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We're talking about the youngest people with type one diabetes: babies and toddlers. When you can't talk and you're barely eating solid food, the challenges of T1D rise to a new level. Stacey's guest is Pediatric Endocrinologist Henry Rodriguez, the clinical director of the University of South Florida Diabetes Center. Check out Stacey's new book: The World's Worst Diabetes Mom! The interview features everything from breast feeding, diluted insulin, pump and CGM use in babies and much more. Join the Diabetes Connections Facebook Group! Resources: Facebook groups: Learning to Thrive: Type 1 and Toddlers Diapers & Diabetes   In Tell me something good. The other end of the spectrum: celebrating a long life with type 1 - 64 years since diagnosis and going strong. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your healthcare provider. Sign up for our newsletter here ----- Use this link to get one free download and one free month of Audible, available to Diabetes Connections listeners! ----- Get the App and listen to Diabetes Connections wherever you go! Click here for iPhone      Click here for Android   Rough episode transcription (please forgive grammar, spelling & punctuation)  Stacey Simms  0:01 Diabetes Connections is brought to you by One Drop created for people with diabetes by people who have diabetes. And by Dexcom take control of your diabetes and live life to the fullest with Dexcom. This week, we're talking about the youngest people with type one diabetes babies and toddlers. At that age, everything – food, sleep, communication has unique challenges, including what happens when you dose and they won't eat.   Pediatric Endocrinologist Henry Rodriguez is the clinical director of the University of South Florida Diabetes Center. He's actually referring to the older insulins there, NPH and regular not commonly used anymore, but that situation certainly still happens. And we talked about everything from diluted insulin, breastfeeding and CGM use In Tell me something good. The other end of the spectrum celebrating a long life with type 164 years since diagnosis and going strong. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your healthcare provider.   Announcer: You’re listening to Diabetes Connections with Stacey Simms.   Stacey Simms  1:42 Welcome to another week of the show. I'm your host Stacey Simms. So glad to have you along. And a special welcome to new listeners from the Greater Western Carolinas Dhapter of JDRF. I attended that summit over the weekend. So hello to anybody who found out about us there and is tuning in for the first time. And hello to all the moms and dads of little ones. You know, this is an episode focusing on babies and toddlers with type one that I've actually been trying to do for a very long time. It is hard to find an endocrinologist who really wants to come on and talk about this. I don't know why, but it's taken a while. So I'm so happy that Dr. Rodriguez decided to spend some time with us. Now as you know, if you're a longtime listener, the subject of babies and toddlers with type one is very near and dear to me. My son was diagnosed right before he turned two. So I want to tell you right now, this is a longer episode. But please stay with it. I mean, come and go. as you please, we will be here waiting for you. You can certainly pause and come back. It's a longer interview. But I wanted to really take advantage of having a person who could talk about this stuff and the interview transcription is available at the episode homepage, go to diabetes dash connections. com, click on this episode, and you will see the transcription just a little bit down the screen there. That's new for 2020 for the show. I know we're well into to January at this point, but my house is finally a little bit back to how normal is now I guess because my daughter just went back to college. She's been home for about a month which was fabulous, but she was definitely ready to go back to school and I don't know what I'm going to see her again and maybe just until spring break. Oh my goodness. And of course Benny is at regular high school so he's been back for a while now too. Very happy to have a new sponsor this year! Diabetes Connections is now brought to you by One Drop, and I spoke to the people at One Drop, and I was really impressed at how much they get diabetes. It just makes sense. Their CEO Jeff was diagnosed with type one as an Dult and One Drop is for people with diabetes by people with diabetes. The people at One Drop work relentlessly to remove all barriers between you and the care you need get 24 seven coaching support in your app and unlimited supplies delivered, no prescriptions or insurance required. Their beautiful sleek meter fits in perfectly with the rest of your life. They'll also send you test strips with a strip plan that actually makes sense for how much you actually check. One Drop, diabetes care delivered, learn more, go to diabetes dash connections calm and click on the One Drop logo. My guest this week is Dr. Henry Rodriguez, a pediatric endo and the clinical director of the University of South Florida Diabetes Center. As Dr. Rodriguez confirms, as you'll hear, more younger people are being diagnosed with type one, a trend that seems to have started about 15 to 20 years ago, but there's not a lot of easily accessible information to help parents in this age group. I will link up some information in the show notes on the episode homepage, including a couple of Facebook groups I do recommend for parents of very young children. But when Benny was diagnosed, we really didn't know anybody with a child that young. And I felt like we were making up a lot of it as we went along. Now the good news there is that he's fine, although I certainly made a lot of mistakes. But when you're talking about babies and you real six months old, one year old, it's a totally different ballgame. So if you are new to the show, I just want to warn you. I think I talked more in this interview than I usually do. definitely get on my soapbox a few times, and you'll hear me pushing my opinions and pushing some of them on to Dr. Roger. Yes. And he pushes back a couple of times, which is great. I feel very strongly about this age group. I mean, this is my wheelhouse, but of course, I am not a doctor. So here is my interview with Dr. Henry Rodriguez. Stacey Simms  0:02 Dr. Rodriguez, thank you so much for talking to me. I'll be honest, this is an issue I've been trying to cover for a long time. And I'm thrilled that we're finally getting to talk about it. So thanks for coming on.   Dr. Henry Rodriguez  0:14 Oh, it's a pleasure.   Stacey Simms  0:15 I'm not even sure where to start. I mean, between my personal experience, and then talking to so many moms of babies and toddlers, let me maybe back up and ask you, as a pediatric endocrinologist when somebody comes into your office or you meet them at the hospital, and they have a child under the age of two, where do you go? What do you tell them? How do you start?   