Podcasts about adls

What are Activities of Daily Living (ADLs)? What about Instrumental Activities of Daily Living (IADLs)? What are the warning signs that someone might need assistance with these daily tasks? How does a senior living community decide which care level a resident needs? What if a resident's needs change and they need different help? What should I do if I notice that my loved one is needing more help with their ADLs and IADLs?Our experts are answering these questions and more. They're sharing specifics about different types of daily tasks like bathing. Plus, offering their best tips and tricks for how to recognize changes with a loved one – and how to talk to them about it.

Dr. Wells talks about a case of chronic low back pain with scoliosis, reading up and implementing Schroth Method basics and having some success with stretching and repeated loading. Dr. E gives some suggestions based on his experience with Schroth and how to combine it with 3d sustained loading and other positional modifications for ADLs.Let us know what you think and if you see more patients in this particular population.Untold Physio Stories is sponsored by⁠Comprehend PT⁠- Leave Comprehend PT running in the background or record audio when you have time. The AI based SOAP note generator does the rest! No need for accuracy or exact wording! It's a game changer and will give you more time with your patients! Use code MMT50 to save 50% off your first month. Free trial available at sign up!⁠⁠The Eclectic Approach Network⁠⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠⁠EDGE Mobility System⁠⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com

Send us a textThe wave of long-term care insurance claims is rapidly approaching, and home care agencies need to be prepared. With nearly 4 million policies written between 1995-2005, we're entering a period where these policyholders—now in their peak claim years of 80-85—are seeking home care services in record numbers.Bill Comfort, with over three decades of experience in long-term care insurance, walks us through the critical steps agencies must take to successfully work with these valuable clients. First and foremost is understanding whether your agency qualifies as an eligible provider under various policy definitions. While many policies use the term "home health care" generically, the actual definitions vary widely. Most policies specify providers must be "licensed by the state if licensure is required"—a crucial distinction for agencies in non-licensure states.Documentation emerges as perhaps the most critical factor in successful claims management. Agencies must carefully document whether assistance with Activities of Daily Living (ADLs) is hands-on or standby—a distinction that can determine claim approval or denial. The caregiving notes must consistently reflect assistance with at least two of the six ADLs (bathing, dressing, transferring, toileting, eating, and continence) for clients to maintain benefit eligibility.Payment structures present another consideration, with Bill strongly recommending against accepting assignment of benefits until claims are fully established. This protects agencies from financial exposure when claims are delayed or denied. Instead, establish procedures to help clients submit claims while maintaining your direct billing relationship.Building referral partnerships with financial advisors and insurance agents offers tremendous growth potential. Organizations like NAIFA and FPA provide perfect networking opportunities where agencies can position themselves as knowledgeable resources. By demonstrating expertise in navigating long-term care insurance claims, your agency can attract both insurance-funded and private-pay clients.Ready to position your agency as an expert in long-term care insurance claims? Learn more about obtaining the Long-Term Care Claims Professional certification to demonstrate your expertise and grow this valuable revenue stream.Continuum Mastery Circle IntroVisit our website at https://asnhomecaremarketing.comGet Your 11 Free Home Care Marketing Guides: https://bit.ly/homecarerev

Senthuran Sivananthan comes on the show to talk about the Well-Architected Framework (WAF) and Well Architected Resiliency Review (WARA).   Media file: https://azpodcast.blob.core.windows.net/episodes/Episode512.mp3 YouTube: https://youtu.be/xTxG7X9RoWQ   Resources: Azure Pricing Calculator Azure Architecture Review Web Application Firewall Other Updates: Retirement of Azure Automation's Powershell runbooks using AzureRM modules TLS1.0/1.1 retirement for Azure Automation Customer Managed Unplanned Failover for ADLS and Storage+SFTP

In 2003, a group of Indian Americans established the Hindu American Foundation (HAF), an organization explicitly modeled on the Anti-Defamation League (ADL), in a bid to address anti-Hindu discrimination in the US. Just as the ADL has long insisted that fighting American antisemitism requires bolstering support for Israel, the HAF committed itself to lobbying for India's Hindu nationalist movement in the name of protecting Hindu Americans' civil rights, an approach that has garnered significant success. The HAF is not the only organization that has drawn inspiration from the ADL. In 2021, the Asian American Foundation (TAAF) was formed in direct partnership with the ADL as a way to address growing anti-Asian racism. While lacking connection to a single ethnonationalist movement, TAAF nevertheless drew on the ADL's and HAF's approaches in positioning anti-Asian racism as a unique problem requiring carceral solutions instead of solidaristic organizing. As such, TAAF debuted with ADL head Jonathan Greenblatt as the only non-Asian person on its board, and Hindu nationalist Sonal Shah as its founding president. The HAF and TAAF's use of the ADL model has thus far helped them achieve significant support and legitimacy. However, as the ADL itself faces an unprecedented crisis of legitimacy in the wake of October 7th, affiliation with it now risks becoming a liability. For instance, following members' criticism over its ties to an increasingly repressive Greenblatt, TAAF removed him from his board this July (while still affirming its “strategic relationship” with the ADL). As dissent continues to grow in Asian and South Asian American communities—with reporters and activists questioning ties of anti-racist groups in the US to injustices abroad—it is not just ties to the ADL but the power of the ADL model of antiracism that stands to come into question. To discuss these developments, Jewish Currents news editor Aparna Gopalan spoke to associate editor Mari Cohen, New Yorker contributing writer E. Tammy Kim, and Savera coalition activist Prachi Patankar about the similarities and differences between the ADL, the HAF, and TAAF; their embrace of a “hate crimes” approach to anti-racism and what it leaves out; their ties to supremacist movements; and their shifting fortunes in the wake of the pressures over the past year. Thanks to Jesse Brenneman for producing and to Nathan Salsburg for the use of his song “VIII (All That Were Calculated Have Passed).Texts Mentioned and Further Reading:“How the ADL's Israel Advocacy Undermines Its Civil Rights Work,” Alex Kane and Jacob Hutt, Jewish Currents “ADL Staffers Dissented After CEO Compared Palestinian...

Our guest this week, Daniel Smilovitch, completed his Master's in Occupational Therapy (OT) at McGill University and is finishing up his first year as a professional in the field. He weaves a compelling narrative, taknig us back to his humble beginnings in a barebones basement rat lab, through the intensive, hands-on program in OT, and finally to a day in the life of a working occupational therapist. So fasten your diapers, cause we're about to make a g'day out of bidet! Whether you're an undergraduate student curious about research or a career in OT, or a regular listener of the show excited to jump back in after an extended hiatus, or or anything in between, this chat is sure to entertain and to inform. Sit back, relax, and enjoy! THE MENU: ACADEMIC PATH (0 - 35)SchmoozingPsychology BackgroundThe Rat LabSemi-Natural EnvironmentsA Turning Point S/O Joe Inhaber (Episode 56)A Desire for ChangeDemographics of OTThe CASPER TestCareer Crossroads: The Bird Problems ProblemThe Butterly EffectCommunity, Compassion and CommunicationWHAT IS OCCUPATIONAL THERAPY? (35 - 51)"How do we get people to do the things that they want to do?"Branches of OT (1/2)Autonomy and IndependencePEO: The DSM of OTTask BreakdownInteracting Factors"They've tried to make me go to rehab..."ADLs and IADLsEquipmentBranches of OT (2/2)Internships x4OT RESEARCH (51 - 1:03)The Cognitive Stimulation ToolkitBrain Games and Wii GamesTailored Research, World Cafes & OT-ceptionContext, Parameters & the Validity of ResearchON THE JOB (1:03-1:15)The OT's Interdisciplinary TeamThe PT-OT BifectaImposter SyndromeDreams of ExpertiseSensation, Mirror Therapy, DysphasiaTHE CLOSER (1:15 - End)Your Role with a capital "R"The Plea /// Liking the show? Drop us a juicy 5-star rating or a written review on ⁠Apple Podcasts⁠! Support the show by Following & Subscribing on: ⁠Spotify, ⁠⁠Facebook⁠, ⁠Instagram⁠ & ⁠Twitter⁠ Cover Art:Youssef Naddam via Unsplash

Dr. Jennifer Stelter is a clinical psychologist, the CEO of the Dementia Connection Institute, and the author of The Busy Caregiver's Guide to Advanced Alzheimer Disease. In this episode, she shares insights on how to better care for and connect with individuals with dementia. Dr. Stelter delves into the neuroscience and psychology behind their frustrations and behaviors, offering sensory-based tools to enhance the well-being of both those with dementia and their caregivers. We explore how engaging the senses — smell, sight, sound, taste, and touch — can create positive experiences. By incorporating tools like essential oils, music, color, and hands-on tactile experiences, we can enhance mood, attention, memory, language, neuroplasticity, food intake, independence, and connection. Likewise, reducing or eliminating negative stimuli, such as distressing news, violent media, or disruptive lights and sounds, helps diminish negative emotions and behaviors, fostering a more positive environment and overall experience. We discuss the psychological effects of various scents, including lavender, rosemary, citrus, and peppermint, and how we can use them to alter our mood and actions. Even if you don't have a loved one with dementia, these sensory tools can still benefit your own mood, health, cognition, and overall well-being. Experiment with different sensory experiences, embracing those that work best for you while removing those that don't. RESOURCESBOOKS- The Busy Caregiver's Guide to Advanced Alzheimer Disease by Jennifer Stelter - The Curious Case of Benjamin Button by F. Scott Fitzgerald ORGANIZATIONS- International Caregivers Association (ICA)- Johns Hopkins University- McDonald'sPEOPLE- Barry ReisbergTV PROGRAMS- Memory Lane TVVOCABULARY- activities of daily living (ADLs)- amygdala- hippocampus- limbic system- Memory Care- occipital lobe - olfactory bulb - Pavlov's dog - retrogenesis- Santa Fe**Connect and Learn More**Website: dementiaconnectioninstitute.orgBook: The Busy Caregiver's Guide to Advanced Alzheimer DiseaseInstagram: @neuroessenceorgLinkedIn: /neuroessenceorg

Boat enthusiast Matt Cain enthralls us with the history and restoration project behind one of Dunkirk's most famous rescue ships. The Lady of Mann from the Isle of Man. Matt and Paul discuss the Dunkirk operation and stories behind it. Manx veterans talk about their experiences on Manx Radio. "Scary, fascinating and hilarious"   Please do subscribe or follow the show (for free forever) in your listening app as it helps me with the search rankings.  Buy Me a Coffee https://www.buymeacoffee.com/fightingthrough Full show notes, photos and transcript at: https://www.fightingthroughpodcast.co.uk/103-matt-cain-interview-dunkirk-little-ship-manxmen-ww2 Reviews on main website:https://www.fightingthroughpodcast.co.uk/reviews/new/ Patreon:https://www.patreon.com/FightingThrough Follow me on Twitter: https://twitter.com/PaulCheall Follow me on Facebook:https://www.facebook.com/FightingThroughPodcast YouTube Channel:https://www.youtube.com/channel/UCnlqRO9MdFBUrKM6ExEOzVQ?view_as=subscriber   Links to features in the show: Manx Radio interview with Matt grandfather and others https://youtu.be/ssS-WJYKkxU?si=0q1ZkA50GP8RMKGC Dunkirk: 80 Years On   Manx Radio www.Manxradio.com   The Association of Dunkirk Little Ships ADLS Facebook page https://www.facebook.com/DunkirkShips   ADLS website  - The Association of Dunkirk Little Ships. www.adls.org.uk

The 34 ADLs (Activities of Daily Living) cover day to day things like brushing one's teeth or getting dressed, but these aren't necessarily the things one does for their job. So how are these ADLs relevant for assessing a workplace injury? In this episode, Dr. John Alchemy explains how ADLs help us understand workplace injuries and how they are balanced against the WPI (Whole Person Impairment).For more information on this episode, and other helpful tips about workers' compensation, visit the RateFast Blog. Visit our YouTube channel to see this video and more!If you're a workers' compensation provider, adjuster, or case manager check out RateFast Express: the service that writes your impairment reports with you!Questions? Comments? Suggestions for podcast episodes? Reach out to us anytime at caworkcompreport@rate-fast.com!Connect with RateFast CEO Dr. John Alchemy on LinkedIn!

Talked with Angie Mason, DPT, OTR/L and Tyre Patterson, DPT  from Dynamic Duo PT.  They are members of the T Leroy Jefferson Medical Society and do educational outreach for them.  We discussed what Phyical Therapy and Occupational Therapy disciplines do and some of the reasons folks may go to see a  PT or OT. Some of which are sports injuries, hip/knee issues, gait/balance issues, pelvic floor/incontinence, neurological  disorders (stroke, parkinsons), Carpal Tunnel, workers comp, chronic conditions like arthritis, back or knee pains and help improve ADLs (activities of daily living).  Listeners can find out more at www.dynamicduopt.com or call 561-563-2828.

Let's dive deep into the critical topic of long term care (LTC) insurance and its transformative impact on health and quality of life. DG explains the necessity of LTC insurance, defining it as assistance for activities of daily living (ADLs) and spotlighting the shift towards home-based and community care. With insights into policy specifics, eligibility requirements, and buying strategies, DG covers crucial points such as the benefits of hybrid policies, the financial implications for retirees, and the importance of securing an honest insurance agent. Navigating through the intricacies of Medicaid, Medicare, and the challenges of relying on familial support, this episode underscores the importance of proactive planning for long term care to ensure financial stability, avoid potential family conflicts, and maintain a dignified, independent life in one's later years.Connect with Aging with Grace at agingwithgraceinfo.org

