's no different for the person in front of you. That's been living with it for years. They've just got more pain and had it longer, maybe feeling more vulnerable and more desperate to find a way out. And that's completely understandable. So shame on that clinician, because that is not okay. Laura Rathbone (44:07): We have got to invest in our dialogue abilities. We've got to commit to being good communicators and compassionate communicators and compassionate listeners. And, you know, really want to know about the human we're working with as opposed to dismissing their pain as something that a book can feel. And of course there are very helpful books out. There are helpful textbooks that have been written by very compassionate clinicians and some are better than others. And I'm not trying to say all self help tools are all bad because that's not, that's not the point here. The point here is that if there's no, there's no way, there's no space for the person who is living with pain to explore with you, the solutions that you're putting up, then, then it's very difficult for people to know what to do next. And it's very easy for them to feel like they're doing it wrong or that they're somehow not committed enough. So then they'll might do it twice as many times and more often and more days, and with more effort, because that's the only solution we've given them. Karen Litzy (45:18): Yeah. And then I think it also brings on for the patient sort of coming from my own experience is that, well, I can't even get this right? Like you failed yourself. You don't even know your own body. It takes you. I think it disembodies you even more than perhaps you already are out of protective purposes. And it just takes you further away from yourself and your person, if you will, because if you can't, you know, you read the book, you're doing it. The doctor said, you're doing what the therapist said, and you still can't get it right. Then you're just a failure. And it, again goes back to feeling hopeless. Like you said, like your mom felt like she didn't have any hope and she felt very hopeless. And I think these sort of faulty communications and inability to tune into what the patient is telling you leads to that feeling of hopelessness and failure from the patient point of view. And so I can totally see how using ACT as a framework and being able to acknowledge the person and what they're doing. And, are there some alternatives that can be used, maybe not now, but maybe in the future or where you are now and what can we do at this point? And it was working now, but let's keep in mind that there are some other things that we might be able to augment your program with. Laura Rathbone (46:58): Yeah. And I always say that brings me on to probably the next thing that really, I think, feel very, very passionate about. And there are many new ones to watch my Facebook page, but you know, this is, I think one of the big misunderstandings we have about integrating psychologically informed physiotherapy, right. Is that we still think that it's something we do to other people. And that's why I don't really like the term psychologically physiotherapy, because it's still, although I think it's the best one we've got right now. And I think that, you know, it's a lovely way of thinking about how we therapize people, but it still puts the workload and the part of our identity that is physiotherapists. It's still what we do when we put the uniform on or when we go into our clinical encounter. Laura Rathbone (47:51): And it's still something that we do as a thing to all the people. But, you know, if we think really and truly reflect on the idea of the biopsychosocial model and the hierarchy of natural systems, this idea that a human is embedded within their environment, then the clinician is a part of the external environment and the patient or the person that's chosen to work with us is a part of our external environment and has an influence on us. And we have an influence on them and we need the real richness with acceptance and commitment therapy is that it is something that we're thinking about, okay, what is happening in my present experience that I might be struggling with that might be coming up in me that might be having an influence on somebody else? Laura Rathbone (48:45): What is my reaction to that person's story or that person's behavior, or that person's diagnosis, right. You know, what's happening in me so that we can also remember that work with our own resistance and become aware, especially now become aware of our own privilege and how that might influence and take away from somebody else's privilege or equity or equality or justice or access. And this is something that we need to reflect on very, very deeply as clinicians working in an area like healthcare, where access is very, very important. And it's our role to make sure that we're delivering high quality care with open access. And so acceptance and commitment therapy is a way for us to also take that moment and be like, okay, well, what's going on in me here? How am I helping this person what's happening in my reactions and my emotions and my sense of self and is that always helpful? So if my goal is to deliver an open and evidence-based and compassionate approach to experiencing any resistance or challenges to doing that in this situation, and maybe I need to work with that. Laura Rathbone (50:02): I think that can be true. Across musculoskeletal health, when, you know, people see, you know, patients or people with pain coming in and they have persistent pain, and it's not going to get better in six sessions, three to six sessions, and we've all got those targets, right. And they're going to need more than 30 minutes. So we're going to have to explain to our manager why actually did more than 30 minutes. You know, all these sorts of things what's happening is our instinct to push them away to somewhere else, or to create departments where we, you know, where we don't accept people who have pain for more than three months, or, you know, then there are those departments out there that push the access away to somewhere else. Laura Rathbone (50:49): So there's a bottleneck in all the parts of our clinical approach. Actually, maybe we could just upscale a little bit and recognize that persistent pain is a very big part of our musculoskeletal population. And we all have a duty to be better at it.   Karen Litzy: Yes, very well said. And like you said, especially in these times, so listen, Laura, I want to thank you for coming on, but before we wrap things up and get to a good, and now a nice announcement from you and what you're doing in regards to ACT, I'm going to ask you one more question that is knowing where you are now in your life and in your career, what advice would you give to yourself straight out of university? Laura Rathbone (51:52): Gosh yeah, I would say what I am learning is that I'm not always the right person at that moment. And sometimes my desire and urge to fix people quickly as well, and to do right the injustice of having pain and to really get rid of that pain as quickly as possible. Sometimes that has I think, taken away from the therapeutic potential in some environments and in some experiences. So, and also has just caused me in a lot of pain, you know, and we have to remember that we are humans in this, that we are not, clinicians are people that go home and try to, you know, keep going after hearing some very difficult stories of all the people and, you know, we're also not immune to when the people we work with don't get better in the way we want them to, you know, we take that on. Yes. One of the most important skills that I have been learning is to be more forgiving of myself. Laura Rathbone (52:51): And to remember that life is complicated and people are coming into our clinics with a whole lifetime of experiences that I am not aware of and not privileged to. And they are not aware of or privileged to mine and being slower, taking more time, being more gentle, not only with people who choose to work with me, but also with myself actually has brought me to a place where I am having a better relationship with my job. I'm getting better relationships with the people that I work with. And I just, yeah, I am able to sustain this work now for longer than I would have been, you know, eight years ago when I first started in particularly working with longterm pain, it was very hard for me and I went through my own version of a burnout when I was constantly finding, trying to find more information and be better and upskill, upskill, upskill. Yes. We need to upskill. Yes. We need to learn about these things, but we also need to find good supportive mentors and good environments that we can next explain and explore what we're going through and ask for help. If we're feeling very effected by what we're hearing every day, you know, good relationships with our colleagues, physiotherapists, occupational therapists, psychologists, social workers, help us to, you know, share our experiences and our load. And be more forgiving of that, I guess. I don't know if that's a good answer. Karen Litzy (54:27): That's an excellent answer. Are you kidding me? Fantastic. And now speaking of gaining skills in service of others, what do you have coming up? Cause I know you have like a course that you have put together. So can you talk about that and where people can find more information? Laura Rathbone (54:52): Yeah. So about six months ago, I started putting together and planning a two day course, right? Typical 15 hour, two day course, people would come to our room and we would do two days of ACT. And then, you know, the situation with COVID-19 and all of our lives changed, and that didn't seem like it was gonna make most sense. So it shifted into a sort of online collaborative learning and it's still, we're still figuring out how this is going to work, but instead it's going to be four sessions of three hours of contact and collaboration over four weeks. And then there's going to be like support and forums in between. And that will be going live hopefully at the end of July, if I can get the luck. But if people do want to come on a course with me, or they're interested in exploring ACT and they just got some questions, best thing they can do is go to my website for information for even better, because I'm basically always on social media, find me on Facebook or Twitter, whatever, flip me a DM. Karen Litzy (56:03): And now, so we'll have links to all of that under the show notes at podcast.healthywealthysmart.com, but can you just shout out your social media handles? Laura Rathbone (56:17): If I can remember them. @laurarathbone (twitter) @laurarathbonevanmeurs (facebook) @laura.paincoach (Insta) Yeah, that's more of a patient facing platform for me. So that's Laura.pain coach which is the title that I tend to prefer. So sort of working as a coach, as opposed to as under the strict title of physiotherapy yet. So that was, yeah, those are the three social medias I use the most. Karen Litzy (57:02): Awesome. Well, Laura, thank you so much. This is a great conversation. It's certainly got me thinking of the way that I work with my patients and my clients, and maybe how I need to do a little more introspective work and try and really check my biases, whether they're conscious or unconscious biases at the door and really see what I can do for the person at the moment and listen to them and see what I can facilitate for them. So thank you so much for coming on the podcast and sharing all of this information. Thank you. Laura Rathbone (57:40): Oh, no, you're welcome. There's lots of books and websites and patient information out there. Just want to give a shout out to Steven Hayes who really is responsible for the framework of acceptance and commitment therapy and the association for contextual and behavioral science, I think it is, but I'll make sure that you get linked with that and why there are you know, resources on there for people to learn about acceptance and commitment therapy, because you know, this work isn't being done, the research hasn't been done by me, it's been done by lots of other people. So I would like to just direct people to look that up as well. Karen Litzy (58:21): Awesome. Well, thank you so much for coming on and everyone, thank you so much for listening. Have a great couple of days and stay healthy, wealthy and smart.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Anne Stefanyk on the show to discuss website optimization.  As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs, and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions. Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp. In this episode, we discuss: -Why your website is one of your most important marketing tools -The art of simplicity in branding -How to track the customer lifecycle -The top tools you need to upgrade your website -And so much more! Resources: Anne Stefanyk Twitter Drupal Anne Stefanyk LinkedIn Kanopi Website HotJar Google Pagespeed Accessibility Insights WAVE Web Accessibility Google/Lighthouse Use user research to get insight into audience behavior How to make your site last 5 years (possibly more)   A big thank you to Net Health for sponsoring this episode!  Learn more about Four Ways That Outpatient Therapy Providers Can Increase Patient Engagement in 2020!   For more information on Anne: As Founder and CEO of Kanopi Studios, Anne helps create clarity around project needs and turns client conversations into actionable outcomes. She enjoys helping clients identify their problems, and then empowering the Kanopi team to execute great solutions. Anne fell into the Drupal community in 2007 and admired both the community’s people and the constant quest for knowledge. After holding Director-level positions at large Drupal agencies, she decided she was ready to open Kanopi Studios in 2013. Her background is in business development, marketing, and technology, which allows her to successfully manage all facets of the business as well as provide the technical understanding to allow her to interface with engineers. She has accumulated years of professional Drupal hands-on experience, from basic websites to large Drupal applications with high-performance demands, multiple integrations, complicated migrations, and e-commerce including subscription and multi-tenancy. Anne is an advocate for open source and co-organizes the Bay Area Drupal Camp. When she’s not contributing to the community or running her thoughtful web agency, she enjoys yoga, meditation, treehouses, dharma, cycling, paddle boarding, kayaking, and hanging with her nephew.   Read the full transcript below: Karen Litzy (00:01): Hey Anne, welcome to the podcast. I am so excited and happy to have you on. Anne Stefanyk (00:06): Nice to see you. Thank you so much for having me. Karen Litzy (00:09): So before we get into what we're going to talk about today, which is kind of how to use your website as a marketing tool, and that's putting it lightly, we're going to really dive into that, but I want to talk about kanopi. So for a lot of my listeners, they know that I'm a huge proponent of female entrepreneurs of women in physical therapy. We have a whole conference for it every year. And I love the fact that kanopi is a majority female company. So can you talk about the inception and kind of the journey that you've taken with the company over the years? Anne Stefanyk (00:47): Sure, I'd be happy to. So I founded kanopi kind of off the side of my desk and it actually came from meeting a need that I needed to take care of with my family. My family became quite sick and I had to stop working and as a result it forced my hand to pick up some contract work. And that contract works. Certain cuts soon kind of snowballed into, Oh my goodness, I have actual projects. I probably should hire some people and get out of my personal email to run the business. But it did come from a place where I needed some lifestyle flexibility. So I built a company that is fully distributed as well. And as a result of the business model that we created, it allowed us to really attract and retain really great talent. Outside of major cities. And I have a lot of single moms or a lot of moms and I have some single dads too, but we really are able to, with our business model, attract and retain a lot of top talent. Anne Stefanyk (01:39): And a lot of those are girls. So we're over 50% women and there's only really two men in our leadership, a team of nine. So there's seven girl bosses out of the nine that run the company. And we really have focused on helping people with their websites and making it really clear and simple and easy to understand. We find that there's always too much jargon out there. There's too much complexity and that we all are just craving simplicity. So building the business was twofold, was one to obviously help people with their websites. What was also to really create impactful futures for my staff and give them opportunities to kind of grow and expand in new ways. So I'm really proud that as kanopi has formed our team, I'm part of our retention plan has to really been to take care of our families and put our families first. Anne Stefanyk (02:28): Because if we realize that if you take care of the family, the family takes care of you. And so we've extended a lot of different benefits to be able to support the family journey as part of the business. And we find that as a female entrepreneur, really recognizing and appreciating that we need flexible lifestyles to be able to rear children or take care of elderly parents or we have a lot of demands as females on us. I mean the men do too, don't get me wrong, but as a female I'm creating a space of work where we can create that space for everybody really makes me proud. And happy. Karen Litzy (03:03): Yeah, I mean it's just in going through the website and reading about it, I was just like, Oh gosh, this woman's amazing. Like what a great way to go to work every day. Kind of knowing that you're staying true to what your values are and your mission is and that people really seem to like it. Anne Stefanyk (03:22): Yeah. Yeah. We always say it's not B to B or B to C, it's H to H it's human to human. And what do we need to get really clear to speak to our humans to help them, you know, move forward in their journey, whatever that looks like for them. Karen Litzy (03:34): Right. And, so now let's talk about that journey and it's kind of starts with the website. So let's talk about how you can make your website an effective marketing tool. Because not everyone, especially when you're first starting out, you don't have a lot of money to throw around to advertising and things like that. But we all have a website or maybe we all should have a website and have some sort of web presence. So how can we make that work for us? Anne Stefanyk (04:00): Yeah, definitely. You need a website. It's like a non negotiable factor these days and it really doesn't matter. The kind of website you have, especially when you're just getting started. There's lots of great tools out there from Wix, Squarespace, even WordPress that comes with templates or pre-baked themes. And I think the most important part is to really connect with your user and figure out who your user is and what kind of website needs to support their journey. But yeah, definitely you have to have a website and you actually have to have a good website. Having a bad website is the non, like, it's really bad because it will detract people so quickly and they'll never come back. So you pretty much have that first impression. And then if you don't make it, they won't come back. I think there's a well known stamp that if your site doesn't load within four seconds or three seconds they'll leave. And if it doesn't load within four seconds, they will never come back to that URL. Karen Litzy (04:56): Wow. All right. That's a great stat. I'm going to be, I'm going to go onto my computer, onto my website and start my timer, you know, so there's some really cool tools. Anne Stefanyk (05:06): We can include them in the show notes, but the Google has a page speed test where you can actually put your website URL and see how fast it is and give recommendations on what to fix. Karen Litzy (05:15): Oh perfect. Yeah, and we'll put all those links in the website and we'll get to that in a little bit about those different kinds of tools. But let's talk about, you said, you know, you're human to human business. We have to know who are we putting our website out there for. So how do we do that? Anne Stefanyk (05:34): Yeah, that's a great question. So when you're first starting off, you probably all like if you're just starting your business, you're just trying to figure out who you serve, but you may have special things that you'd like to, you know, that you're passionate about or you specialize in. Like for example, maybe you really specialize in women's health or sports medicine or you know, one of those things. And just to kind of get clear on who is your best customer. If you've been in business for a couple of years, you probably have a pretty good idea who your ideal customer is and how they engage with you. So first off, it's really thinking about who your target audience is and what are their needs. So when we're thinking about a website and thinking about that user journey, you often identify them as certain people. So you may have like, Mmm you know, kind of creating different avatars or different personas so you can really personify these people and help understand their journey. Anne