Dr. Henry Rodriguez  0:39 Well, I think, you know, we certainly start with the basics in terms of, you know, we feel the etiology of Type One Diabetes is how we think, you know, develops. I think what we end up doing these conditions many times is, is you know, first addressing you know, I think, whatever challenges diagnosed with Type One Diabetes, even though we fully appreciate it providers that are treatable. You know, there's that sense of loss and morning. So I think acknowledging that, and then we try to really focus on, you know, the fact that, that it is a treatable condition. It is challenging, there is no question that life is going to be different as folks at home, but but it's it's manageable. And, you know, in our center, we have the luxury of a multidisciplinary team. And we're all about supporting that family, you know, is is the case, I think we fully realized that. I think there are two times of life, at least in the pediatric age group, that are particularly challenging. It's in the very young children. And then it's the children they get diagnosed around the time of adolescence. And so for the very young child, the bottom line is that I think it is extremely important that we tailor the therapy to the patient. It's true across the board, but I think particularly with the youngest ones,   Stacey Simms  2:00 When you're talking about the youngest ones, I think as we go through this interview, we will kind of section it because obviously, there's a difference between a six month old and a 16 month old, you know, and a three year old. But my personal experience was was interesting. So when my son was diagnosed, our pediatrician he was he was not yet to it was about five to six weeks before he turned two. She said, Bring him in. It sounds like type one diabetes, but he's too young. I've never had a case of someone under the age of two. So bring him in. And let's roll it out. And luckily, you know, we did we brought him in. I mean, unluckily, we rolled it in, obviously. But is that something that was either common at that time, which is 13 years ago? Does it still happen that people think you can't possibly have type one if you're under a certain age?   Dr. Henry Rodriguez  2:44 No, no, I think you know, what we encounter typically is at the other end of the spectrum, it's, it's adults that come in and the assumption is, well, you're an adult, you obviously have type two diabetes, you couldn't possibly have type one. But I will tell you that You know, and we we actually I oversee both adult and pediatric providers at our center. And, you know, historically, pediatric endocrinologist, pediatricians will assume it's type one until proven otherwise. And on the adult side, it's the opposite. So, you know, I think we are in in less danger of mismanaging, so to speak a young child because, you know, our, our kind of default is to treat those children with insulin and then, you know, figure out the rest afterwards. elevated blood sugars, you know, can can occur transiently in a child who's Ill know in the midst of stress of illness and we can kind of say, well, Mom, okay, well, let's just see how how things don't obviously if you have a child that has an extremely high blood sugar that has, you know, positive ketones, possibly acidosis well, then then, you know, you know it's insulin deficiency and So you proceed in that regard. But you know, for a child that comes in with, let's say RSV pneumonia and you get a few older blood sugars will let that slide, so to speak. But, but for sustained high blood sugars, you know, we always resort to insulin therapy.   Stacey Simms  4:17 Okay, so it was just maybe my pediatricians personal experience hadn't borne that out. It wasn't some something common. And before I move on from that, is it. I had heard anecdotally, again, that there are more cases of younger children with type one in the past 10 to 15 years than there were, say 30 or 40 years ago. It's true.   Dr. Henry Rodriguez  4:38 Yeah. Yes, it is true. Unfortunately, we know that overall, the incidence of Type One Diabetes is increasing. And that increase is really most affected children less than five years of age. I should mention before we move on, you know, and we will come into the youngest individuals as you said, but for children less than six months of age, one thing that always factors into the equation, particularly if there's any kind of, you know, multiple family members that are affected by quote type one diabetes, we also have to think about monogenic diabetes. So those are individuals who have a genetic mutation that has affected the machinery as it were, that's necessary to monitor the blood glucose to you know, make the insulin, store the insulin, release the insulin, all those things. Now, it's far less common. But we have to think about those things in the youngest individual.   Stacey Simms  5:42 And I will say will, as you listen, we will link up information about monitor genetics, diabetes in the show notes, you'll can find it on the website, and I'm actually doing a show in just a couple of weeks with a family that thought the child had type one thought the parent had type one, but it turned out it was monitored now. So we'll be talking more about that in a future episode but more information because as we're talking about the youngest kids here, that is something you absolutely have to keep in mind. Alright, so let's talk practical, because most of the questions that I have taken from other parents, and then I had myself I remember when my son was diagnosed, we're about precision of dosing. I mean, it's so hard, right? I mean, when baby was diagnosed, he was he was a bigger kid, luckily, so we were not using diluted insulin, which I'll ask about, but we were drawing up quarter units, which are not measurable. They don't make up you know, there's no lines for quarter units. At least there weren't a syringe. There wasn't even a half unit pen at that time. How do you advise people to do these itty bitty teeny weeny doses for kids?   Dr. Henry Rodriguez  6:49 Honestly, I am so mentioned we were get to it, but I'm not a great fan of diluted in so I think you can do that. I perhaps you could accuse me of a bit of paranoia, but I'm always concerned that they're there, either, you know, less likely on the part of the period but, you know, another caretakers so forth an error at that level of the pharmacy. I'm always concerned when when you dilute insulin, think about it.   Stacey Simms  7:16 I'm sorry, I cut you off. I got excited. Yeah, I mean,   Dr. Henry Rodriguez  7:18 it, you know, if you're diluting the insulin tenfold and for some reason, you you make an error and you develop those, you deliver the full strength insulin. That's 10 times the dose you had intended giving. So that that is as I said, there may be a little paranoia on my part. I tried to get away from that. I, I will tell you, as you mentioned that, you know, even with the syringes, there are now insulin syringes that half half unit increments. And when you say you're going to measure a quarter unit, you have to understand that you're getting between zero and you're not giving the unit units   Stacey Simms  7:55 was not my husband's quarter unit. We knew that we were just trying to Bad tech.   Dr. Henry Rodriguez  8:01 But I think that's where I generally move towards, in fairly rapid progression. Move towards insulin pump therapy.   Stacey Simms  8:12 Okay, wait, but before we do, because there jumped you jumped? Right? Let's Let's continue that because I do think it's worth talking about we never used it. I didn't even know it was an option at that time. But when I see people talk about it, they seem very enthusiastic about it before we go any further and I'm happy to, as you said, on the one hand is the paranoia on the other end of the parents who do think it works well. But let's start with the facts. What is it? I mean, you're not diluting insulin at home, are you a pharmacy? Oh, my goodness.     Dr. Henry Rodriguez  8:39 So you can go Yeah, you can go one of two ways. I mean, the manufacturers do. Provide them you can purchase a diluent it's essentially the solution that insulin is prepared in and you you can dilute that insolent. Some folks do that for is, again you can you can segue to off of the pump their baby deal with the pump as well. But, you know, you dilute the insulin and it's it's something that my preference if you're going to go that route is to get a reliable pharmacist to do that for you. But there are some individuals that do it at home.   