Dr. April Dominick // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick shares how YOU can make a huge impact on the quality of life of a client with an upcoming prostatectomy simply through education on pelvic floor muscle retraining, lifestyle changes and physical activity AND learn the ESSENTIAL clinical pearls to include in a pre-operative physical therapy session when working with this population. Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION APRIL DOMINICK This is Dr. April Dominick. I am on faculty with the ICE Pelvic Division. Today we are chatting about prehab for a prostatectomy surgery. Why is prehab important and what should be included in your PT session with that pre prostatectomy client? This topic, it is so near and dear to my heart. it's because these humans just don't have the treatment or education that they deserve prior to going into these surgeries and afterwards when they come out. And if I can convince you why it is so important to be able to connect with these humans and to even just educate them on, hey, there is Help for you. There's pelvic floor muscle training that can be done education about behaviors whether that is you actually doing the PT session or you referring them to someone else it can have incredible outcomes for them post-op just because they are aware of pelvic floor physical therapy for their surgery the prostatectomy so Let's dive into what a prostatectomy surgery actually is. It is something to treat prostate cancer, and that's going to be by removing part or the full gland of the prostate. They're also going to remove surrounding tissues and seminal vesicles. The gold standard for surgery is a radical prostatectomy where they remove the entire prostate gland. I didn't have a walnut, so here's what we're working with. This fig represents the prostate. So let's run through some real estate of where everything is situated in someone with a prostate in terms of the pelvic floor and the organs. So we have our bladder here and then we have the bladder neck with the urethra that goes through our prostate. and this is going to be representative of the urethra itself. So the urethra goes from the bladder neck through this fig or the prostate and then down into the penis and that is how everything is set up. With a prostatectomy, after the prostate is removed, that extra support around the urethra is now lost, and the remaining bit of that urethra now needs to be reconnected back to the bladder. This reconnection, we can think about it like a bridge, or a fancy term is the anastomosis, and that anastomosis needs time to heal. So a Foley catheter is placed in for about five to ten days. That means that the bladder is or the urine is emptying passively. The bladder is not doing its job. It's off on vacation. And then once the catheter is removed, the bladder acts like it forgot how to start or how to store urine. It doesn't know what to do with it. And so we have a lot of urinary leakage. So among other things, this is why urinary incontinence or urinary leakage is a major side effect with these prostatectomy surgeries. post-op, the external urethral sphincter is relied on for maintaining continence. So good news for us, the pelvic floor muscles help to close that sphincter and keep pee in until it's appropriate to release it. And that's why pelvic floor muscle training with physical therapy can be so important pre-op and post-op, at least from the bladder side of things. So who does the prostatectomy surgery affect? Well, obviously those diagnosed with prostate cancer. It is the second leading cause of death from cancer in males. It's going to affect our individuals who are older than 50 years old and who are African-American. So if you think about who you are treating currently, if you're treating individuals who have prostates who are older than 50, one in eight of them are probably gonna have some run-in with prostate cancer, whether that's treated with a surgery or not. That's where you come in. You could have such a profound effect with these individuals just by educating them that pelvic floor muscle training exists And whether you're again, whether you're doing the treatment or you're referring out to someone else, you can have such an incredible impact on their post-op outcomes potentially. So, We talked about with a post-prostatectomy, we talked about that surgery can result in urinary incontinence or leakage. It can also affect sexual function. There can be reduced physical function. Think about it. If you're leaking all the time, is that really going to convince or motivate you to go work out? For some, no. And then it'll also affect the overall health-related quality of life. Take 65 year old Phil. You've got a Phil in your clinic. You're already treating him for low back pain, um, with his hikes and his weightlifting, say. And he went in for his annual physical, and then he walked out with a date for a surgery for radical prostatectomy. Besides being in shock that he now has this potentially life threatening diagnosis, Phil comes in and is like, this happened. He's like, am I, am I ever going to be able to hike with my hiking group and not be the person that smells like pee? Am I going to be able to be cool with being in the changing room in the, in the locker room after my weightlifting session, like removing this soggy pair of underwear, or am I going to be able to enjoy sexy times with his partner? Well, since you're here and you intently are listening to this podcast, You, your first line of question is, hey, Phil, did they recommend any sort of physical therapy for you? Um, whether it's pre-op or post-op. And of course, Phil's like, no. So you teach him that pelvic floor muscle training can be so effective and helpful, um, and play a huge role in those side effects that he's worried about. Y'all, what if we could have an incredibly bigger impact, building the foundation, setting the stage for what to expect post-surgery, just with PT sessions? Clinically, I've been treating this population, hopefully you can hear my passion behind it, for about seven years. I've interacted with so many fills that come in, if they even get to me, right? and they are just slapped with that surgery date, and the side effects are kind of breezed through during their appointment, it seems like. And their concerns aren't really heard, their well-being and their questions, they're just kind of like not given a lot of attention. I didn't always do pre-op sessions, but once I started, hoo-wee, I was just blown away by how different the clinical outcomes were in terms of improving, whether that was decreasing the volume of urinary leakage for some or having them return back to their ADLs exercise a little bit sooner. The biggest thing, which was so powerful for me, is these people came in extremely uncertain, having no idea even why, if their doctor did send them to PT, why they were there. And they were just uncertain about these really scary side effects, about how maybe for the first time they were going to experience some sort of losing control of their bodies, from peeing unexpectedly to changes in their erections. And they walked out of that first session feeling a little more confident, a little more certain. And that is the power, I believe, of these pre-op sessions. And then from a research side of things, what's shaking out in the few RCTs that we have for these pre-op sessions and their effects on prostatectomy, some may be helpful in improving quality of life. they may affect a shorter hospital stay. They may reduce post-op urinary leakage in the short term. So some studies find around month one, three, or six, that the individual is leaking less, meaning they're drier faster. Now, when you compare someone who had some pre-op PT to someone who did not around 12 months, they are about the same with their rate. But I would argue that I bet folks are going to be a lot more satisfied if they did that prehab and they are drier sooner, right? So let's go into what a prostatectomy PT session entails before that surgery. We've got these sessions already in place. for folks who are going in for surgery for their ACL repair, for their hip replacement. But just like we're fighting with our pregnant and postpartum population, we are somehow having to fight for someone to have a pre-obsession for something like a prostatectomy, and that impacts so many daily functions. Let's outline what is involved in that pre-op PT session. Again, you can educate someone on what to expect if you're referring them to someone to do this. So we'll go over subjective, objective, and the treatment. From an assessment side of things, from that subjective piece, what you can be talking to your patient about is what are their current bladder and sexual habits? How many voids do they have during the day? How many times do they go pee? Do they have an urge? Do they have urinary leakage or hesitancy? And there are some outcome measures that go over these things. The International Prostate Symptom Score goes over those things. Plus they ask about nocturia or nighttime urination. And then the NIH Chronic Prostatitis Symptom Index is another outcome measure. And I love it because it asks about the impact of these symptoms. How is it affecting your quality of life? Then you want to also ask about their sexual function. How would they rate their erection strength or their satisfaction with their sexual life? From an outcome measure standpoint, you can give them the International Index of Erectile Function. This is something that asks them to rate qualities of their erection from the past four weeks. Then you want to also get a good idea of their current physical activity regimen. What a wonderful time to, if they're already a little physically inactive, hey, let's like plug in for, here's why it would be really great if you could up that physical activity. Not just for that immediate post-op surgical outcome, but also, hey, we can lower all cause mortality. And then from an objective side of things, so we went over the subjective, objectively speaking, we want to get a pelvic assessment. Whether that is over the clothes, external, near that midline, or it is a visual or tactile palpation, or an internal rectal assessment, if that's what you're trained in. So we're looking for, what's their awareness? Do they even know that they have this group of muscles that they can control? called the pelvic floor. We want to be looking at their coordination, timing of the pelvic floor, and then also getting an idea of what is their breathing and bracing strategies for things that increase interabdominal pressure, like fitness activities or functional lifting of the groceries, coughing, running, weightlifting. Typically, this population tends to be a breath holder. So we're gonna spend some time, there's just so much that we can do to help them in this area, to help them have improvements in their methods with that. And then we also wanna be doing some sort of general orthoscreen because what if their hips are cranky? Obviously that's gonna affect pelvic floor, low back, and all those surgical outcomes. From a treatment side of things, so we went over subjective, objective, highlights from the treatment side of things. where we'll talk about education, what to expect post-op, and some homework for them to work on. Education. I cannot stress this enough. The education piece here is vital for affecting their outcomes and well-being. Let's educate them on the pelvic floor. Here's what it is. Here's the anatomy and physiology. Here's how it affects your penis. whether that's for sexual health or for the urethra for urination. Here is what happens during the surgery. Get to know the surgeons in your area and which methods they use. What are their outcomes, right? And then you want to be explaining the risk factors for these side effects like urinary leakage and sexual function. dysfunction. Non-modifiable factors. If you're older, it's not going to help you as much. And if you already have some reductions in urinary function, like you're already leaking, that is not going to help you on the backside. Modifiable factors, tons. So things like smoking, poor nutrition, That is gonna delay healing post-op. Can we identify some current bladder irritants and reduce those immediately post-op? What about poor mental health? Things like low self-efficacy or if they're experiencing anxiety or depression, helping them ID these things and finding them some psychosocial support to have upcoming for the surgery and post-op, so key. and then reduced physical activity. Hard health is heart health. What do I mean by that? Erections, ejaculation, is related to vascular health. Hard health is heart health. So what affects our vascular system? Aerobic and resistance training exercise. If we can have them and talk to them about how it's important and how increasing that physical activity is going to improve their physiologic resilience to the surgery itself and any complications that come up, that is gonna be having such a huge impact on their quality of life. Regarding physical activity, in a 2014 RCT by Mina et al, they found that men who were meeting physical activity guidelines prior to surgery had greater health-related quality of life at six and 26 weeks post-op compared to men who were not meeting those physical activity guidelines. So, from a post-op perspective, we want to tell them what to expect. Urinary incontinence and sexual dysfunction. From the urinary incontinence side of things, they will have a Foley catheter in for five to 10 days. Remember, the bladder doesn't work during this time. Once that catheter is removed, we gotta retrain that neural pathway to help control the bladder so that they know, oh, my bladder is filling, or this is how I'm gonna stop that leakage from coming out, and how to fully empty the bladder. Another huge tip, have them bring a hygiene product, whether that's a pad or a diaper or something, with them to the hospital so that when they are discharged, they have something to help protect them on their way home or on their way to the store to grab their meds. And then urinary incontinence could be present from a couple of months to a year post-op. We see a significant improvement in that three to six month range, but it could be affected by things like, hey, it gets worse at the end of the day because the pelvic floor muscles are tired, or with transitional movements like sitting to stand. So working on these movements with them is gonna be super helpful pre-op. And then maybe talking to them about how, if you're not going to see them for 10 days or so post-op, we may be using the pad weight or the number of pads in a 24-hour period as a marker for our progress. So just having that in the back of their mind. When it comes to what to expect from a sexual function standpoint post-op, it can take up to two years to recover to baseline function from an erection standpoint. We want to set these expectations from an ejaculation standpoint. Dry ejaculate is going to happen now because those seminal vesicles were removed, and that's what helps produce that ejaculate. There may be some changes in their orgasm sensation. Erections, it could be dependent on surgery outcomes. How much nerve sparing was there in that procedure? They have the potential to get better with this, especially with pelvic floor muscle training or things like pumps. And then loss of penile length. This is something that we want to let them know can happen so they don't get a little surprise. Homework wise, we want to address any of those pelvic floor deficits we found from that objective piece, especially that breathing and bracing strategy. We can do that with biofeedback, whether that's with a mirror, with a palpation from the therapist or from them, and just to really improve their awareness and coordination there. And then giving them cues that connect them to the pelvic floor. Evidence supports, hey, pelvic floor contractions with the following cues, like shortening the penis, though I've been told nobody wants to have that. So something like nuts to guts or stopping the flow of urine is great for that. One side of the range of motion, the contraction side of the range of motion of the pelvic floor, and then something for the relaxation side, like let the testicles or base of penis hang loose. I did an Instagram post recently, so you can check that out on the ICE or Revitalize Pelvic Physio page. And then we wanna be, for homework, modifying their poor lifestyle habits. Can we reduce those bladder irritants, process sugar? Can we increase your physical activity and mental health? And then finally, we want to be scheduling their followup visits on the calendar. So whether that's for pre-op, a couple more sessions, or as early as 10 days, once that catheter is removed, they can pop back in to your office. SUMMARY So, I hope you found that information helpful. We reviewed how prevalent prostate cancer is, especially for those who are 50 plus. We know that radical prostatectomy is the gold standard for treatment. Two major things that are affected post-op are urinary incontinence and erectile dysfunction. Pre-op PT sessions are fairly new, but we have some evidence that says, hey, those who partake in pre-op sessions are drier sooner than their counterparts. And then from a PT session standpoint, thinking about asking what their current bladder and sexual function is, asking them about physical activity, mental health, objectively getting a measurement of the pelvic area, and helping them connect with that area a little bit more. Treatment-wise, we want to really harp on that education. about what the pelvic floor is, how it can help with their function, and also what to expect, possible side effects, modifiable risk factors, and then giving them homework to work on those deficits, and then finally scheduling that additional follow-up before surgery and then getting their post-op session on the calendar. My next podcast, I'm going to go into detail on what a post-op session post prostatectomy looks like. So tune in for that. And then if you want to learn more about pelvic floor examination, join us live. We have our next two courses. One is July 20th, 21st in Cincinnati, Ohio. And then July 27th and 28th, we are gonna be in Laramie, Wyoming. If you're wanting more of a virtual option, we have our two different courses that are eight weeks, L1 and L2. And in L2, we go over the male pelvic health conditions as well. Thank y'all so much for tuning in from my prostate slash walnut. Happy Monday, and I'll see you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. 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Dr. Dustin Jones // #GeriOnICE // www.ptonice.com  In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult division leader Dustin Jones shares tips to make HIIT more objective, being diligent with monitoring vital signs, and underdosing high-intensity with medically complex patients when needed. Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION INTRODUCTION Hey everybody, Alan here, Chief Operating Officer at ICE. Thanks for listening to the PT on ICE Daily Show. Before we jump into today's episode, let's give a big shout out to our show sponsor, Jane. in online clinic management software and EMR. The Jane team understands that getting started with new software can be overwhelming, but they want you to know that you're not alone. To ensure the onboarding process goes smoothly, Jane offers free data imports, personalized calls to set up your account, and unlimited phone, email, and chat support. With a transparent monthly subscription, you'll never be locked into a contract with Jane. If you're interested in learning more about Jane or you want to book a personalized demo, head on over to jane.app.switch. And if you do decide to make the switch, don't forget to use our code ICEPT1MO at sign up to receive a one month free grace period on your new Jane account. DUSTIN JONES Alright folks, welcome to the PT on Ice daily show brought to you by the Institute of Clinical Excellence. My name is Dustin Jones, one of the older adult faculty within the MMOA division. Today we are talking about the top tips to apply high-intensity interval training amongst medical complexity. So I think many of us have been there, right? We're working with that individual that has a whole laundry list of different diagnoses, different medications on board, maybe in a more acute setting. And we know that high intensity interval training is helpful for people. We've seen some literature, we've read some of the research, but what does it actually mean to apply this amongst a very complex situation? All right. So we're going to cover, some key takeaways from a super helpful article that was published last year in 2023 in the Cardiopulmonary Physical Therapy Journal titled, Putting It All Together, An Evidence-Based Guide to High-Intensity Interval Exercise Prescription for Patients with Complex Comorbidities. And I really appreciated the team that wrote this article because it is difficult to navigate, right? Like, we will see some of these headlines of high-intensity interval training proven to be effective in the ICU, for example, or HIT being effective with folks that have recently suffered from a stroke. Some of these things we typically wouldn't associate high-intensity interval training with, but it's been shown to be effective. Now, when we go to apply that, it can be rather intimidating, right? I can speak to this mainly from the home health setting where The trend in home health is that people are getting discharged from more acute settings like the hospital a little too soon, right? So you have these very medically complex individuals in their home with very limited monitoring, medical support if something goes awry, and all the negative thoughts and what coulds, right? What could happen starts to creep into your head, and that can dramatically influence our intervention. Let's talk about three, I've got three main tips for y'all, things that I have learned through mainly mistakes in my career, but then also what this article talks about. One is objectify, two is monitor, three is, I'm gonna save that one for last. BE OBJECTIVE WITH HIGH-INTENSITY TRAINING All right, so the first one, we go to apply high intensity interval training. We need to be objective. Here's what can typically happen. You read an article, you maybe hear a PT on Ice daily show podcast, see a social media post like, all right, I'm going to use this with Betty tomorrow. All right, Betty, we're going to do high intensity interval training. And you're already working on gait training, for example. with Betty and so you're going to be like all right Betty I want you to go fast for 30 seconds and then I want you to walk slow for 30 seconds we're going to do that for a total of 10 minutes right great start I love what you're doing there you got a one-to-one work rest ratio it's already a goal that Betty has to improve her ambulation ability, maybe even distance endurance. Awesome. But what typically happens, right? She goes to do her fast walk. What does that actually look like? Is it fast? Or is it just slightly faster than her normal or a slower walking speed? All that I'm saying here is when, say ambulation, when we aren't objectifying it, when we aren't giving people a number to hit, to look to, to get that real-time feedback loop, they will often undershoot their intensity. This is where the ergometers that many of us have access to can be very, very helpful. A lot of these things are, they're collecting a lot of dust in a lot of clinics, to be honest, right? Like the new step. It's either collecting dust or we're throwing people on there for 20 minutes while you finish your notes or they take a nap, right? We got our recumbent bike. Maybe you have a rower, maybe you have an echo bike, maybe you have a ski in your clinic, but these are functionally all ergometers that are measuring work, they're measuring speed, they're measuring distance traveled. Those are objective metrics that we can use for dosage, that we can use to give people that target to try and hit to make sure you're reaching an intensity. Right, RJ, outpatient, has an Echobike. Echobike, you look at that screen, you've got calories, you've got watts, you've got your revolutions, right? You've got your distance. These are all things that we can use to set a goal to achieve appropriate intensity while we're performing our intervals. So RJ, for example, with the Echobike, it may be watts, right? You may say, pick a number of watts that you're trying to hit. during that 30-second interval and then it's going to be 30 seconds easier, 30 seconds rest for maybe like a total of 10 minutes with someone. Giving them that objective thing to look at is going to be so much more effective than just quote-unquote saying go faster, all right? NuSTEP has the same thing, right? Many of you all have already, I shouldn't say wasted the money, the NuSTEP can be helpful with certain patient populations But my gosh, the price per square foot of a NuStep is absolutely ridiculous. But if you already sunk the money and have one, freaking use it, man. That thing has all kinds of data and information that we can use to really redeem the NuStep, redeem that piece of equipment and achieve a higher intensity. All right? That's the first one. We need to objectify what that high intensity actually looks like. Use ergometers. If you don't have the ergometer, maybe use something like a percentage of a heart rate, for example, some other metrics that we can use to objectify. MONITOR VITALS Speaking of heart rate, number two is going to be monitor. Now, this is what really allows us to apply higher intensity intervals with medically complex individuals, is when we are monitoring Vital signs and signs or symptoms. Vital signs are absolutely huge especially in so many acute settings. Hopefully many of you all are getting them at rest initially, hopefully at least bare minimum at the initial evaluation, right? But when you're working with more acute individuals, you have these complex comorbidities. We need to be checking vitals every visit, but then when we're applying these high intensity intervals, it can be very helpful and advantageous for you to check vitals before, during exercise, and then after to gauge their response. Now I'm not saying check every single vital sign, right? But there's gonna be some pertinent ones based on who you're working with, right? So like if I have someone that is constantly cruising, you know, in the 150s over 90s blood pressure, they're pretty hypertensive. It's not managed terribly well. They sometimes have some symptoms, but a lot of times it's asymptomatic. I'm going to be checking blood pressure pretty regularly. I'll also be checking their heart rate as well. And I can do that during, and before, during, and after an interval. That's where these ergometers can be really helpful. Like a new step, for example, when I program that interval, they're working hard, but then they have that rest. That rest is when we check our vitals. I'll support their arm, get a manual blood pressure reading, and you're going to be able to gauge their response and make sure that you're in a safe zone, right? And the way we like to think about these zones is we like to think about them as traffic lights. So there's a red light in terms of things that you may see where we're going to stop exercise and a yellow light where we're going to be cautious but proceed and then green is just full send. We go into those in our Level 2 course, related to resting vitals, exercise vitals, signs and symptoms as well, related to high-intensity interval training. But for our purposes here, we want to monitor during, so you'll have a good idea of how they're responding. Another one is if someone has some type of cardiopulmonary issue, then a pulse ox can be really helpful, looking at oxygen saturation. We can see their response, make sure we're good to go, and we can adjust our dosage based on that. when we're able to monitor those vital signs it's going to give you an objective view of what's actually happening and I don't know about y'all but here's what typically happens with me is I may throw someone on a new step for example a recumbent bike and we're doing high intensity interval training and I know they've got some cardiopulmonary issues on board, some things that I'm somewhat concerned about, and I literally tell them to go hard. I may give them, you know, hit this number of watts during these hard intervals, and I literally am closing my eyes, crossing my fingers, praying to the rehabilitation gods that something bad doesn't happen. But if we're able to monitor and get that objective information, you can rest assured that you're giving that person exactly what they need, and it is safe. UNDERDOSE THE HIGH-INTENSITY FOR MEDICALLY COMPLEX PATIENTS Alright, so first we need to objectify it, second we need to be able to monitor it, and then third and the counterintuitive one, but it's the reality when we're going to apply high-intensity interval training amongst medical complexity, is that we need to underdose. I hate to say it y'all, but we need to underdose. Oftentimes, I'm not gonna say always, but oftentimes these folks are have a lot on board, right? And from the medical side, but then also from the psychological side, you take someone that has been given the diagnosis of heart failure and imagine what that feels like, right? You may have some perspective of what that actually means, a prognosis of that and what people can continue to do with a diagnosis like that. But there's so many individuals that will get these seven syllable medical diagnoses and they literally view it as a death sentence and they're actively falling apart right in front of your eyes. And that is not necessarily the case. There's a lot of psychological damage as well as physical damage along with these medical complexities. And it can be very advantageous when you introduce something novel and new like high intensity interval training to do it in a very approachable manner. This is where I am typically when I'm introducing I may use something like a subjective report, like an RPE, a rating of perceived exertion. That goes against the first thing I said, right? I told you you need to objectify it, but maybe initially, we want them to be a little bit more in the driver's seat and give them that RPE. You may say, I want you to go hard, I want you to go fast, I want you to go at a seven out of 10, RPE of 10 is your all-out effort, right? Initially, I think that is helpful. But we don't want to stay there because most of the time, people's true high intensity doesn't necessarily match up with their perception of high intensity. And that's where we need to be objective to calibrate that. But initially, I think under dosage, self-report can be very, very helpful. We also need to consider what these high-intensity intervals can do to people outside of our session, right? I learned this the hard way way too many times in home health, where we'd have this epic session. We'd be gone for about 20, 25 minutes, high-intensity intervals, you know, doing steps or ambulation, and then we do some transfer training. I'd take them, walk them out to their mailbox and back. They haven't seen the sunshine in weeks. Man, it was an epic session. And then I come back in a few days. What has that person done since that session? Nothing, right? They weren't able to do their laundry. They weren't able to do any tasks around their home. they were laid up because I absolutely gas them. And so we want to be able to leave gas in the tank for many of these individuals to be able to do things that are really important to them like ADLs, like IADLs, maybe a certain social function, right? And so when we start with that under dosage, you will be able to tweak and progress without impacting the rest of their life too much. which is really important. Many of you all may not have experienced that, right? I think many of you all probably did MRF, right? Memorial Day, high volume, you're working real hard for, you know, 40, 50, 60 minutes, maybe more if you're me, right? How'd you feel after that, right? Many of you all, myself included, were absolutely wiped and that's what a 10-minute session can do for some of these individuals. SUMMARY So, We may want to introduce it in an underdosed manner, see how they respond, make it approachable, and then gradually progress it from there. Then we start to objectify it, give them that target for, I want you to hit this many watts, for example, or this many revolutions per minute. And then we continue to monitor their vitals before, during and after those intervals, and you've got a potent cocktail that can really influence people's functional capacity, but then also the disease process that they are suffering from, and most importantly, it can be safe. All right, let me know your thoughts. Let me know any tips that you have from applying high-intensity interval training amongst medical complexity. I would love to hear from the folks in the ICU, in acute care, in skilled nursing facilities, in acute rehab, where you're dealing with a lot of medical complexity. Love to hear from you all. Drop in the chat on this Instagram video, or if you're watching on YouTube, if you're listening on the podcast, we're grateful for you listening. Hop on social media, and I'd love to hear your take as well. Hope this was helpful. I'll also put the citation for the article, the really helpful article, in the comments on Instagram as well. All right, hope you all have a lovely rest of your Wednesday. Go crush it, and I'll talk to you soon. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

OT Pioneers: Intro to Pelvic Floor Therapy  opens Sept 16-20, 2024Introducing the Functional Pelvic Practitioner Levels and Certification - for OTPs Craving a Structured and Recognized Path to Specialize in Pelvic HealthLearn more about the Body Ready Method Pro training here.Pick up your recordings of the OTs in Pelvic Health Summit 2024 here. ($100 off + 1.6 CEUs!)____________________________________________________________________________________________Pelvic OTPs United -- Lindsey's off-line interactive community for $39 a month! Inside Pelvic OTPs United you'll find:​ Weekly group mentoring calls with Lindsey. She's doing this exclusively inside this community. These aren't your boring old Zoom calls where she is a talking head. We interact, we coach, we learn from each other. The power of these community calls is staggering. Plus, she's got a lineup of experts coming in you don't to miss (see the P.S.).​ Highly curated forums. The worst is when you post a question on FB just to have it drowned out with 10 other questions that follow it. So, she's got dedicated forums on different populations, different diagnosis, different topics (including business). Hop it, post your specific question, and get the expert advice you need.​ Private podcast. Miss a group coaching call? Not a problem, the audio is uploaded to a private podcast so you can listen on the go. Turn your commute into a transformativeMore info here. Lindsey would love support you in this quiet corner off social media! ...

We have a great new mailbag from Chris Young! Chris Young from metro Detroit here. My question is a simple one. Is Fabric soup yet? I know its GA, but do we trust it with production processes yet? My organization has not enabled it our tenant yet, opting to keep using ADLS and ADF for now for fear of instability. Is this justified? My boss and I are chomping at the bit to start using Fabric, but he's nervous. Help us out, please. Get in touch: Send in your questions or topics you want us to discuss by tweeting to @PowerBITips with the hashtag #empMailbag or submit on the PowerBI.tips Podcast Page. Visit PowerBI.tips: https://powerbi.tips/ Watch the episodes live every Tuesday and Thursday morning at 730am CST on YouTube: https://www.youtube.com/powerbitips Subscribe on Spotify: https://open.spotify.com/show/230fp78XmHHRXTiYICRLVv Subscribe on Apple: https://podcasts.apple.com/us/podcast/explicit-measures-podcast/id1568944083‎ Check Out Community Jam: https://jam.powerbi.tips Follow Mike: https://www.linkedin.com/in/michaelcarlo/ Follow Seth: https://www.linkedin.com/in/seth-bauer/ Follow Tommy: https://www.linkedin.com/in/tommypuglia/

Bone fractures can be devastating. They can decrease quality of life by resulting in decreased mobility, increased need for assistance with activities of daily living (ADLs), increased likelihood of institutionalization, increased risk of future fracture, and increased risk of death. People with MS are at increased risk for falls and increased risk of injury after a fall making the detection of osteoporosis even that much more important. Join Dr. Kathleen Burgess to learn about osteoporosis and what people with MS need to consider.