Stefanyk (06:27): And from there you kind of understand that if someone's coming to you for physical therapy, there's going to be different mind States that they come into you with. So when you first have your website, you're going to want to, of course, a lot of people just put up who they are. Like, you know, this is my practice, this is who I am. This is my credit, my accreditation, and my certifications. And maybe maybe here's some testimonials. And then we run and we go off to the races. And that's great to get you out the door. Once you started your business, you're going to recognize that you're people, when they call you, they're going to have a million questions and there's ways to answer those questions using your website. And as a solo entrepreneur, like I ran my business by myself for three years, which means I was everything and I wore all the hats. Anne Stefanyk (07:09): I was the project manager, I was the designer, I was all the things that was the marketer, was the, I know that feeling well. So it took me like three years to operationalize. And I think the first thing I did as a female entrepreneur, I hired an assistant. I would highly recommend that as being one of your first hires as an entrepreneur. And that's just someone who can do all the little itty bitty details and then move on to whatever that looks like for you. But when you're building your website, the next level you really need to take is it serving my humans? Is it serving my audience? So are they able to get the information they need? And I think this strange time that we're in, we're all, this is an opportunity for us to look at our own website and our own stuff and say, is this the best representation possible? Anne Stefanyk (07:52): Because no longer are they just picking up the phone and calling you because your practice is probably closed. You're at home right now, your phones, maybe you if you have them redirected, but either way they're going to your website first. So it's like having the right information there at the right time for the right person. And that really comes to the user journey and that's where you know, if someone is just broken their ankle and they're now told by their doctor, you have to go into physical therapy, that's their first stage as they now are going to Google and saying, you know, PT for San Francisco and interestingly enough as Google wants to keep you there, so here you are. You user is Googling for you or Googling for physical therapy wherever, San Francisco, San Jose, wherever, and up comes the Google listings. If you can get past that point, then they go into your website and they're going to click open a bunch of them. Anne Stefanyk (08:43): That's what we call, you know, your awareness phase. They're becoming aware of you. There's certain things that a user wants to see in that phase. So understanding of someone's looking for you, they're going to, Oh yeah, they specialize in ankles. And I really think you know, Oh, that's person's for me. Versus now they're in the consideration stage and now they've chose likely, but Sally over here and James and Jimmy and we're figuring out which PT to go to, then that's a different level of content and what are they looking at to compare and contrast. And then when they've actually decided to work with you, then there's another layer of content you have to consider. So, Oh, I've decided to work where they're located. How do I get there? Was there anything I need to prepare their forms I need to fill out in advance? Anne Stefanyk (09:27): And then you even have the persona of the user once they've actually gone through all your services as I imagine. And therapy. A lot of you folks are getting referral and word of mouth. Let's nurture that. Let's use the website to nurture the word of mouth and referral work. Let's give your patients a place to go really easily to provide feedback, which will then change, you know, getting those Google reviews up leads to a higher ranking on that Google page. So if you understand where they began and where they pop out at the end, kind of map it all together. You'll start to see your gaps.   Karen Litzy: And is it possible to go through sort of a quick example of what that might look like? So if someone's there on Google, they hit Google, they click on your website, you just said if it doesn't load within a couple of seconds, they're gone. Anne Stefanyk (10:14): Right? So that's a good awareness phase situation, right? What else? Someone's there, they're just click, click, click trying to find someone. What is it that they're looking for in that awareness stage? Like what are they, what is going to be like, Ooh, I like this, this person. I'm moving them from the awareness bucket to the consideration bucket. Yeah, yeah. So they need to see themselves in the way that their problem gets solved. So when they look at the website, they can say, Oh yeah, that person had the same problem and they got help. And then, Oh, look at their results. Oh look, there's a picture of them, you know, back on their skateboard six months later as part of this patient follow-up log. Oh, we don't, you know. So that's the kind of stuff is that when users really want to just be able to see themselves, they crave simplicity. Anne Stefanyk (11:01): And so often I think that if we're too close to it, we don't actually see how complex our stuff is. And sometimes when we're really smart and we have degrees in specialized things, we use vocabulary that our users are not even aware of yet. So it's really when you're talking to getting them from that awareness into considering you, it's about using really basic common language. It's about guiding them through a bit of a story. People love to read stories. So showing them like, Oh, you know, I was really showing another patient and showing the patient journey that all, I considered multiple companies locally, but I ultimately went with Sally as a PT because this, and just showing those things helps the user kind of see the whole journey so they can say, okay, okay, if you've never broken your ankle before, have no idea what to expect. You've never gone to physical therapy, you have no idea what to expect. And just the anticipation, if you can show them what snacks they feel a sense of relief that they'll be taken care of. Karen Litzy (12:04): Yeah. So what I'm hearing is that your testimonial page on your website's pretty important, is that something that should be front and center on the homepage? Anne Stefanyk (12:16): Well, that's an interesting thing. I think the main thing you want to use that front and center is being really clear about what you do. Right? Some people like to put these big sentences up there, but getting to know your user and the problem they have and this, you know, getting to how you're going to solve the problem is the most important part of that, of that real estate upfront. I will warn everybody that please don't use carousels. They're a big fad and they're just a fad. They're from a usability standpoint. And what happens is the end user thinks that whatever you put in your carousel is what you do. So if you're promoting an event in your carousel, they'll think that you're just doing the events. Anne Stefanyk (13:01): They won't even know that you're a physical therapist. Really clear upfront about what you do. You know, like I help people with, you know, however it goes, and then provide supporting content. So a testimonial is wonderful if it can also be like imbedded within a bigger story. So it tells the full story. I like that video. I mean everybody has an iPhone. So, or at least access to video really easily. You could do a quick little video testimonial with one of your clients over zoom for two minutes to say, Hey, you're one of my favorite PT clients and can you get on a quick video with me and just do a video testimonial. That's great way to leverage video content on your website to help the user see themselves as what the solution's going to be. Karen Litzy (13:47): Yeah. Great, great, awesome. And then one stipulation I would say on that is talk to your lawyer because you'll need them to sign a release for HIPAA purposes, right? To make sure that they know exactly where this video is going to be. You have to be very clear on that. Okay, great. So we're out of the awareness phase, so we're in consideration. So let's say it's between me and one other PT in New York city. What should I be looking at on my website to get that person from consideration to yes. Anne Stefanyk (14:20): So one of the greatest ways to do stuff is actually a very tried and it's email marketing or text-based marketing. So if you can capture an email during that awareness phase, even if it's just like you know, Mmm. Interested in getting some tips and tricks on how to rejuvenate your bone health during, you know, it doesn't have to be like sign up for a newsletter or sign up for this. It could be just a very simple, if you know your user is coming there specifically for a thing and you can provide some type of value added content, then there might be some small way to get a snippet of data so that you can continue the conversation. Cause most people are just bombarded with information and overwhelmed. So if there's any way to connect with them so you can feed them information. But another great way to kind of pull them into that consideration content is once you've got their eyeballs hooked and you're in, there is again to kind of figure out what are the common things, questions they need to have, they have answers they need answers to. Anne Stefanyk (15:22): And this might be from your experience, just answering phone calls when people are starting to talk to you. But it's like the questions like you know, maybe how long does it take for me to heal, you know, will I have different types of medicine I'm going to have to take? How much homework will there be? Do I need any special equipment? That's kind of, you know, just showing that you're the expert in the field and you have the answers to questions they didn't even know they had to ask. That kind of aha moment makes them feel really trusted. They trust you because they go, Oh I didn't even think about asking that question. Oh my goodness, I'm so glad they thought about that. I feel so taken care of. And that's where I think a lot of websites drop the ball is they straight up say like this is what we do, here's some testimonials. And they don't put all that soft content and that builds the trust. Can be a little blog, a little FAQ section and this is all like non technical stuff. You don't need a developer to do any of this. It's mostly just your writing time. Karen Litzy (16:18): Yeah, no and it's making me go through my head of my FAQ, so I'm like, Hmm, maybe I need to revisit. That's the one page I just sort of did a revamp of my website. We were talking about this before we went on, but I actually did not go to my FAQ page cause I thought to myself, Oh, it's probably good. It's probably not. I need to go back and do a little revamp on that too, just to think about some of the questions that I've been getting from patients recently and how does this work and things like that. Especially now with COVID. You know, like what about tele-health? What about this or about that? Anne Stefanyk (16:51): Yeah. Google loves when you update your content. Google loves it. Google loves it so much. It is one of the biggest disservices you can do is build your website and leave it. That's just not healthy. People think you have to rebuild your website every two to three years. That's who we are. That's bananas. You have to do it. If you just take care of your website and you nurture it and you love it and you make it, you make it work and you continually work on it and maybe that's just an hour a week, maybe it's an hour every month, whatever it is. Just a little bit of attention really goes a long way and it is something that we believe a website should last for at least 10 years, but that means you got to take care of it, right. A lot of clients come to me and say, Oh well, you know we're going to have to rebuild this in three years, and I'm like, no, you shouldn't. Anne Stefanyk (17:31): It should be totally fine. It's just like if you get a house right, if you don't do anything with your house a hundred years later, it's probably demolished. Like you're going to tear it down versus you've got to do the roof and you've got to replace the carpets and you got to do the perimeter drain. Right. It's kind of the website stuff too. I mean, Google will throw you curve balls if you're spending a lot time on social. Unless you're getting direct business from social media, don't worry about it so much. Google has changed their algorithms, which means that social doesn't count for as much as it did. Oh, so if you're spending two or three hours a week scheduling social, unless you're directly getting benefit, like from direct users, finding one social tone that way down and spend more time writing blogs, spending more time getting you know content on your website is, that's what matters from a Google standpoint. Karen Litzy (18:16): Good to know. Gosh, this is great. So all right, the person has now moved from consideration. They said, yes, I'm going to go and see Karen. This is what I've decided. Awesome. So now how can I make their patient journey a little bit easier?   Anne Stefanyk: So we started at Google, they got from awareness to consideration. They said yes. Now what? Yeah, now what? So it's continuing the conversation and creating kind of being ahead of them. So text messages, 99% of text messages are open and read. Okay. Yeah, I think it's like 13 to 20% of emails are open read. So it would be skillful for you to gather a phone number so then you can text them, alerts, reminders, et cetera. That's a great way. There's a wonderful book called how to, what is it? Never lose a customer again. And it's beautiful. It's a beautiful book. Anne Stefanyk (19:11): It applies to any business. And it really talks about like how when you're engaging with a new client, the first two stages of that are the are the sales and presales. But then you have six steps. Once a person becomes your clients on how to nurture and engage and support that client journey. And that might just be simply as like if they're deciding to work with you and they book their first appointments, there's a lot of cool video. You could just do a little video recording and say, you know, thank you so much for booking an appoint with me. I'm so excited. I really honor the personal relationship that we have together and I want to build trust. So this is a just, and then giving them like a forum to then ask the question to you. So just building that relationship. Cause even though your clients, I mean if they're coming for PT, they might just be a onetime client. Anne Stefanyk (19:57): But again, they also might have lots of friends and family and that works. So when their friends and family and network happened to have that, how do you also kind of leverage the website that way? But a lot of it is just clarity. And you'll notice that big way to find out what's missing is interview your last few clients that have signed up, find out what they found was easy, what was difficult, what they wish they had more information. And if they're a recent enough client, they'll still remember that experience and us humans love to help. It's in their nature, right? So you should never feel worried about asking anybody for advice or insights on this. You know, there's even a little tool that you can put on your websites. It's a tool, there's a free version called Hotjar, hot and hot jar. Anne Stefanyk (20:47): And it's pretty easy to install. We actually have a blog post on how to install it too. It's really, we'll put that blog posts, but what it allows you to do is it allows you to see where people are clicking and whether they're not clicking on your website. So you can actually analyze, you know it's all anonymous, right? It's all anonymously tracked, but you can do screencast and you can do with these color heatmaps, you can kind of see where people are going. You can track this and it's free, right? Three you can do up to three pages for free. So I feel like the guys looking at stuff like that, you kind of get the data that you need to figure out where your gaps are because what you don't know is what you don't know, right? So I first recommend like getting clear on who your user is, you know, if you specifically take care of a certain set, figuring out where their journey is, what kind of content you'd need for each of those and what the gaps are. And then filled out a content calendar to fill the gaps. Karen Litzy (21:42): Got it. And a content calendar could be like a once a month blog post. It doesn't have to be every day. And I even think that can overwhelm you're patients or potential patients, right? Cause we're just inundated. There's so much noise, but if you have like a really great blog that comes out once a month and gets a lot of feedback on it, then people will look forward to that. Anne Stefanyk (22:11): Exactly. Exactly. Exactly. And I mean, humans want to get clarity, they want to receive value. And right now we live in an intention economy where everything is pinging at them. So realistically, the only way to break through the noise is just to be really clear and provide what they need. Simple. It's just simple. It's actually, you just simplify it, remove the jargon, you know, make it easy. And I mean a blog post, it could be as short as 300 words. You don't need to write a massive thing. You can even do a little video blog. Yeah. You don't like writing, you can just do a little video blog and embedded YouTube video and boom, you're done. Right? Karen Litzy (22:46): Yeah. Yeah. I love this because everything that you're saying doesn't take up a lot of time. Cause like we said before, when you're first starting out as a new entrepreneur, you feel like you've been pulled in a million different directions. But if you can say, I'm going to take one hour, like you said, one hour a month to do a website check-in, right? One hour a month to get a blog post together or shoot a quick video. Like you said, we've all got phones embedded in every device we own these days. So it doesn't take a lot. And I love all those suggestions. Okay. So now I'm in the nurturing phase and what we've done is, because I didn't use jargon, I was simple, clear to the point, filled in the gaps for them. Now those patients that who have come to see me are referring their friends to me and we're starting it all over again. So it's sort of this never ending positive cycle. Anne Stefanyk (23:41): Exactly, exactly. And that's what we really frame. We call it continuous improvement, which is the methodology of that. You always need to be taking care of it, nurturing it, loving it. Because if you just let it sit, it will do you no good. Right. And that's where you know, when you're that little bit of momentum and it's about pacing yourself and choosing one goal at a time. Like if you're feeling like, Oh my gosh, where am I going to start? What am I going to do? You know, just say, okay, I just want my site to go faster. Just pick one goal. You run it through the speed test, it's scoring forward of a hundred you're like, Oh, I need to make my site faster. So then you look at that and you say, okay, I've learned, you know, big images create large page speed load. So it'll tell, you can go through and look at your images and say, Oh, I need to resize this image. Or maybe I need, if I'm using WordPress, put a plugin that automatically resizes all my images. You know, a lot of it is content driven that you can kind of make your cycle faster with an accessibility. Accessibility is so dear and near to my heart. Karen Litzy (24:44): When you say accessibility for a website, what exactly does that mean? Anne Stefanyk (24:48): I mean, yes. So that means that it is technically available for people of all types of ranges of ability from someone who is visually impaired to someone who is physically impaired, temporarily or permanently disabled. So if you think about someone who's got a broken arm and maybe it's her dominant arm. I'm doing everything with my left. Try using a screen reader on your own website and you will be shocked that if you can't type you know with your hands and you're going to dictate to it, you'll be a, is how your computer does not actually understand your words. So it's about making your website really technically accessible with consideration. Four, font size, color contrast. Yeah. Images need to have what we call alt tags, which is just a description. So if your image is like one, two, three, four, five dot JPEG, you would actually want to rename it as lady sitting in a chair reading in a book dot JPEG because that's what a screen reader reads. Oh. So it's about the technical stuff, so that if somebody needs to use a screen reader or if somebody can't use their hands from physical, they can't type, they're reading, they're listening to the website. It's about structural, putting it together correctly so the tools can output. Karen Litzy (26:12): Mmm. Wow. I never even thought of that. Oh my gosh, this is blowing my mind. Anyway, so there's tools out there to look, let's talk about if you want to just maybe give a name to some of those tools. So how about to check your websites? Anne Stefanyk (26:28): Yeah, so it's Google page speed and it's just a website that you can go in and put your URL. There's another plugin called lighthouse, and lighthouse is