Stacey Simms  9:24 And okay, so this sounds like a very foolish question, but I don't we're just at the beginning here. How do you do it? I mean, do you literally take a regular vial of insulin and then dilute it at home with you pull it out? You put I try to think of how I would do that.   Dr. Henry Rodriguez  9:39 Well, I mean, you have a while of the diluent. And then you introduce however many units of insulin internet, we used to do this back in the old days request from our therapy, you know, we could tailor the concentration to provide a volume that was reasonable to inject it sir doable, but, you know, we, I generally prefer to go with simpler, not never going to be foolproof, but making it less likely that an error is going to occur.   Stacey Simms  10:17 I know that people really have good success with it, but it would make me very nervous as   Dr. Henry Rodriguez  10:24 I share that   Stacey Simms  10:26 was just a go. I mean, insulin we know has a shelf life, so to speak, you know, out of the refrigerator for 28 days and in the refrigerator for the date that's on the packaging, just diluting it change that.   Dr. Henry Rodriguez  10:39 It shouldn't but obviously, as you indicated, I mean, you want to do it, and then this sterile fashion as possible. So you know, it I, and again, I'm stating the obvious here, but, you know, we think 28 days, it's not because on the 29th day, the insulin no longer functions, it degrades over time. And considering particularly when you're dealing with small doses like this, and considering the accuracy that we try to achieve with regards to dosing for the individual carbohydrates for the correction doses, you if if on day 45, your insulin is 90% as effective as it was in day one. That's not ideal. So that's why we generally encourage people to rotate out the vial over the 10 every 28 days now, in a child that isn't using very much insulin, you know that that means you're disposing of a lot of insulin. And so you know, there is a certain level of waste there. What we typically try to do is, you know, your pens hold 300 units, your vials hold a full thousand units. I think, if you're looking at it from an economical standpoint, even if you cannot use the pen to the The video says you can draw from the pen with a syringe. However, I think it's incredibly important that folks understand that once you've done that with a pen, you're going to potentially introduce error to any insulin you deliver with the pen mechanism. In other words, you're changing the volume within that cartridge in such a way that if you then turn around and use that pen, the way it's intended, you run the risk of inaccuracies in the dosing. So we always tell folks, once you've drawn from a pen with a syringe don't revert to using that pen has as an injection device by itself.   Stacey Simms  12:37 Yeah, yeah, we do that we actually pulled insulin out sometimes to using the pump from a pen. But then you cannot use that pen to inject as a pen. That's it. It's done. If now it's just a big dumb vial. You can't use it anymore.   Dr. Henry Rodriguez  12:50 It's a little it's a little   Stacey Simms  12:51 it's a little dump file. Um, okay. You mentioned instead of diluted insulin, that you would prefer the precision of an insulin pump. And this isn't an editorial statement, but I'm just thinking when I remember when my son was on the insulin pump, he was two and a half. And I see these babies that are on insulin pumps, and the babies are so teeny tiny, you know, and the pumps are so large, this isn't really a medical question. But they really do okay on them.   Dr. Henry Rodriguez  13:20 They do they, I mean, you you make allowances I mean, if you think about So, so here is where your choice of pub is important. You know, the easiest pump is is the only pot I mean in terms of educating people how to use it, in terms of placing it and so forth. The problem is is you appreciate the pod takes up quite a bit real estate, when you compare it with a tip you know, and otherwise traditional infusions site. So that comes into play as well. I mean, typically you're placing the pod either on the fly of an infant or a box and, you know, changing diapers and so forth that then becomes a potential issue there. So it is not without its difficulties, but it does allow you for more flexibility for more precision in insulin dosing. And if you think about the youngest one, let's let's take an infant who's breastfeeding while they're feeding every two hours, you know, get first of all, that's a lot of injections. If you don't go with, you know, I generally will prefer to provide insulin more physiologically, if the child is continuing to make some insulin on their own might be able to use a long acting insulin to kind of cover things over the course of the day. But you're not going to achieve the degree of control that most folks would really see as, as as a goal with just money Jessica, this one you can do intermediate acting insulins, but then you You're really requiring that you have regimented, you know, caloric intake, carbohydrate intake. And in a very young child, or an instance of that better eat type in, I think it's nearly impossible to ensure that.   Stacey Simms  15:19 Well, you you brought up breastfeeding, which is on the list because I see these moms. Again, my son was a little bit older. I did breastfeed, but it was done by the time he was 23 months old. But a lot of these moms are breastfeeding their kids with Type One Diabetes, which I think is unbelievably challenging, because we don't know what they're actually eating. Even without diabetes, we worry about that. So what do you tell moms who really want to continue breastfeeding? You mentioned a couple of different options there. But do you just check a billion times? I mean, how do you do it?   Dr. Henry Rodriguez  15:54 Well, I again, not that to put more more hardware, so to speak on this little one, but You know, this is where continuous glucose monitor, you know, I think is a lifesaver be provides you with a lot of data and you know, you could certainly, and decimal changes over time, but you can certainly have the breast milk analyzed and you can you can look at the carbohydrate content and so forth, but you still don't know what volume that child is going to take. So, it is a bit of trial and error, quite honestly, I mean, so much as type one diabetes management is, but it really comes down to well, you know, pro breastfeeding session, you know, the blood sugar typically goes up x, you know, we'll try a little bit of insulin and we'll see how that goes. And it really becomes trial and error and this is where, you know, it is it is so much a partnership between the diabetes care provider and the parents. Many times and the primarily being mom, but you know, it is trial and error. We always OPT or The default will be, you know, we want to be really cognizant of the risk for low blood sugars. So we don't want to over those will likely undergoes, you know, until not that many years ago, you know, we as as a pediatric endocrinology community would say, Well, you know, it's a very it's very young child, we might tolerate, you know, a one sees of nine, in some cases 10%. Now, I think nowadays, with the more rapid acting insulin analogs with the possibility of insulin pump therapy with continuous glucose monitoring, we're all those things help reassure us and allow us to be more aggressive, so to speak. So we don't have infants with blood sugars that are routinely elevated, you know, once you cross that threshold of 180, or 200. Keep in mind that that child is is going to be urinating more because they're losing glucose in the urine, and so That creates challenges in terms of keeping them hydrated. And certainly you've got to get more calories into them because they're losing them. And so, you know, it definitely is a complicated process.   