Our goal with OT when working with pediatric clients is to help the children and their families get through the day easier, learn the skills necessary for ADLs and IADLs, provide emotional regulation tools for all environments that the child is in, and ultimately be successful in all occupations of life that the child wants to participate in.Success is different for each child and each family which is why there's no one-size-fits all approach when it comes to treatment or discharge.In this episode, we discuss what to look for when discharging a client, the downsides of clients becoming dependent on OT services, home exercise programs, and more!Make sure to check out all of our links below!We'd love to answer your questions on the podcast! Fill out this form -> https://harkla.typeform.com/to/ItWxQNP3Brought To You By HarklaThis podcast is brought to you by Harkla.  Our mission at Harkla is to help those with special needs live happy and healthy lives. We accomplish this through high-quality sensory products,  & child development courses.Podcast listeners get 10% off their first order at Harkla with the discount code "sensory". Head to Harkla.co/sensory to start shopping now.LinksAll Things Sensory Podcast InstagramHarkla YouTube ChannelHarkla Website - Shop Sensory Products!Harkla InstagramPushing Through PlateausTips for Home Exercise Programs

In this episode, Wade and Alex introduce the long-awaited arc on long-term care planning. They discuss the importance of planning for long-term care and the impact it can have on retirement. They define what a long-term care need is and explain the activities of daily living (ADLs) that determine eligibility for long-term care benefits. They also highlight the distinction between ADLs and incidental activities of daily living. The episode concludes with a preview of the next episode, which will cover the costs and prevalence of long-term care. Listen now to learn more.   Takeaways Long-term care planning is a crucial aspect of retirement planning, as it can have a significant impact on financial security and the well-being of individuals and their families. A long-term care need is defined as requiring assistance with activities of daily living (ADLs) for more than 100 days. The six common ADLs include bathing, continence, dressing, eating, toileting, and transferring. Cognitive impairment, such as dementia, may also trigger the need for long-term care, depending on the policy's definition. It is important to distinguish between ADLs and incidental activities of daily living, as only ADLs typically qualify for long-term care benefits. The next episode will cover the costs and prevalence of long-term care, providing further insights into planning for this important aspect of retirement. Chapters   00:00 Introduction to Long-Term Care Planning 03:01 Personal Experiences and the Importance of Long-Term Care Planning 08:58 Budgeting for Long-Term Care 14:12 Determining the Amount to Set Aside for Long-Term Care 21:36 The Demographics and Increasing Need for Long-Term Care 26:39 Defining a Long-Term Care Need 27:56 Activities of Daily Living (ADLs) and Cognitive Impairment 32:46 Incidental Activities of Daily Living 36:53 Summary and Next Steps   Links  Join the waitlist for the next Retirement Income Challenge by visiting risaprofile.com/podcast  The Retirement Planning Guidebook: 2nd Edition has just been updated for 2024! Visit your preferred book retailer or simply click here to order your copy today: https://www.wadepfau.com/books/    This episode is sponsored by Retirement Researcher https://retirementresearcher.com/. Download their free eBook, 8 Tips to Becoming A Retirement Income Investor at retirementresearcher.com/8tips

In this episode I sit down with Dr. Lori Brotto; Professor in the UBC Department of Obstetrics and Gynaecology, Registered Psychologist and Executive Director of the Women's Health Research Institute of BC and Principal Investigator in the HER-BC Research Study on Midlife Women and Menopause to discuss:The impacts of perimenopause/menopause on midlife women The lack of current researchAims of the HER-BC Research Study on Midlife Women and Menopause:To describe the health experiences and behaviours of midlife women (aged 39-60)Impacts on QOL and ADLS including caregiving and workHealth-seeking experiences and behaviours The barriers to obtaining care Ways this data may be used:Demonstrate that care providers require more trainingInform insurance providers Improve health care Eligibility criteria: Between the ages of 39 to 60Residents of BC; andAssigned female at birthIdentify as a woman or gender diverse or transVisit the study website here: https://whri.org/our-initiatives/her-bc/Support the show

Dr. Alexis Morgan // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Alexis Morgan discusses the essential, yet often overlooked as aspect of early postoperative care. Alexis explores the wide range of concerns and adjustments individuals face postoperatively beyond the usual need for return to exercise. From emotional and mental health needs to navigating the logistics of daily life, we share valuable insights on how to care for individuals early postoperatively. Save this podcast and share it with your communities to educate them, and let them know what an early postop visit with you might would look like too! Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. In today's episode of the PT on ICE Daily Show, #ICEPelvic division leader Alexis Morgan discusses the essential, yet often overlooked as aspect of early postoperative care. Alexis explores the wide range of concerns and adjustments individuals face postoperatively beyond the usual need for return to exercise. From emotional and mental health needs to navigating the logistics of daily life, we share valuable insights on how to care for individuals early postoperatively. Save this podcast and share it with your communities to educate them, and let them know what an early postop visit with you might would look like too! Take a listen to learn how to better serve this population of patients & athletes or check out the full show notes on our blog at www.ptonice.com/blog. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION INTRODUCTION Hey everyone, this is Alan. Chief Operating Officer here at ICE. Before we get started with today's episode, I want to talk to you about VersaLifts. Today's episode is brought to you by VersaLifts. Best known for their heel lift shoe inserts, VersaLifts has been a leading innovator in bringing simple but highly effective rehab tools to the market. If you have clients with stiff ankles, Achilles tendinopathy, or basic skeletal structure limitations keeping them from squatting with proper form and good depth, a little heel lift can make a huge difference. VersaLifts heel lifts are available in three different sizes and all of them add an additional half inch of drop to any training shoe, helping athletes squat deeper with better form. Visit www.vlifts.com/icephysio or click the link in today's show notes to get your VersaLifts today. ALEXIS MORGAN Good morning, YouTube. Get Instagram going here. Good morning. Welcome to the PT on Ice Daily Show. Happy Monday. My name is Dr. Alexis Morgan, and I am one of the faculty with Ice Pelvic. In our pelvic division, we enjoy talking about all things around exercise. And, you know, if you are part of ICE, you know that and understand that. But sometimes our reputation scares people. It might scare our community like, oh, that's the exercise person. They're definitely going to make me exercise immediately. Today's topic is surrounding non-exercise topics for that early post-op care. non-exercise topics for the early post-op care. This is incredibly important, maybe because of the reputation that you have in your community, which if you have that, great, so do I. Awesome reputation to have. However, we need our potential patients, we need our clients, we need them to understand a lot of the things that we can do early post-operatively that don't necessarily involve exercise. And that's not just to get them in the door, but that's also because there's a huge role that we play in early post-op management. Now I'm discussing this with the lens of early post-op post C-section or post-op post hysterectomy or any of these post hernia surgery, any kind of core and or pelvic floor, pelvis type of surgery. That's the lens that I'm going to be discussing this in. However, I will say this is going to be in many of these cases pertaining to really post-op, any surgeries. And we've had a couple of great podcasts on this topic. And Lindsey Hughey has one that comes right to mind on things that we can do to educate to reduce inflammation postoperatively. But I'm going to add a couple other things to that list. So let's go ahead and jump right into those. ASSESSING VITAL SIGNS So number one, we need to be assessing vital signs. This is incredibly important in the postpartum period as maternal death rates are actually increasing in America. And for black women, maternal death rates are three times the rate as white women. Many of these are because of some type of cardiovascular event. We have got to check blood pressures. And in many cases, we as the conservative care providers, those physical therapists or rehab providers, we're some of the only ones that are checking postpartum. Or we might be able to catch something very soon before they might have a six or eight or 12 week follow-up postpartum. we've got to be checking their vital signs and assessing and making certain calls when necessary. That is absolutely important and definitely not exercise related at all. We can get them in and get their blood pressures checked. OWNING SCAR MANAGEMENT Additionally, we, we assess sutures or incision sites or whatever whether that was an abdominoplasty where they have an incision from ASIS to ASIS, whether that is a C-section incision, a little bit smaller, more midline, or that might be smaller little incisions all throughout the belly from some type of laparoscopic surgery. Whatever the case, We, as their rehab providers, assess that incision. We're gonna look for signs of infection and we're also educating about those signs of infection. We're assessing to see how the patient feels about it. Maybe we need to set some expectations surrounding what the C-section scar or what any of these scars are going to look like in a month and in six months. And with that, we can go ahead and begin some scar mobilizations. Now, very early postpartum, we're still in the proliferation phase, inflammation, then proliferation, and then maturation. We're still in that proliferation phase, so we're not gonna be doing scar mobilization on the actual scar, but we can come inches above and below and surrounding. We can teach them how to pull on their skin and press on their skin well away from the scar to go ahead and begin that desensitization. That is incredibly valuable. And just going ahead and painting the picture of what that scar rehab is going to look like over the next three to four months. Many individuals have a lot of fear and concerns surrounding the scar. And we are the best people to be giving them home exercise program, these interventions and helping them understand what it's going to look like. We know we're the rehab providers that have seen this all along the way in several other of our patients. So we can help them understand what to expect and If there's concerns where we need to refer to a mental health provider, then we're absolutely going to do that. That is completely within our realm to assess that and to refer out. And what a great opportunity to help someone. Body image is rather difficult. It always has been, but with social media and the way the world that we live in right now, It is incredibly difficult. And so we need a lot of times mental health providers to help us navigate that. So first we talked about vital signs. Now talking about sutures, we can absolutely discuss fueling. That's the podcast I mentioned with Lindsay Huey, so I won't jump into that necessarily. ASSESSING DAILY FUNCTION But next is ADLs. I was just looking through my messages, some screenshots that I've saved from various, um, various people who have messaged me about, um, pelvic floor related topics. And what I saw was this message from someone who said, I just went to my, uh, follow-up and they told me not to lift any weight. And the person asked, can I lift my baby? And they said, no. Now, obviously this is hopefully a one-off. Hopefully that word is not being said. And who actually, I don't know if the doctor actually said that, but the point is, is that this individual did think that that's what the doctor said. We are here to help them understand how can they be safe? How can they hold their baby? How can they get out of bed? How can they bend over and get the clothes out of the dryer, out of the washer? We can help them navigate these things. This is a great opportunity for occupational therapists as well. We can lean into their expertise here. Helping individuals with these ADLs can be really valuable for these individuals and can help them feel more confident in their body in that early postpartum period. Sometimes they just need to share their story. I think a lot of times we as rehab providers really feel this urge to do, do, do, put hands on, give home exercise program. I need you to do all three of these. We feel like so rushed in order to provide and sometimes The best thing that we can provide is a listening ear, is someone to be someone who can just ask questions about their surgery, about how they felt, about how they felt going into that and how they felt coming out of it. That can be incredibly helpful. ASSESSING READINESS TO EXERCISE While we're talking about non-exercise plans, I said that we wouldn't be doing exercise, but I didn't say that we wouldn't be talking about it. So when we have someone early postpartum, they might be an exerciser and they might be saying, oh, I'm not ready for exercise just yet. Well, that's okay. Let's talk about what does exercise mean to you? What does readiness look like to you? What do you want and what are your timeline expectations? And do they match up with what we have seen or what we expect? Having a conversation about an exercise plan and exercise expectations can be incredibly helpful. Some people may not understand that they can go ahead and start to move now. and they think exercise is any type of movement, and we can kind of break that down. We can discuss different exercises that individuals can do or that this person in front of us can do in this early time, like walking or some basic hip exercises or arm exercises. A lot of times there's several restrictions surrounding surgeries. But just because there's restrictions doesn't mean that there has to be zero exercise. So we can discuss that plan and kind of help them understand what that overarching picture of exercise and health looks like. I already mentioned one referral, but there are several other referrals that we can also make. So in the postpartum realm, referring back to their provider, their OB or their midwife. We can refer to a lactation consultant, to mental health providers. Postpartum doulas are another great referral source, particularly for people who are postpartum and maybe don't have a lot of family nearby. There are so many ways in which we can help people and We don't hold the keys to everything. I can't help with mental health. I can listen, but I don't have all of the tools, but I can absolutely refer to somebody who does. And together we can work to get this person in front of us feeling really good. SUMMARY So vital signs, checking the sutures or those incision sites, discussing fueling, helping them with their activities of daily living, their ADLs, listening to them, listening to their story, figuring out an exercise plan and referring out. The last thing I'll just mention here with pelvic floor and particularly with postpartum, we're gonna discuss with them expectations surrounding those. That's a whole nother podcast for another day, but discussing the expectations surrounding bleeding postpartum, leaking heaviness and pain and giving them what to listen to when we say, listen to your body, giving them a key to understanding what that exactly means. That way, once again, they can be successful. So that's just a little sneak peek into a whole lot of what you're going to learn if you take our online level one course. Our next cohort for our online level one starts March 5 so upcoming in one month at the beginning of March. It is going to sell out, just like this current cohort did so if you're on the fence about it, I recommend going ahead and purchasing that ticket because. If you wait too long, you're not going to get a seat. And we are very strict on keeping our student to faculty ratio at an appropriate level. That way you get your questions answered and you get the care that you need as you're learning from us in the course. So sign up for that. And we also have our first online level two course coming up at the very end of April. And so you're not going to miss that. Once again, that is definitely going to sell out. We are still months away from that, but only a few few seats remain for that. We're going to shut that one down pretty soon. So if you're on the fence about the online level to go ahead and sign up for that one. We are all over the place in twenty twenty four. Our next upcoming cohorts. for our live course. We're going to be in California, North Dakota, South Carolina, and Colorado. Those are our upcoming next courses, all in March and April. So be sure to check us out on the road. And remember, when you do all three of these courses, you are eligible for the ICE certification certified in pelvic. We are here to change the game when it comes to pelvic floor health and pelvic floor rehab. And we need more of you. So please consider hopping on the train, coming to our courses. We know you're going to have a great time. Thanks for being here this morning and listening with me. Have a great rest of your day and we'll catch you next time. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review, and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Today, in part one of our two part series, we're taking a close look at the methods for performing pre-operative functional capacity assessments and their utility in predicting patient outcomes. In part 1, we focus our discussion on METS, activities of daily living (ADLs) and the DASI score.In part two - which will be released in a fortnight - we'll cover the M-DASI, the 6-minute walk test.Resources for today's episode:BJAED: Subjective methods for preoperative assessment of functional capacity by Silvapulle & DarvallBJA: A simplified (modified) Duke Activity Status Index (M-DASI) to characterise functional capacity: a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) study by Riedel, B. et al.BJAED: Preoperative cardiopulmonary exercise testing by Agnew. N.BJA: Using the six-minute walk test to predict disability free survival after major surgery by Shulman, M. et al.STAT Pearls: 6 minute walk test by Matos Casano, M. & Anjum, F.Feel free to email us at deepbreathspod@gmail.com if you have any questions, comments or suggestions. We love hearing from you! And don't forget to claim CPD for listening if you are a consultant or fellow. Log us as a learning session which you can find within the knowledge and skills division, and as evidence upload a screenshot of the podcast episode. Thanks for listening, and happy studying!

Have you ever wondered how much you can actually do as an SLP when it comes to dementia care? One of the most common misconceptions about dementia care in general is that not much can be done. It's a progressive disease after all, right? This is where medical SLPs can shine, and Adria Thompson, MA, CCC-SLP is here to talk about it! Adria is a dementia consultant who teamed up with an OT to create a dementia program and traveled around to different facilities to teach this program. In this week's episode of the Swallow Your Pride Podcast, Theresa and Adria explore the importance of understanding dementia stages and supporting caregivers. They address misconceptions about therapy for patients with dementia and cover recent changes in billing that allow for caregiver training without the patient present, including the potential for caregivers to receive financial support for their services.  If you support individuals with dementia and their caregivers in any capacity, you won't want to miss this episode! Get the show notes at: https://syppodcast.com/312 Timestamps: The need for better dementia care (00:02:36) The role of speech therapists in dementia care (00:07:01) Understanding dementia staging (00:10:10) Caregiver support and collaboration (00:14:27) Challenges of caregiver role (00:19:01) Therapist-patient communication (00:19:22) Billing for caregiver time (00:21:25) Caregiver payment and reimbursement (00:23:09) Medicare and Medicaid services program (00:24:54) Support for caregivers (00:25:18) Speech-language pathologists in hygiene ADLs (00:27:19) Communication issues in hygiene ADLs (00:29:06) Training and competence for SLPs (00:32:07) Communication intervention in hygiene ADLs (00:33:49) Challenges and learning experiences (00:36:27) Role of SLPs in caregiving (00:37:09) Therapist Collaboration (00:37:22) Collaborative Care (00:40:20) Specialization Communication (00:42:26) Encouraging Learning (00:44:07) The post 312 – Navigating Dementia Care as an SLP: Tips and Insights from a Dementia Consultant appeared first on Swallow Your Pride Podcast.

There are many strategies to filing a successful Long-Term Care Insurance claim.I chatted with Dwight Smith, the owner of AMADA Senior Care Columbus & Toledo, about the LTC insurance claims process.In this episode we covered:

In this episode, we welcome student athlete Sami Phelan to the show to discuss her experience of recently committing to play D1 ice hockey in New York and how she has achieved this goal.  In this episode, we also chat about balancing school and sports, how ADLS has helped her with that balance, facing adversity and doubtful people, anticipation of playing D1 sports, and much more. Tune in to hear more from Sami!  Connect with the hosts: Learning Reimagined Podcast Instagram  Allison's InstagramSandy's Instagram  AdvantagesDLS Instagram  Advantages DLS Website