a plugin that you can use through Chrome. And then you just on that and it'll output a report for you. And some of it's a little nerdy, right? And some of it's, you know, some of it's very clear. I love it. They, they'll put some jargon, let's just say that they don't quite understand that not everybody understands laptop, but if you're on a tool like Shopify or Squarespace or Wix, which a lot of like first time entrepreneurs, that's a great place to start. It's really affordable. They take care of a lot of those things built in. So that's the benefit of kind of standing on the shoulders of giants when it comes to those. But lighthouse is a good tool because it checks accessibility, performance, SEO and your coding best practices. Karen Litzy (27:28): Oh wow. Okay. So that's a good tool. Cool, any other tools that we should know about that you can think of off the top of your head? If not, we can always put more in the show notes if people want to check them out. But if you have another one that you wanted to throw out there, I don't want to cut you off, if you've got more. Anne Stefanyk (27:45): Oh no worries. There's lots of different checkers and I think the big thing error is just to be able to understand the results. So I'm always a big fan of making technology really accessible. So if you do need help with that, you know, feel free to reach out and I can get more help. But generally we look at search engine optimization, which is are you being found in Google? And there's some tools like SEO. Moz is one. And then we look at accessibility, is it accessible to all people and then we look at performance, can it go fast, fast, and then we look at code quality, right? Like you want to make sure you're doing your security updates cause it's a heck of a lot cheaper to do your security updates than unpack yourself if there is. Karen Litzy (28:27): Oh gosh. Yeah. Yeah, absolutely. And, like you said, on some of those websites, that security part might be in like already embedded in that or is that, do you recommend doing an external security look at your website as well? Anne Stefanyk (28:44): Exactly. Most of the time when you're using a known platform like Shopify or if you're using WordPress or Drupal, then what you want to do is you want to work with a reliable hosting provider so they will help you provide your security updates. It's just like you would always want to lock your car when you would go out in the city. It's just like some do your security updates. So, but yeah, that's the benefit of being on some of these larger platforms is they have some of that stuff baked in. You pay a monthly fee but you don't have to worry about it. Karen Litzy (29:14): Right. Perfect. Perfect. And gosh, this was so much good information. Let's talk a little bit about, since we are still in the midst of this COVID pandemic and crisis and what should we be doing with our websites now specifically to sort of provide that clarity and calmness that maybe we want to project while people are still a little, I mean, I watch the news people are on edge here. Anne Stefanyk (29:47): Yeah. I think everybody's a little on edge, especially as things are starting to open. But nervous about it. All right. So I think the main thing that you can do is provide clear pathways. So if you haven't already put an alert on your website or something, right on your homepage, that speaks to how you're handling COVID that would be really skillful in, that could just be if you, you know, Mmm. Some people have an alert bar, they can put up, some people use a blog post and they feature it as their blog posts. Some people use a little block on their home page, but just something that helps them understand that what that is, and I'm sure most of you have already responded to that cause you had to write, it was like the first two weeks, all of our clients were like, we got to put something on our website. Anne Stefanyk (30:26): Right. And so, from there is I think being very mindful about how overwhelmed your peoples are and not trying to flood them with like tips and tricks on how to stay calm or how to parent or how to, you know, like that's where everybody's kind of like on overwhelm of all the information. So for right now, I would say that it's a wonderful time to put an alert up so people visit your site. If you've switched to telehealth and telemedicine, it'd be a great time to actually clarify how to do that. So if they're like, okay, I'm going to sign up for this and I want to work with you. Mmm. But how does it work? Are we gonna do it through zoom? Is it through Skype? Is it through FaceTime? Is my data secure? You know, like you said, updating all your FAQ is like, we're in this weird space where we really have almost like no excuse to not come out of this better. Anne Stefanyk (31:16): You know, as an entrepreneur we have this like lurking sense of like, okay, I gotta make sure I'm doing something. And the web is a great place to start because it is your first impression. And to kind of go through your content, and maybe it is if you don't have a blog set up is setting up a blog and just putting one up there or writing two or three and not publishing it until you have two or three. But it is kind of figuring out what is your user need and how do you make it really easy for them to digest. Karen Litzy (31:41): Perfect. And now before we kind of wrap things up, I'll just ask you is there anything that we missed? Anything that you want to make sure that the listeners walk away with from this conversation? Anne Stefanyk (31:56): I think the big thing is that this can all get really confusing and overwhelming very quickly. And all you need to just think about is your humans that you're servicing and like how can I make their journey easier? And even if it's like if nothing else, you're like, Hey, I'm going to get a text messaging program set up because I'm going to be able to actually communicate with them a lot faster and a lot easier. Or, Hey, I'm just going to focus on getting more five stars reviews on my Google profiles, so I show up. I'm just going to make that the focus. So I think the big thing is just a one thing at a time, and because we're in a pandemic, set your bar really low and celebrate when you barely hit it because we're all working on overwhelm and overdrive and we're all exhausted and our adrenals are depleted. Even in overdrive syndrome for like 11 weeks or something. Now I know it's kind of like, Oh my goodness, my websites maybe a hot mess. I'm going to get one thing and I'm going to give myself a lot of wiggle room to make sure that I can take care of the pressing needs and just being really like patient because it isn't a journey where you're going to have your website and your entire business. Karen Litzy (33:00): Yeah. We never got to turn off your website. Right. I hope not. Oh, you never will. Right. Telemedicine is going to give you a new kind of way to practice too. It's revolutionizing the way we treat patients. A hundred percent yeah, absolutely. I personally have have been having great success and results with telehealth. And so I know that this is something that will be part of my practice going forward, even as restrictions are lowered. I mean here in New York, I mean you're in San Francisco, like we're both in areas that are on pretty high alert still. But this is something that's definitely gonna be part of my practice. So if there is a silver lining to come out of this really horrible time, I think that is one of them. From a healthcare standpoint, I think it's been a game changer because you're still able to help as you put it, help your humans, you know, help those people so that they're not spinning out on their own. So I love it. Now final question and I ask everyone this, knowing where you are in your life and in your career, what advice would you give yourself as a new graduate right out of college? So it's before, even before you started. Anne Stefanyk (34:21): Yes, yes. Honor my downtime. I think especially as a girl boss, that's always like, I've been an entrepreneur pretty much since I was in high school. I never took weekends and evenings for myself until I became like a little older. I would've definitely done more evenings and weekends because the recharge factor is just amazing for the brain. When you actually let it rest, it figures out all the problems on its own, get out of your own way and it'll like just, you know, even this COVID stuff. I find it so interesting that you know, as a boss you feel like you want to do so much and you want to get it done and you want to help your staff and you've got to figure out how to be there for them and then it's like, wait, you gotta put on your own mask before you put it on the others. Anne Stefanyk (35:04): And I feel like healthcare professionals, it's like so important for you to honor that little bit of downtime that you have now. Yeah, I mean, if I knew that back then, I'd probably be way stronger way would have honored myself. And as a woman, self care seems, we put it like second to our business and our families and second, third, fourth, fifth. So it's like, you know, advice to pass out. Let's take care of you. Yeah. It will be great. You will do wonderful things. Take care of you. You'll feel great. You know, I broke my ankle because I wasn't taking care of myself. Yeah. Karen Litzy (35:36): Oh wow. What advice. Yeah. Honor the downtime. I think that's great. And I think it's something that a lot of people just don't do. They think that in that downtime you should be doing something else. So you're failing. Anne Stefanyk (35:48): Yeah. And it's just so silly. It's just this weird, you know mental game that we have to play with ourselves. I listened to one of your recent podcasts and I just loved the girl that was on there said like, you know, successes is 20% skill, 80% of mind game. And I could not agree with that. You know, having a company full of women, imposter syndrome is the number one thing that I help coach my females with. It's like, no, you know exactly what you're doing because nobody knows what they're doing. We all learn, right? There's no textbook for a lot of this stuff. Like we went to school, there was a textbook, there was structure. We got out of school and now we're like go learn. It's like okay, okay so I find the entrepreneurial journey so cool. And that means like kind of like also finding out other tribes like where can we lean into and that's why I love you have this podcast cause it really focuses on like building a tribe of entrepreneurs that are focusing on taking it to the next level. Like how can we be empowering them to do their best, be their best selves. Karen Litzy (36:47): Exactly. I'm going to just use that as a tagline from now on for the buck. Perfect marketing tagline. Well and thank you so much. Where can people find more about you and more about kanopi. Anne Stefanyk (37:00): So you can go to kanopi or you can simply just look for me just go to kanopi on the Googles and you'll find me. But if you want to reach out via LinkedIn or anywhere, I'm always just a big fan of helping people make technology really clear and easy to understand. So find me on LinkedIn or on stuff and we can chat more there. Karen Litzy (37:23): Awesome. Well thank you so much. And to everyone listening, we'll have all of the links that we spoke about today and I know there were a lot, but they're all going to be in the show notes at podcasts.healthywealthysmart.com under this episode. So Anne, you have given so much great information. I can't thank you enough. Anne Stefanyk (37:39): Well thank you so much for it. I'm really grateful for the work that you're doing. I think it's fantastic. Karen Litzy (37:45): Thank you. And everyone else. Thank you so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.     Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Gabbi Whisler on anxiety. Dr. Gabbi Whisler is no stranger to anxiety and depression. After years of struggling to find her path, she landed on physical therapy and has been combining the two worlds together, the use of physical therapy to help treat and coach patients with anxiety. No system ever works alone and when the physical, the mental, emotional and spiritual can be all addressed, then that is when true healing can be found.  In this episode, we discuss: -When anxiety manifests in the career cycle of a physical therapist -3 practical steps towards mastery over your anxiety -Why communication is important to break down the stigma surrounding mental health -The future role for physical therapists in mental health treatment -And so much more!   Resources: Gabbi Whisler Instagram Gabbi Whisler Facebook Mind Health DPT Website     A big thank you to Net Health for sponsoring this episode!  Learn more about the Redoc Patient Portal here.                                                                        For more information on Gabbi: Dr. Gabbi Whisler is no stranger to anxiety and depression. After years of struggling to find her path, she landed on physical therapy and has been combining the two worlds together, the use of physical therapy to help treat and coach patients with anxiety. No system ever works alone and when the physical, the mental, emotional and spiritual can be all addressed, then that is when true healing can be found.   “I've shared intimately my experiences with anxiety, panic attacks, alphabetizing, fixations, and suffering. Meds failed me. Doctors failed me. Anxiety controlled my life. I was drained, exhausted and defeated. I knew something had to change and I had to do it myself. I created freedom. You can too.”   For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt   Read the full transcript below: Jenna Kantor(00:03): Hello. Hello. Hello. This is Jenna Kantor with the podcast, healthy, wealthy, and smart. I'm here with Gabbi Whisler, like give a little whistle and I'm so excited to be jumping on and talking about anxiety and if you can tell from my energy, Oh gosh, I never deal with that. What physical therapist deals with anxiety. So first of all, Gabbi, thank you so much for popping on. What got you interested in really focusing on anxiety for physical therapists? Why this passion? Why not just treating patients and focusing on the patients and their anxiety?   Gabbi Whisler: Yeah, so it's kind of an ironic story because I was out in California working as a travel PT. I was maybe four or five months out from graduation from PT school and I was miserable. I was like, I cannot do this the rest of my life kill me. Gabbi Whisler(00:59): I just can't. It was awful. And Andrew Tran, owner of physio memes is my now roommate, but he was actually across the country, I think in North Carolina maybe. And he was one of my colleagues that do travel PT to somewhere and I called him and I was like, Andrew, I can't do this. It's miserable. And I don't know what else to do. I just racked up $180,000 in debt. Like I'm supposed to love this. It's supposed to be great. I'm helping people but I hate it. What do I do? And he was like, well, what do you want to do? What are you good at? What would you love? And I was like, I honestly have no idea. So I had to go to the drawing board and really do some digging. And I was like, what would I love? And the very first thing that popped in my head is I dealt with anxiety all my life. Gabbi Whisler (01:38): I'm in a much better place. I can't think of anything better than helping other people to get to that destination as well. And I was like, I can do that as a PT though, right? And I called Andrew and I was like, am I even allowed to do this? Like is this a thing? And he was like, well it is if you make it. And something just clicked. And I was like, well that's kind of cool and ever since I still don't always know what I'm doing but I'm making the path to be able to do it. So it's a lot of fun. But I still, like I said, I don't know what I'm doing most days and I still deal with anxiety myself as well. So it's kind of this ironic but fun twist because that allows me to connect with my clients now on a deeper level than as a PT. Gabbi Whisler (02:19): I've never dealt with a shoulder replacement or a knee replacement or anything like that to really connect with my patients in the outpatient ortho setting or I've never really had like a major fall to connect with my geriatric patient, but to connect with a 28 year old woman sitting in front of me who's had major anxiety, doesn't want to take meds and it's like, what are my other options? And to show her how to use exercise and kind of monitor what she's eating and drinking and just a mindfulness approach to feel better is incredible. And we can do that. As PTs, we learned about breathing, we learned about reflexes, we learn about exercise and movement and it's a lot of fun.   Jenna Kantor: So I love that. And, why do you think there's the whole thing with anxiety and PT? I think this goes hand in hand with burnout. Gabbi Whisler (03:07): Yeah, it does. So from a clinician perspective or from a patient perspective, because it's on both ends actually, which is really focusing on clinician focusing on the physical therapy. Yeah, a lot of it is burnout. A lot of it is expectations that I don't think we're prepared for in PT school. Well I think going into PT school, we have this grand idea that, you know, we're a doctor of physical therapy, we have all this autonomy and we have the ability to almost do what we want. And it's really quite the opposite out there for most of them. Until we realized that we are able to kind of break out of that mold. But in the traditional setting, we're very limited in what we can do and we're dictated and governed by doctors and other clinicians and our patients and insurance, and we think we're going to have all this freedom to make this what we want. Gabbi Whisler (03:58): Certainly cannot always do that. And I think that leads to a lot of anxiety that that gap in expectations, expectations from other people and expectations within ourselves in there are aligned. And that's what causes burnout as well. So it goes hand in hand.   Jenna Kantor: Yeah, I totally get that for forgive the sounds, the grumbling sounds, I just want to give a complete, you know, story here that's construction in the building, not me being gassy. Okay. I just want that to be clear as we are all just massive ladies here for anxiety, for anxiety. You were saying, it's interesting where you're saying, I don't know anything about this, but then you clearly have a drive to know more in order to help other people. What is it within you that's getting you to help out other people when you are dealing with it yourself? Gabbi Whisler (05:00): Yeah. Yeah. So I know what it's like to be at like that rock bottom and not have any outlet. Cause when I was going through all of this, you know, dealing with anxiety, depression, OCD, I knew in my heart I did not want to take medications. I knew in my heart talk therapy wasn't for me. I had given it a try and I was like, this is just, it's awkward for me. And I never felt like I left there feeling better. So I was like, I'm not going to continue wasting my money. And it was one of those things, I sat down with my primary care doctor and I was like, okay, what's next? And he had no direction for me. And I just remember what that felt like. And now as a PT, I know. So I said, I know, I said I don't know what I'm doing. And that's true. I don't necessarily know the direction my career is going. Yeah. PT, I know what I'm doing. Gabbi Whisler (05:38): I know how to prescribe all of these exercises. But at the same time I don't, and I think that's how we all feel in our careers. So really it's not anything I'm normal but knowing that I have tools that other people are searching for, knowing that someone out there needs what I have to offer but I'm just too afraid to put it out there sometimes is what gives me that little motivation or that little push to go ahead and do it anyway. You probably deal with that too cause your niche is so specific and so focused and so high performance. I'm sure you encounter that as well too.   