Stacey Simms  18:12 All right, we have to stop you there. Because I have to go back. I've written a bunch of notes, and we're going to follow up on everything you've said. But there's two really dumb questions I do have to ask before we move on. And the first is, oh, well, hang on. So sending the breast milk out to be analyzed. Who is analyzing their breast milk? No, do I? How do you mean, how do you do it? Is that something people should   Dr. Henry Rodriguez  18:34 do? Well, I think it's probably I mean, yeah, you can have that done.   Stacey Simms  18:43 Who does that? Well Google it and find a bunch of services that give me the calorie count.   Dr. Henry Rodriguez  18:49 No, no, no, I think I think you get bored with your healthcare provider and you can send it out to a laboratory and have that done. Now, I and I'm not saying that that absolutely, positively has I think, you know, in many cases, that's probably the healthcare provider, the dermatologist, trying to get a better handle on things, you know, and it makes the trial and error perhaps a little bit easier. But, you know, breast milk does change and it's it's consistency. And it's caloric content and so forth, over over, you know, the period that the child is breastfeeding. So it's not foolproof, it's not as if you know, you've got a nutrition label that tells you exactly what what the what the   makeup is the breast milk fascinating.   Stacey Simms  19:41 And then I guess that would be a lot of help for pumping breast milk as well. Right.   Dr. Henry Rodriguez  19:48 Exactly, exactly. So, you know, for and again, as a pediatrician, we obviously advocate for breastfeeding. breastfeeding is best and pumping does allow You particularly for, you know, a child that maybe is having some challenges in terms of feeding on a routine basis or even, you know, tolerating the large volume and so forth, you know, being able to quantitate that I think goes a long way and making it easier.   Stacey Simms  20:20 So, you mentioned that in the past, you would be okay, or you tell parents, it's very reassuring to have an agency of nine or 10 at this very young age. And I assume that's because the alternative was so dangerous. You know, you don't want the kids to be going low without CGM in the past and without the fast acting insulin is just so difficult. But I've also heard that in the past, it was thought that there was some kind of protection when kids were very little that the highs kind of didn't matter as much was that am I correct in thinking I heard that somewhere. And is there any truth to it?   Dr. Henry Rodriguez  20:50 Yeah, no, no, no, you are correct. And so the way I used to think of it as well, people didn't think that you know, with regards to complications, and and You know, serious consequences of high blood sugars, that that clock didn't start ticking until after puberty? To which I think that's pretty ridiculous. Unfortunately, over the course of my career, I have seen very young adults that, that, you know, we're poorly controlled. And in young adulthood, they're they're suffering the ravages of high blood sugars there. They've got renal impairment, they're there, they're having issues with their site and so forth. That that, we can't do that. And in as you've indicated, I think this is where continuous glucose monitoring allows us to be far more aggressive. No longer do I have to have a parent check twice a night every night to make sure that that child isn't having low blood sugars overnight. And so as a consequence, I can be more aggressive and say, Well, no, we don't have to have that baby. Go to sleep with a blood sugar of 200. Because we're worried about lows, we can target something far lower because we know that we're going to be able to, in the case of the dex conference that it will alarm that will, it will, you know, notify the parent that, that there's an impending blood sugar and you can intervene before the top actually goes well,   Stacey Simms  22:22 before we go on, I just want to be clear on and maybe this is a bit more of an editorial statement, but I think you'll back me up when you're saying that the concern about babies and toddlers, you know, going over 200, because you know, we're all looking at time and range. Now those of us were lucky enough to use CGM, which is really 70 or 80 to 180. I don't want parents who are maybe newer diagnosed, to feel like their kids are going to die or go blind if they hit 200. Because obviously, you don't want to stay there. You don't want to stay at 300. But can you give us a little reassurance that the concern there is just on a regular basis, you're worried about hydration, you're worried about long term But if your child hits 200 it's not the end of the world. I just worry about. I don't know. All right, I'll let you talk. Sorry.   Dr. Henry Rodriguez  23:11 No, no, no, no, I really do appreciate you pointing that out. Because there are some parents that, you know, I think sometimes we, we, we, we focus on, you know, this is the ideal. I think we're actually doing much better with CGM now. But, you know, it used to be that the gold standard was, you know, up a post meal blood sugar that doesn't go over 180. And you have to appreciate that even somebody that doesn't have diabetes does have a rise in their blood sugar after meal, but it typically doesn't go above you know, certainly 140. So, you know, it your point i think is well taken. We don't want the parent of any child or a particularly young child to think oh my lord, you know, they've they've had Our blood sugar's of 230. Over the last week, horrible things are going to happen. That That certainly is not the case. We do for the reasons that you've raised, particularly with regards to hydration, and just overall longer term risk. We do want to minimize high blood sugars, but you know that the occasional blood sugar over, you know, 200 is not going to have lasting effects on that child.   Stacey Simms  24:34 All right. Which brings us to another topic that I think is really important for this is more toddlers than babies, but once they start eating, right, we all know that pre bola Singh is the gold standard you're supposed to figure out, you know how far in advance when my son was younger, we could bolus ahead maybe 10 minutes. Now we can pre bolus 20 even 30 minutes for some meals. He's a big kid. You know, it's differently it's a lot different have a 15 year old than a 23 month old But that also can be very complicated for parents who don't know what the heck they're toddlers going to eat. I'm curious what you counsel people who say, you know, how do I do this? My kid throws food on the floor, or he will only eat a cookie, or we sit down to eat and he takes two hours to eat breakfast, you know, how do you I have my own feelings? But I'm curious as a as a mom, but as a medical professional, what you tell people?   