Dr. Zac Morgan // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Spine Division division leader Zac Morgan discusses the importance of working with patients to dispel negatives beliefs & fear concerning movement aggravating symptoms. Zac describes different strategies to discuss with patients how not moving after surgery or while in pain is probably the riskiest decision.  Take a listen or check out the episode transcription below. If you're looking to learn more about our Lumbar Spine Management course or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 - ZAC MORGAN Good morning PT on Ice Daily Show crew. I'm Zac Morgan, so I'm lead faculty with the spine division. I teach lumbar and cervical spine management, so you can find me on the road doing those things. Shout out to that crew in Hartford, Connecticut or Waterford, Connecticut this last week. We had a good time learning about cervical spine over there in Waterford. Few more courses on that note coming up this year that if you're trying to jump into either cervical or lumbar, just wanted to point you in the direction of. So November 11th and 12th, we'll be back in that Northeast region up in Bridgewater, Massachusetts for cervical spine. December 2nd and 3rd, Hendersonville, Tennessee for cervical spine. And then if neither one of those work for you, the next chance will be at the turn of the year on February 3rd and 4th over in Wichita, Kansas. If you're looking for lumbar spine management, we've got three different courses this year that are all still have tickets available. Frederick, Maryland, that's next week or this upcoming weekend, October 21st and 22nd. Then we've got November 4th and 5th. That'll be over in Fort Worth, Texas. And then lastly, Charlotte, North Carolina on December 2nd and 3rd. So still several Good offerings if you're looking for cervical or lumbar spine management. We've already got quite a few booked for next year as well, so if this year the calendar doesn't work out or if the Con Ed budget resets at the beginning of the year, Take a look at the 2024 course offerings as well and more to book there. 01:36 - CATASTROPHIZING REST So team, this morning I wanted to talk to you all a little bit about rest and why I think we need to catastrophize rest. I think we need to make a bigger deal out of it when our clients come in and we find out that they've been resting. So let me talk a little bit about this. I've been chewing on this idea for a while and I think it's important for us to sort of understand that when someone's in pain, their risk meter is broken. Like they don't have the ability to conceptualize what's actually risky for them often when they're in pain. And so let me unpack what I mean with maybe a clinical scenario that we're all really familiar with. Let's think about something like a knee replacement. I think most of us in our career will interact with patients who have had a knee replacement. Usually we have interacted with those people on the days right after they have had a knee replacement or maybe you're the one that's getting them out of the bed in the hospital and you're the first person that's getting that person moving. I think we understand the risks to this person pretty well, and as a profession, we respond to them pretty well. We understand what this person's actual risk is when it comes to the knee replacement, and their risk would be being too sedentary or resting too much. And what would come alongside of that risk would be a lot of problems that we'll cover in a bit. You think about what that person's concerned about when you talk to that person in the subjective exam on day one, or maybe you just went into their hospital room and you're talking to them. That person's usually concerned about things that are unwarranted. They're worried that their knee is gonna pop out when you start to flex it. The first time you have that person do active range of motion, that person's like, oh my gosh, is my knee gonna fly out? Is the implement actually gonna pop out? They're worried about things like that, but we as PTs, we know that's not very common. We tend to mobilize knees really early and get them moving really, really rapidly and get as much range of motion as possible as quickly as possible in something like a knee replacement because we know that it's crucial that that happens at short term. So a large part of our job early on in managing this person who has just had a knee replacement is convincing them that their risk meter is off. Again, they're afraid to move. They walked through the door that day with a lot of blood in their amygdala. They were very concerned. They were worried, what if something's going wrong? I didn't know it was going to hurt this bad. I didn't think it was going to be quite like this. And they have typically not been moving as a response to all that pain. 03:22 - CONVINCING PATIENTS TO MOVE And our job is to help them understand that, hey, if you don't move, that's where the risk lives. The risk lives in being sedentary after a knee replacement. Like what's actually risky is if we don't move, the blood will pool, right? And we will wind up with things like a blood clot. Very risky. If a blood clot ends up dislodging and we end up with a pulmonary embolism, that's life-threatening. So that's real risk. That's something that we have to help those people understand is like, hey, if you're too still, we could wind up with something like a blood clot. And maybe we don't fear-monger that to patients, but we do help them understand that risk. You think about some of the other risks that that person has if they don't get moving. What about long-term mobility? If a knee replacement patient does not get their knee moving, you think about what that person's long-term mobility is gonna look like, and it's gonna be quite poor. That first 12 weeks after knee replacement is the most important time for us to restore full extension and get as close to full flexion as we can. We're really trying hard to push range of motion early because we know that person's long-term risk is having a stiff knee. and then not being able to participate in some of their ADLs because of the immobility in their knee. We get the risk so we help unfold that to the people in front of us. I mean the last big ones that happen if someone rests are things like atrophy or loss of cardiovascular endurance and we know this happens very very rapidly. when someone's on bed rest, when someone's immobilized, when somebody's truly sedentary or even sedated, things like that. We know the body responds and we see wasting of all those systems. The same thing's happening if someone doesn't move when they've had knee replacement. maybe not as rapidly as true rest, but we know that they're losing muscle mass, we know their muscle girth is going down, we know their endurance is getting worse. All of these things are truly risky for that person. And for that reason, I think we as PTs do a really good job of helping that person understand, hey, I know it hurts, but the risk of you moving through pain is much less than the risk of you not moving through pain. So I need you to move. And I think we do a really good job with patients like knee replacement patients or patients with a knee replacement. I think we do a really good job with those folks, getting them moving, even though it hurts, getting them back to their ADLs, getting them progressively loaded back to where they're out of sort of disability. I want to shift gears now. And I want to talk a little bit more about my expertise area, which is cervical spine and lumbar spine. So patients with neck pain and patients with back pain. That's typically who I'm seeing the most of in the clinic these days. And I think our response to these folks is a bit different than it is with the knee replacement patients, which is sort of understandable, because with a knee replacement, you understand exactly what happened to that person, where with back pain and neck pain, we never know what the tissue driving their symptom is. 06:57 - FEAR & OUTCOMES WITH BACK PAIN But I think we often respond with fear, and I think that influences the person's outcome. So let me unpack what I mean. So when someone acutely strains their back, they do something, they were lifting their kid and something happens and now their back is really strained and they're in high, high levels of pain and usually high levels of disability as well. Like a lot of patients will tell me, Zach, I can't even tie my shoes. I have to have my wife help me tie my shoes. I can't get my pants on. I can't get on and off the toilet. The activities of daily living are really influenced by these high pain levels. And a lot of these people, when you start to talk to them, they're terrified to move. Especially a forward bending, but really just to A lot of people in general with acute back pain, they're so scared to move their back around. And they're afraid that what will happen if they move their back around, is that they'll worsen their scenario. They're concerned that if they move too much, and maybe some of this is valid, but if they move too much, they'll worsen whatever's wrong with their back, and then they'll have long-term problems. But team, as you're hearing that unfold, you and I both know that's not the case, right? Like it's actually the people who choose not to move who usually wind up with worse recurrence of their back pain. It's why, I mean, you look at the Olivera study in 2018, where they compared all the lumbar clinical practice guidelines around the globe that they could get their hands on. And there's really only two things, all CPGs, not profession specific, um, not region specific, just all the CPGs that they looked at in that study, they agreed on two things. One of them, don't image. The second one, get moving, right? Don't rest, some sort of exercise. We know people with back pain need to get moving. It is clear, no one argues about that anymore. There's no studies, no big studies that have looked into, hey, rest is actually the successful recipe for back pain. It's not that. We gotta get them moving. But I think sometimes we let our fear of allowing that person to move hold them back. But we need to conceptualize those risk factors. Like you think about what it was like for your knee replacement patient. Maybe we don't have the same concern of like a blood clot or an infection, but think about this person's other risks. 06:57 - THE IMPORTANCE OF MOVEMENT Like, what about long-term mobility? If someone doesn't restore their ability to forward bend, they often end up with a loss of long-term lumbar flexion. And how does that usually wind up? Maybe sometimes they're fine and they're asymptomatic throughout the rest of their life, but often when I see recurrent back pain patients, They have had episodes throughout life and they've chosen to avoid a certain range of motion and part of our job is to do some graded exposure back to that to help them conceptualize the risk. To help them realize actually being still is where the risk is. We've got to get moving. You think about atrophy. You think about what happens to that person's muscular system. If they have severe back pain and they're not doing the things that they normally do, perhaps they're laying in bed a little bit more, sometimes they're laying on the couch a bit more, a lot of times their spouse is helping them out, their partner is helping them out with a lot of their ADLs. Team, when people have acute back pain, they often get very still because their fear level is really high, and part of our job is to help them understand that where their head is at, what they're concerned about, is actually much less risky than being still right now. Being still is where the risk lies. If we don't get back to movement, you're going to lose that long-term mobility. You're going to lose a lot of your muscular system. You're going to end up losing quite a bit of your cardiovascular endurance. That's where the risk lies. Because what do we all know about people who tend to lose muscle mass, who tend to lose cardiovascular endurance? Most of those people will struggle to get that back. And I think the longer they live, the more challenging that climb back to fitness is going to be. So our older adult clients are definitely in this boat. We've got to keep these people moving. We've got to get them afraid of resting. That's where the fear should be because what happens when you rest is the long-term stuff. That's what causes recurrent back pain. If a person hurts their back and they're now afraid to move in that range of motion and they don't restore capacity, whether that's cardiovascular capacity or the actual strength of the tissues because of fear, now that area is more fragile. It's more susceptible to injury. They're usually careful with that area and being careful with that area often is not a solution for getting rid of a recurrent back pain. As a matter of fact, we want to move more towards things like graded exposure, graded exercise, building that engine, building the tissues, how robust that underlying tissue is. That comes with movement. It doesn't come with rest. So team, I think just putting this whole thing into perspective, what I want to get across this morning is that when someone comes in to see you in pain, their brain is not in the right decision making area to understand risk. Their amygdala has all the blood in it. They're really concerned. they don't know if they're going to be okay. It is our job to use our prefrontal cortex because we can use that in that state because we're not anxious because we see this all the time. We use our prefrontal cortex to say, you know what, actually we need to develop a plan that gets you back to X, Y, and Z. And that's what we do with rehab. And that's how we try to bring down that recurrence, is we avoid all these catastrophes that happen when people sort of follow their natural instinct, which is to rest. So that's all I've got for you this morning. I want us all catastrophizing rest a lot more on our patients, helping them understand that that is not necessarily the safe choice. A lot of times people's risk meter is broken there and it's actually the unsafe choice. So let's catastrophize rest, get out there this Tuesday team, meet us on the road if you're looking for anything. Please feel free if you want to have a big conversation here, jot it into the thread and I'll be on here all day answering any questions. Thanks team. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.