Jenna Kantor: Yeah, I get that. I get that. I hadn't really dealt with anxiety until after the conference. Smart success physical therapy like just this past year. And it was when I came back home and I have a best practice where I work with dancers and all of them were better, which of course it's great, but as business goes freaking out, Oh my God, I was just like, this is the worst thing in the world and we're, for some people that would be something to brag about. For me that was something to significantly freak out about. Jenna Kantor(06:55): Awful, awful, awful, awful. I do not recommend anxiety and stress at all. Not even a little, Oh my God, this sucks so bad. So that's my experience with anxiety and it's gone. I've gotten better with it over time and I think that has to do with really acknowledging taking action for myself. So for you, with people, what are your like big overall tips that you just, when somebody reaches out to you and they're like, Oh my God, I'm about to like, collapse my anxiety so bad right now. What are things that you give them to kind of help them out at that point? Yes. So like top five things or three or 20 I don't know what your number, I'm just saying numbers. Gabbi Whisler (07:54): Very first thing I tell them is give yourself grace and permission. Cause so often we can find ourselves to the notion that anxiety is this horrible thing and cause anxiety and depression are just emotions truly like their emotions and we so often label them as good or bad emotions in general and we always strive to feel happy and we strive to run away from anxiety and depression. The very first thing I told girls or guys or whoever I'm working with is let it be your anxious, like accept it and just sit with it for a minute and allow your body to feel that because your body needs it. It's very uncomfortable. It's very uncomfortable. It's like not butterflies, but it's like, Oh it's very uncomfortable. It's hard. Her own skin. That's the best word that I can think of. Like you literally want to run out of your own body. Gabbi Whisler (08:43): Yeah, yeah. Lots of you can have a moment. So that's what I was like, give yourself the grace to be human. The fact that you're experiencing this and then use it as an indicator. So like, so often we're controlled by our emotions and they tell us how to live our life. You know, when we were anxious we want to sit in bed but instead use as an indicator. What's this trying to tell you? Like what's going on in life? You feel this way? And beyond that, what can you do about it? So like you said, action, what action can you take to move on from this? Cause so often we let it paralyze us, but that's really when we need to take some sort of action, whether it's to talk to someone or maybe getting a medication or going to talk therapy or going for a run or lifting weights or like what needs to happen to make you feel better. Gabbi Whisler (09:31): And it's different for every person. So those are my top three starting points. I guess. Three is my number, but really it's giving yourself that grace, using as an indicator and then taking action.   Jenna Kantor: Yeah. Yeah, that definitely makes sense. When you're saying give grace, what are ways that you can, because it's not just like, okay, I'm giving myself grace. What are things where you could actively be, you know, literally taking actions, you know, like cleaning the dishwasher, you know, what are things that you could do to help you start learning what it is to give yourself grace? Do you know what I mean?   Gabbi Whisler: Yeah. So I'll just share examples of what I do in my own day cause I think that might be easier. But when I get anxious, I literally will sit with myself and say, Hey Gabbi, it's really okay that you feel this way. Gabbi Whisler (10:18): And I just kind of let my body off sit with it for a minute, you know, I recognize, okay, my chest is tight, my fingers are tingling, my eyes, my vision sometimes changes just a little bit. And I'm like, this is normal. It's nothing to panic over. This is my body's response. Okay. It's okay in the moment. Like it doesn't take it away, but it's like, okay, I know I'm not dying in the moment because often we do, right? Like, we're like, Oh my gosh. Gabbi Whisler (10:55): So I'll sit with it and then from there, a lot of times what I'll do is I like to have one person in mind for, you know, if I'm feeling angry, it might be my sister that I call if I'm feeling hurt, it's my mom that I call who's really good at helping me through whatever I'm feeling in the moment. And I always have that on the back burner and that's the first thing that I'll do is get it out because the more we hold it in ourselves, the worst off we get. And sometimes it's not even talking to the most sometimes like I'll literally sit in my room in front of a mirror and talk to myself. Jenna Kantor(11:46): It’s cool you can out like get it out. Like you did get it out in the universe. You know, before we started recording today, you were sharing something with me about wanting to just get out in the, because once you do that, you're more likely to follow through and take action and feel better about it. It's true. It's true. Like I'm doing this, I'm doing this. It's true. But I never thought about it in a way where you would use it as a tool with when you're like feeling it because it's like a zit that's dying to pop. Jenna Kantor(12:26): Yeah. So for you, where do you find in the physical therapists life with people reaching out you a common time when people, are you actually, okay, I'm going to actually separate this out. Common point in someone's career, whether it be student, new, grad or professional, where are you finding a real, like this is where it's happening a lot specifically in the physical therapy career.   Gabbi Whisler: The answer's kind of funny, but all of the above. So for students I'll kind of go through each one cause I think we all do, it's just a matter of like, so each stage will have points throughout it that are very specific when that anxiety is like greatest. But for students it's typically right before the NPTE or right before an exam, like a lab practical that students are reaching out to like, Oh my gosh, I'm so anxious. Gabbi Whisler (13:18): I don't know how to handle this. I've never really experienced anxiety until now. Usually that's when they're noticing it is in grad school. And they're like, what can I do? And then, you know, I'll try to talk with them through that. As far as anxieties go, a lot of new grads experience it. Cause again, it's expectations. They're in school for so long and they have people guiding them and now all of a sudden they're kind of fed to the wolves and they're expected to do things that they weren't, they weren't yet in their minds, comfortable with. And also seasoned clinicians, a lot of times they're like, it's either burnout, it's not finding satisfaction in their career. It's wanting something more like, not feeling, they're not necessarily burned out, but they're also, they feel like they're doing the same thing day in and day out and they're not contributing to the world in a greater way, I guess. Gabbi Whisler (14:08): Or they're not seeing, yeah, just frustrating for them, but also sad from an outside perspective. Cause they're still making a huge impact, but they're just, it's routine for them now, so they're not seeing, so it's not as fulfilling. They feel like they're very separate from what they're doing.   Jenna Kantor: Yup. Exactly. Exactly. Wow. That's powerful. Right. Because they're still, they're changing people's lives. Like every 20 minutes are changing someone's lives, but they're just doing it so often they don't see it. Where does shame come into all this?   Gabbi Whisler: Ooh, that's a good question. I think it's very specific person to, but probably again, that mismatch in expectations so they don't feel like they're providing the care that they should be for their patients and then in front of their patient, you know, they have to continue and be professional and carry on throughout their day, but inside their brain, they're like, am I really the best person to be helping this person? You know, we tend to tell our story ourselves, stories like that. So that's true. That's insanely true. Jenna Kantor(15:44): Yeah. Wow. Yeah. If there was going to be, I would say one big vision you have for physical therapists regarding anxiety, what would be your big like one day Do you know what I mean?   Gabbi Whisler: So this is kind of a far stretch, but I'll bring it back full circle model clinician because right now as PTs we can't treat anxiety or we can't treat mental health. It's just not like fully within our scope of practice. So myself and another PT are actively working to try to get PT into, there's a world Federation for mental health and there's other countries that are participating in and it's specific to physical therapy. So we're hoping to get PTs in that role because I think right as PTs were very uncomfortable with the idea of mental health because it doesn't get talked about in PT school. We don't really talk about it with our patients. It's one of those things we try to skate around as much as possible and there's some clinicians out there who are great at it and I think we're as a whole, we're getting better. Gabbi Whisler (16:36): But the more we can certainly the more we can start talking about it to our patients, the more we feel comfortable within ourselves talking about it to other people and opening up as well. Cause if we can't get other people to open up, how are we ever going to open up ourselves? So it goes both ways. If we can't open up, then we can't get other people to open up. So I think once we're able to, as PTs kind of get into this role just a little bit more, and it's not that every PT has to treat mental health specifically, but we find ways of bringing it into, because we know if someone's struggling with their mental health, their physical health suffers. And so if we're not addressing that, it's so true. And if we're not addressing that first with our patients, then we're probably not getting them the results that we need. Gabbi Whisler (17:22): But if we can't do that, if we don't know how, and that goes back to our own lives as well. So it all kind of comes full circle. So my big goal is to get PTs to be able to go to conferences at CSM, for example, and have a course, have a talk on the side of mental health. Cause right now there's very little out there for us. So truly but surely like nothing. And it's because we're so uncomfortable with it. So that's my dream is to be able to get us in that scope of practice and also show clinicians how to handle in our patients. And I'm hoping through that they see how they can handle it within themselves as well. And kind of tackle it from that approach.   Jenna Kantor: Yeah, yeah, that makes sense to me. Oh my gosh, this is perfect. Thank you so much for coming on. I would love to ask for you to just have your mic drop moment and this could be for anyone who may be dealing with anxiety right now and I would love for you to just acknowledge that person and just give him some big picture advice if they're really feeling stuck. Gabbi Whisler (18:46): Yeah. So, Oh my gosh, I have so much in my head right now. Start with the word you. So if you are feeling super anxious and having a hard time handling this, especially throughout the workday, my biggest piece of advice for, I guess this is the direction I would go, so specific to clinicians who are feeling anxious throughout the day. And I actually have a couple girls who I work with right now, her PTs and their new grads and they're feeling this way too. They feel like they have to compartmentalize this and they can't talk about it at work. Talk to someone like whether it's your boss or a coworker, someone there needs to know that you're dealing with this because if you continue to try to do this on your own, it's only going to snowball and then your boss is going to come to you one day and be like, what in the hell is going on right now? Gabbi Whisler (19:35): You know what, what? Cause your performances is often the way you speak to patients. So the earlier you can nip it in the bud and let them know, Hey, I'm dealing with this right now. I don't want to go into details. Or you can say whatever the heck you want to, but they need to know about it. And the more comfortable you get talking to your boss, the more comfortable your boss gets talking to their employees about it as well. So you might be opening up the door for another clinician right next to you because more than likely everyone in your building is dealing with some form of anxiety. Jenna Kantor(20:16): That's true. It's not talking about it. That's very true. That's very, very true for clinicians. I love that. Oh my gosh. Thank you so much for coming on. How can people find you, find you and contact you. Thank you.   Gabbi Whisler: First, thank you for having me on. But yeah, @mindhealthDPT, that's my Instagram and Facebook handles, so they're free.   Jenna Kantor: Got it. Wonderful. Thank you so much for coming on. This was an absolute joy. I think that this is going to be extremely helpful for people who are dealing with anxiety. So you guys don't be afraid to reach out to her. She's here to help you. In fact, you're one of many.     Thanks for listening and subscribing to the podcast! 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On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Christa Gurka on the show to discuss marketing. An orthopedic physical therapist specializing in Pilates-based fitness, rehabilitation, injury prevention and weight loss, Christa Gurka’s reputation speaks for itself. With two decades of experience training those of all ages and fitness levels, the founder/owner of Miami’s Pilates in the Grove, which serves the Coconut Grove and South Miami communities, believes in offering her clients personal attention with expert and well-rounded instruction.   In this episode, we discuss: -Why you should design an ideal client avatar -How a small marketing budget can make a big impact -Crafting the perfect message to attract your ideal client -The importance of continual trial and error of your message -And so much more!   Resources: Christa Gurka Instagram Christa Gurka Facebook Pilates in the Grove Christa Gurka Website FREE resources     A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.   For more information on Christa: An orthopedic physical therapist specializing in Pilates-based fitness, rehabilitation, injury prevention and weight loss, Christa Gurka’s reputation speaks for itself. With two decades of experience training those of all ages and fitness levels, the founder/owner of Miami’s Pilates in the Grove, which serves the Coconut Grove and South Miami communities, believes in offering her clients personal attention with expert and well-rounded instruction.   Read the full transcript below: Karen Litzy (00:01): Hi Christa, welcome to the podcast. I'm happy to have you on. So today we're going to be talking about three strategies for marketing for cash based practices. And the good thing about all of these strategies is they don't cost a lot of money, right? And that's important when you're starting a business. You know, we don't want to have to take out a bunch of loans, we don't want to have to spend a lot of our own money. We want to try and start up as lean as we can. And so I'm going to throw it over to you to kick it off with. What is your first strategy for marketing for cash based practices? Christa Gurka (00:43): Perfect. So one of the reasons I just want to start with saying why I'm a little passionate about this marketing thing is because myself included when I first started, I really kind of, I felt like I started backwards almost like from the ends. And I think it's really so helpful for people to learn to start kind of from the beginning. Right? So my very first strategy that I think is really, really important is to have a real good idea of who your ideal customer or who your target audience is. And I get often some pushback from people saying, well, everybody can use my services. Of course everyone can use physical therapy. Absolutely. And that doesn't mean you have to single anybody out. But you know, I think Marie Forleo said it or maybe somebody said it to her, but when you speak to everyone, you really, you speak to no one and so slew thing, your who, your ideal customer is, how they feel, how they think. Christa Gurka (01:45): It's very, very beneficial. So if you want, I can kind of go through like a few questions that I use to kind of narrow down who that person is. So one of the things to know when we go through our ideal customer, we actually give this person a name, an age, a gender demographic, married, not married, retired, not retired, education level, median income. And when we do anything in our business now, so we are ideal customer, her name is Georgia. And so we say every time we have a meeting we say, well what will Georgia think about this? Well Georgia like this, so we're Georgia not like this. So that's the very first thing. And we refer to that person as their name. And then you want to go through like what are their biggest fears about whatever problem they're looking to solve. Christa Gurka (02:40): People buy based on emotion. And so get into the underlying source of that emotion is really, it can be very powerful. So what are their fears? What do they value? Right? Cause when it comes to money, people paying for those, it's not always a dollar amount. It's more in line with what do they value? And if you can show these clients that you serve, offered them a value, the money, the dollar amount kind of becomes obsolete. So things like that. What could happen, what would be the best case scenario if this problem were solved for them? What would be the worst case scenario of this problem were never solved. So in terms of physical therapy, let's say generalize orthopedics, right? Back pain. 80 million Americans suffer from back pain. Yeah. So an easy one to start with, an easy one to start with, right? Christa Gurka (03:35): So let's think of, you know, back pain, it's so general, right? But if you can say, what is the worst thing that can happen because of this back pain, right? So maybe the worst thing that could happen is this person loses days at work because they have such bad back pain, they can't sit at their desk or maybe they have such bad back pain that there performance drops and so that cause they can't concentrate. And so now maybe they lose their job or they get emoted because their back pain. So the worst case scenario is maybe they're not, they ended up losing their job because of back pain. So you kind of take it all the way back. And then if you could speak to them about how would it feel if we were able to give you the opportunity to sit eight hours at a desk and not think of your back pain one time and what would that mean to you? So really kind of under covering a lot, a lot, a lot about who your ideal customer is. It's my number one strategy. Karen Litzy (04:39): And I also find that it's a great exercise in empathy. So for those that maybe don't have that real innate sense of empathy, it's a way for you to step into their shoes. And I always think of it as a what are their possible catastrophizations? So if we put it in the terms that the PT will understand, like when I did this number of years ago, I sort of catastrophized as this person. What would happen if this pain didn't go away? I wouldn't be able to take care of my children. I wouldn't be able to go to work. It would affect my marriage. My marriage would break up, I would be a single mom. I would, you know, so you can really project out really, really far and then reel it back in, like you said, and say, well, what would happen if they did work with you? What is the best case scenario on that? So yeah, I just sort of catastrophized out like super, super far and it's really helpful because when that person who is your ideal client then comes to you and you're doing their initial evaluation, you can ask them these questions. Christa Gurka (05:51): Yeah. Yeah. It's very powerful. And I love how you brought in, like you empathize with them and you know, and by the way, a lot of our clients do catastrophize, right? And we have to reel them, we have to reel them back in. So that was a really great point. I also think it can be sometimes on the flip side where somebody maybe comes in and their goal is very benign. Maybe it's, I really want to be physically fit. I want to look good. Right? So you kind of think, well, what's the catastrophe if that doesn't happen? But maybe, maybe they're in a relationship where they're a partner. Aesthetics is a big part of that. And maybe they feel insecure and they feel if they don't present well to their partner, their partnership may dissolve whatever the case may be. So now you're getting to an underlying, it really is more emotional than physical, right? So now you're being able to empathize with them in that way and speak to them in those terms, give them positive things that maybe they don't even realize they need. Karen Litzy (06:53): Exactly. And then it also seems like once you're in those shoes or walking in their shoes, in their footsteps, however you want to put it, that’s when that person does come to you, you can have a conversation with them that's maybe not so much centered around back pain, but that’s centered around their life. And that's when people make that connection with you. Right? So when we're talking to patients who are not sure that they want to start physical therapy, if we kind of get them, they're much more likely to come and see us. So it's not about the back pain, it's not about the knee pain. It's about how are we going to make a difference in their life. And if we can make that, like harking back to what you said earlier, it's an emotional experience and people tend to buy things based on emotions and their gut feelings and how they feel. So if we can tap into that in a really authentic way, then talk about a great marketing strategy. Christa Gurka (07:58): Excellent. Exactly. Karen Litzy (08:00): And then, okay, so we've got our ideal customer, client avatar. Now what do we do? Christa Gurka (08:10): Great. Now what? So you've got your ideal customer, right? And so by the way, people also sometimes think like, well, I don't want to pigeonhole myself into this, right? But by the way, your ideal customer may change. It's okay first of all to change. And he doesn't have more than one. You can have more than one. Certainly we have more than one in our business. And by the way, you may start out thinking about one ideal customer, but the people that keep coming back, maybe somebody else and you're like, Oh, obviously, maybe I have to rethink this. Right? And again, it doesn't mean that you can't serve someone else. It just means that when you're thinking about marketing and stuff, you're going