Dr. Henry Rodriguez  25:24 Yeah, so, okay. Management of Type One Diabetes is all about compromise. I think back to you know, early in my career in diabetes is when the first rapid acting insulin came came came on board, and that that was life priority walk. And so prior to that, you know, the recommendation would human regular insulin was to administer it 30 minutes before before eating. And so I, you know, I imagined the parents of a very young child toddler, where they they did what they were told and then The child refuses to eat whatever they put in front of them. And, you know, at that point, you know, panic sets in and is you know, children learn very quickly. And those children many times and hold out for whatever it is that they want it. And so you can imagine the the parent getting out the, the ice cream or, or the chocolate milk or whatever it is little Johnny wants little Johnny's going to get because the consequences otherwise is that that child is going to have, you know, potentially a serious low blood sugar. So the rapid insulin analogs allowed us then to say, Well, you know, human log Nova log a Pedro have an onset of action of bout twice as fast as regular insulin. And so, understanding that it wasn't perfect, but it was reasonable to say well, if you really not sure that that child is going to eat you can give the influence after they're done, now, if they take an hour to eat, that's going to be a problem because you're going to get a significant blood sugar rise. Before that insulin actually starts working. Keep in mind that even your rapid acting insulin analogs, they don't peak for an hour to hour and a half. So, if you're waiting to give the insulin, you know, after you eat, there's going to be a significant rise in blood sugar before it comes down. And, you know, this is where, again, you know, you're you're now for lack of a better term, ultra rapid acting insulin a logs that are now coming to the forefront or about twice as fast as your human log, no log in a Phaedra. And so I think, from that perspective, there's hope that we're not going to suffer from, you know, higher blood sugars just because we're giving insulin beforehand. You know, we're the one ultra Rapid acting insulin and all that is currently available is as part of its fat, the dashboard or fast. And that's made by Millville. I know that we're actually doing one study here at our center with the ultra rapid form of human walk. And so it's interesting because at least in the adult studies, that insulin given up to 20 minutes after the meal, worked about as well as controlling the blood sugar is giving, you know, ordinary life pro human log beforehand. That's great. So I think, yeah, absolutely. So I again, it's allowing us to be more aggressive and limiting the rise in blood sugar after a meal, even if it's given afterwards.   Stacey Simms  28:48 Yeah, and I will admit, we did not have a CGM until my son was nine years old. And we just came up before that, but frankly, I didn't think it was accurate enough at the time for what we needed, and he didn't want to Second Sight, told the story before. So we bolused after until he was probably six years old, and not having to use glucose monitor, obviously, you're not seeing the rise of blood sugar, because to two hours later, he's fine. But our agencies were always great. You know, I really feel like it didn't hurt him, for whatever reason to do it that way. He's also though, you know, he was a healthy eater, he did not take an hour and a half to eat a meal, he probably took three seconds to eat his food. So it doesn't really like we were waiting that long. But but it really can be done. And I'll be honest with you, Dr. I really feel like and this is a little soapbox moment, which I may take out, we'll see. But this is a little soapbox moment. I just feel like you can you can create disordered eating, honestly, if you're not careful. You know, and if your kid starts saying things like I'm going to only the ice cream or I'm going to hold out for the desert. You know, there's really and my heart goes out to parents who are so concerned about never rising over. 120 or 140? I see these parents, Facebook groups all the time. And it's like, oh my gosh, your kids. I mean, I hate to say it, your kids can have diabetes. For a long time. I hope there's a cure. But I mean, it's very difficult. So I appreciate you saying that. I appreciate you giving some hope fest directing insolence. But just permission to bowl this after is amazing. But also, you mentioned if they're gonna eat for an hour, again, with an insulin pump, it's so helpful because you can maybe bolus right there's there's 25 carbs in this plate. I'm going to get five carbs up front. I'm going to give five carbs five writes in right I mean, you can do it as they go to which is fabulous.   Dr. Henry Rodriguez  30:40 Now, I think if I may digress for a moment, I think, you know, I'm sure you've heard the term brutal diabetes. Yes. And it and so I really on in my career, and admittedly erroneously assumed that was a non adherent patient. In other words, their blood sugar's were far more difficult to control because they weren't doing doing what we told them as their providers to do. And over the years, I've come to appreciate that even though I still don't like the term, type one diabetes, not Type One Diabetes for everyone. We've done so much research over the last few years. There are individuals that have had type one diabetes, you know, that the gold medalist from Johnson that continue to make insulin years and years later and so for individuals that have you know, their their pancreas is still making some insulin. It it's far easier for them to have more stable blood sugars, as opposed to someone who's totally dependent on what we refer to is exhaustion is rejected insulin by a pump or or needle. It's a different animal. And so, you know, if you have an individual that is, if you think about has a prolonged honeymoon period, they're making insulin summons, when not enough in the background kind of takes the edge off. If you think about it, not only, you know, in that honeymoon period, not only are the blood sugars that are controlled on the top end, but think about the risk for low blood sugars, it's less because, for example, if you're making 50% of the insulin you need, and you're going low, you have the ability to turn off that 50%, at least in theory, right, so that your body can respond by making less insulin, and therefore you have less risk for low blood sugar. So, you know, I think I've grown somewhat wiser over the years and in really come to appreciate that. You know, it just because someone has erratic blood sugars, it doesn't mean that they're not following the management plan.   Stacey Simms  32:58 Absolutely. And then conversely, I will say, perhaps I was on my high horse. If someone has a good experience, it doesn't mean that's because they're doing everything right. I will also point out that for one some magical reason, my son does not get ketones easily at all. And it's been it's been a remarkable because it has, I mean, knock on wood, all I can everything I can knock on. But you know, he just doesn't develop that he's been sick just like every other kid. He's been high for days. I mean, he's a teenager, and he hasn't developed large ketones that I ever remember where I have a friend whose kid hits to 50 for two hours, and he's got large ketones. So it's a great reminder that everyone's experience really is different. I appreciate that. Let's just talk a little bit you mentioned the honeymoon period. I have heard again, this is a lot of I've heard Can you confirm but I have heard that when children get type one it is very acute, and almost always the honeymoon period is either short or you know the insulin producing cells are just gone. Is that true?   Dr. Henry Rodriguez  34:05 Depends.   