Episode 69: Find Balance as a Mom with a Demanding Career with Dr. Bonnie Koo   Join Dr. Prianca Naik on the Empowering Working Moms Podcast! In this episode, she and her special guest Dr. Bonnie Koo discuss various topics ranging from how important it is to take care of your mental health to how doing so creates a positive model of behavior for your kids. Dr. Naik and Dr. Koo invite you to learn about investing time into yourself in order to build a life you don't need a vacation from.   In this episode, you will learn: Take time for yourself: This gives you time, space, and a breather to get clarity in what you want to do with your life. Get coached: Dr. Bonnie emphasizes the importance of seeking coaching, therapy, or other forms of support for your mental and emotional health. Coaching can help you understand how your thoughts create your feelings and how to navigate life's challenges. Take Solo Trips: Taking solo trips or spending time alone can be rejuvenating. Whether it's a weekend getaway or a spa resort experience, dedicating time to yourself allows for reflection and self-discovery.  Start with a dinner if that's too daunting. Focus on Emotional Regulation: Dr. Bonnie also highlights the significance of focusing on emotional regulation, especially for parents. Teaching children how to handle their emotions and modeling healthy emotional regulation is vital for their growth.   To end burnout and exhaustion and get your peace of mind back, check out her free masterclass on 4 steps to overcome burnout, get rid of overwhelm, and get your peace of mind back. https://program.stresscleansemd.com/4-secrets-to-living-a-life-you-ll-love-podcast   If you want to work with Coach Prianca Naik, MD, go to www.priancanaikmdcoaching.as.me to book a 30-minute consultation call.   Follow Dr. Prianca on social media:   https://www.facebook.com/prianca.naik   https://www.instagram.com/doctorprianca   https://www.linkedin.com/in/prianca-naik-md-0524a196/   Join her FREE Facebook group:   https://www.facebook.com/groups/646992382603860   Follow Dr. Bonnie Koo on social media:   Instagram: https://instagram.com/wealthymommd or @wealthymommd   Facebook: https://facebook.com/wealthymommd   Website: https://wealthymommd.com     [FULL TRANSCRIPTION:]   You're listening to the empowering working moms podcast episode number 69. Today I am so excited to have a special guest coming to us on this podcast, Dr. Bonnie Koo. She is a master certified life coach, physician, and founder of Wealthy Mom, MD.   She's a money coach for women physicians, and a proud graduate of Barnard College and Columbia University's College of Physicians and Surgeons. She is the host of the WealthyMomMD podcast and author of Defining Wealth for Women: Peace, Purpose, and Plenty of Cash. She currently resides in northern jersey with her family. So let's get to it and dive in.   All right, I am so excited today because I have a very, very special guest. Her name is Dr. Bonnie Koo. She was actually a coach of mine, and I'm thrilled to have her here. She's been doing amazing things and really thinking outside the box, which is what I want to dive into today. So welcome, Bonnie. Hey, there. Thanks so much for having me. Yeah, it's great to have you on. So I wanted to ask you, I know you're a dermatologist by trade, what really led you to becoming a coach?   Yeah. So I'm just laughing because like, it was not what I was expecting. I think that's the story for a lot of us. It's not like we were like, let's go to medical school or whatever career and then let's just change your mind a few years into it, right? Like, I don't think any of us had that goal. And so, I mean, the short story is that I was learning about money just for myself, because I realized I had no idea what I was doing. And then I was in a Facebook group of other physicians and it was for money, specifically. Just a community group where people were helping each other out.   And then I noticed that I was answering all the questions, and then people started tagging me, this was just fun for me. And then someone was like, why don't you start a blog? And so I did. And then it just went on from there. And then I just started getting asked to speak. And then I started working with a coach because to me, this was just a hobby. And then eventually, I got to the point where I had to either let it go, because I just had my son who's now six or make it a business, although there's obviously a lot of options in between, but those were the two options in my head.   And then at some point, I just decided, it wasn't like there was a specific reason if I'm perfectly honest, I was like, why not? The worst that can happen is that it fails and I'm still a doctor. Yeah, being a physician is not a bad fallback career, I suppose. I'm sure people are thinking that. Okay. So the personal development is the hobby, right? Which leads you to something that you're really enjoying, and then you make a decision to monetize it.   So what I think is really remarkable here, and why I really wanted to have you on the podcast is what gave you the courage to step out of that box, because there is pretty much, with or without people acknowledging it, there is kind of a box that physicians are put into or whatever box you might be in, in your culture, and just having the guts to step outside of that not really knowing what comes next.   Yeah, that's a great question. I think for me, I started meeting other people doing similar things. And so there's a conference called fincon, it's like in the fall of every year, it's probably like, happening this week or last week. And it's where all the people in the finance media world come together. And so I started to just meet other people who are doing this, including other doctors, there were a few other doctors. So I think just having that community, it was small, but just other people doing it. So like, I wasn't the only like weird and crazy person doing this. I think that was helpful.   And then honestly, working with a coach, like she helped me navigate the decision. And then once I decided to do a business, she helped me figure out what I could or couldn't do. And she also pointed out some things that maybe I wasn't thinking of, she's like, you have basically been building an audience for the past two years, not like on purpose, but just because I've been just helping people. And so she was like, you're in the perfect position to monetize it, if you want. And then I was like, okay. So it's interesting.   And then I took all these courses on how to learn how to run a business, because I didn't have any business skills. And so why would I Google it myself? I feel like a lot of people do this. I'm like, why would I Google it like people already know how to do this. I'm just gonna learn from them. I don't know if I'd describe it as courage. I think again, it's like being surrounded by these people. So it was almost like normalized that you can do this.   But what's really fascinating in life in general, is that a lot of us think that, especially physicians, you go to college, you go to med school, you pick a speciality, you go into residency, maybe fellowship, and then you work and then it's going to be a steady income, and all the steps are there.   So it feels so certain, even though you do have to pass the boards and do a lot of steps along the way. So it isn't actually certain but this false sense of certainty that we have in our careers, as opposed to being an entrepreneur, which just by nature is much more shaky, and it's more obvious that step A is the opposite of certainty. Exactly right.   So it's a lot of trial and error or failing forward or any of those concepts. So that is why I bring up the courage piece. Where of course, stepping into the unknown pretty much we're doing that all the time. We have no control over what the future holds.   Right, but at the same time doing something that's so different from what you're used to, or what you've been taught, or what you thought your life was going to be, and really just going for it, I think is really inspiring for people like, and that's why I say courage because for many people staying in the status quo, no matter how boring or dissatisfying or even malignant and might be, they'll stay there because they're terrified of the change. So yeah, can you relate to any of that, or can you elaborate on?   Yeah, well, here's a few things that I didn't mention. So two things is I had a different career before medical school, I was a non traditional student, I worked at Morgan Stanley, not in finance, but I worked in IT. And so I didn't have this like identity of just being a student. So I think that's part of it. The second thing is right after college, I did some pretty intense personal development work. And so I say that because I think I was already sort of more open minded that things can change, and that people do this, if that makes sense. Like, I'd forgotten about it. And I feel like I regressed during medical training.   But I think that's also why when I started working with my first coach, it was just really clear to me like, oh, yeah, remember this work, and just how fun it is to always be growing. Because I think what happens is, whatever career you choose, you become stagnant at some point, right? Because like in med school, it's like, we're learning all these new things, and you have residency, you're learning all these new things. And the first year or two of being attending is also exciting, right? And I feel like a lot of doctors get bored after like, three to five years, sometimes earlier.   Well, there's nowhere to go. The beauty of medicine is it is a steady job. People will always need doctors. But at the same time, there's not that much upward growth, like you're a doctor and you're doing the same thing more or less, unless let's say you're managing your practice, and maybe you work less, or maybe you become an entrepreneur on the side, but just straight being a doctor, you're going to do the same thing in your 10th year that you're doing in your first or second year. And that, I agree, like you kind of just hit like a plateau there and you aren't really growing in your career, per se.   Yeah. And I think that's when a lot of people get. They talk about the seven year itch and marriage, but I feel like it's more like a three to five year itch in medicine. I think people look around and are like, oh, is this it? Because I think we all thought like once we became attendings that we would live happily ever after, basically. And then we learned that's not a thing, and then we're really disappointed.   Correct. And then the beauty is you have the steady income. And sometimes you can, well that's the work that you do, which feel free to talk about that. Like so, you have the money. And then what do you do with it? You have the luxury of maybe making your money work for you? Yeah, I mean, so I coach people on money. But what I realized after doing this for some time is it's not just about the money because you can have all the money in the world. But if you're an unhappy person, it doesn't matter. Right, you can take nicer vacations and eat at Michelin star restaurants, I guess, right?   So I really try to teach my clients money is a tool to help you do things, it is very useful, obviously. But also money is not going to make you happy. And because we all know that technically, but we really think we'll be happier with money, like certain things are possible. And certain things are more fun.   Like I love traveling first class, like I definitely am happier while flying first class, right? Like, there's no doubt about that. But those experiences alone aren't going to make my life rich and fulfilled. So I really try to help my clients do a little bit of both. And that's mainly from like the coaching because once you get coached on one area of your life, it kind of filters into other areas of your life.   I was laughing about the first class business class flying, laughing silently, but what that brought up for me was that those kinds of experiences are transient. Right? So money might buy you that but that comes and it goes but a lack of money, I think also can create a lot of stress that will make you unhappy.   Yeah. Well, so I don't know exactly who your listeners are. Are they mostly physicians or high income women?   It's pretty much career driven, high achieving, working moms.   I mean, pretty much everyone listening is not going to struggle with basic needs that money provides, right. And so I'm sure you've heard of a study that over a certain amount of money adjusted for where you live doesn't increase happiness, right? Obviously, if you don't have money to buy food, being able to buy food is definitely going to increase. It's not even happiness. It's like, just be not worrying about those primal things you need to live right. But yeah, after a certain amount of money, like it doesn't do as much as we think except for flying first class.   And the fancy meals, which by the way, I feel like the fancy meals that are curated and they look beautiful on the plate. I always leave those places hungry, wanting a piece of pizza. Like if you've ever been to 11 Madison Park, or you know they do these, well, that's a bajillion courses. But if you go do like a lesser version of that, like three courses, of like bite sized food, and then I'm leaving craving more, having spent how much money.   It's funny. I just went to France a few months ago, Paris specifically and I don't think I enjoy fancy food as much as I used to. To me it was like it's about the food. It's also the experience and I'm not sure if I enjoyed it. Maybe I'm just getting older and I'm just not used to going out as much as I used to. But basically what I'm saying is I don't need to go to a fancy two or three Michelin star restaurant, they tend to be kind of stuffy anyway, you know. And I feel like you know, a bit more of a modern hip restaurant is more my style now.   I agree. During COVID, when I didn't go to restaurants, after people started emerging, I remember being really appreciative of service. But now I'm at a point where I think most of like the fancy meals, it's the same thing like every single time. So it does start to lose its novelty. And then you're kind of just looking for the quality of food, rather than the fanfare of it all. So something I wanted to also ask you is, what do you think would be useful for the exhausted burnt out professional moms, in terms of if they're on the precipice of making a change? What advice would you give them?   Wow, there's so much. Well, I think the first thing is to take care of yourself, right? Because all those things you described is mostly a result of just not prioritizing themselves. So I think there's a lot of work in that, right. And women, we're basically socialized to be caretakers. And even if you don't have kids, that extends to just the people around you, maybe your parents, etc, right?   Maybe in your culture, too. But in my culture, or a lot of other cultures, like you want to have a daughter because a daughter takes care of you, the sons don't. Right, have you heard that before? Yes, of course, in general, cultures, letting men walk away scot free from so many things that they could actually be contributing to including caring for your parents. Right?   Yeah. So I think there's a lot of that. And I think it's even way more exacerbated if you're a parent, because you're just giving so much to your kids. And that has a toll on you. Because then I see a lot of women, they feel like they don't even know who they are anymore. Because they've just been giving, giving, giving. And then obviously, depending on your work circumstances, and whether you've gone through a divorce, there's obviously a lot of things that can cause stress. And so I would say number one is really take care of yourself.   I actually taught a lot of my clients be willing to go part time and work less. But of course, they're always like, Well, what about money, right? They don't want to make less money. I was like, listen, money circumstances are temporary. And part of me is like, you might need to go part time or even take a sabbatical in order to a) recoup.   And then what if that's necessary to actually make more money? That's something people don't consider, because they're so focused on like, well, if I work part time, that means I make less money. In the short term, yes. But then the thing is, you don't have headspace to think about things or be creative, or to even think about having a side gig when you're burned at both ends, you know?   Absolutely. So I'm really intrigued by that. I love that concept that you're mentioning, what's the strategy behind that? Like, how do you coach your clients who you're saying, hey, maybe go part time, maybe take a sabbatical? What does that look like in reality? And how are you helping women to actually do this? Because that sounds really scary. And I'm sure many women are listening to this thinking, yeah, that's great and everything, but no, thanks. You know, they're all freaked out.   Yeah. So part of it is looking at their money to see what's going on. The thing is, most of my clients aren't going to go broke. Like when I say go broke, like, they're not going to not be able to feed their kids or their family if they take some time off. Most of them will just go part. I mean, it's all different. To be honest, the thing is, even when you're doing a sabbatical, there are so many options to make money. Like you can just do like a per diem or locums. Right, I think you do something like that.   So it's not like you turn the money faucet completely off. But it's like, how can we create more space and time and for some people, it's like literally just working one less day a week at their current job or, again, as physicians, there are a lot of options, expert witness work, etc. So it's not like you have to completely turn off the money income, but then it's also getting their money in order. Because the goal is to be in a position where if your job income stops, there shouldn't be a catastrophe in a month or two, right?   Yes, exactly. It's more, I think, just the idea of slowing down the incoming and what am I doing about the outgoing, that people just kind of freeze and have a fight or flight moment during that conversation.   I think they also have to realize that what they're doing now is completely unsustainable. If you think about the decrease in income being temporary, you could think of that as like the investment in yourself to get better, and to build a life where you're not going to need a vacation from right.   Yeah, we need time and space to actually create and have thoughts flow. Because when you are in the day in and day out, day to day grind, you're just surviving. So there's very little room to actually transform or grow during that time. What else besides the part time work would you add to your advice for busy exhausted mothers?   Well obviously getting coached. And I'm not just saying that as a coach, but also as a client. Like I don't know if you're getting coached actively right now, Prianca, but like people always. Actually I was just doing a call with someone and they were like, surprised that I was still getting coached on stuff.   What I've learned from that is, I think people think, whether it's for themselves or looking at other coaches, that we get to a point where our brains are just beautiful inside and like there's no negative thoughts and like, I can handle anything and that kind of thing, unfortunately, yeah, we're human.   Yeah, we're still human. Like, I'm working with a parenting coach now and like. Oh, that's cool. I would say parenting it's like the hardest job in the world right?    And the most important too. I feel like most people feel like for me, my job as a mom is the number one job even though I spend a lot of time with my career and other things but it's top of mind.   Yeah. And then also what I realized is like I think every parent absolutely needs a parent coach. And part of being the best parent that you want to be is like working on yourself. And so that's why I also think coaching is, every parent coach does it differently. Mine coaches me and then also helps with some tips and tricks, but a lot of it's just coaching me and I'm like, freaked out, Jack's gonna get kicked out of school, like, you know, our brains just go to worst case scenario, he's gonna get kicked out of school, and then wanting to fix it right away. And so she has to coach me to calm my brain on that topic.   But yeah, I think getting coached is so important because understanding that our thoughts create our feelings, it's just life changing. But there's more than just, as you know, like, the way I'm trained is like really just working on your thoughts and how they downstream to feelings. But as you probably know, there's like other things at play that aren't just related to thoughts.   So like, I just feel like there's so much support that's available for your mental and emotional health that I think a lot of us neglect, because everyone kind of knows, like, oh, yeah, you should work out and go to the gym, because you'll feel better. And it's good for your health, right. But our mental health is just not prioritized at all, as you know. So I think that's really, really important is to prioritize your mental health. And there's so many ways to do that. Whether psychiatrists, therapists, coaching all the above.   I mean, I have a personal therapist, I'm in group therapy, and I have a coach. So I very much believe in taking care of myself first. Because that's always how we get to show up as the best versions of ourselves for them, and also setting an example for them, hopefully, so that they grow up caring for their own mental health as adults.   Oh, that's such a good point. I don't think I really thought about that. Here's another thing, right? And I didn't mean to make this into a parenting thing. But this applies whether you're not parent is if you think about it, our generation, although I think you're a lot younger than me Prianca. I'm not that much younger than you. I think I'm like a couple years younger than you. Yeah.   You just look so young. But you know, we were raised not being taught anything about how to handle our emotions. And if anything, especially cultural is like, don't show emotion, like, be stoic. And then if you're highly educated, it's just like pushing on through school and getting whatever you have to done. And then if you're a doctor, it's worse as well through residency.   So I think we have to learn that skill ourselves and learning it ourselves. Everything we do, our kids are watching us, it's modeled for them, right? And so if you grew up in a family just yelled and punished, and grounded you all the time. It's so funny, because no one's gonna say like, well, how a parent I'm gonna do the same thing for my kids. But as you know, like you end up parenting like your parents. It's kind of insane kind of a mind f, if you think about it.   Well, it comes really naturally. My experience is, I think about the way I was parented, and then I think about. It's in a book, How to Raise Successful People, which I may have recommended to you by Esther Wojcicki but she talks about really going through everything, how you were raised, and thinking about what you want to propagate forward and what you want to eliminate.   I don't know if I want to propagate any of it.   Okay, so for me, a lot of it. I'm like, okay, I'm not like my parents at all. But then what I find is in an academic setting, or like, when I start seeing my son, if he's doing well in school, then I'm kind of like, Alright, I have to help foster this, but not in the same way that my parents did, in a gentle kind way. But I can feel that it's all stirring up the old stuff where I was trying to do the best I could in school, and then I'm thinking alright, yeah, let him do the best he can do but without the punishment, and without tying in any his self worth to that and having like, a way bigger distance from all that.   Well yeah, we definitely were raised in the punishment is how you get people to comply and I mean, it is effective, but it also totally squashes self esteem. Anyway, that's what I'm learning how to navigate. And it's been fascinating for me, and also just showing me like all the areas that I still have work to do, you know?   Yeah, well, we're all constantly growing and changing and doing the best we can. And I really believe that our generation, we are doing better than our parents did. And hopefully our kids will do even better. I think so. Yeah, yeah. Although, I bet our kids are gonna say the same thing about us.   Well, I'm wondering if it's gonna be because even social media and all the info that's out there, it's very much we're trying to foster these independent people. And we ask them all these questions, and we're much more into mental health, but I wonder if the complaints gonna be the other way. Like, why couldn't my mom just be normal? And why did she have to ask me like how I felt about this? Like it was too psychological?   Interesting, but everything comes down to feelings, like truly.   Well, yes. So today, I was talking to coaches in my mastermind. And I was saying that really the work that pretty much we all do is helping people to sit in the discomfort because once you learn to actually sit with it, that's the currency for the good life because it's being able to be present with your anxiety sometimes, or whatever negative emotions and getting a little bit distance from them, be it through the model or other methods, but really not being one with our thoughts and our feelings. 24/7 Because that's where the torture lies.   I know and little kids, they can't understand like, why can't I have something that I want? Or why do I have to do things I don't want to do. Like brushing his teeth it's like a battle. Like, well I don't want to brush my teeth? None of them do. They don't. Yeah. And he's like, so why should I like I don't want to so therefore I shouldn't.   If I'm really honest here, one of my least favorite things with my kids is the ADLs like, I dread the morning brush teeth and the evening like brush your teeth before bed. And it really depends on how tired I am at night. But especially my two year old, she won't let me brush her teeth. And then I just let her do like very subpar job. And I'm like, alright, it's over.   I mean, which kid actually does the full two minutes? I mean, I don't think anyone does. I do 30 seconds. I'm like, You know what, 30 seconds is good enough?   Yeah I don't know. They hate brushing their teeth. I don't know. And they can't understand that is an automatic and a non negotiable of life. It's just one of the things that we don't need to get into the reason with them, but they hate it.   It boggles my mind. I'm like, doesn't he like. But like, wake up and you've got that, like morning mouth thing going on? I'm like, how is he not bothered by that? But kids just don't seem to be.   They don't care. I know. I hear you. Anyway. Yeah, those chores are tough. I will say though I have an au pair now. She often does the morning brush teeth. And they actually let her help and whatnot, like more than they will me. So yeah, my life has become infinitely better with that. Extra set of hands with her. So I highly recommend that if you have the space for it. It will take that stuff off your plate.   Yeah, I mean, we just have one. We both work from home. So we haven't needed one. But I wouldn't hesitate to hire one if I had multiple kids and had a schedule that made it hard to handle it myself.   Any other advice for exhausted professional moms?   So even if you can't, like I talked about go part, time take a sabbatical. Like you could take a little trip and go to a spa resort by yourself. I'm glad you asked this again. Because when I tell people that I take solo trips, they're shocked. A lot of women are shocked whether they have kids or not. Right. They're just like what, you can do that? And so I travel a decent amount for work. I go to a lot of conferences, but for my birthday this year, I went to Maribel for two nights by myself.   I remember when I told Matt he was like, what? You're not going to hang out with the family? I'm like no. Maribel is an all inclusive spa resort. I love it. I've been there many times. It's amazing what just even a weekend away will be so like nourishing and for anyone listening Maribel, there's three locations, Austin, Berkshire's, which is Massachusetts and Arizona, just two hours south of Phoenix. They are amazing resorts. It's all about wellness and prioritizing and mindfulness. Have you been to one?   I have. I enjoyed it. I also went by myself. My only thing was I felt like I was hungry there. They're too healthy. And I know it's all about wellness. They do the food health, you know, the healthful eating, you know.   You can always get more food, right?   I know but it's all, it's too healthy for me, like I need a steak or a burger like.   Oh, you should have done cook for me. Do you do that? That's good.   I did do that one of the nights. Yes. And that was good. But yeah, that was my only qualm with that place. Yeah.   So yeah, I think that's a great place or just like taking a trip with your girlfriends. I think, again, so easy to just stop doing that because you get into this routine. So I think even that, like I require a decent amount of time for myself. And now it's like normal, I don't feel like, although lately I have been trying to minimize travel a bit more just because Jack started kindergarten and I want to be available for him because we sent him to a Waldorf school.   I saw your post on social media about a more nature immersed school, and I thought, wow, that's awesome.   He's on a farm. And he is gardening and feeding animals, like they're outside, even when it's wet outside. So I had to buy him all this special gear. There's zero academics in their kindergarten. Because their whole philosophy is that developmentally like it's easier to learn when they're a little older. So they actually read a lot later than mainstream school. And so my friends warned me that they won't be reading until second or third grade, even.   They really focus on social and emotional development. And so it just was in line with all the things that I've been learning myself, right, just like really focusing on emotional regulation. Because if you think about it, those skills are way more important than your academics.   It's so true with my children, too. I always think like, well, what is the endgame in this? Like, whatever it is. It's not straight A's. Right, that's for sure. And also people get really crazy about sports and teams and this and that. And I'm like, alright, well are you gonna become a professional athlete? If not, like we don't have to be so crazy about this. Like, it's okay. They learn to be on a team. To me, it's more of a social, like you're talking about skill building.   I don't understand. Like I remember even before Jack was born, just like seeing that this was a thing. And I was so confused, because that's not how it was when we grew up, like our activity was just roaming around the neighborhood on our bikes and our parents not knowing where we were, you know those were our activities.   And so I actually, because he is on a farm all day, like they're literally being physically active. Like, I don't feel the need to do it. And also, they actually said that it's actually not great for them at this age, I forget, but that was enough for me to be like see, they told me not to do it, I'm not gonna do it.   Yeah, I think that's amazing. One thing I will say is my son's kindergarten teacher was saying that she teaches the kids a song about boundaries. And I said, oh, my, I was freaking out. I said, Oh my god, that's amazing. I said, can you imagine if we had learned that at a young age, boundaries like I didn't know what that was until.   They just learned about the personal bubble, the space bubble. Learning that like yeah, there's like everyone has a bubble and you have to ask for consent. And Jack that's his challenging area because he doesn't understand that and because he's so sweet and loving. If he met you like he would just like hug you but he's very strong. So it's almost like he's tackling you. So he doesn't quite understand that not everyone likes to get hugged. I'm like, listen, I know some people are weird. They don't want hugs. So you always have to ask, he still doesn't ask he just will embrace you.   Aw he has to regulate his kindness. Aw. I love that. So I love this concept of take some time and go on a trip alone. I think people are really afraid to do it.   Start with, it doesn't have to be even a night like I think baby steps, right? Because if you're married with kids, I know we're focused, because I'm sure not everyone listening has kids. Like, I have met women who are married with kids who literally never been away from their kids, even one night and their kids are older. I know your eyes are just wide.   I don't even know how that's possible. That's really intense.   So many people, they don't even go out to dinner without their kids.   It's too much. Start with a dinner. Let's just say that, start with a dinner alone. And actually, you never know if you let's say you sit at the bar and you eat dinner, you can meet people around you and you make new friends or just the possibilities are endless with that. What I was going to say about the alone time, I recently realized because I would take my kids on trips, and I took a few days to just reset by myself. And it was so magical that I only had to care for myself.   That was the whole thing that I didn't have to worry about. All right, the brushing teeth or the breakfast. All their needs, which we care for all the time. It's so automatic that one day even to just only think about yourself and be quiet. I like the friends trip idea. But I also think the time when you're not talking to other people and feeling like you have to be entertaining, or engage or listen or any of those.   That's why I like Mirabel solo. Because you don't have to talk to anyone. And it's fine, because a lot of them are there by themselves. Some people go with their girlfriends, but like no one's expecting you to like engage. And it's in that solitude and the quietness that you can get your best ideas or just restore or you're not giving to anyone except yourself.   And I think that's so fascinating that so many women, that concept of oh, let me just give to myself, and no one else, is so shocking for them. It's a world that they don't know. So yeah, start with that. Even if you can do, like I have a goal of doing it one 24 hour shift a month alone, like that is my goal.   That's amazing. I don't think I have, well, when I went to Paris for 10 Nights. Yeah, I didn't bring my family. I didn't mean for it to be that long. But you know, my business class tickets were already booked. So I couldn't change them. Probably not entirely true.   That's so funny. Yeah. So I have that as a goal. In addition to I think with friends, it's always good to have like a yearly trip you do with a certain group, let's say for doctors or med school friends, or college friends, or whatever other group you have, and just make it an annual thing. And that way, it's already there. Because if you just let these things go years go by. I know time goes so fast. And it's also like I only have one I can't imagine what it's like with more than one little one. But I think lately I've been trying to pick resorts to have a kids club of some sort.   So we can just park them there for even a few hours is helpful. Or I bring my mom sometimes. Yeah, although she needs a break too. Well, that's not your job, though. But yeah, I mean, I think that's another thing, it's like, don't feel bad about having support. Because I think also we think do everything ourselves. Right.   So like hiring the au pair, or just hiring a part time babysitter or like, don't clean your house, someone else could do that. Like there's so many things you can outsource and they don't cost as much as people think. Like a lot of women I meet don't like to cook, I'm like you can hire a personal chef or get meal, like there's so many services now that do that. Even if you did it a few times a week, that would be helpful.   Absolutely, or just really taking inventory of the things that bring you joy and don't and then start outsourcing the ones that you don't enjoy. Like if you don't find cooking therapeutic, some people do, but if it's not a therapy session for you, and you find it tiring, you don't want to clean up. For me all the prep, the cooking the cleaning afterwards, like that's a big chore for me. So I'd rather have someone help.   I don't do that Matt does it and then he just leaves stuff everywhere. And I was like, listen, you do the laundry. He loves doing laundry. Like you do the laundry, I sometimes cook, I take care of all things Jack, and then you have to deal with dishes and the garbage. Like it's a great division of labor that we have, you know.   I clean up sometimes but it's just putting stuff in the dishwasher. It's not like it's hard, you know? No, it's not.   No, I was gonna say and also he can manage Jack when you take your solo trips.   Yes, I think that might be harder. So that's something we have to navigate because his school is kind of far right now. And so it's a lot of driving. And so I think this fall, I've kind of minimized although I already took one trip and I have another one coming up but just being more picky with like speaking engagements and things like that, because I want to be away a little less because last year I was gone a lot. I mean, it was fun for me. Don't get me wrong.   Yeah, things wax and wane. I love that. Well, thank you so much for all of your pearls and your journey. So beautiful that you shared with us today. And please tell us anything about your business, how we can find you, follow you, all those good things. And of course, I will link to everything in the show notes as well. But definitely tell us verbally.   Yeah, so everything is wealthy mom MD. So it's my website. That's my instagram handle, same as my podcast, wealthy mom MD. And then as you know, I have a book, you can find that on my website, but it's called Defining Wealth For Women. It's a pink book.   I love that you wrote a book and I just think that that speaks to how we all have the ability to make our dreams come true. It's just them matter of getting your mind to it and then taking the action to make it happen Exactly just taking steps, like all this stuff happens by doing like a lot of little things   Wonderful, well thanks so much for coming today, it was great having you.

In this episode, we welcome Eduardo Trindade to the show to discuss the many different styles of education from around the globe. Eduardo has been a member of the ADLS team for many years and has loads of experience both in selling education and being educated himself in multiple different parts of the world.  In this episode, we also chat about the importance of being exposed to different cultures, thinking outside of our own bubble, the largest educational difference throughout the countries Eduardo has visited, and much more. Tune in to hear more from Eduardo!  Connect with Eduardo: https://www.instagram.com/edu_trindade_04_1974/ Connect with the hosts: Learning Reimagined Podcast Instagram  Allison's InstagramSandy's Instagram  AdvantagesDLS Instagram  Advantages DLS Website

The guys discuss the Astros upcoming series matchup in the playoffs against the Minnesota Twins in the ALDS. 