to go after everything should funnel into one specific thing. So then the next step in the marketing is, okay, so where do these people live? Christa Gurka (08:59): And I don't mean live like literally what neighborhood do they live in? Where do they live in terms of getting their news information? Where do they live in terms of being on social media? Where do they live in terms of, you know, what do they value as far as like personal or professional life? So one thing I see is, you know, people you know are like, well, I'm gonna put an ad in the newspaper, that's great. But if you live in an area where nobody reads the newspaper, then you're putting your money somewhere that you're not going to be seen. Or maybe the flip side is, well, I'm going to do a lot of stuff on Instagram. Well, if you were, your clientele is over 65 studies show that most people over 65 are not on Instagram. That doesn't mean they're nobody is, it just means, you know, or vice versa. Christa Gurka (09:50): If your client is 25, they're probably not on Facebook anymore, right? So, then again you can be, this is why it won't cost you a lot because you can narrow down where you are going to spend your money, right? Also, if you're running Facebook ads, which will then go on Instagram you can narrow down in your audience when you build out your audience to be very, very, very specific based on are you a brick and mortar establishment? So are you trying to get people to come in to your place? Right? So you want to say, well, if people are not, if you know that your ideal customer's not convenience as important and they're not going to travel more than five miles, you shouldn't market to people that live or work outside of a five mile radius from your studio. Right? So that's important to know as well as also maybe your customer gets their information from friends or relatives, you know, or like someone said, you know, you need to go see Karen, she's been really great for me and that's how they get to you. Christa Gurka (11:00): So how can you then get in front of your client's friends, right? Maybe you could do an open house, invite a friend, bring them in. Let's do one-on-one, you know, just kind of like a talk, right? Maybe you could bring them in if, say your ideal customer, let's say your ideal customer is in their sixties, what are some things that people in that age group are going through? Maybe you can have a talk about that specific thing. Not necessarily a therapy, but now you get everyone to kind of come to you. It's not even about what you actually do cause you can need them based on where they are. And most people, by the way, they say there's the numbers range, but usually they have to see you about seven times or have seven points of contact with you before they're comfortable buying from you. So these are just way to get people to know, like, and trust you and then they'll buy from you. So that's strategy number two. Once you know really who your customer is and they could take a couple years to really start to peel back all the onion of that, then the next thing is be where they are, be in front of where they are. Karen Litzy (12:13): Yes, absolutely. And, I love that you mentioned the different types of social media and who's on where, because like you said, this is something that isn't going to break the bank because you have narrowed down exactly where you want to spend your money. Right? So we're taking who that ideal person is, where finding out where they like to hang out, what they read, who they're with, all that kind of stuff. So that when you build out a marketing campaign for your business, you kind of know who and where to target. Christa Gurka (12:49): Right? Exactly. Yes. And even so, even with Facebook, yeah. When you build out your audience, right? So you can have a variety of audiences. You can create lookalike audience, which I'm sure is like a whole podcast onto itself, but you can also target people that like certain brands. So when I do my ideal customer, I'm like, well what brand do they resonate with? In other words. So I would say that our brand is a little more towards Athletica versus like Lulu lemon. And that's not to say one is better than the other. It just means that's who my generally customer is. And why, what do they value? They value that customer service. You get, you know, Athletica has like a, you can take anything back all the time, right? So when you build out a Facebook ad, you can also target, that's right. They've bought from Athletica online. Right. So now you're reaching people. So you kind of near just keep narrowing it, narrowing it, narrowing it down, which can be, you know, other interests is your client. Do you do pelvic health? So obviously women, although men do it right, if moms can you target people that like mom influencers on Facebook or on the internet. So these are all just ways that the more you know about them, then you can use that in your marketing strategies afterwards. Karen Litzy (14:15): Absolutely. Fabulous. Okay. So know who the person is, know where they're hanging out. What's number three? Christa Gurka (14:23): Okay. So number three to me is the most important, the most, most important. And that really is messaging. So when you're working with your ideal, when you're working through that ideal customer you know, workbook getting to them, to you for them to use their own language for you. So I see this very, very commonly, and I am sure you can attest to it too. When physical therapists, we love what we do. We are passionate about movement and anatomy and biomechanics but you know what, the general population has no idea what we're talking about. None. Zero. Yeah. And so oftentimes I feel like, and by the way, I'm not saying I did this for a long time too. I think that we're trying sometimes to get other practitioners to say, Oh, that's a really good therapist. So we're talking about pain science and biotech integrity and fascial planes and the general population. Christa Gurka (15:32): The end consumers, like I have no idea what you're talking about. So you need to speak to them at their level based on what their problem is. And kind of like how we spoke about before. It's not always the back pain, it's what the back pain is keeping them from doing. Right. it's not always, let's take pelvic health for example. Right? A lot of pelvic health issues or not necessarily painful. Okay. So say you have moms, this is super, super common stress incontinence. They leak, they leak when they jump and they go to CrossFit and they're embarrassed to start with a jump rope because they, it's not, why? Why do women go 16 years after childbirth? Because you know what? It's not really painful. So they don't consider it a problem. Like physical therapy is not going to help me with it. So, but if you say to them, Hey, that might be common, but that's not normal, and guess what? Christa Gurka (16:25): There's a solution to that, you know? That is something that will resonate with them. Do you like things like, do you feel, do you worry when you're out at a restaurant as it gets later and later that the line at the bathroom is going to be too long and you stop drinking because you're afraid to wait in line for the bathroom? Right. So some women will be like, Oh yeah, I totally do that. Right? Are you afraid to chaperone your child's field trip? Because the bus ride is going to be three hours and you don't think you can hold it three hours on the bus without a bathroom. That's terrible for a mom. She can't chaperone her kids field trip because she's embarrassed that she might have to go to the bathroom. So using their language. So I like to send out surveys very frequently. Christa Gurka (17:09): Google doc is super easy. Survey monkey and ask them things like, what are your fears about whatever it is you're trying to sell. Right. what are your fears about exercise? What are your fears about back pain? How does it really make you feel? Okay. what are your, like maybe even if you could pay and if money was not an issue and you could pay anything, what would that look like for you? How would that make you feel and starting to, then you start to use that language. We've all seen marketing campaigns where you're like, yes, exactly. Totally. That's how you need to get into them. Right? And so maybe maybe as a physical therapist, it's tough for us because we're like, well, no, their hamstrings are not tight. It's not hamstring tightness. It's neural tension and it's the brain and the nervous system, but they don't, they don't understand. Christa Gurka (18:06): So you got to get them in. What they feel is that they have hamstring tightness. So you got to tell them that you can fix their hamstring tightness. And then little by little you explained to them that it's neural tension, right? But if you start off with neural tension, they're going to go somewhere else. And so I kind of like, I use this example a lot if you, cause I think we can all relate to this. We're on tech right now, right? Okay. So if you have, I have a Mac, I have an Apple. If I go to the Apple store, cause my computer crashes or my phone won't turn on and I go talk to what are they, what are the genius bar, the genius bar. And the guy's like, you know, so what I see here is the motherboard has this month and this software program, you only have so many gigabytes. Christa Gurka (18:50): I'm like, can you fix my computer? That's all I want to know. And if he says yes, I'm like, I don't care how you do it. So whether you use taping or I use myofascial release or somebody uses Pilates or somebody uses craniosacral therapy, it doesn't matter to them. So the end consumer, they just want to know that you can solve their problem. People have problems and they want to know that you have the answer to solve their problem. And that's it. So messaging is really, I think, crucial. It's the crucial point of the puzzle. Karen Litzy (19:28): And now let's talk about messaging. Let's dive into this a little bit further. So I think we've all seen different websites of healthcare practitioners, physical therapists and otherwise that kind of make us go like, Karen Litzy (19:43): Oh boy cause it's in cringeworthy in that it comes off as a little too salesy, a little too slick, a little too icky. So how can we compose our messaging to avoid that? Unless maybe that's what their ideal patient wants. I don't know. But yeah, how can we craft our messages that are going to hit those pain points, get that emotion going without being like a salesy, weird gross Christa Gurka (20:18): So the other thing I think that's important to understand is people's buying patterns. And when people say no to you, maybe they're not saying no to you, they're just saying this. It's not a value to me at this time. So one of the phrases, one of the things that I've really restructured, cause I used it, take it very personally, if someone will be like, no, I know and I'd be like, what you mean I could totally help you? And now I'm like, you know what? It's basically I look at it like if I'm at a party or I'm having a dinner party and I serve or Durham and I'm like picking a blanket and be like, no thanks. I'm like, okay, walk away. So I say therapy with Krista. No thank you. No problem. Let me know if I can help you in the future. Christa Gurka (21:04): Right? So the way that I say it is if you just speak honestly to your customer, honestly, to your customers. Nobody can be you at being you. So be your authentic self, whatever that brand is for you. And whether it's your company or you yourself, and let that come through in your messaging. Right? So in other words, like if your messaging is also about mindfulness and positivity and looking past the pain and what is your relationship with your pain or dysfunction that should maybe come through in your messaging that you're more holistic, that you're not going to be a treat them and street them type thing. But maybe if your messaging is, Hey, we're going to treat you and street you and you'll be out of here in 15 minutes, you're going to attract that type of customer. So either one is fine, but I just say really be authentic. Christa Gurka (21:59): And the other thing is, I would say send your website. I don't put a lot, a huge amount of stock in my website to be perfectly honest. I do love my website. I'm a very like, analytical person. So the colors and where everything sits is important. But I don't think as, I'm not a big believer that as much selling goes on your website as a lot of people may think, I think it's a place where yes, people are going to Google, someone gives you a reference at a cocktail party, they're going to Google your website, but they're basically going to look like, does this resonate with me? So what you want to hear is, you know, that tagline at the very beginning, you know, is does that tagline, the first thing that they see, does that resonate with that person? Right. So we use, because we're Pilates and physical therapy, we will, right now our website's a mess because it's got coven. Christa Gurka (22:47): We're close, we're not close. But helping people heal with love, every twist, every turn and every teaser. Teaser is a plot. He's exercise. So we stuck that with love in there because that is part of who we are. We are a community. We care about our clients. So you're not just going to come in here for like two things. We want to help you where you are. So that's, so if someone's like, yeah, that's cheesy for me, then it's okay, they can go down the street. Right. and we don't, I used, by the way, this has come with like 10 years of testing. You just got to test it. You got to test it and you got to see like who does it resonate with? Send it to a bunch of people and ask people for their honest feedback. Give me, you're not going to hurt my feelings. I need to know like, what do you see when you see this? What, how does it make you feel? So ask people their opinions and not physical. Karen Litzy (23:45): Yes. Yes. And you know, I just redid a lot of the messaging on my website and I sent my website from what it was and I'm in a group of female entrepreneurs, none of whom are physical therapists. I sent it to them, they gave me some feedback, I changed a little things. I sent it again, they gave more feedback, I changed some more things and now I feel now they're like, Oh see this sounds more like you. So before what I had in my website is what I thought was me. But then once I really got like had other people take a look at it, they're like, Oh, no this sounds more like you. And yeah, I love that tagline on the front. Like the tagline on the top of my website is world-class physical therapy delivered straight to your door, Christa Gurka (24:28): Which is short and concise and what you do. And it's what I do. Very easy. Perfect people. Oftentimes I see these like tat and they're like, you know, they had their elevator pitch. I'm like, what's your elevator pitch? You know, people talk about, Oh, what's the elevator pitch? I'm like, if you cannot describe what you do and like two sentences or 10 words or less, how do you think other people are gonna if you can't understand it for yourself, how are other people gonna right, right. Like you said, that takes time though. It does. It does take time. I struggled with this for a while, but me always, yes, but I think as physical therapist, one of the reasons we struggle is for a number of reasons. One. If we're business owners, we tend to be overachievers, right? We tend to have weak temp. We're bred from a certain mold. Christa Gurka (25:18): Right? the other thing I think is physical therapist, we're very analytical. We're very left brains, right? We are, I mean I think it's what makes me a really great physical therapist. But then the flip side of that is we're perfectionist. Everything has to be analyzed. And so we get so caught up in like the details of analysis and we went to PT school. So we have to show how smart we are. But being smart also means understanding what your customer's going to understand. And so you kind of have to swivel out of that. So sometimes even in groups when I'm like, when we see people like, Hey, what do you guys think of my website? I'm like, don't ask us, we are not your customer. Go ask your customers like what they think of your website. And so when I was in a group, you know, my coach challenged me to narrow things down as well. And they used to say things like, if you were running through a desert and you like and you were selling water, what would your tagline be like what would you, what would your board say? And you know, people will be like ice cold, dah dah dah. And he was like, just say water. If someone's running through a desert, all they need is water, water will suffice. Water will suffice. Clean water less is more free water. Even less. Yeah. Karen Litzy (26:42): And I remember, this is even years ago, I was doing like a one sheet, like a speaker one sheet. This is a lot off topic but talking about how we need to tailor our message to our ideal audience. So I had, you know Karen, let's see PT and I remember the person was like, does that mean like part time personal trainer? And I was like no physical therapist. Like you need to write that out then because the average person like PT. Okay. Does that mean part time personal? Like what does that even mean? So it just goes down to or sorry, it goes back to kind of what you said of like we have to speak the language of the people who we want to come to see us. Right? And the best way to do that is on our websites is we just have to simplify things and it doesn't mean dumb it down. It just means like simplify. And I'm going to give a plug to a book. It's called simple by Alan Siegel and it's all about how to simplify your language, your graphics, and how everything comes together to create a site that people, number one are attracted to and number two want to hang out at. Christa Gurka (27:53): Right? Exactly. And there's a lot of testing and I'm a big thing like testing. It's just testing, testing, testing. We test our sales page, we test even now with like some of my coaching stuff, working with other female business owners, testing, sometimes going in and testing, switching a graphic, have what you have above the fold. So the fold for those of you that don't know is like when you're on a website, it's you don't have to scroll. So everything is above where you have to scroll. I'll call to action a CTA right at the top. Changing phrases, you know, not using broad language like confidence, like what does confidence actually mean, but maybe making it more specific using language so that that's a really good thing. Helping or like, you know, reading yourself a back pain so that you can live the life you desire and deserve. Christa Gurka (28:57): Right? So changing little, and you can change that by the way, mid campaign, mid launch daily. You could change it if your Facebook ads are so one of the things, if you're, if people are clicking on your ad, but when they're not converting on your sales page, that usually means that either the messaging and your ad is really off and they're, once they get to your sales page, they're not understood. There was a disconnect between what you're offering or your messaging is great, but your sales page sucks. Or vice versa. Maybe nobody's clicking on your ad. Then whatever you're trying to sell them there does not resonate with them, right? So there has to be a connection. And usually when people don't buy, there's either a, with your offer or a problem with your messaging. Christa Gurka (29:49): So test means put it out there, see what kind of feedback you get, and then it's think of it as, okay, what we do in therapy, right? So this, what do we do when we get a patient in, we assess, we treat, and then we reassess, right? So what's going on? Let's try a treatment in here. Let's reassess. Is it better? If it's not better, what do we do? We go back, assess again, and then do another treatment and then assess, right? Reassess. So in marketing it's the same. So let's say you wanted to do, let's say you're working on like a sales page on your website, right? A sales page. I know it sounds salesy, but it's basically your offer, right? If people are getting there, so you see people you can track. By the way, with Google analytics, like people coming to your site, if a lot of people are coming to your site but they're not clicking on the call to action or they're not following through to check out some, there is some disconnect there. Christa Gurka (30:56): So maybe it's the messaging. So then maybe try to change the messaging, tweak the messaging, and then watch the outcome again, maybe people get all the way to the checkout and then abandoned cart. Maybe it means that something they got confused with something at the end. Maybe there's the customer journey wasn't right. They got to the end because they put something in the cart and then maybe your checkout structure is off or something like that. So test it and then just retest until your numbers are like, now we hit it. And by the way, it's taken me. I mean I'm still testing. Hmm. It seems like it's a constant reinvention. Constant, constant. Because the market keeps changing. Especially now. By the way, by the way, right now I don't know why there are. So at the time of this recording, we are in the middle of COVID. So when people come back, your messaging, okay. Is going to have to change, right? So we need to be aware of that. Karen Litzy (31:49): Yes, Absolutely. All right. So as we start to wrap things