This is one of those areas. So you're probably familiar with Type One Diabetes trauma. And before that it was the diabetes prevention trial. So we had been screening family members of individuals with Type One Diabetes, to determine, really, you know, who's at greatest risk. And then in some cases, we've been doing oral glucose tolerance test, really, if you think about it, just kind of testing your pancreas to see if they can make enough insulin to keep the blood sugar in normal range, even with lots of sugar coming in all at once. And what we found is that, you know, the progression first tends to be more late and slower in older individuals and it tends to be most aggressive than the youngest, which is a little bit disheartening, but but it is what it is. And so there was a publication came out that was jointly authored by the endocrine society jdrf and the ADA, and this came out, don't quote me on this, you will have to double check it, but I think it was December of 20 16%. I'll look it up. And, and based upon and I can provide the reference later on, but based upon largely all the individuals that we screened, and trauma, and our follow up of them, what we have determined is that type one diabetes, you don't have type one diabetes, when you end up with high blood sugar and in the emergency room, we are typical symptoms of urinating a lot, drinking lot, perhaps losing weight without trying. Those are the classic triad of symptoms that we that we associate with gosh, you have type one diabetes, we can and we have intermit, tested up to five different antibodies that we can measure in the bloodstream, that are a signal that the immune system has begun to Identify the cells in the pancreas that make insulin the beta cells as quote for it, and then the immune system makes antibodies that can target those cells. We can measure up to five, what we've determined is in individuals that have two or more, their lifetime risk of developing type one diabetes is nearly 100%. So that's where it's now accepted that there's a staging system for type one diabetes. Stage One is when you have an antibody, at least lashley, excuse me, two antibodies of the five. Stage Two is when you have those two antibodies, and on that oral glucose tolerance test, the stress test for the islet cells that they don't rise to a level but the standard for diagnosing Type One Diabetes based on the test is a two hour level it's 200 milligrams per deciliter or more. So you haven't reached that threshold, but you're above the 140 So you're in that gray zone. So that's what we refer to as glucose intolerance. It basically tells us that the beta cells are starting to fail, so to speak. And so that's stage two. Stage Three is when you have classic symptoms, when you generally present with clinical symptoms, and then stage four, or individuals that have established diabetes for an extended period of time. So So to answer your question, the auto immune process occurs in the background. And it's, you know, we are as part of research studies, primarily trauma screening individually. I'm sorry, there are some religious studies in Europe as well. But we're screening individuals that we know are a great risk or greater risk because having a family member now, if I can go off a little bit for a moment, keep in mind that the vast majority of people that get diagnosed with Type One Diabetes do not have a family member. Okay. So Somewhere around 90 95%. But for those individuals that do have a family member, their relative risk is about 15 fold greater. And you might say, well, gosh, that sounds like, you know, that's terrible, that's really high. What you're what you're basically looking at is a relative risk of about 5%. In other words, for every 100 individuals that we screen that has a family member with type one, only five end up being in a body positive. If you were to look at that in the general population, it's maybe two or 3000, as opposed to 500. So the risk is greater in family members, but the majority of individuals who do get diagnosed with Type One Diabetes, there is no family history.   Stacey Simms  38:46 It's so interesting, and that that was us. You know, we had no family history, like so many people, as you said, but then three years later, my cousin was diagnosed. So now we're thinking, hmm, you know, is it something is it because we won't know I mean, you really I guess we won't know until the next generation perhaps, but both kids have gone through. Several of us have gone through trial net. So, you know, nobody else has any markers. So we shall see. But it's a great idea. I know it's you know, it's funny because it is great. And then you have to be honest with you. I my first reaction was guilt. I mean, I guilty that I didn't have it, and I would have felt guilty if I did have it. Oh, that's a different show. Okay, so we're gonna Yeah, exactly. Um, I got a really interesting question that I wanted to make sure to address to you and it was about food and I know you know, you maybe I could have a nutritionist on and go into this in a more specialized way. But the question was, sometimes especially with kids, you know, we get these these free snacks. You know, you can have I remember my son was anything under 10 carbs was a free snack. But the question was low carb snacks are tough for infants and toddlers, because at this age group, things like nuts and raw vegetables. are choking hazard. Right? Any ideas or comments on low carb snacks?   Dr. Henry Rodriguez  40:06 Their challenge? Hey, if you think about it even, you know, I mean, breast milk, as we mentioned, or you know, regular milk, I mean that there are some carbohydrates there. I think, you know, it all comes down to, you know, as we said, it's a compromise, and you have to do your best I I have a number of patients who, we don't recommend this and younger children by any means, but there are adults, as you're probably aware, that find that their blood glucose control is far better if they really restrict your carbohydrates. Okay. And again, I want to emphasize again and children, we generally discourage that because children need a balanced diet in order to grow and develop, but adults will find in some cases, they severely restrict your carbohydrates. So we're talking about 15 or 20 grants in an entire day. Now, you might say, well do they need it? Certainly the basal insulin, you need that regardless. But for those individuals, we we focus on the protein intake, because protein will raise your blood sugar not nearly to the degree that carbohydrates do. But you need some insulin to cover that, that glucose rises that can occur with the increase with with intake of protein. So in the absence of carbohydrate, we look at dosing for protein. But the short answer to your question is, you know, it's going to depend on the age of the child, as you said, and youngest children, you don't want to give them foods that they may choke on. You should certainly make snacks with almond flour and things like that, where you know, you don't have that choking hazard. I think there are a lot more options out there now than there were in the past.   