Dr. Lindsey Hughey // #ClinicalTuesday // www.ptonice.com  In today's episode of the PT on ICE Daily Show, Extremity Division Leader Lindsey Hughey explains that patients with frozen shoulder often struggle to manage their condition and experience fear of the unknown, which can significantly impact their cognitive and emotional well-being. Lindsey emphasizes the importance of understanding the patient perspective and their emotional stories. She highlights that patients may fear the future and the unfamiliar territory of living with a frozen shoulder, which can have a profound effect on their psychological well-being. Lindsey also emphasizes the need for healthcare professionals to appreciate the expectations and experiences of patients with frozen shoulder, acknowledging that their pain is not an exaggeration. She suggests providing controllable solutions and empowering patients to advocate for themselves in order to receive timely care and diagnosis. Lindsey underscores the challenges faced by patients with frozen shoulder in managing their condition and the significance of addressing their emotional and cognitive well-being. Lindsey reinforces the importance of healthcare professionals assisting patients with frozen shoulder in finding ways to continue engaging in activities they love. This involves helping them adapt their activities or modify their movements so that they can still experience joy and maintain a sense of autonomy and independence. Take a listen or check out the episode transcription below. If you're looking to learn more about our Extremity Management course or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. EPISODE TRANSCRIPTION 00:00 LINDSEY HUGHEY Good morning PT on Ice Daily Show. How's it going? I am Dr. Lindsay Hughey. I will be your host today on Clinical Tuesday. It's so good to be with you all. It's been a little while. Today I am going to chat with you about frozen shoulder and helping your patients navigate no man's land. But before I unpack this episode, I'd love to tell you a little bit about courses that Mark, Cody, and I have coming up. Cody actually was just promoted to lead faculty. We are so excited. And he will be teaching his first class this weekend solo in Minnesota so Rochester and there are still tickets left if you want to join him he would love that and you're sure to have a blast with him this weekend so October 7th and 8th can you believe we're already in October so wild other courses coming up in November on November 11th 12th we'll be in Woodstock Georgia and then our final courses of the year are in December. So you have two opportunities on December 2nd, 3rd. Cody will be in California, Newark, California. And then December 9th, 10th, I will be at CrossFit Endure again. That's always a blast of a spot. So Fort Collins, Windsor, Colorado area would love you to join. Those are our last of 2023. And then we'll be in 2024, which is super wild. So please join us. Thanks for letting me share courses coming up. 03:37 LIVING WITH FROZEN SHOULDER So last week, if you tuned in to clinical Tuesday, Mark hopped on here and he chatted about frozen shoulder, just the challenges associated with treating folks with frozen shoulder. And he really highlighted not only best treatment as we know it, but the importance of coming alongside the patient. And we need to do that better because this is an area, and if you think about any patient you've ever seen with frozen shoulder, it's always challenging, right? Because they are suffering and there are just so many unknowns. But we do have more knowns in regards to the patient perspective that just came out this past May. William King and Claire Hebron out of the Physiotherapy Theory and Practice Journal published a qualitative review of frozen shoulder. So specifically giving us the vantage point from the patient. So this study involves six folks, two were females, four were males. Their age range between 35 and 66. So a varied mix of sexes and then age ranges. They all were British and there was a mix of right and left and even bilateral frozen shoulders. So these interviews were done with these six folks and the question that was asked of them was can you describe in as much detail as possible what was important and meaningful to you in your experience of living with frozen shoulder? They used hermeneutic feminology methodology for those research nerds that want to know and they found the following five themes And so today I'm going to tell you what those themes are, and then I want to unpack some of the participant details from each theme. And I'm sure you'll be able to relate with some of your patient care experiences. And then kind of end the show with suggesting a rewrite of the title, plus some key takeaways for us going forward in caring for these folks with frozen shoulder. So the five themes illuminated from this article, and again, that's title, and I'll drop the link, is Frozen Shoulder, Living with Uncertainty and Being in No Man's Land. The five themes that were found were, number one, patients felt an incredible pain experience that they described as dropping me to my knees. Two, a struggle for normality in life. Three, an emotional change of self four the challenges of traversing the health care journey and then five coping and adapting and learning how to do that. So I want to unpack each one of these just a couple examples to help you appreciate that patient perspective. So dropping me to my knees that incredible pain experience All of the patients that were interviewed described multiple experiences where if they move their shoulder quickly or hit up against an object unexpectedly or involuntarily kind of reached and forgot about their shoulder for a second, that this pain would literally drop them to their knees. That when they would go to like stretch in the morning, they would scream and writhe out of pain. And this not only affected their body and their discomfort but like their family. Some of the participants described kind of scaring their partner because of like sudden outbursts or yelled. So an experience that's not just personal but affecting those around them. 07:28 EMOTIONAL CHANGE OF SELF Number two, the struggle for normality. So a lot of the folks describe multiple daily activities just being very limited and I'm sure your patients have had the same right just getting dressed, just rolling over in bed, unable to sleep, just that constant ache that's with them always kind of being in their mind and then challenging just normal daily activities. Not just ADLs and IADLs, but starting to lose work function, missing work and or recreational function. So one participant actually had to sell their fishing boat or chose to because they said just transporting the boat became so cumbersome and a reminder of their shoulder limitation. One of the participants described being unable to throw the ball. They're at a family gathering and their kid is watching other people throw the ball with their parent and the parent that has frozen shoulders just sitting there thinking, oh I can't even like throw the ball with my kid so this normalcy doesn't only impact them personally again in their daily life but it's impacting their family relations around them their work right their ability to actually provide for their family and then the recreation like enjoyment in life people that love to fish that was my dad's like favorite pastime if there's an emotional psychological peace here that is huge then that is challenged when someone has frozen shoulder that they can't do that one activity that brings them peace or joy and they can't um help provide for their family because they're suffering Which leads us to that third theme found, an emotional change of self. So all of the participants described overall just low mood from being in constant pain, having low self-esteem and starting to feel less worth in their family unit. Just kind of feelings of uselessness because not being able to reach overhead or being limited in the ability to just help out with daily chores. this was a really challenging thing to read, but one of the patients described that emotional change as if you were an animal, you would be put down because you're miserable. So basically like lack of thriving and like that was heartbreaking to read, but like this is how low emotions get when you're in, when patients have that frozen shoulder state. And a lot of them said not just the emotional drain is challenging, but like you're physically drained because of that emotional taxation. So multiple participants reported poor sleep, which I already mentioned earlier from a normalcy perspective, but they linked that to how this led to fluctuating mood because you never know when you're gonna get a good night's sleep. And so overall mood was very cantankerous and unpredictable. which patients even again mention that they're not able to even sleep in the same bed as their partner because they're so disturbed and uncomfortable in their sleep. And so they're sleeping in a separate room, again, that's that intertwining like emotional change of self being affected. and when this happens right you start seeing sleep being affected it makes you want to prompt for health care help right and so this leads to that fourth theme where patients are traversing the challenge of the health care journey going to a health care professional hoping they can help them sleep better helping they can take away the pain. 09:28 IMPACT OF DELAYED DIAGNOSIS ON TREATMENT But what most of the participants really highlighted is that this delayed diagnosis happened consistently where they saw multiple healthcare professionals prior to actually getting a solid diagnosis that this is in fact frozen shoulder. And so there was this, there's this period of not knowing and switching back and forth, like what's wrong with my shoulder? And then you finally know. And, um, even the treatments they were getting were challenging because patients said they didn't actually see solid results. So they would ask for a pain medication and then some of the healthcare professionals would be afraid of addiction. So they wouldn't give them stronger medications to help. And so there was this balance of figuring out what's that pain medication that's right for the patient. A lot of the patients, said that injections were life-changing. So getting a corticosteroid injection was helpful, but it didn't always happen right away. And some of them had to really advocate for that to occur. And that some, even the patients that were finally recommended to get the injection mentioned they were afraid of the needle. So we have to understand it might be a delay to get to the treatment that's effective, And then they might even have a fear of actually using that treatment that's recommended from the healthcare provider. So they're dealing with a lot of challenges in the healthcare journal. And disappointingly enough, as for most of our audience that are PTs, a lot of the folks said that PT wasn't the greatest. They didn't have initial great experiences because the PT would give them stretches that were super painful and not working. And the patient would have to wait a whole week to tell the therapist that, and then the therapist would give them something new, and then the stretches would hurt and not really work, and they'd come back again. We can do better here, right? If you test, retest in that session, you'll know whether that's working. So some kind of disappointing healthcare journeys for most of these folks. But there was some hope along the journey. So the fifth theme found was coping and adapting. Once patients did finally get to the healthcare provider or the PT that started providing effective care, they did have hope. Once they saw it start working or when they got that injection and the pain started going away, they could move their shoulder a little bit more. So when pain's down and range is better, they were super jazzed about it and finally had some hope. Various participants did say that it requires that coping and adapting, it requires you to shift your mindset, that press on attitude in the face of adversity. So helping our patients get there quicker, I think is something that we have an opportunity for. Another part of that, some coping strategies was people just learning, some of the participants mentioning that learning to work around the disability, right? If they were right-handed, starting to use their left arm, to keep functioning in kind of a pushing through mentality. The final binding theme of all of these, so we've unpacked examples of dropping me to my knees, an incredible pain experience, the struggle for normality, three, an emotional change of self, four, the challenges of the healthcare journey, and then five, coping and adapting. That theme that they found binding them all together was uncertainty. Or as the authors of the study titled No Man's Land. One thing I said that I was going to unpack was a suggestion for a rewrite. So we are dealing with humans, not just men. So I'd love to suggest that we call this No Human's Land. But this does come from a phrase, right, that was used to describe unowned land or unoccupied land or land that's not officially owned or inhabited by someone. but we are dealing with multiple humans, right? Not just males. So that rewrite I think is important here. 13:58 FROZEN SHOULDER & THE FEAR OF THE UNKNOWN But ultimately the main thing I want you to appreciate is with the unknown of how this disease may progress or regress, we have to do better for our patients here. They will not be able to manage their present living with frozen shoulder if they're fearful of the future. They don't read it. Oh, hopefully you're all still there. Give me a wave or like a thumbs up. If you are a little alarm went off. Sorry about that. Um, but patients will not be able, um, to manage living with their frozen shoulder. If they don't know how to manage it in the present, if they're fearful of the future, sorry for the folks that had to hear this twice on YouTube, but That fear of the unknown, right, or no humans land territory, this affects cognitive and emotional well-being. So what can we do with these themes, knowing patient perspective a little bit more deeply here? And I know it was only from six folks, but I'm sure you can relate and think back and reflect on patients you've seen, and they've had similar tough experiences. There are powerful takeaways here. appreciate that expectations from your patient they're always tied to a real human with an emotional story and we have to know that and appreciate that. We have to know that this pain is not an exaggeration. We need to give stabilization to that human story. with some of the facts of the do's and don'ts about frozen shoulders. See Mark's podcast last clinical Tuesday because he dove into best treatment and about what we know, what we thought we knew, and where we are presently. We have to provide controllable solutions. Some solutions. Help your patients advocate for themselves early. and with tenacity with their specialist, right? Help them get to that corticosteroid injection. You don't usually hear us saying that, right? That medicalization, we try to avoid that here at ICE, but here's a condition where we see, especially in the United Kingdom, this being a helpful pathway in combination with physical therapy. So help them get to the proper care and diagnosis faster. Make it so they don't have to see three healthcare professionals before they start feeling better. USPTs test retest the value of your treatment in session. Don't send someone home in writhing pain that worsens their range. Send them home with something that is helpful, right? That's easing and know that before they leave so they don't have a whole week of time of ineffective self-care. Let's not forget the human behind the painful and stiff shoulder. Those with frozen shoulder, let's help them feel direction at a really destabilizing time in their life. Help them figure out a way to do what they love, to keep working, help them be autonomous, to navigate their pain, their setbacks, and then their interactions with the healthcare team. We have a really cool opportunity to make living with frozen shoulder a little bit more endurable and making the patient feel more known. Thank you for being with me this clinical Tuesday and sorry about that little blip in the middle. Happy Tuesday. Cheers. OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to PTOnIce.com and scroll to the bottom of the page to sign up.

“I think the most amazing thing we see is the softening of the skin, which can occur during the first two weeks of the conditioning regimen. The nurses on the floor see it, and I think it's just a tremendous gratification for them to see the results of something right before your eyes,” Tanya Helms, PA-C, from the division of hematological malignancies and cellular therapy at Duke University Medical Center in Durham, NC, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a discussion about what oncology nurses should know about transplantation for patients with non-oncologic conditions such as autoimmune disease, how the transplant process differs for non-oncology indications, and the clinical pearls oncology nurses should consider when caring for patients with autoimmune diseases during the transplantation process.  You can earn free NCPD contact hours after listening to this episode and completing the evaluation linked below.   Music Credit: “Fireflies and Stardust” by Kevin MacLeod  Licensed under Creative Commons by Attribution 3.0  Earn 0.5 NCPD contact hours of nursing continuing professional development (NCPD), which may be applied to the early post-transplant management and education, treatment modalities, diagnosis, staging and treatment planning, or coordination of care ILNA category, by listening to the full recording and completing an evaluation at myoutcomes.ons.org by September 29, 2025. The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center's Commission on Accreditation.  Learning outcome: The learner will report an increase in knowledge related to hematopoietic stem cell transplantation for scleroderma and other autoimmune diseases.   Episode Notes  Complete this evaluation for free NCPD.  Oncology Nursing Podcast:  Episode 173: Oncology Nurses' Role in Stem Cell Transplants for Pediatric Sickle Cell Disease  Episode 148: Stem Cell Transplant Nursing in the Home Setting  ONS Voice article: What Oncology Nurses Need to Know About Vaccination and Cancer (and other immunocompromised diseases)  Clinical Journal of Oncology Nursing article: Early Intervention With Transplantation Recipients to Improve Access to and Knowledge of Palliative Care  ONS course: Hematopoietic Stem Cell Transplantation  ONS Huddle Card™: Hematopoietic Stem Cell Transplantation  National Scleroderma Foundation  New England Journal of Medicine article about the SCOT trial: Myeloablative Autologous Stem-Cell Transplantation for Severe Scleroderma  Systemic Sclerosis as an Indication for Autologous Hematopoietic Cell Transplantation: Position Statement from the American Society for Blood and Marrow Transplantation  Autologous Hematopoietic Stem Cell Transplantation for Systemic Sclerosis: A Systematic Review and Meta-Analysis    To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library.  To provide feedback or otherwise reach ONS about the podcast, email pubONSVoice@ons.org.    Highlights From Today's Episode  “The goal of treatment for patients with scleroderma is to reset the immune system, and there are three main components of the regimen used at Duke—that's total body radiation, cyclophosphamide, and ATG. This targets all the areas where the immune effector cells live. We also use CD34 selection, which is a process that separates CD34-positive cells from the stem cell product that's collected prior to transplant, to eliminate the possibility of reinfusing activated immune cells back into the patients.” TS 3:18  “For patients with diffuse scleroderma, you want to offer transplant when they have evidence of significant disease, but they're not so compromised that they can't tolerate or have increased risk of complications from the conditioning regimen. Understanding the patient's rate of disease progression is key when determining to transplant.” TS 6:45  “When a patient is referred, we call the patient, and we talk about how the transplant conditioning regimen works to reset the immune system and stop disease progression. We explain the workup visit and go over an example of the timeline needed to collect the cells, admit to the hospital for conditioning, and the recovery process as an outpatient. We want patients to understand the big picture before they ever come to Duke.” TS 7:57  “Some patients come to us significantly disabled by their scleroderma. They may be in a wheelchair, so they require special vehicles for travel. Patients whose hands are severely involved need assistance with their ADLs [activities of daily living].” TS 11:43  “There have been three clinical trials that show autologous transplant improves event-free survival and overall survival and has been shown to decrease all-cause mortality. But it does not repair damaged gastrointestinal, pulmonary, or cardiac tissue. Any fibrosis that has happened is permanent.” TS 12:22  “The most amazing thing we see is the softening of the skin, which can occur during the first two weeks of the conditioning regimen. The nurses on the floor see it, and I think it's just a tremendous gratification for them to see the results of something right before your eyes.” TS 13:01  “Social media has been a huge contributor towards patient self-referrals. Patients are telling their stories on Facebook; patients are asking other questions about how to get referred to a transplant center; and patients whose rheumatologists have not referred them will seek out transplant centers to learn more about transplant for scleroderma.” TS 13:48  “For people with hematologic malignancies, it's all about getting that patient to remission and then transplanting them. . . . These patients have experienced chemotherapy and the adverse effects. They know about low blood counts and fatigue and recovery. They know about central lines and transfusions. The scleroderma patients come to transplantation with progressive disease. They've typically not had blood transfusions, but they are now going to receive total body radiation, chemotherapy, and a stem cell transplant over the next six weeks. And it can be overwhelming. . . . Every day is something new for them to process and learn.” TS 14:56  “Patients become pancytopenic, and they are heavily immunosuppressed. They are on steroids during the conditioning regimen to prevent scleroderma flares during conditioning. These patients have a central line so monitoring for infections, such as assessing vital signs for signs and symptoms of infection, and being aware that steroids can mask a fever.” TS 16:49   

Several weeks ago I sat down with friend of the channel Ian Robertson, who is a person with PD diagnosed for the last 11 years. In part 2, we discuss how to improve turns while walking and performing activities of daily living (ADLs) and how Ian breaks out of freezing episodes (and what might trigger them for him). The video version is here: https://youtu.be/5dmFaQc_nKY For access to the full, raw, unedited version be sure to joint any of our channel memberships with this link: https://www.youtube.com/channel/UC0g3abv8hkaqZbGD8y1dfYQ/join #parkinson #parkinsonsawareness #parkinsonsdisease #parkinsons #yopd #interview #podcast #offtime #parkinsonsexercise #exercise #balance #walking #freezing #fog

Guest moderator Jullia A. Rosdahl, MD, PhD, interviewed occupational therapist Omar Mohiuddin, OTR/L, MS, MPH, CLVT, and Ed Haines from the organization Hadley on the topic of vision rehabilitation. They discussed providers and services that specialize in helping to maximize your remaining vision. Omar Mohiuddin has worked in both clinical and non-profit eye care settings as well academia doing research in the field of preventive medicine. He currently works at the Duke Eye Center in the Vision Rehabilitation & Performance division where he sees clients with age-related and acute onset vision impairment and addresses how changes in vision affect participation in activities of daily living, instrumental ADLs including, community and work accessibility, functional mobility, and driving safety. Ed Haines is the Chief Program Officer at Hadley, a 100-year-old organization dedicated to providing free programming that helps older adults discover news ways to do things made difficult by vision loss. Ed is a Certified Vision Rehabilitation Therapist and has served adults with vision impairments for 25 years, both in the public and private sector. Jullia A. Rosdahl, MD, PhD, is a board-certified and fellowship-trained glaucoma specialist at the Duke Eye Center. After completing her doctoral work on retinal ganglion cell biology during her MD-PhD at Case Western Reserve University in Cleveland, Ohio, she is working to save as many retinal ganglion cells as possible and preserving sight for her glaucoma patients as an Associate Professor of Ophthalmology at Duke University. #Glaucoma #VisionLoss #GlaucomaAwareness