up here, let's just review those three strategies again. So who is your target market is number one, where are they hanging out? Where are they living? Not physically their address, but you know, where, what are they reading? Where are they hanging out, what are they doing online, what are they doing offline? And then lastly is making sure that your messaging clearly conveys part one and part two. And how you can solve their problem. Awesome. So now if you were to leave the audience with you know, a quick Pearl of wisdom from this conversation, let's say this might be someone who's never even thought about any of this stuff before. What did they do? Christa Gurka (32:40): So in terms of like, never even thought about marketing before or going into brand new, brand new out of PT school are, or brand new, like they want to kind of dive in and start doing their own thing, but they want to do it in a way that's efficient and that doesn't break the bank, right? So I would definitely say, Christa Gurka (33:17): Start with the end in mind. So that's from a great book, right? So so start with the end in mind meaning, but don't start at the end. I think a lot of people confuse that with, they start with the end in mind, but then they go right to the end and they go to marketing, right? So I like to equate everything back to physical therapy, right? So when we learn about developmental patterns, we all know, like we start with rolling and then Quadruped high kneeling, right? So if you take a patient that's injured and has a neuro, you know, and motor control problem and start them in standing off with multiple planes, you've missed a bunch of it, right? So you start marketing without understanding who your ideal customer is and finding out what they think and how they feel. Christa Gurka (34:01): You're going to spend a lot of money and you're not going to know why it's not working. You're just going to think Facebook ads doesn't work or I'm not good enough, which is a very common thing, right? So take the time to do the work. The ground work. Nobody loves to learn rolling patterns. But why is it important? Because if you work from the ground up, you take the time to instill these good patterns underneath. So take the time to do that. And the other thing I would say is just decide, you know, don't go through analysis paralysis. Decide and move. And the only way you're going to know is you got to put it out there. So you know, Facebook lives, Instagram lives. That's, you know, we didn't maybe start when social media was big, but which, so by the way, I have to make a point that I think that's why it's harder for us. Christa Gurka (34:52): So our generation did not, we didn't have, so I didn't even have a computer when I went to college. Nope. Like, so we didn't start with, I didn't have a cell phone like, so it's very different for us because this next generation coming up, they're comfortable on social media. We may not be, but the truth is, it's like everything else, just do it. The more you do it, the easier it becomes. So, and you know, if no one's what, well, I'm afraid no one's going to watch it. But who's watching it now, if you're not putting it out nobody. So you're no worse off. Right? So just do, create an action step. Like, you know there's a book and now I forget who the author is. It's called the one thing, right? And you just focus on thing. Focus on one thing that you can do today to improve on understanding your ideal customer. If you're already past that, what can you do today to understand more about your messaging? Karen Litzy (35:50): Easy. The one thing you could just, just choose one doesn't have to be a million things you don't have, it doesn't have to be perfect. No, and it doesn't have to be perfect. Just one thing. Just one thing. Awesome. And now last question is the one that I ask everyone, and that is knowing where you are now in your life and in your business and your practice, what advice would you give to yourself as a brand new physical therapist straight out of PT school? Christa Gurka (36:19): Woof. Mmm. I would probably say be open to the possibility. Yeah. Yeah. Just be open to possibility of what's possible. Yeah. Karen Litzy (36:35): Excellent advice. Now Christa, where can people find you if they have questions they want to know more about you and your practice and everything that you're doing? What the deal? Christa Gurka (36:44): So my business is Pilates in the groves, so they can always find Pilates in the Grove. All has everything about our business. But they can find more about me at christagurka.com.  I have some freebies up there. So that's like Christa Gurka is more really about kind of business strategy. Okay, great. Like launch you know, mindset, that kind of stuff. And then the Pilates and the Grove website really if you want to look at what we do, brick and mortar wise, do it. But like I said, the websites kind of a mess. Right? Karen Litzy (37:21): We understand it's exceptional times. And, I know that you have some free resources and some freebies for our listeners, so where can they find that? Christa Gurka (37:33): Yep. So there is a link which we can either link up in your show notes, right? Or we can, so there's a marketing quiz that I created that basically will put people at, it'll kind of just give you an idea of where you are. Are you like a novice or are you a pro? Have you got this stuff down? And I could probably be calling you for advice. And then based on where you are, it kind of tells you kind of what you should focus on as well as then we have that lead you into. I have a social media and a Facebook live checklist. It kinda just gives you kind of a little bit of, I find structure helps me. So learning how to batch content, learning to say that like, okay, every Monday I'm going to do a motivational Monday post. Every Tuesday I'm going to do a Tuesday tutorial post. I think it just helps me map things out. And so I think it helps business owners also feel less overwhelmed when they can have a calendar. And we have national days. It has like a bunch of national days that pertain to our industry already built out for you, which is easy. Karen Litzy (38:35): Awesome. That sounds great. And I'm sure the listeners will really appreciate that. So thank you so much. This was great. And again, the thing that I love about all these strategies is it takes very little money to accomplish them. Just some time, which right now I think a lot of people have a lot of time. So thank you so much for taking the time out of your day and coming on. Thank you. And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts

On this episode of the Healthy, Wealthy and Smart Podcast, Jenna Kantor guests hosts and interviews Javier Carlin on the art of listening.  Javier A. Carlin is the Clinic Director at Renewal Rehab in Largo, Florida. He is originally from Miami, he graduated with his Doctoral Degree in Physical Therapy at Florida International University and is a Certified Strength & Conditioning Specialist through the National Strength & Conditioning Association. In this episode, we discuss: -The difference between nosy curiosity and coaching curiosity -How to frame questions to dive deeper into conversations -Verbal and nonverbal signals to watch for during client interviews -How your clinic environment can help develop deeper client relationships -And so much more! Resources: Javier Carlin Facebook Javier Carlin Instagram  Life Coaching Academy for Healthcare Professionals Phone number: (305) 323-0427   A big thank you to Net Health for sponsoring this episode! Learn more about the Redoc Patient Portal here.   For more information on Javier: Javier A. Carlin is the Clinic Director at Renewal Rehab in Largo, Florida. He is originally from Miami, he graduated with his Doctoral Degree in Physical Therapy at Florida International University and is a Certified Strength & Conditioning Specialist through the National Strength & Conditioning Association. Javier has always had a passion for health and fitness and his mission in life is to help you get back to doing the things that you love to do, pain-free. His goal is to inspire people to live a healthier, happier, more fulfilling live through simple and effective wellness principles; proper nutrition coupled with a great exercise routine and good sleeping habits works wonders in how you feel inside and out! Javier enjoys spending time with his family, he loves being by the water either soaking up the sun on the beach or on a boat! He is an avid traveler, enjoys exploring new places and experiencing different cultures. He also has an adventurous side; bungee jumping, skydiving, rollercoasters, cliff diving! For more information on Jenna: Jenna Kantor (co-founder) is a bubbly and energetic girl who was born and raised in Petaluma, California. Growing up, she trained and performed ballet throughout the United States. After earning a BA in Dance and Drama at the University of California, Irvine, she worked professionally in musical theatre for 15+ years with tours, regional theatres, & overseas (www.jennakantor.com) until she found herself ready to move onto a new chapter in her life – a career in Physical Therapy. Jenna is currently in her 3rd year at Columbia University’s Physical Therapy Program. She is also a co-founder of the podcast, “Physiotherapy Performance Perspectives,” has an evidence-based monthly youtube series titled “Injury Prevention for Dancers,” is a NY SSIG Co-Founder, NYPTA Student Conclave 2017 Development Team, works with the NYPTA Greater New York Legislative Task Force and is the NYPTA Public Policy Committee Student Liaison. Jenna aspires to be a physical therapist for amateur and professional performers to help ensure long, healthy careers. To learn more, please check out her website: www.jennafkantor.wixsite.com/jkpt Read the full transcript below: Jenna Kantor (00:04): Hello. Hello. Hello. This is Jenna Kantor with healthy, wealthy and smart. I am here with Javier Carlin, thank you so much for coming on. It is an absolute joy Javier. As a physical therapist. He runs a clinic. What is the name of your clinic that you run? Javier Carlin (00:21): It's renewal rehab. Jenna Kantor (00:23): Renewal. Rehab. In what area though? In Florida. Cause you're part of a chain. Javier Carlin (00:27): Yeah, it's in Largo, Florida. So close to Clearwater. Jenna Kantor (00:30): Yes. I feel like the key Largo, Montego baby. What are we going to make it? I feel like that's part of a song. Right? Well thank you so much for coming on. You also, Oh, you also do have an online course. What's your online course? Javier Carlin (00:45): Yeah. Yeah, so it's a life coaching Academy for health care professionals where I teach healthcare professionals how to become life coaches and get their first clients. Jenna Kantor (00:54): Freaking awesome and perfect timing for that right now with everything. Corona. Thank you so much for coming on during this time and giving us both something to do. I wanted to bring Javier in because he has a skill, a magic skill that if you don't know him or you do know him now, you know, he is a Supreme listener. The first thing we did when we got on this call is, he goes, he just asked me questions just to listen what's going on. And I don't, of course I try to emulate it, but I'm not as good at him. You know, like I asked a few questions and I didn't deep dive as well as he does. So I want to dive into his brain and with this pen that I have holding and I'm going to part the hairs, get through the skull into the cerebrum. And so we can really deep dive into how your brain works when you are learning more about others, the art of listening. So first of all, thank you for having that skill. Javier Carlin (02:08): Yeah, no, absolutely. I honestly had no idea I had it until someone brought it up. And then looking into, it's kind of one of those things where, you know, I guess you have a skill. But you don't really know it. And then you try to dissect, okay, what exactly am I doing? Right? So, you know, leading up to this interview, I'm like, okay, let me actually think about this and reflect on what it is that I do. And what is it that I don't do? So that I can actually, you know, hopefully provide some value throughout the next few minutes. Jenna Kantor (02:40): Yeah, I would love to know. I think I want to just go into our conversation even before hitting the record button. What was in your brain when you first came on? Was it, Oh, I want to know what's going on. I'm just honestly like what was in that led you to start the conversation that way? Javier Carlin (02:58): That's a great question. So to be honest, I mean, I haven't seen you in a long time. We haven't spoken in a while. And so, I really, you know, did want to know what's been going on in your life? I've seen your, you know, posts on Facebook, but really had no idea what it is that you've been working on. And I always know you're up to something. So I really had a deep desire to really find out exactly what you've been working on and the people that you've been impacting. Just to know. I don't know. It's like, it's just natural for me. So, yeah. Jenna Kantor (03:38): You're like a curious George. Javier Carlin (03:40): Exactly. Yes. Jenna Kantor (03:42): Do you think that is a big base of it? It's just true curiosity. Javier Carlin (03:47): Yes. I think it's a curiosity and definitely curiosity. I'm always you know, really in tune with what people are doing. Cause I feel like it just, you know, looking deeper at it. I feel like there's, it just, I come from a place of always wanting to learn more about someone, deeply understand what they're doing and why they're doing it. Cause I think there's a lot to say about that. And it's very similar with you know, health care professionals in the sense that we're working with patients all day and we are truly, really trying to figure out you know, what's going on and where they want to get to and understanding really what they truly want the outcome to be when it comes to us helping them throughout, you know, our physical therapy and other rehab professions. And it's no different. Like that's the same, the same curiosity that I have when I, you know I'm serving patients I have with people in general. So I do believe that curiosity is a big thing and having the curiosity that's a, not in a nosy curiosity but more of like a coaching curiosity and really figuring out what's behind the words that someone is saying. Jenna Kantor (05:02): What do you mean by nosy versus coaching? Would you mind going into more depth on that? Javier Carlin (05:09): So, yeah, absolutely. So I believe, and this is, you know, there's a clear you know, when you're having a conversation with a friend, you're not really thinking about all these things. And then I think deeper into the coaching side of things, you start to think about the specific things. So when it comes to a nosy curiosity, there's always a story that someone's telling you and sometimes the story isn't even related to what the person is actually dealing with. So people use the story to kind of, let's see how I can put this to separate themselves from the interaction that you're having. Cause it's sometimes it's stuff for us to have conversations with people and really get deep down into our own emotions. So the story around it as you know, as someone who's dove into life coaching the story is actually at times something to distract people from that. And sometimes what I mean by nosy curiosity is that we actually get involved in that story, which has nothing to do with why the person is talking to you in the first place. Jenna Kantor (06:09): So it's like this superficial, superficial kind of thing, superficial thing, right? Javier Carlin (06:13): So instead of being nosy and it's the actual story and talking about the people that were in their story, we want to, you know, kind of separate that from the actual person and have a conversation about them and why that situation affected them as a person, not, you know, bringing everyone else. So that's what I mean by nosy. And he knows he's trying to get involved in their story and you know, getting involved in not just their emotions but everyone else's emotions and why they hate their boss and why this and why that. So it's really separating that from what they're telling you. Jenna Kantor (06:45): Hmm. I like that. Yeah. Yeah. Could you just keep talking cause I don't even know what question to ask next just because I'm really taking that in right now. Just tell me something else more about listening. Cause I know you came prepared just because when you're going into this, you just opened up a world of how much, I don't know, just from even that concept. So I feel a bit of the, honestly a lot of loss of words for it because just even that concept of the superficial versus diving deep down in, I guess my next question would be then when you deep dive in and you're getting, doing those investigative questions to really find out what really is the core of what's going on, how do you phrase your questions too? Because you're probably going to get to some real personal stuff. How do you do it delicately with them? So that way as you are deepening, deepening your listening, you're not invading their space. Javier Carlin (07:54): That's a beautiful question. So, I think a lot of it comes before you know, before you dive into that. So you know, you've heard of obviously you're building rapport, building trust, and at the end of the day, if someone's coming for help it typically comes with an idea that, okay, I'm going to have to, if I want someone to help me, then I have to open up to them. Otherwise, you can't really help someone. So I think, you know, it comes with that understanding and I think a lot of it also comes from coming from a place of neutrality. So not tying your emotions and your ideas and your thoughts and your beliefs and your opinions to what the person is telling you. Jenna Kantor (08:37): That's hard. That's hard. Yes. Very hard. Yeah. Javier Carlin (08:41): It really is. And, that's where, you know, that's when someone can actually feel that you're trying to either push them in a direction that they don't want to go, or that's where that nosy type of know feeling comes in, where they're like, Oh, like why are you, why are you asking me that? But I think the second thing is whenever you make an opposite, whenever you make a statement that's more of an observation or a fact Javier Carlin (09:08): As opposed to, you know, something that's a bit more emotional, you want to always end with a question. So as an example, a question. So after every statement you want to end with a question saying, Hey, you know, what's true about that? Or what comes to your mind when you hear that? Those, two questions allow you to kind of pull yourself from Hey, listen, what comes to your mind when I say that? As opposed to I'm saying this because Hey, you should do this or you should do that. Or you know, that came out like pretty that that came out as if, you know, instead of saying, Hey, you sound angry. Right? It's saying, okay, like what, you know, when I heard that it sounded like you, you know, there was some anger and what's true about that and now you're giving them the ability to respond back to that. Javier Carlin (09:57): So now it's more of an observation as opposed to kind of like telling them, or you know, letting them know, Hey, you sound angry. Right? There's more emotion to that. It's more of like, Hey, you're coming at me now. That's when someone can get a bit defensive or feel like their space has been invaded. But when you just state a fact and then ask them a question, it makes it a lot easier to have that conversation moving forward. I hope that, does that make sense? Jenna Kantor (10:25): Yeah, that does. That does big time. It actually connects, it brings it back to a conversation I had with my brother. I'm going to go a little deep on my own thing. I remember my older brother and I don't have a good relationship, but this is back in high school and there's a point to this that's not just about me, even though if anyone knows me, I love talking about myself, but he, I remember there was one evening where he was more of a night elephant, and we started talking. It was a rare time, was a rare opportunity when you just get into a deep conversation about life and anything and we were already at least an hour or something in and I'm just feeling my eyes shut on me. And I remember going through this like I have two options to continue this conversation to continue this conversation with him. Jenna Kantor (11:29): So I remember I had this opportunity to continue the conversation and force myself to stay awake and I felt like it was a very vital conversation. There was this little thing that was like, if I cut this off, it will be cutting off something big in our relationship. Me not being here to be part and present when he's open and being open to talking to me, for me to be able to hear what he has to say. Do you think that and it has over time now we don't have more. We have more solidly not a strong relationship. Do think there are conversations like that that exists that if you are not present and listening and you push it away too soon, it could actually cause damage to that relationship long term. Javier Carlin (12:33): Oh, 150%. Yeah, absolutely. Absolutely. Yeah. Yeah. and you know, it's tough. You know, diving back into exactly, you know, what you were feeling and how you're feeling and why perhaps that conversation was maybe at that time