Stacey Simms  41:55 Yeah, another question I got was about communication. Because an oh my gosh, this was so difficult for us. You know, when you have an older child, they can tell you kind of how they're feeling even if they don't have all of the hypoglycemia awareness and they're not really sure how they feel. When you have a baby, they can't I mean, my son couldn't say diabetes. And how do you talk to parents about I remember my biggest question was, what is he napping? Is he low and passing out? You know, we were just checking him against the gym can be very helpful, but not everybody's gonna have one. You know, what do you eat? But   Dr. Henry Rodriguez  42:31 yeah, so that particular instance more and more. We try to get that child on the CGM as soon as we can. And we will we will go to bat for that family and we will try to get it covered through the insurance will find a way because otherwise, you know, I parents are sleep deprived. You're the monitoring that child overnight, and all hours. And so I think continuous glucose monitoring in that Keith is almost decentral. I mean, we we're at the point now where the devices are accurate enough. Certainly, we're well beyond the stage where the FDA said when they were first introduced that, you know, you couldn't do any insulin dosing based on the CGM reading. So we know that they're accurate. You know, we always double check the blood glucose if we're concerned, but I think it, it brings so much value that I really strongly advocate for trying every possible means to get that young child on a continuous glucose monitor.   Stacey Simms  43:40 And I'm, I'm sure if my son was diagnosed at that age today, I would push for it as well. But I do want to ask you one thing before I let you go here, you know, you said parents are sleep deprived. I don't know if you're aware you probably are. That even with CGM, and I actually think again editorial in part because of it, that more parents are more sleep deprived. Because they cannot stop looking at the numbers. And it's not only   Dr. Henry Rodriguez  44:05 to their self well,   Stacey Simms  44:07 please, but you know, you have your alarm set, but people either don't trust it, or they're so worried. Or On the flip side, as we mentioned earlier, they've got their higher alarm set to 125. So they're not sleeping even with CGM. Right you do about that? How do we balance this amazing technology that is supposed to give us less fear with this odd? I don't know if it's social media phenomenon, or what's happened in the last five years, where there is almost more fear, in a way,   Dr. Henry Rodriguez  44:35 right. So I think it really is a matter of education. And so I think that's where, you know, in some cases, you may be talking about maybe meeting with a psychologist to address those fears, but, but I always tell families, you know, I never tell a parent that they should not check if they feel they need to check. But I do tell them that I would like them to get to a place where they feel comfortable sleeping overnight, and not having to look continuously. And so that means, you know, ongoing communication with with that family and working with their diabetes care team to get them to a point where they feel comfortable, that's critically important. Otherwise, you know, all Type One Diabetes is stressful, I don't need to tell you that. But But getting folks to the place where, you know, they feel that it's less of a burden, and more more of a benefit of a tool that that will allow them to, to, you know, not not worry so much. You know, we're not at the point now, where we have closed loop systems, unfortunately, we're getting there, right. But if you think about it, even with a closed loop system, I can't tell you. It's funny. I've got patients now that have been on continuous glucose monitoring. Almost At the time they were diagnosed. And it was it was telling to me because I had a patient say, Well, what did folks do before there was CGM? It's, it's really interesting. But But I will tell you not to put all the blame on the adolescence. But you know, I said I had all this and patients that for whatever reason, you know, their CGM, either they run out of supplies or, you know, as you as you mature, know, a couple weekends ago, you know, there was lots of connectivity receivers and still work, but, but at any rate, they somehow forget that they have the ability to poke their fingers and use a traditional glucose monitor. So, yeah, yeah, it's a challenge. But even when you have a closed loop system, you know, influence being delivered under the skin, you're dependent upon that little Kameelah that sits under the skin. So one of the things that I really, really focus on is, you know, kind of worst case scenario. So, if don't change your site right before you go to bed, you want to make sure that you have the ability to observe you with a CGM or do a blood sugar reject, you know, an hour to after you set aside change, you know, As matter of routine, so that you know that the candle is in place that is, you know, the insulin being delivered and so forth. You we always have to come back to basics. If you have a closed loop system, and there's an interruption in insulin delivery, you need to be aware. And so I think those are some basic skills that that folks will have to still master even when we have closed systems.   Stacey Simms  47:28 Yeah, that's at any age too. That's great advice. Alright, so let me ask you one more question here. Before we wrap this up, you are a pediatric endo. You've seen kids from infant ages, you said and you do see some young adults. So what's it like for you to see somebody who was diagnosed as a toddler or a baby? grow up with type one? I'm sure you've had patients. I mean, we've been seeing the same endo for 13 years and he's seen my son from a pacifier. I mean, my son would be mortified, but from a pacifier in diapers to now he's got his driver's permit. You know, what was it like for you? Watch these kids grow up.   Dr. Henry Rodriguez  48:02 It's inspiring. And actually, I, it's funny, you should mention that. So I've been at the University of South Florida now for nine years. And there's a patient that I saw at the time of diagnosis when I was in Indiana. And, you know, we both ended up moving down to this area. And so it's a young lady who's now a freshman in college, and I saw me she was diagnosed at five years of age, and, and she's just phenomenal. You know, it really is a testament to her to her, her family. You know, it's, it's funny. People ask me, and for years, they've asked me, Well, how do you how do you end up in diabetes? And I used to say that I don't have a personal connection to diabetes, because diabetes is not something that's my family, and we've got other issues. But now I tell some I don't have a genetic connection because I have had really the great fortune of working with individuals in the diabetes community, as you said, it's a fairly small one, particularly talking about type one. But there are some phenomenal inspiring individuals that that really, you know, when I have challenging days, I think of those individuals and it really does inspire me.   Stacey Simms  49:20 So as you're listening, and I know most listeners this week will probably be parents who have very young children. You know, I think we can all think I still think back, Dr. Rodriguez of when my son was diagnosed, and I thought what is his life going to be like, you know, this it's not going to be the life I thought he would lead. He's only he's not yet to and this is gonna ruin things. And it didn't. Like I said, He's got his permit. He's, he's healthy. He's obviously changed our life, but my fears from that age didn't come true.   Dr. Henry Rodriguez  49:51 And again, every day, individualism jdrf, the American Diabetes Association really has made great strides. You probably Heard of the ruling of the FAA? Just recently that, you know, used to be that I told children that, you know, what, what do you want to be when you grow up? And, and they tell you well, I want to be a pilot and that was not an option. Now is that now so? I think the technology, the advances in therapies have gotten us to a place where, you know, we, you can do just about anything you want to do. And so that's, that's something that's, we try to communicate that message to all of our families.   