Dr. April Dominick // #ICEPelvic // www.ptonice.com  In today's episode of the PT on ICE Daily Show, #ICEPelvic faculty member April Dominick  kicks off part 1 of a series on postpartum depression. In this episode, she discusses the differences between postpartum depression and other PP mood disorders. She then highlights the prevalence of and risk factors for developing postpartum depression. In her next episode, she will focus on screening for and how to communicate with folks who may have postpartum depression. Take a listen to learn how to better serve this population of patients & athletes. If you're looking to learn more about our live pregnancy and postpartum physical therapy courses or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab. Are you looking for more information on how to keep lifting weights while pregnant? Check out the ICE Pelvic bi-weekly newsletter! EPISODE TRANSCRIPTION 00:00 INTRO Hey everyone, Alan here. Before we get into today's episode, I'd like to take a moment to introduce our show sponsor, Jane. If you don't know about Jane, Jane is an all-in-one practice management software with features like online booking, scheduling, documentation, and a PCI-compliant payment solution. The time that you spend with your patients and clients is very valuable, and filling out forms during their appointment time can quickly take away from the time that you all have together. That's why the team at Jane has designed online intake forms, that your patients can complete from the comfort of their own homes. And to help them remember to fill out their forms, Jane has your back with a friendly email reminder sent 24 hours before their appointment. This means they arrive ready to start their appointment and you can arrive ready to help. Jane's online intake forms are fully customizable to ensure you're collecting everything you need ahead of time, whether that's getting a credit card on file, insurance billing details, or a signed consent form. You can build out your intake forms from scratch or use templates from Jane's template library and customize it further to meet your practice needs. If you're interested in learning more, head on over to jane.app.com. Use the code icePT1MO at sign up to receive a one month grace period on your new account. Thanks everyone. Enjoy today's episode of the PT on Ice daily show. 01:26 APRIL DOMINICK Good morning, everyone. Dr. April Dominick here from the Ice Pelvic Division, and today we're gonna talk about postpartum depression. This is a series, so in part one, we will define it, we'll talk about its prevalence, and we'll go through some risk factors for developing this condition. But before we dive in, we have some exciting updates from our division. Drum roll, please, or Harp glissando. So if you didn't catch our big news that dropped on Thursday of last week in our pelvic newsletter, we now have an eight week online level two course that will drop in spring 2024. We are so excited for this course. It is loaded with fun material. So we'll talk about pelvic pain syndromes. We'll go through post-op rehab for the pelvic and abdominal surgery that someone may get. We'll go through some birth prep and talk about all things fertility and infertility. So hop into that course when it becomes available. If the virtual option is not for you or your cup of tea, then I invite you to join us on the road live where we teach all things pelvic health rehab, bridging the gap between the fitness athlete and pelvic health. We're doing internal exams, external exams. We are talking about core rehab, going through labs that go over diastasis recti, return to the barbell, hopping on the rig, endurance, impact. It is so much fun as well. So when can you catch us live? We have some courses coming up September 23rd and 24th in Scottsdale, Arizona, and October 13th and 14th in Milwaukee, Wisconsin. Those classes will be with Dr. Alexis Morgan and Dr. Rachel Moore. Or you can find Dr. Christina Previtt. That's right, I said doctor. She just earned her PhD and we couldn't be more proud of her. So Christina and I will be out in the Pacific Northwest in Corvallis, Oregon on October 21st and 22nd. Tons of opportunities for you all to learn with us head over to PTOnIce.com and check out more. 06:34 POSTPARTUM DEPRESSION All right, postpartum depression, the topic of the day. Let's just cut to the chase. We'll call a spade a spade, pregnancy and parenthood. That is a transformative time. It's filled to the brim with new challenges when it comes to emotional, physical, mental, and lifestyle changes. We'll talk about pregnancy, I mean, that's approximately nine months of physical body alterations that support and nurture the baby. Then we have labor and delivery. That's an incredible feat. It's remarkable in the mental and physical strength that is required to get the baby to come out into the world. And then we have postpartum. Voila, the baby has arrived. Now what? So even though the baby may be all that the birthing person has ever dreamed of, it's gonna come with a lot of emotions, anticipation, joy, maybe even fear. Not to mention the added responsibility of caring for a baby while the birthing individual is functioning on minimal sleep, who knows what's happening with nutrition, and then there's an emotional rollercoaster going on. What up, hormones? and all the while that person is trying to heal and recover themselves. All of that can put a person at risk for postpartum mood disorders. We'll focus on postpartum depression or PPD, but I am going to share other conditions that may look like PPD. There's a side note here. A lot of the research that I did is on the postpartum parent who identifies as pronouns she, her, hers, or mother. So I'll be using that terminology for this podcast just based off of the research that I found. So here are three different postpartum mood disorders to include in a differential diagnosis if someone is coming to you postpartum. Number one, we have baby blues. This is gonna be the mild, most mild form of a depressive mood disorder. Then we have postpartum depression. And then our third type is postpartum psychosis, and that's gonna be the most severe form of depression for postpartum. So let's unpack baby blues. Due to the hormonal changes that happen immediately postpartum, About 50% of new mothers get the baby blues. That's a lot. By definition, the baby blues are mood changes that are mild, transient, and self-limited. And that means it'll resolve on its own and there is minimal medical retreatment required. Someone experiencing baby blues may exhibit signs of tearfulness, sadness, exhaustion, They may be irritable, they may have decreased concentration, mooniness, and decreased sleep. But all of those changes don't affect the person's ability to care for the baby or their own daily function. So from a time standpoint for baby blues, the onset and conclusion is like a bell curve. The symptoms come on within two to five days after childbirth, they peak, and then they generally resolve within two weeks of onset. One of the most common complications though of baby blues is the development of postpartum depression. So what is postpartum depression defined as? The DSM-5 defines it as a moderate to severe depressive episode that starts around four weeks post delivery. And this is typically going to require medical intervention. Compared to the baby blues, The big difference is that with postpartum depression, or PPD, symptoms persist for a longer period of time, so they aren't transient. 09:06 EFFECTS OF POSTPARTUM DEPRESSION If we zoom out, a person with postpartum depression can have changes in feelings, changes in everyday life, and they may even change how they think about their baby. Common symptoms for someone who is experiencing PPD They may have chronic feelings of guilt, feelings of failure as a mother, loss of interest in activities that used to bring them joy, feelings of despair that do interfere with their ADLs, and self-care. They'll also have unreasonable worries about the child's health and possibly infanticide or suicidal thoughts. So I wanted to talk about the effects of postpartum depression on the members in the family. So it's going to put the mother at greater risk for developing depressive episodes in the future. It can also affect the mother and infant bonding, and this has some potential implications if, say, the person is wanting to breastfeed, that may interrupt the success with that just due to the bonding issue. Beyond that, it's gonna affect the co-parent or the spouse and overall family dynamics. And there is some research showing the effects of postpartum depression and how that may negatively affect the behavioral and emotional development of the child. All right, so we went over baby blues, we went over postpartum depression, I can't leave this conversation without talking about postpartum psychosis. This is a psychiatric medical emergency. It's associated with increased suicide and infanticidal risk. It's rare. The global prevalence of it is about one to two and a half in every 1,000 women. It's going to emerge during the first few days or weeks of childbirth. And folks with postpartum psychosis will demonstrate rapid shifts in mood swings that are similar to bipolar tendencies. They'll have a loss of sense of reality. They may experience hallucinations, lack of sleep for several nights, agitation, delusions, and attempts to hurt themselves or the baby. So when you're meeting with a client, two keys for differentiating between baby blues and postpartum depression is the time since childbirth and severity of symptoms. So with baby blues, symptoms are usually present and gone within the first two weeks. Whereas those symptoms that persist beyond the first few weeks are more in the PPD camp. And then with baby blues, the symptoms are more mild and they don't affect the daily function of the individual. Whereas with PPD, it is more moderate in symptom nature and it will affect their daily life. So what is the prevalence of postpartum depression? It is one of the most common complications for someone after they give birth. PPD occurs in 15% or one in seven postpartum women. One in seven. These numbers are just representative of those who actually report it. So according to a study done in 2006 by Beck and colleagues, as many as half of PPD in new mothers goes undiagnosed because the individual is not wanting to share this with their family members or to share it with a research study. They wanna protect their own privacy. There are some effects of race as well in terms of prevalence, at least in when postpartum depression hits folks. So African-American and Hispanic mothers reported the onset of PPD within two weeks of delivery versus white mothers who tended to report the onset of PPD later. Region also matters. So geographical region. The prevalence of PPD varies by country. And what we know is that folks from developing countries have a higher prevalence of postpartum depression. Okay, what are the risk factors for postpartum depression? Y'all, there are so many. There were so many that I'm only gonna highlight the ones that came up over and over again that had the greatest impact in the research. So a 2022 literature review of risk factors of PPD identified the following as those that had the most powerful impact on development of PPD. Previous history of depression or psychiatric illness, depressive symptoms during pregnancy, and decreased social and spousal support. So there has been some research done that suggests, hey, if someone has healthy and supportive relationships, that is going to act as a protective mechanism during the prenatal period, specifically for the development of depression as well. There were some other factors, risk factors for PPD. Low socioeconomic status, stressful life events, and obstetrical specific factors like gestational diabetes, negative birth experiences, preterm deliveries, and low birth weight infants. All of these have a profound effect on the development of PPD. There was another systematic review from 2021 that they identified six major risk factors, which some of those we've gone over. But there were two in their list that I thought were interesting. One was that a risk factor if you were a pregnant woman who gave birth to boys, and then if you had an epidural anesthesia during childbirth. So I felt like those two were interesting, just side effects or side notes, and they were from a systemic review as well. 15:06 THE ROLE OF THE HPA AXIS Another area of emerging evidence looks at the role of the hypothalamus pituitary adrenal axis, or HPA. So we're about to get a little nerdy, but I love the brain, I love neuroscience, and I'm a psychology major, so let's talk about the brain and the endocrine system. So the HPA, or that hypothalamic pituitary adrenal axis, is a known responder during stress because it regulates physiologic processes such as the immune system and the autonomic nervous system. The HPA releases cortisol in trauma and stress. So if the HPA is not functioning correctly, there's a poor stress response. I think we can all agree that pregnancy itself and labor and delivery are some pretty extreme stressful and sometimes traumatic events. So during pregnancy, there are higher levels of estrogen and progesterone. Then during the delivery of the placenta, there's a dramatic fluctuation and drop of estrogen and progesterone. This rapid drop in hormone levels during that immediate postpartum period is a potential stressor and thought to contribute to the onset of depression. There was a 2017 systematic review that found seven out of 21 studies evaluating postpartum blues, and then 15 out of 28 studies evaluating PPD found abnormalities in the HBA axis. And from previous literature, we know that the dysregulation of the HBA axis is present in those with mental illness. So from all that, this is what I want us to think about. A healthy management of stress during pregnancy and postpartum should be a priority. We as rehab providers and medical professionals can have a tremendous impact in offering solutions for stress management like exercise, nutrition, sleep, proper medications. All right, let's recap. 18:39 IDENTIFYING POSTPARTUM DEPRESSION When working with the postpartum population, one of the most common complications is postpartum depression. It affects 15% of women giving birth. It's imperative that we're aware of the different mood disorders that can happen postpartum and the differences between them. We have postpartum blues, very common, affects about 50% of new mothers. It's mild, it's transient, doesn't usually need medical intervention, but we do need to provide some validation and compassion for those individuals. It's usually resolved by week two from childbirth. Then we have postpartum depression. It's moderate and severe in symptom nature. It can arise around four weeks post childbirth. It is going to affect daily functions and be present for up to a year postpartum. It will usually require medical intervention. Then we have postpartum psychosis. This is going to be a medical emergency. It's rare. but the person will present with rapid shifts in emotions, maybe have hallucinations, and the lives of the birthing person and infant are at risk. We as PTs play a tremendous role in identifying postpartum depression and other mood disorders. We can refer them to their physician, their mental health providers, and this can be helpful for someone if we think it's a medical emergency and we're suspecting postpartum psychosis. Understanding risk factors for PBD can be impactful when it comes to managing and treating it. Some of those major risk factors we can ID during pregnancy as well. So, hey, we're treating someone who is pregnant and we notice, oh, they have a lack of social or spousal support. They've told you they have a previous history or are having some depressive episodes during pregnancy. They have a lower SES or increased stressful life events besides pregnancy and delivery. Or they may say, hey, I was diagnosed with gestational diabetes. What I want to point out, these risk factors are modifiable. So in my upcoming podcast in this postpartum depression series, we'll discuss screening for PPD in the clinic, ways to communicate with a client who may be suffering from PPD, Then our final episode will cover resources, support, and the effects of exercise in treating PPD. Cheers, y'all. 19:53 OUTRO Hey, thanks for tuning in to the PT on Ice daily show. If you enjoyed this content, head on over to iTunes and leave us a review and be sure to check us out on Facebook and Instagram at the Institute of Clinical Excellence. If you're interested in getting plugged into more ice content on a weekly basis while earning CEUs from home, check out our virtual ice online mentorship program at ptonice.com. While you're there, sign up for our Hump Day Hustling newsletter for a free email every Wednesday morning with our top five research articles and social media posts that we think are worth reading. Head over to ptonice.com and scroll to the bottom of the page to sign up.  

Ever found yourself racing against time, praying your body won't let you down? This was the stark reality I faced, sprinting through a parking lot in New York to make a flight. Life serves up unexpected curveballs, and this illuminating experience made me truly appreciate the concept of ADLs or activities of daily living. It's not always about hitting the gym or running marathons; maintaining physical fitness for our everyday tasks can be equally crucial. But, physical fitness isn't just about the ability to sprint or lift heavy weights. It's about the strength to indulge in our favorite pastimes without fear of losing our ability to do so. It's about the vitality to keep living life on our own terms. Join us as we discuss personal experiences, share fitness tips, and provide insights that will inspire you to make health and physical activity a priority. This episode is a heartfelt conversation about not just surviving, but thriving in life by embracing an active lifestyle.

"Dementia is a medical condition; it's not an identity." —Melissa Batchelor, PhD, RN, FNP, FGSA, FA Healthcare professionals have a responsibility to provide honest and clear information about the diagnosis of dementia particularly. About the person's current state and provide anticipatory guidance about what areas of loss and decline can be expected. But a diagnosis like this impacts everyone in the family. So how to you handle the next few weeks and months as you all make this transition will be important for getting off to a good start. This week, I will share  “4 Tips for Good Care at Home After an Alzheimer's Disease Diagnosis". Key points covered in this episode: ✔️ Tip # 1: See the Whole Person First off, remember that dementia is a medical condition – it's not who you are. Even though things might change, you're still you. When someone gets diagnosed with Alzheimer's or another form of dementia, it doesn't mean they suddenly become different. Sure, there might be some adjustments along the way, but not everything will change all at once. Most folks get diagnosed early, so there's still much life to enjoy. I encourage you to learn about the diagnosis – it's like gathering tools to make informed choices for today and tomorrow. And speaking of tomorrow, staying connected is important. Here's the scoop: you're still the same amazing person you were before. Alzheimer's might bring some changes, but it's not the boss of everything. You've got plenty of living to do. So, take it one step at a time, keep learning, stay connected, and most importantly, keep living life to the fullest.  ✔️ Tip #2: Encourage Connection  Receiving a diagnosis like Alzheimer's can be challenging, but it's important to remember that life doesn't stop here. You can take steps to encourage connection between you and your loved one.  Here are some tips to help you both continue living your lives to the fullest: Stay Engaged: Keep yourself mentally and physically active. Participate in activities you enjoy and find new interests if needed. Staying engaged helps maintain cognitive function. Stay Connected: Share the diagnosis with friends and family. They can provide the support and understanding you both need. Encourage your loved one to accept invitations and continue socializing. Support Groups: You're not alone in this journey. Joining a support group can provide a safe space to share experiences, advice, and emotional support. This connection can positively impact both of you. Volunteer and Join: Engage in activities that interest you. Volunteering, joining clubs, or taking classes provide a sense of purpose and social interaction. Maintain Routine: Having a routine can provide a sense of stability. Regularly connecting with loved ones, participating in church activities, or visiting family can create a comforting routine. ✔️ Tip #3: Focus on Strengths and Abilities  Every person with dementia experiences this disease differently. While there will be losses over time, there will also be remaining strengths and abilities at any given time.   Don't assume that just because the person was given this diagnosis that it automatically means they can't do things that they used to do, or they can't make decisions, or they're no longer able to learn new things.  To help both of you stay aware of this, you can make a list of the skills and abilities the person with dementia still has. Think of two activities that can help guide you: Instrumental Activities of Daily Living (IADLs) and Activities of Daily Living (ADLs). Instrumental Activities of Daily Living (IADLs): Using the phone Shopping Cooking Cleaning Doing laundry Driving Managing meds Handling money Activities of Daily Living (ADLs): Bathing or showering Dressing Moving in and out of bed or a chair Walking Using the toilet Eating Look at these lists every 2-3 months to see which activities the person can still do independently. Write down their progress and share it with your healthcare provider.  Changes might appear first in IADLs before ADLs, and remember, involve the person with dementia in these discussions whenever possible. This way, you work together to understand and adapt to these changes. ✔️ Tip #4:Embrace Well-Being The concept of well-being encompasses various elements such as identity, connections, security, joy, and self-worth. Importantly, individuals with Alzheimer's can still experience a sense of well-being, with a shift towards prioritizing emotions over memories. To promote well-being, the key lies in concentrating on the individual's feelings rather than fixating on their recollections or current abilities. This approach involves dedicating more time to recognizing their emotional needs and optimizing their strengths and capabilities rather than dwelling on the aspects they may have lost. A helpful analogy for understanding well-being is to visualize a doughnut. Think of the doughnut's shape, which includes a central hole. Similarly, people sometimes get caught up focusing on the "hole," which signifies what's missing or what someone can no longer do.  Instead, the focus should be on the "doughnut," representing the strengths and abilities that are still present. This shift in perspective can greatly contribute to fostering a sense of well-being for individuals with Alzheimer's.  ✔️ Unlocking Support: Connect, Engage, and Empower! Thank you for listening! If you need support, visit my website MelissaBPhD.com for updates on working with me directly. Sign up for my newsletter and follow me on social media for announcements. Like, share, and review to spread valuable information—your engagement matters. If you have questions or comments or need help, please feel free to drop a one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you by recording an answer to your question.  About Melissa Batchelor, PhD, RN, FNP, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-master Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the Duke University School of Nursing faculty as an Assistant Professor. My family moved to northern Virginia in 2015, which led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Welcome episode 222 of The Cloud Pod Podcast - where the forecast is always cloudy! This week we take an in depth look at the latest earnings reports from all the major players, changes to IPv4 costs (inflation), Healthscribe, and all the news (in cybersecurity) that's fit to print.  Titles we almost went with this week:

Episode 59: How To Stop Yelling At Your Kids Join Dr. Prianca Naik on the Empowering Working Moms Podcast! In this episode, she discusses mindfulness tools and methods to help keep yourself from yelling and staying grounded. Dr. Naik invites you to learn about what you can do to reduce irritability and stop yourself from yelling, even when you really feel like it. Tune in to this episode for more on this topic.   In this episode, you will learn: Preparing ahead of time for stressors Mindfulness tools to process irritability Proven processes to cultivate inner peace Self-compassion to create inner confidence   To end burnout and exhaustion and get your peace of mind back, check out her free masterclass on 4 steps to overcome burnout, get rid of overwhelm, and get your peace of mind back. https://program.stresscleansemd.com/4-secrets-to-living-a-life-you-ll-love-podcast   If you want to work with Coach Prianca Naik, MD, go to www.priancanaikmdcoaching.as.me to book a 30-minute consultation call.   Follow Dr. Prianca on social media: https://www.facebook.com/prianca.naik https://www.instagram.com/doctorprianca https://www.linkedin.com/in/prianca-naik-md-0524a196/   Join her FREE Facebook group: https://www.facebook.com/groups/646992382603860   [FULL TRANSCRIPTION:]   You're listening to the Empowering Working Moms podcast episode number 59. Hello there. Thank you so much for tuning in today. I'm thrilled to have you. To my current and old listeners, I am so glad to have you here.   If you're new to my podcast, welcome, welcome. I am a physician and a mom of two small children. And I do this work to help women like yourself who have serious careers and are managing it all, right, and you might be exhausted.   A fun thing I have to tell is one of my clients, Samar, a mother of three young kids and a physician as well, she was telling me that before coaching with me, she was struggling to keep her house and her marriage together while heading into a clinical depression. And imagine how tough that is, and you might be able to even relate.   But through coaching with me, she found the tools that she needed to manage stressful situations. She said when stress and anxiety arise, "I am no longer spiraling into shame, blame or sadness anymore. But I know I am in control, and I have the confidence to manage them. My relationship with my husband is much better. I am balanced and grounded and a better mom and doctor."   And I love hearing this feedback from clients of mine. Knowing that they're getting out of that exhaustion, out of the burnout and truly finding peace of mind and enjoying their lives. The work we're doing inside my coaching program is really not time intensive. And clients like Sumir are beyond burnout and really creating the life they want. So if it's possible for Sumir and my clients, it is possible for you. To learn more join my free on demand masterclass to ending burnout and exhaustion and finally getting your peace of mind back.   So today's episode I'm doing because I know this is something that my clients struggle with, and you probably are struggling with too. And that is yelling at kids, how do I stop yelling at my kids. And I was actually inspired for this episode because I was working a lot and I found myself a bit cranky and a bit tired. And then I even was sick. And I woke up in the middle of the night with a really bad headache, which I never get. And my five year old was pulling normal five year old antics. And I truly felt like yelling, but I did not. But I did feel like it.   So that really inspired me to give you the material in this episode. Now remember, I've been doing this work for a really long time. So I was able to use my own mindfulness tools and methods, some of which I will teach you in this episode today, to really keep myself from yelling and to keep myself grounded. But I could feel how irritable I was from my lack of sleep. And when I take call, and I still take call in my medical practice, I take phone calls at night. So I'm sleep deprived. And I have found that my two year old and five year old are also waking up more at night as well. So I have a lot more interrupted sleep. And that, of course creates a bit of crankiness, right.   But here's the bottom line, we're human, and we're not perfect. And that means that we make mistakes. And sometimes that includes behaving in a way that can be out of integrity with who we want to be. And we get to give ourselves compassion for that. So I want to talk about giving ourselves compassion and giving ourselves grace. Today's tips and formulas are not going to mean that you never ever, ever yell again. But they are going to help a lot with helping you cultivate peace of mind, making you feel grounded when you feel like yelling at your kids. But I guess this could be used and applied to when you feel like yelling in general.   So here are tips to keep from yelling at your kids. First, I'm going to list the things that you can do ahead of time, or ahead of tiring and annoying moments when your patience is tested. Then I will get into more practical tools that you can use in the actual moments of the annoyances or when your patience is being tested. So ahead of time, take care of yourself. And this is work you can do in general.   Also this includes self care, and I normally don't go on and on about self care because it is pushed a lot in self help and in coaching and in my opinion, it is not the end all be all for wellness. But if you do not care for yourself and you do not take time for yourself, then you really may resent the irritating things that your kids might be doing.   So keep that in mind. And part of this is adequate sleep, and definitely some semblance of alone time and or connection time with your partner if you have a partner, otherwise focus on yourself, right? Cultivating joy of some sort, eating healthfully, limiting alcohol intake, and having some sort of a morning routine even if it's 5 to 10 minutes of savoring your morning cup of coffee or being alone, a quick meditation, whatever makes you happy in the morning. Get your foot started on the right day, you could set an intention for the day. So these are examples of what you can do ahead of time and how you can care for yourself.   Now, in the actual moment, when you feel irritated, let's say your kids won't go to bed on time, they won't get ready in the morning, they're refusing to brush their teeth, here's something you can do in that moment. First, ask yourself why you are irritable. Then give yourself compassion, for being irritable, and know that it's okay to feel irritable. I'm gonna give an example of this.   So the other day when my son was dancing around the hall refusing to brush his teeth, I was annoyed. And I knew I was annoyed, because I did not want to be in the long line for camp. Now, mind you, this is a very nice camp he goes to and it starts at 9am. But you cannot bring kids before that time because they charge you extra and they're already charging enough. So there's a whole time shebang for that. And if you get there closer to nine, then there's a massive line, it feels like it takes forever. Meanwhile, my daughter's daycare slash school starts at 9am also. So it's just this annoying kind of dance that's going on in the summertime. So it just takes extra time. And I did not want to be late for work, of course, and all this rigmarole.   So given all that you can imagine, I was getting annoyed when he was refusing to brush his teeth, dilly dallying. But what kept me grounded in that moment, what kept me from feeling stressed, what kept me from getting super agitated, even though I was sleep deprived, mind you. I realized that what I was worried about was being late, what I was worried about was waiting in line, maybe my daughter being late to daycare, and in the scheme of things, those things really don't matter.   So as he prolonged the morning routine ready time, I just chose to let it go. So if you can practice something like this, where you zoom out and see how important something really is. Why are you getting annoyed? And is it really worth it? And notice how much stress and energy you may be creating for yourself and intentionally choose whether or not you want to create that stress for yourself in any given moment, including moments like these.   Another tip is to realize that the moment will pass and I talk about this a lot. But this is so helpful in all storms of life, be it big or small. This too shall pass. And when you know that, it's really something that will help you zoom out and not get so upset in the actual moment. Realizing that unpleasant times, big or small, they're not going to last forever.   So an example of this was I went through the Starbucks line for food for myself. And this was in the drop off morning time. And I did not get my son a croissant because he was misbehaving in the morning, he wasn't following the routine, and I did actually get him Starbucks only a few days prior. And while we're waiting in this line, and it's taking a long time, he would not stop asking me why he couldn't have a croissant. Why, but why? And I would explain why, you know you didn't follow the morning routine, you were misbehaving, and that is why. And then eventually I just told him that I was no longer going to answer this question. I had already answered it multiple times. But he was being repetitive.   And I was already irritable because I was sleep deprived and I felt a little rushed. And I reminded myself that him asking me about the croissant was not going to last forever. And that moment was going to pass, though it feels like forever when you're in that time. I know that because I too have been there. But it actually does not last forever. So that's just something to remember that though these unpleasant moments or waiting in line or whatever it is, or repetitive questions from children can't take no for an answer. It's irritating, but it will pass. And that really can help just ease the pain of having a listen to the same thing over and over again. So that's that tip.   Next tip is give yourself a time out to collect yourself, because it's amazing how quickly we can actually shift gears or bounce back from a certain feeling. So you can even say to your children, I need a timeout right now to just collect my thoughts. I need a breather. And it's a great way of modeling to them how to cope with negative feelings or thoughts, right.   My next tip is to express yourself and actually say how you feel in the given moment. So if your kids are acting up, you can say I feel frustrated. I feel like yelling. I'm going to focus on my breath and belly breathe to calm myself, to really center myself. And I will actually do this and I will breathe and they can see me doing it. And not only does it help me center and ground myself, but it also is a great example for them of a coping skill for when you're feeling frustrated.   Another tactic I use is repeating a phrase over and over again until it gets done instead of yelling. So with the brushing teeth, I might want to scream, brush your teeth, right. That's an easier way to go about things. But instead of that, I will just say, brush your teeth, brush your teeth, please brush your teeth, please brush your teeth, please. And that's kind of boring, because it's not getting a rise.   The other thing about us yelling that you have to remember, especially for younger kids, is that it kind of shows that they're getting a rise out of us, it shows that we're responding, they're getting the attention. So the more we can be matter of fact, and just say brush your teeth, brush your teeth as if you don't care. All the more that they're not going to be so invested in fighting the force of you know, the activity of daily living, or ADLs, as we call it in medicine, when we're assessing elderly folks on how well they can take care of themselves. I digress. But yeah, when they're avoiding just regular things that just need to be done non negotiables, like teeth brushing.   Next technique, listen up to this one. So I will really use my mind body connection to ground myself. So also when I was sitting in the drive through with my son, and that was the same Starbucks scenario, another technique I used was feeling my body. I noticed my body sitting on the seat of the car. And I really focused on my breath. And as I was able to notice my body, my feet on the ground, the weight of my body, and focusing on my breath, and sometimes I will just count my breaths. And that helps me get out of my head and into my body.   And what this does is it takes our focus away from the irritating situation, and gives us distance from that irritated feeling, or the thoughts that we have that are creating that feeling. So we can not be so married to our thoughts and feelings. And then we can really help ourselves get distance from what feels like a stressful situation. And if you really are able to do this, practice this and tune into your breath in your body, you can learn to sit with the unpleasantness, notice where it is in your body and not play into it as much. And even let it go. Magical, right?   Well, this tool, it really helps us. And it helps us even decrease more suffering when we're already tired or feeling irritable. So in that scenario, for example, I was already feeling tired. I was already irritable because I hadn't slept well. And then, you know, my son is repetitively asking me the same question. He can't take no for an answer. And I have a choice to get further stressed in that situation, or ground myself and observe how I feel irritated or irritable. And then really breathe, let it go and realize that it's a temporary situation.   The other thing I will say is if you try all of these things, or maybe in the moment you forget, and you don't try and you end up yelling at your kid or kids, give yourself compassion, forgive yourself and realize that you're not perfect. And it's okay to not be perfect, because that's just impossible anyway, because this is the human experience and to be human is to err, to err is to be human. And as you forgive yourself, apologize to your child too. And you can say, hey, I'm sorry for yelling, I was feeling irritable, and I shouldn't have yelled and I'm sorry.   And that way they can see that you're not perfect and that they have permission to be imperfect. They have permission to be human, and much more comfortable being not perfect than we are. And maybe if we show this example our kids won't grow up to be perfectionists like we are. So try any and all these tips. Let me know how it goes.   You can find me @DoctorPrianca on Instagram.  To have a streamlined process to find confidence, get clarity, make decisions and have inner peace to finally end burnout while having a positive ripple effect on your kids, book a call with me to get started on this work. PriancaNaikMDcoaching.as.me. You can be out of exhaustion and burnout in 90 days or less. Thank you so much for tuning in and I will talk to you next week.