of interest or something that, like you were saying, you know, you felt like maybe falling asleep. Javier Carlin (13:03): So, you know, there's a lot to it that we could dissect really. But yes, I do agree with that. I think what happens in many conversations especially, you know, looking into it even deeper, it's, you know, when people have make offhand comments you know, short little statements in between the conversation that you're having. Most people are quick to kind of just let that pass. But that's what the person truly deep, deep inside is actually feeling and really wants to talk about. Everything else is just surface level. So, you know, exploring those offhand comments goes a very long way. And that's when people really know that you're truly focusing on them. And listening to them and that's where you get into those deeper conversations now. Again, back to the story that you just shared. There's so many different factors when it comes to that, but I definitely do believe that that can have a massive impact on, you know, the relationship moving forward and with anyone with, you know, your patients, your clients, people remember how you made them feel and that really, really sticks. Jenna Kantor (14:19): Yeah, you guys can't see me, but I'm like, yes. Hey man, I feel like I just went to church on that. But it's how you made them feel. So then, back to the clinic, you could have say a busy time, a lot of people, a lot of patients and everything and your time is running short. How do you cater to these conversations? If you see that there needs to be more time or if you do need to cut it shorter, how do you continue to feed that relationship, that trust? So you can have find an opportunity maybe later to spend more time listening to them. If you don't have it right then. Javier Carlin (14:52): That's a great question. I think there's several different ways to do it. I'll speak to more cause there's a tactical way of doing it and that's, you know, with I guess you can call it, you know, nature and the relationship through other methods with text messaging, emails and all those things. Right. Where you feel that connection with someone and continue to develop that relationship over time through sometimes automated, you know, systems and or where you're actually just sending a mass email, you know, once a week where it can still actually help to build a relationship. Right. But on the other front, you know, with our clinic specifically the way that we do that, because we do work as a team cause we are, you know, we do have insurance based model. Javier Carlin (15:40): So we do see several patients an hour. Because of the team that we have where for us specifically, it's a PT, two PTAs and two techs. Once we have a fully established clinic and got into that point that is where the PTA is that we have actually step in to treat the other patients that are there. And if I noticed, cause there's a lot of so when it comes to listening, there's, you know, when people say active listening, active listening really is it's not just listening to the words that are coming out of someone else, someone else's mouth, but also painted with everything else that's going on the unsaid, right? You really want to explore the unsaid. And that comes with a body language. You know, a visual cue is a body posture. You know, the way someone says something, their tone, their pace, right? Javier Carlin (16:28): And obviously as you get to know someone, you really get to feel how they feel when they're having a great day and when they're having a not so good day. So, you know, not letting, again, kind of like not letting offhand comments go. You don't want to let those, the visual kind of feedback that you're getting you don't want to let that go either. So, when you do see someone that's in that specific state where they might be disappointed, angry, upset, frustrated, you want to make sure that you address that right there. And then, and the way that we do that specifically at the clinic is we take them into the evaluation room and we can do that because of the fact that we work as a team, everyone on the team knows exactly what every single patient should be doing and knows them at a deep level so I could actually step out and have that deeper conversation with whoever needs it at that time. Javier Carlin (17:20): We'll sit for, you know, five, 10, 15 minutes, however long we need, really to explore what is going on at a deeper level so that we can ensure that they don't drop off. Cause typically what happens is that when you don't, when you just kind of let that go, that's where you get a patient call in to cancel and then it happens not just once, but twice, three times, four times, and then they ghost you. So that's how we handle that situation. Jenna Kantor (17:50): Absolutely. Absolutely. I think that's a really important thing to put into place. So for clinics alone, how would you, if they don't have something set up and say they're a busy clinic and they don't have something set up where people can have the time to necessarily sit and listen, how could they start implementing that in order to improve the relationships with their patients and then they're showing up? Javier Carlin (18:13): Yeah, that's a great question. And I think there's so many variables depending on how the clinic is set up and ran. I believe that, you know, I think as you know, obviously as physical therapists ourselves, I think our first instinct is to always like go to like the physical, right? Like, you're feeling this way today. Okay, don't worry. Like, we're going to make you feel better after this. It's like, wait a second. Well maybe the person, maybe for those initial 30 minutes, they don't even need, you know, therapeutic exercises or whatever it is that we're prescribing them for that day. Maybe they just need to have a conversation, right, for 20, 30 minutes and just to let it all out. And those 30 minutes of actually just talking to them just because we can't bill for that time technically. That's going to be the difference maker between them actually seeing the results longterm and dropping off. So it's making that clear distinction and deciding, okay, what this person needs at this point in time is not, you know, to do a core exercises or to get manual therapy. What they need is to just have a conversation about what's going on in their world. Cause ultimately that's what matters the most event. Jenna Kantor (19:28): So yeah, true question. I think that was great. That was good. I just want you to know, okay. So then during this time, the Corona virus, what has your clinic been exploring on a listening standpoint with the switch to virtual to try to fit those needs? Like, I don't know, it's kind of an open ended question for you to interpret this however you'd like. Javier Carlin (19:58): Yes. So I think, you know, it's been, to be honest, it's been a challenge. And the biggest reason why is, you know, knowing that tele-health existed for, you know, the last year, two years, et cetera. And, has been existing, we didn't really make a push to have that as an additional service. So what's happening now is that it's like physical therapy, right? A lot of people still don't know what physical therapy is and it's not something that they necessarily want. It's just something that they need. Right? So, same thing with telehealth. It's something that, you know, now we're adding to things that people don't know, which is physical therapy and telehealth. And now we're, you know, most people are now trying to figure out, okay, how can we push tele-health without, you know, having any like, previous conversation about this. Javier Carlin (20:53): So that's where the challenge lies is that you have people who are, you know, the ones who do know what physical therapy is. We're coming in and you know, when they think of PT, they have this, you know, they have this picture in their mind because it's what they've been doing for the past, you know, X amount of weeks and now you're trying to get them to jump on to a different type of platform to, you know, provide a service that in their minds can only be done in person. So what we've seen started to do is we've started to offer complimentary telehealth visits. So the first visit is completely free 15 to 20 minutes in length. And offering that first, you know, giving the patient an opportunity to experience what it's like and showing them how valuable it can be. Javier Carlin (21:39): And then from there deciding to make an offer for them to actually purchase, you know, X amount of business. And typically, you know, your time is your time, so you want to typically charge the same that you would an actual in person session. But because this is so new, we have decided to offer it at a very, very low rate. So that barrier to entry is a lot less, especially in this time where you know, people's finances might not be at their all time high, or at least, they're not going to say, they're a little bit more reserved with what they're spending their money on. People are still spending money, but with what they're spending their money on. So that's how we're handling that now. A lot of, you know, constant communication through text messages, emails and just listening. Jenna Kantor (22:34): Yeah, yeah, yeah. Yeah. That's amazing. Thank you so much for coming on. Is there anything else you want to add in regards to the art of listening that you think is a key point for people to take home with them? Javier Carlin (22:47): Yeah, so I think the last thing, and this is actually a quote from Stephen Covey and I have it here cause I didn't want to butcher it, but basically he says most people do not listen with the intent to learn and understand. They listen with the intent to reply. They are either speaking or preparing to speak. So that's it. Jenna Kantor (23:09): That's great. That's a really good quote. Sums it up. Yeah. Well thank you so much for coming on Javier. How can people find you on social media? What are your addresses on Facebook, Instagram, all the above? Javier Carlin (23:32): Sure. So I'm on Instagram. I'm at @drJavierCarlin. So dr Javier Carlin on Facebook have your Carlin's so you can just look me up there and friend request me. I do have life coaching Academy for healthcare professionals a Facebook community. So you can always jump into that as well with a podcast coming out soon. And I think that's it. If you want to send me a, you know, text message and just link up my phone number is (305) 323-0427 to have a conversation. Jenna Kantor (24:05): I love that. I love that so much and if you guys want to see or hear him in action, if you're in the group or even in his future podcast, you'll see from the way he interviews and speaks with people how he really uses his curiosity and deep dives and learns more and listens so well. Just watching him in action alone, aside from just even experiencing it yourself, you'd be like, Oh wow, he's good at this. I feel very listened to, thank you so much for coming on. Everyone jumping in, thank you for joining and have a great day.   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on Apple Podcasts!

On this episode of the Healthy, Wealthy and Smart Podcast, I welcome Tracy Blake on the show to discuss the evolving role of physical therapy in sport. Tracy’s desire to contribute to sport beyond the field of play motivated her clinical work with athletes from over 25 sports at the local, provincial, national, and international levels, as well as doctoral research focusing on pediatric sport-related concussion and physical activity. It remains the driving force behind her current work as a clinician, researcher, educator, editor, and author. In this episode, we discuss: -The preventative and reactionary roles of physical therapists in sport -How to optimize the healthcare team’s strengths to amplify the organizational mission -Equity and shifting power dynamics between the athlete and clinician -COVID-19 and ethical considerations in sport -And so much more!   Resources: WCPT statement of diversity and inclusion WCPT symposium on diversity and inclusion 2016 consensus on return to sport Introducing patient voices Coin model of privilege and critical allyship Tracy Blake Twitter   For more information on Tracy: The only daughter of Trinidadian immigrants, Tracy Blake and her youngest brother were raised in the multi-cultural, multi-ethnic, multi-faith, working class Toronto (Canada) neighbourhood of Rexdale on the traditional territory of many nations, including the Mississaugas of the Credit, as well as the Anishinabeg, Chippewa, Haudenosaunee, and Wendat peoples. Sport was a power source of connection and vehicle for connection throughout Tracy’s upbringing. Tracy’s desire to contribute to sport beyond the field of play motivated her clinical work with athletes from over 25 sports at the local, provincial, national, and international levels, as well as doctoral research focusing on pediatric sport-related concussion and physical activity. It remains the driving force behind her current work as a clinician, researcher, educator, editor, and author.   Read the full transcript below: Karen Litzy (00:01): Hi Tracy, welcome to the podcast. I am happy to have you on. And I'm so excited to get to speak with you one on one. I heard you speak at WCPT in Geneva last year and I think I've told you this. It was one of my favorite sessions and we can talk a little bit about that session later. We'll probably sort of weave it in as we go along here, but it was a great session at WCPT and I'm really excited to have you on the podcast today to talk about the evolving role of physical therapy or physiotherapy in sport. So I'm just going to hand it off to you and if you can kind of let us know what that role kind of maybe where we were and how you see it evolving and how it has evolved up to this point. Tracy Blake (00:53): Yeah, so I think historically, physiotherapy or physical therapy, I'm Canadian, so I tend to use both. Historically in sport was seen as reactionary. So injury happens, enter physiotherapist from stage 1 right. And I think over time what has happened is that both from a clinician standpoint and an organization standpoint in sport there has been a change in perspective with an increasing level of focus on primary injury prevention. And so what that has meant is physiotherapists are not only responsible for there reactionary role, the rehabilitation, the remediation of injury, but also there has been a serious investment both in their time and an organization's resources around preventing injuries from occurring at all. I think the other part of this is that part of the evolution has been in the team around the team. So historically speaking, there may have been a physical therapist and athletic trainer, a doc, and that would sort of be the primary set of your team. Tracy Blake (02:14): Now, more and more organizations are having maybe multiple therapists, strength and conditioning, nutrition, dietician, sports psychology, other disciplines are involved in the team, which both alters the way in which we gather information, gather experience, the way we develop as practitioners, and also the way in which we engage in our role and in our competencies. Within a sport context. And I think that there's sort of three arcs in which I see physiotherapy in sport, which is consultant. So in a consultant role, you may not be actually involved with front-facing athlete care at all. You might be making recommendations or talking to ownership or be brought in special cases for example. As a concept, then you have external service providers. They might have more regular athlete contacts, but they're not embedded in the daily training environment, which is the third aspect. Each one of those rules has a role to play in today's modern sport, particularly as you get into more resource abundance levels, your high performance or Olympic level or professional level. But the arc of change for each of them is going to be different. The arc of evolution is different. And what that means for the practitioner and the profession will also be different. Karen Litzy (03:47): And so when we talk about those tiers, so let's say you sort of outlined consultant the external service provider and those people who are really embedded with the team on a day to day basis. And before we went on, you sort of use the example of the NBA example. So can you talk about that just to make that a little bit clearer? Tracy Blake (04:10): Yeah. So there was a time where like if you were, the internet still existed, but maybe like online rosters and Google's worth weren't quite as prevalent, I know, usage, but you wouldn't have been able to just go on and find a physical therapist listed on an NBA team. There might've been one a decade ago, maybe two. And now in today's days and times, every NBA team has at least one and sometimes multiple that are working in various specialties within physical therapy. And so I think that that is also something to consider it, right? So what exactly is your contribution to the team in the context of both your profession, which is a healthcare paradigm and your occupation, which is in a performance paradigm in your sector. And so how do you reconcile those two in a way that allows you to contribute and to be of service? Tracy Blake (05:11): And I think we were, I mentioned this to you as well, that I think that the only way to reconcile that in a way that is grounded and sustainable is to be really clear about what your specific mission is as a physical therapist. And then making sure that whatever role you're in, whatever tier you're in, in the incredibly fast paced moving world of physio and in the fast, fast moving world of sport that you're grounded to that regardless, it makes you more responsive and adoptive, particularly in these days and times where on top of the unpredictability of sports and the fast paced moving to sports, we now overlay a global pandemic into that. And so you lose your footing. It's real easy to lose your footing in sport these days. And so if you are not grounded in something that is separate from your job professionally, it is very easy to lose your way. Karen Litzy (06:10): And especially now that there is no sport happening. Correct. While we're in the midst of this global pandemic, there is no sport happening. And so I guess being very clear on what your mission is, does that then allow you to find other ways you can contribute to the team aside from direct we'll say patient care, athlete care or direct overview of strength and conditioning programs and things like that. Tracy Blake (06:41): Yeah. So, then the question becomes is how is a team still a team when they're not playing? So when the technical has been removed from you, what makes you a team? And then in that context, what is your role in maintaining that team in contributing to that team? So I think when we were at WCPT when I had mentioned the idea of what is your mission, I had told people to think about it and you're not allowed to use the words rehabilitation, remediation, illness or injury in whatever your mission statement is. The purpose of that at the time was that you were having conversations with people in sport who do not come from your health care background. So if you only use language that relates to health care remediatory way or inaction reactionary way, you're undervaluing what you do. And you also run the risk if that's not understood in the same way you intended. Tracy Blake (07:52): It turns out that that actually works out in this case as well because now we've taken all of the trappings or all of the preconceptions that come with our role have now been wiped away. Right. So what are you contributing to the team in this context? Are you, for example, as it's somebody who is usually in the daily training environment? Having a team that is sometimes centralized and sometimes decentralized. I made sure that I continue to talk to my team and do check-ins even when they're decentralized. So now we're decentralized longer than we would have been because the Olympics aren't happening. Right. But their communication with me isn't somehow new. Karen Litzy (08:42): Smart. Tracy Blake (08:44): So that's not everybody's option. But that is for me, a way in which the relationships we've had, we're not based on strictly what was on court in the team context. So therefore the relationships are able to be sustainable when an earth shifting history shifting thing is occurring.   Karen Litzy: And, I have a question for you. What is your mission statement? Without using remediation, rehab, et cetera, et cetera.   Tracy Blake: So my mission in sports specifically is the optimization of health function and performance, whatever your age, stage or field of play.   