Download for FREE today -  special Mnemonics Cheatsheet - so you can be SURE that you have that Must Know information down:  bit.ly/nursing-memory   Outline BATTED B-Bathing A-Ambulation T-Toileting T-Transfers E-Eating D-Dressing Description When assessing a patient's ability to care for him or herself at home we must assess their ability to complete activities of daily living. A patient's ability to bath, walk, and toilet on their own will help us determine the level of care they will need when they leave the hospital.

Clinicians are now charged with providing quick gains in an episode of care with complex patients, such as those with Parkinson's disease. Funding cuts continue to require clinicians to provide shorter episodes of care, despite neurological disease progression. This one-hour podcast will provide physical therapists, physical therapy assistants, occupational therapists, and occupational therapy assistants with targeted evidence-based interventions for the Parkinson's patient. These targeted interventions will allow for translation of skills to balance and ADLs while also demonstrating measurable gains. Practical and successful tips will also be provided to address typical complications in an episode of care with the Parkinson's patient. Clinicians will leave the course with new interventions and strategies for use in their next session with the Parkinson's patient. To view accreditation information and access completion requirements to receive a certificate for completing this course, please Click here   The content of this Summit podcast is provided only for educational and training purposes for licensed physical therapists and occupational therapists. This content should not be used as medical advice to treat any medical condition in either yourself or others.

Contributors: Andrew White MD & Travis Barlock MD In this follow-up episode Dr. Andrew White, a practicing psychiatrist with an addiction medicine fellowship, and Dr. Travis Barlock, an emergency physician at Swedish Medical Center, discuss mental health holds, psychiatric placement, pharmacologic vs. non-pharmacologic treatments, and outpatient care of psychotic patients. If you missed it, be sure to listen to part I for details on the management of psychotic patients in the ED. Educational Pearls: Mental health holds should be approached on a case-by-case basis; this includes assessing safety risks immediately, over a 24-hour period, and chronically over the last few months. Lastly, collateral information is useful in assessing a mental health hold.   What happens after patients get placed in inpatient psychiatry? Typically an antipsychotic is started; in the absence of metabolic risks, patients will often be started on Zyprexa, especially in oral dissolvable form. Doses of Zyprexa ODT start at 2.5 - 5 mg per day.   If psychotic patients do not pose direct harm to the environment, they do not necessarily need to be medicated. However, patients will often need medication at some point; for example, some people may be calm during their psychosis but unable to feed themselves or perform other ADLs.   The goal of pharmacologic treatment for psychosis is to save the brain; each episode of psychosis damages the brain. Oftentimes, patients will be started on long-acting injectables like aripiprazole or risperidone to give patients 30 days of treatment with one shot.   Non-pharmacologic approaches to psychosis are challenging given the nature of the disease. There have been attempts at therapy for psychosis but not have not been hugely successful. Options for support include PT/OT, family support via organizations like NAMI, and other resources for families of patients with psychosis.   Outpatient care of patients with psychosis includes contextualizing the events. For example, many people who experience brief psychotic episodes do not go on to develop schizophrenia so it is important to identify a prognosis. On the other hand, someone who has worsening symptoms over several months may require more aggressive treatment.   The primary goal of outpatient management of older patients is to reduce the adverse effects of long-term treatments. The CATIE trial in the early 2000s showed that only 25% of people were on antipsychotics by the end of the trial; it is more important to engage patients than focus too much on medications' adverse effects. Summarized and edited by Jorge Chalit, OMSII | Studio production by Jeffrey Olson, MS1  

How well do you recognize what our Occupational Thearpy colleagues bring to the table?They are much more than simply ADLs and play huge roles in the successful management of pain.Tune in this week and hear Megan Osgood Doyle discuss this and more!Check out Megan on: Instagram at @meganosgooddoyle81112Twitter at @MOsgoodDoyle*********************************************************************

About half of cancer survivors report difficulty with ADLs and a third difficulty with iADLs.But, unfortunately, only around 1 in 10 older adults with cancer who have a known functional limitation receive a referral to OT or PT. Even less make it to an eval.And, even less than that, complete their full course of rehab. Why are we failing to support such a large percentage of this population?  And, what is the best way to support them when they do make it to us for occupational therapy?Honestly, the results from this randomized control trial we are exploring in this 1-hour episode were not what we hoped to see. The OT/PT provided did not improve functional deficits or maintain functional status for these patients. And, instead of giving a glimpse of how to improve the barriers to receiving OT care, it only seems to drive home the obstacles. Luckily, this is not the full story. After we break down the article, we will be joined by the article's lead author, Mackenzi Pergolotti, PhD, MS, OTR/L about how this paper changed the course of her career. It spurred her to research further into service delivery models that do open the doors to more patients—and points to the improved outcomes we hope for. In order to earn credit for this course, you must take the test within the OT Potential Club.You can find more details on this course here:https://otpotential.com/ceu-podcast-courses/cancer-rehab-otHere's the primary research we are discussing:Pergolotti, M., Deal, A. M., Williams, G. R., Bryant, A. L., McCarthy, L., Nyrop, K. A., Covington, K. R., Reeve, B. B., Basch, E., &; Muss, H. B. (2019). Older adults with cancer: A randomized controlled trial of occupational and physical therapy. Journal of the American Geriatrics Society, 67(5), 953–960.Support the show

The article we are looking at today challenges us to look critically at occupation—and how it can be used as a tool for justice or injustice. The reality is that many of us have narrowed our view of occupation into the medicalized and individualized categories of ADLs. But, we know from research (and lived experience!) that occupation is much more complex, interconnected, and powerful.The authors outline for us how occupation has played a role in systemic racism in the US. This history and present must be understood and confronted if we are to live our shared value of justice within occupational therapy, and move toward antiracist transformation. After a brief review of this article, we will be joined by the authors Ryan Lavalley, PhD, MOT, OTR/L and Khalilah R. Johnson, PhD, MS, OTR/L to discuss the practical implications for your occupational therapy practice. In order to earn credit for this course, you must take the test within the OT Potential Club.You can find more details on this course here:https://otpotential.com/ceu-podcast-courses/racism-and-occupationHere's the primary research we are discussing:Lavalley, R., &; Johnson, K. R. (2020). Occupation, injustice, and anti-black racism in the United States of America. Journal of Occupational Science, 29(4), 487–499.Support the show

Show Notes:Train Smarter and Harder FitnessThe Garage GymThe 24/7 Hybrid Model?Opening before COVID vs after COVIDSilver vs. Platinum MembershipsUninitiated believers 63% - Price | Time | ValueWhatever you decide to do you're going to have headacheJust send an email, the worst that can happen is they say no or they don't answerZone 2Is low intensity cardiac output work, done for an extended period of timeBuild a bigger gas tankCan you have a conversation still is Zone Two, if you're breathing heavy it's probably not Zone 2If you're not fast or good enough to get on the field, court or ice, then it doesn't really matter how big your gas tank is. Horsepower first.the Long Term Athletic Development Model and Type II muscle fibers during peak velocity growthThere's a lot of Couch to 5K programs, but there are no Couch to NBA programsIt's much harder to help someone get strong or powerful than it is to help someone get in shape.Zone 2 takes so much time that realistically it doesn't make sense to program if you only have 3 hours a week in the gymYour gas tank only has to be big enough, bigger might not be better. If you think of Racing they could put bigger gas tanks in the car to decrease the number of pit stops but a heavier car is a slower car. You'd lose every race.Interval training can improve Vo2MaxWhen it comes to the general population and we are thinking longevity and health then zone 2 makes more sense or I may be more willing to do long slow training for 45+ minutesSports = performance, wins, injury prevention, contractsGen Pop = blood panels, disability years, ADLs, longer life, decrease painMeet people where they're at! Episode 13Context matters, the answer is to probably do a little bit of bothThe MBSC Myzone challenge - Understand your heart!People don't really care about the prizes, people are competitive by nature, wants to compete and wants to be recognized for itThe MBSC Spring Seminar attend In-person or Virtual Sign Up by Jan 18th for the Early Bird Discount!Book of the Week:Brendon: The Book of Joe: Trying Not to Suck at Baseball and Life by Joe Maddon, Tom Verducci, et al.Kevin: How to Raise Kids Who Aren't Assholes: Science-Based Strategies for Better Parenting - from Tots to Teens by Melinda Wenner Moyer

The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/ttU4Pc Dr. Bob was born in New York City. An unusual place for someone who became such a lover of wilderness and things far from the concrete jungle. His family moved to Texas when he was five years old. Lived outside of Houston in a small community known as Seabrook, near a slightly better known region, Clear Lake where he went to high school and played baseball. At an early age he became athletic and stuck with athletics throughout high school and early college. Once he quit competing he became fairly dedicated to training for health with both resistance training and cardiovascular training as part of his lifestyle all the way through college, medical school and into his adulthood. He attended college at Sam Houston State University where he was convinced by his mentor and Cell Biology professor to give up his idea of becoming a fisheries biologist and consider medical school. After taking the MCAT and scoring well, he decided to throw his hat into the ring and just go ahead and apply to the schools in Texas. After interviewing at the University of Texas school systems, he fell in love with UT Southwestern and ranked that school number one, which eventually had him on the hook for going to medical school. He appreciated his education at UT Southwestern realizing it prepared him well. Graduating right at the 10th percentile of his class gave him the opportunity to go into whatever field he wished. He realized he was born to be a surgeon, but after four years of medical he also realized he was not a fan of the hospitals. By this time in his career he was already starting to sniff the fact that there was a lot of questionable practice in medicine. He had also discovered Alaska, having traveled there to work on a commercial fishing boat in the summer between college and med school. Since he knew he wanted to be in Alaska, and he dreamed of opening his own fishing lodge, emergency medicine seemed like a logical choice, and once again he was able to attend the program that he ranked first. After completing a residency in emergency medicine at Methodist Hospital of Indianapolis, he was ready for his new life to begin. As luck would have it, a job was available on the Kenai peninsula, the area he had fallen in love with the first time we visited Alaska. He moved up there, started practicing medicine at Central Peninsula Hospital and immediately turned his off shift attention to building a hunting and fishing lodge. Within three years of arriving to Alaska, All Alaska Outdoors Lodge became a reality. He had obtained his pilots license and captains license during his residency years and began guiding on the rivers and flying and exploring Alaska in his first aircraft, a Piper Super Cub. He quickly realized his heart was in flying, and obtained his commercial an instrument rating and eventually started flying for his own fishing lodge. He worked his way up through flying 185's to a de Havilland Beaver which he still owns to this day. Nowadays, he spends around 100 days a summer piloting a commercial bush plane taking people on the adventure of a lifetime. He plodded along in his medical career, successfully treating somewhere around 60,000 patients in what spanned a 27 year career. By the end, what plagues most ER doctors got him, he was just flat burnt out. He was starting to see patients in his own age range afflicted with the metabolic diseases that ravage this country. In 2014 he decided to train with Cenegenics, a company built by doctors, with a vision of health and wellness achieved through a proactive, integrative medicine design. Of all the training he had in his entire life, this was probably the most impactful. He was at an age where the ADLs were starting to get rough. 100 days of bush activity a summer, flying and guiding, while trying to practice full-time emergency medicine, raise a family, coach baseball and all of the other things, was starting to become more difficult at the same time that his energy level and drive was starting to decline. Turning to Health And Wellness medicine changed all of that. Once he applied the knowledge he learned from the literature that is readily available in this domain, his life and body transformed. By 2017 he had discontinued his practice at Central Peninsula Hospital and started to focus more on health and wellness and building his private practice. He continue to work in some small hospitals to provide expert emergency care in rural areas where the need was underserved. Eventually, the development of the Covid pandemic and all of its baggage was more than he could tolerate, and he completely resigned from all forms of reactive medicine. He now practices solely in a concierge style practice with a small group of patients focused on learning the most about their pre-existing risk and how to mitigate the chance of a bad outcome. A blended model of medicine is provided by Dr. Bob, reaching first for lifestyle but still including conventional medication when indicated and necessary. Order yours today!   Join the Conversation! We want to hear from you! Do you have additional thoughts about today's topic? Do you have your own Prescription for Success? Record a message on Speakpipe   All The Tools You Need To Build and Scale A Integrative Health Business Get a behind the scenes look at our playbook at Texas Center for Lifestyle Medicine to see the underpinnings of how they deliver health while keeping team members fulfilled. Find out more at https://rxforsuccesspodcast.com/IPB Unlock Bonus content and get the shows early on our Patreon Follow us or Subscribe: Apple Podcasts | Google Podcasts | Stitcher | Amazon  | Spotify --- Show notes at https://rxforsuccesspodcast.com/132 Report-out with comments or feedback at https://rxforsuccesspodcast.com/report Music by Ryan Jones. Find Ryan on Instagram at _ryjones_, Contact Ryan at ryjonesofficial@gmail.com

All Local Morning for 10/17/22

Get my 9 page OTs Map to the World of Pelvic Health.Meet me on the OTs for Pelvic Health Facebook Group!Check Out More OT Pelvic Health Content here.Find me on IG! @functionalpelvis-- Transcript  --The wide world of pelvic health -- if this is a new specialty for you, then this episode may be illuminating  because I remember when I first learned about Pelvic Health, the field seemed quite focused and specific.  Many of the OTs I speak with  assume that to work in PH, you mainly work with pregnant or expecting people. I Have to admit that most of my stories and points of reference are also around pre and postnatal ppl. The FP, my company, was the first pp in Manhattan owned by an OT and the pre and postnatal community was my sole focus. So naturally it was my point of ref for everything .   I get a lot of questions from OTs about whether that's the only population you can  work with in this field, so that's what I want to focus on today. This episode  is Meant to arouse your curiosity.. And Inspire you to think outside the box.  You can implement Fundamental pelvic health techniques in a variety of communities and settings. It's not an all or nothing approach. After all, we are OTs, and we are only limited by our ability to problem solve with our clients. And we can problem solve with every single one of them.This is by no means will this be an exhaustive list but I will do my best to present a wide array. If there is something I have left out, please reach out to me via email or via social media and I will gladly add your additions to a future episode!There are a few different ways we can look at the subspecialties of PF.  The first is from the communities we can serve. The ones we will be reviewing today are “ people going through puberty, prenatal, postnatal, perimenopause, men, pediatrics, oncology, elderly, men's health, LGBTQIA+ athletes, ostomy care. Basically if you have a pelvis, we can support you! Let's get into the details of this now.The first was those of us working with clients  in a period of life where there are in transitions: this would include puberty and pre puberty clients, there's the pre and postnatal communities and my heart is absolutely here with this vastly underserved population. Likewise, there's perimenopause and menopausal people. Actually, all of these are underserved individuals who could use our support.  These are periods in our life when our Hormones are in such flux and that has an influence on our pelvic floor function. For example, both with lactating people and with perimenopausal people, estrogen is traditionally in decline, and this affects our PF's ability to be as buoyant, responsive and supple. During the menopause years specifically, These tissue changes and their symptoms are often referred to as genitourinary syndrome of menopause (GSM), and some tell-tale signs include pain with sex, vaginal dryness, and urinary incontinence! (Side-note: some providers may use the term vaginal atrophy instead of GSM). A very similar albeit temporary process happens to people who are lactating. In terms of supporting pre and postnatal people, we can offer birthing rehearsals that help prepare the birthing person for optimal delivery such as optimizing the uterus and ab wall to help push the baby out vs what many people think which is that the vagina pushes the baby out. Quite the opposite, the vagina actually relaxes and gets out of the way for optimal delivery.  Postpartum care can help with the ADLS of being a new parent and all that goes with that. Many OTs specialize in the m&

In this episode, we welcome Pam Dion, our third co-founder of ADLS, to the show to discuss the current state of the education system in regard to school choice. We also chat about ADLS, teacher shortages, new programs, school choice and everything involved, and much more. See below for a complete list of topics covered in this episode and tune in to hear more! Key Topics Covered in This Episode: Introducing Pam Pam's role in Advantages Digital Learning Solutions The teacher shortages and the learning gaps Addressing & assisting the needs of children on the autistic spectrum New programs opening through ADLS Micro schools The political struggles affecting schools currently Public schools vs private, charter, and micro schools Challenges parents might face Looking to be on the show or know an expert who'd make a great guest in 2022? Send us a DM on our Instagram! (Linked below) Connect with the hosts: Learning Reimagined Podcast Instagram Allison's Instagram Sandy's Instagram AdvantagesDLS Instagram

When thinking about care options, especially as one ages or for those living with a chronic condition, it is important to consider the support needed to complete activities of daily living (ADLs) to safely live at home. The inability to accomplish essential activities of daily living may lead to unsafe conditions and a poor quality of life. This episode provides information about the importance of activities of daily living and how caregivers can identify when more support is needed. Listen in to learn more about the following: What are activities of daily living or ADLs. The difference between Basic ADLs and Instrumental ADLs and why is this important for older adults. Conditions that can affect the ability to perform Basic and Instrumental activities of daily living, especially as one ages or is living with a chronic condition. How caregivers can provide support and help their loved one maintain as much independence as possible to accomplish Basic and Instrumental ADLs. How caregivers can assess when more help is needed. Helpful tips / resources for older adults and caregivers. To view resources, show notes and access more My Care Advisors episodes, visit mycareadvisors.com.  We are grateful to be your guide.