Karen Litzy: Excellent. I love it when people are prepared. That was great. And I think it's very clear. I think that's very clear. It's short and sweet and to the point and people get an idea of what your mission is and what your function is within that team setting. And now let's talk about the team, but not so much the team that's on the court or on the field. But let's talk about the team around the team. So you had mentioned you've got maybe a couple of physical therapists the MD, the ATC, a sports psychologist, nutritionist, but let's talk about how the team around the team functions for the good of the team that's performing on the field, on the slope, on the court, et cetera. Tracy Blake (10:15): Yeah, I think that there is, so my circumstances were particularly interesting in my current situation with volleyball Canada in that I was brought in with the strength and conditioning coach halfway through a quad. Like going into Olympic qualifiers, which is highly unusual. Well we were very lucky was that we had our conversation right out of the gate and we were of a mind so to speak philosophically in this way. So we had our first conversation, I say lucky, I think our director of sports science, sports medicine and innovation would say that he planted this way cause he hired both of us. But we were lucky that we were philosophically aligned in both what we thought our jobs could be for the team in this setting and in this circumstance. And then turns out how we work together also worked quite well that way. So that becomes, I think one of the first things is what's your mission? Does it align with the people who you work with? That's the first thing. And then from that spot, how do you use your strengths of each of those team members to amplify what that organizational or team goal is. Tracy Blake (11:33): And then how can you also identify gaps in each other and fill those in. Because that's the thing, like people love to talk about their strengths. To a team and what they can contribute with their strengths. They're less comfortable, particularly in sports, particularly an environment that is bred on competition and winning. And there can only be one. It is much harder to feel comfortable with vulnerability and opening up something that feels like a gap or a weakness or an area that you're not as confident in and trust that somebody else will fill it without exploiting it. So I think both parts of those need to happen for a team to be both functional and that function to be sustainable for anyone for time. Karen Litzy (12:20): Yeah. And I think that's also where the learning happens, right? When you have that team of professionals around the team, I would think me as a physiotherapist or as a physical therapist can learn so much from those other partners. Tracy Blake (12:38): Yeah, I agree. And I'm a nerd. There's no getting around it. I love a learning moment. I love them all the time. I want to know everything. And so for me, I feed on that, but that is not everyone's experience. And so what I've had to learn is timing and approach and repetition. Frankly, being not just clear on my mission once, but clear on it over and over and over again. How do I express my mission in the big and small things that I do in a day so that I'm consistent and I'm transparent so that at no point somebody can be like, well you said that at the beginning but you did this and this and this. That was inconsistent with that. And so I want my own way. And so in those kinds of circumstances I'll be like, look, this is where I was coming from with this. Tracy Blake (13:30): This is why I thought it made sense. I went to a school where when I say school, like entry level physio training, was that a school where we didn't have traditional lectures? Very much. Almost everything was small group learning. And so I feel like that environment really fostered the way that I work in the team environment, in sport where everybody had the same questions. We all went off and found the information and key information, excuse me, and came back to it with our own whatever that information is plus our own experience and perspective layered in on it. And then you figured it out together what was useful, what was not. Karen Litzy (14:13): Nice. Well that's definitely set you up for being part of a team, that's for sure. And now let's talk about, so let me go back here. So we spoke about kind of the different tiers that may be a physiotherapist might be in how being part of the team is so important to understanding your mission, staying true to that. And I think being self aware enough to know that you're being true to that mission and that you can stand by it and back it up. And now let's talk about how does all of this that we just spoke about, what are the implications of that for athlete health and for support in sport? Tracy Blake (14:52): So for me, the cornerstone of every relationship but particularly in the context of sport is trust. I work in sport obviously, but I also work in acute inpatient healthcare. And I also worked in private practice for a long time and people often assume that my private practice life, my private practice, orthopedics and my sport life are the two that are most closely aligned. Okay. Particularly in recent years, I've corrected that. And then I actually think it's my hospital life in acute care and my sport life, particularly in high performance that are the most aligned and the reason why is the relationship building and the communication that they require. So when I'm working with an athlete, the way in which I can get the best out of that athlete is if they trust, but I'm working to the same goal they're working to. Tracy Blake (15:58): Now that does not mean that I don't care about health, right? Because sport is inherently a risky situation, right? There's a level of risk acceptance that you have to participate in them, particularly when the levels get higher. And I believe there was an article by Caroline bowling, it's a couple of years old now that actually talked about injury definition and asked high performance athletes, coaches and sport physios. And in that article, all injury was negative effect on performance. There's no mention of it risk, there's actually no mention of illness or injury. So if I can't have a conversation with you about what I think the injury is doing to affect your performance negatively, I'm only filling in half the picture. So I need you to trust me. And the way in which I garner that trust. The way in which I build that trust is making sure that you always know that I have your goal, which has performance in mind. And so I think that that component of the relationship is the cornerstone. What cannot be left out of it, however, is the role of equity and the power dynamics. Tracy Blake (17:23): Physio is a health profession. Health professions historically are in a position of power or a position of privilege in the context of your practitioner patient relationship, right? If that's the situation already to start, how can you know that the person is giving you the accurate information if they're already in a position where the power is shifted out of their favor? So knowing that and understanding that concept, I've tried to be really intentional and again, really consistent in actively working to even the scales. I do that. Yeah. So I regularly consistently ask athletes, not just what they think, but I start with the part that they know the most about because as it turns out, I've never played professional volleyball, I've never played any sports at a high level, right? So if I start with the part that they know the most about the technical components of that, the way that training happens, the way practices are organized. If I start with what they know and ask questions about that, and then I work the way in which I build a program back from that, what I often say to people, not just athletes, but obviously this applies to athletes as well, is that I say I know bodies, you know your body and what we're trying to do is take what we know about those two things and put them together in a place that gets you to where you want to go. Tracy Blake (19:02): And anything that you think I'm doing that either doesn't make sense for that for you or that you think is working against that you need to tell me early and often. And so that's the framework. That's a conversation that's happening like right away. First day. Karen Litzy (19:19): Hmm. Tracy Blake (19:19): And then I give them opportunities to come back to that over and over. And not everyone communicates the same way. So you can't expect somebody to like just be like, you spit out five minutes of like clinical decision making information at them and they're going to be like, yeah, aha, Oh by the way, this, this, that and the third. Right. That's not going to be how it happens all the time. So making sure that people have time to think about it. Give time to reflect how the place to come back to you. Some athletes want to break it down into small bite size pieces. Some athletes want to be like, just fix it. I don't want to talk about it. And that's also my responsibility to make sure all of those different types of personalities, those people with different relationships with their bodies. How the power of the emboldened to be able to say what they need to say to meet their goal. And so that's what for me, that communication and relationship building part has to be the cornerstone because it's the only way we can get anything done with the kind of both the speed in which we need to get it done in the context of sport, but also in a sustained way. Because if someone keeps getting hurt, that is also not going to help anybody’s situation both from my job security or theirs. Karen Litzy (20:34): Right, right. Absolutely not. And so again, this kind of goes back to being part of the team. And so what I'm sensing is, and again, I feel like as therapists, we should all know this, but the team around the team also includes the team. You can't just have the team around the team making the discussions and these return to play decisions without involving the members of the team without involving that athlete. Tracy Blake (20:48): Correct. And one of the things that I found, like I'm saying a lot of these things to be clear, I'm saying them now and it sounds Zen, but I found out most of these things through failure to be clear of course a million times over. It has brought me to where I am having this conversation today, but I just wanted to be clear that I did not like walk out of entry-level physio with this knowledge on a smorgasbord. No, I know. Shocking. Shocking. What kind of program was this? You went to again, that didn't prepare you for high level sport athletes shawty is what it was. But the idea that the idea that an athlete, an essential part to their healthcare team still is radical for many and they see it, they see it. Tracy Blake (22:03): But what happens is when there actually requires an actual power shifts to make happen. Yeah. It's hard for people when it actually requires them to let go of some of their power if it requires them to acknowledge. There was a moment in the process of programming, in the process of delivery, in the process of recovery that they are not the expert in the room. It can be a blow, particularly people who've spent in our cases years getting to that point.   Karen Litzy: Oh absolutely. And I think in several presentations I've seen in writings of Claire ardor and I feel like she goes through this which with such specificity and simplicity that it makes you think, well of course, kind of what you just said. Like for some people it's a radical view that the athlete should take this big part in their recovery and their return to sport or in their health. But when you listen to folks like you or like Claire, it's like, well yeah, it all of a sudden turns into a no brainer. So where do you think that disconnect is with those people who still considered a radical idea and the people who are on the other end who are like, well, of course they should be part of it. Tracy Blake (23:09): Some of it is experience. And so what I mean by that is not just like length of time experience, but I found that when everything's going well, it's going well, right? There is no impetus to change. There is no disruptor that actually acts to give you a moment to or recalibrate as you need. And so when I say experience, I mean I've had instances where, to be honest, I wasn't sure if it was going well. I wasn't sure I was doing what I thought needed to be done and I was doing what felt right. Again, I was aligning with the mission that I had because I didn't have any real world context in this specific sport or circumstance that I might've been in. And then something goes wrong. And you realize in the aftermath of that, whether it's an illness, whether it's an injury, whether it's something off court altogether, right? Whether it's an abuse and harassment situation, whether it's a boundary situation, whether it's a patient confidentiality situation, right? You realize when those things go sideways, but that's whereyour power and your metal is tested professionally. Tracy Blake (24:46): And so I think that's one part of it. I think another part is there's ability to what they call it mission creep, right? Where over time you sort of like, this is what you think your mission is, but then you did a little of this and you do a little of this and the next thing you know, you're far away from where you started. And I think that a lot of people, I think they're in service to the mission one in sometimes they actually end up in service to the business model. And particularly in sport where the jobs or when I say sport, like high performance sport professional sport, where the jobs are few, where the jobs are highly competitive. I don't think I've ever applied for a sport job that had less than 75 applicants and upwards of several hundred in some cases. Tracy Blake (25:43): Wow. Everybody wants that gig. And so people can sometimes get led by the, or creeped away from their mission by the instinct to do what is necessary to stay in the position rather than what is necessary to optimize the health function and performance of their athlete. So having a situation where you've been tested and sometimes don't, aren't successful and mission creep. Those two things I think are maybe the biggest ways that aren't just related to like personality. Like those are that things can be trained or modify. Those are like the modifiable things I think. Karen Litzy (26:44): Great. And then, you know, we had said as we are recording this, we are in the middle of the global covid-19 pandemic. And so there is no sport going on. And so to the best of your ability, and we're not asking you to be a future teller here, but what do you think will happen to the role of physiotherapy in sport and the medical teams in sport? Tracy Blake (27:28): I don't know necessarily what will happen. What I hope happens is that all healthcare practitioners, but particularly physical therapists in our case because I'm biased in that direction that they recognize their role in contribution to population health in the context of sport. So public health in the context of sport, we often think of sports as a bubble and it is to a certain extent, but that bubble is manufactured. That means all parts of an athlete's existence are manufactured, right? All parts of what the athlete is provided with from a health perspective are manufactured. So have gaps are left in that it's up to you as the person who is actually in the sport context to identify and try to remedy and resolve. Right? It's deeply problematic for athletes to not have the same information that somebody who works in the public house. It's deeply problematic for athletes too, not have access to labor rights. It's deeply problematic for athletes to not have be informed and be given informed consent to participate in mass gatherings during a time of pandemic. Tracy Blake (29:02): And I also think there is a strong ethical quandary that comes with providing services, two events that fly in the face of public health recommendations during times like this. And I've been on record with this, I said this a couple of weeks ago, I posted about it on Twitter where there was a massive wrestling tournament happening and I thought to myself, it's wrestling, it's a combat sport. It can't happen. Like they literally would have no insurance if there was no medical covenant medical coverage provided. So if you didn't have medical coverage, the event couldn't happen. So how does medical coverage or physio coverage or what have you happen against public health recommendations? We can't continue to act in separation with each other. We need to view sports as part of population health. And then we need to make sure athletes and those in the sporting community are acting in accordance with the public health. Tracy Blake (30:11): At the times demand as well. And I think the Rudy go bear situation was truly, genuinely shocking for a lot of people. They were unprepared at every level, not just sports medicine and sport physical therapy. And so what I hope lingers for people is that we think about emergency action plans a lot, right? We think about how we're going to get somebody off the court in the case of an emergent issue, Encore, how are we preparing them for life in that same context? How are we in preparing ourselves as professionals in that context? And I hope that those conversations, because it turns out you don't need to be in person for that. Tracy Blake (31:01): That people are reflecting on that now and that steps are being taken to improve both the gaps that are specific to the city, the situation with the pandemic now, but also how do we identify these things going forward. And I think some of that had already started to show its colors around issues of food insecurity, issues of education, issues of like the younger your players are coming in. Are you providing appropriate development? I went to you as a, you know, I went to the United nations last year for the sporting chance for him, which is around sport and human rights. And last year, 2019 was the year of the child. And so there had been a special rapport to report on the rights of the child and child exploitation and snails. There is an entire section dedicated to sport and how sport has been used as a vehicle for the exploitation of the child. Tracy Blake (32:08): And I think of things like that, like those are the kinds of gaps. But now that you know that these kinds of gaps exist now you know, you understand in a very real way and it's kind of, it's telling in some kind of ways that it needs to strike so personally close to people's wallets and they'll help. But now that we've had that touch, now that we've been exposed in this kind of way, can we continue to be proactive in the way we address other things going forward? That would be what I would hope to see. Karen Litzy (32:40): Well, and I think that's I feel like very doable hope. I don't think it's like a pie in the sky. Hope. I think all of those conversations can be had and hopefully can be had by everyone surrounding sports, not just the physiotherapist or just the medical team, but straight up to owners and players and everyone else in between. So Tracy, thank you so much for such a great conversation. Tracy Blake (33:13): Yeah, it's been great. And I think again, like physios are really well situated because you have physiotherapists who have really like have access to the player and have access to the coaching, the ownership, the administrative stakeholders. They're well situated to be able to bring these things to light on both sides and be involved in those conversations even if they don't have out right decision making power. Karen Litzy (33:38): Right. Absolutely. Tracy Blake (33:39): Yeah. Thanks for letting me out of the shadow. Karen Litzy (33:42): Oh, it was great. Thank you so much. And then before we sign off here, I have one more question that I ask everyone. And knowing what you know now and where you are in your life and in your career, what advice would you give to yourself as that fresh graduate, straight out of physiotherapy school? Tracy Blake (34:04): I would say that you need a mission early and you need to speak it into existence. It's not good enough to keep it in your head. You need to say it out loud to people and you need to get feedback from people and whether it's clear or not. And I also think that one of the things that I learned I was 36 almost 37 when I took my first dedicated health equity class and aye, it was a workshop. And in the beginning she said for some of you this will be new information and it was specifically targeted at health professionals, not just physio. And some of you would have learned this in, you know, your first year equity studies, first year gender studies kind of course. And after the weekend where I slept for basically three days because of all the information floating in my head, I was like, there are 18 year olds walking around with this in there. And so I think that if I could go back now, I'd be like, you need to start taking those courses early. You need to start embedding it into your thinking early. Maybe you'll be better at being intentional about how you use it earlier. Karen Litzy (35:11): Excellent, excellent advice. Now, where can people find you if they want to shoot you a question or they just want to say how great this episode was? Tracy Blake (35:22): So I'm active on the Twitter, so my Twitter handle is @TracyABlake. I am not as active on the on Instagram. My Instagram still private, but if you shoot me a message I usually find it anyway. So that also works. Same handle @TracyaBlake. Karen Litzy (35:38): Perfect. And just so everyone knows, we will have links to certainly to your Twitter at the show notes over at podcast.Healthywealthysmart.com. So Tracy, thank you so much. I really appreciate it. This is a great conversation. Thank you so much. This is quite the podcast debut. I appreciate it anytime and everyone, thanks so much for tuning in and listening. Have a great couple of days and stay healthy, wealthy, and smart.   Thanks for listening and subscribing to the podcast! 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