Stacey Simms  50:35 Well, thank you so much for spending so much time with me, I could probably talk to you for another three hours, but I really appreciate it. Thanks for sharing so much of your expertise.   Dr. Henry Rodriguez  50:43 Well, it's a pleasure chatting with you. -------------------- (Stacet) I'll link up some more information including the Facebook groups that I mentioned, for the very youngest people with type one diabetes over at the homeless. page and remember on the episode homepage you can find the whole transcription of this interview. I know it was long I really appreciate that you stuck with it stuck with it coming up in just a minute. Tell me something good. We're gonna go to the other end of the spectrum, not babies, but a woman who was diagnosed 62 years ago. Diabetes Connections is brought to you by Dexcom and we've been using the Dexcom G6 since it came out last summer and it's amazing. The Dexcom G6 is now FDA permitted for no finger sticks. Whoops. We've been using the Dexcom G6 since it came out and it's amazing the Dexcom G6 is now FDA permitted for no finger sticks for calibration and diabetes treatment decisions. You do that two hour warm up and the number just pops up - previous iterations of Dexcom didn't do that. I am still getting used to that kind of magical pop up without calibration. You know we have been using Dexcom for six years now and it just keeps getting better. The G6 has Longer sensor. We're now 10 days, and the new sensor applicator is so easy to use. Benny does it by himself. He says it doesn't hurt. Of course we love the alerts. Of course, we love the alerts and alarms, and that we can set them how we want. If your glucose alerts and readings from the G6 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions. To learn more, go to diabetes dash connections dot com and click on the Dexcom logo. It's time now for Tell me something good brought to you by real good foods where we tell the good news in our community. And I got a great note in the Facebook group and that's diabetes connections the group if you're not in there already, please go ahead and join. Carolyn Fellman said that she is celebrating 62 years with Type One Diabetes. She writes. I was diagnosed at 11 I remember the pan at 11. I remember the pan my mom kept on the back of the stove with the glass syringe. And steel needle that had to be boiled every morning, I took about 70 units of length take insulin. I'm sure if I'm saying that right. One of my favorite stories she says is that one day my mom asked the pharmacist for a pumice stone to file a rough spot of a needle. And he yelled at her for an actress buying a new needle, they cost 50 cents. I started MDI about 40 years ago, and a pump about 25 years ago. I got a Dexcom two years ago, and I learned more about what my body does with food in that first year with a CGM that I had learned in the previous 60. Thanks for asking. She says, well, Caroline, thanks for asking. She says, well, Carolyn, thank you so much for telling us your story. And one of the best parts about her post in the Facebook group is that other people who've lived with type one for 5060 years, chimed in and started telling their own stories. It's just so great to hear and it's just incredible to think about how far everything has come I mean you hear these stories right but here's somebody who lived it and is still doing well. Wow Carolyn I really appreciate it! Send me your Tell me something good stories we’re sharing them on social media this year as well. It can be anything from a very big milestone diverse story to something your kid did that was fun to something you really just want to share maybe someone in your community did something nice. You can email me Stacey at diabetes dash connections calm or post it on social I'm all over the place. Stacey at diabetes dash connections. com or post it in the Facebook group or message me over social bind me and tell me something good. As I mentioned in our last full episode with the time shiftiness of podcasting, Benny was supposed to get off crutches and into physical therapy and I am thrilled to announce that he is if you're new to the show, he tore his meniscus in October and it has been a long road. He missed the entire Wrestling's Season pretty much, it's almost over now. But he's doing great. He's been so patient. I mean, I got to give this kid some credit. It's been really tough and he's done a great job. He has just had a really good attitude in a really crummy situation. So I'm really, really proud of him. We went to see our endocrinologist in the beginning of January, it was a great visit. He's had the same a one see, for the last three, maybe four visits, if not all four. It's been very, very close, which we're really thrilled with. Going to be excited to see what happens with control IQ. And if that makes a difference. I can't imagine that it won't. Our next book stop is actually tonight. If you're listening today, this is released on the 14th. I'm heading to Columbia, South Carolina, to talk to the JDRF chapter there. I'm very excited to share some world's worst diabetes mom stories, and then it's off to Raleigh on February 1, we're doing a lot of stuff around the Carolinas, which I love. I live in Charlotte, North Carolina, North Carolina, I posted the complete book tour through March on social media and you can see all of the stops at diabetes dash connections. com just click on community. We have a short episode one of our minisodes coming out on Thursday, and that is all about control IQ. I did a full episode with all the information you need and you can go back just a couple of weeks ago that is with Molly McElwain. Malloy, this episode is just my hope for control IQ, my expectations, my thinking, my expectations, my thinking on hybrid closed loop. You know what I really think Benny is going to get out of it. So that's coming up in just a couple of days. So that's coming up in just a couple of days. Make sure you are subscribed to this podcast. If you're listening on a podcast app, hit subscribe and you will never miss an episode. Thanks as always, to my editor john Kenneth from audio editing solutions. Thank you all so much for listening. I'm Stacey Simms. I'll see you back here on Thursday when we're talking about control IQ   Transcribed by https://otter.ai

How (and when) should you use public relations in tandem with your inbound marketing strategy?  This week on The Inbound Success Podcast, Ruby Media Group Founder Kristin Ruby breaks down the myths surrounding PR and inbound marketing. In this conversation, she gets into detail about who should consider using PR, when to use it, how much you should expect to pay, and what kinds of results you should expect.  In addition, Kristin covers the difference between PR for brand building and PR for SEO, as well as the difference between reactive and proactive PR. There's lots of practical information here for any marketers who has ever considered using PR as part of their strategy. Highlights from my conversation with Kristin include: Kris is a PR specialist, which is different than a media relations specialist. PR can encompass anything in the communications plan and marketing plan whereas media relations is specifically about interaction with the media.  PR is a good strategy for any business that is looking to build a long term, sustainable funnel of leads, as well as to build their brand.  One of the big benefits of PR is that it can contribute to building your domain authority, which is great for SEO. In terms of setting expectations for a PR engagement, Kristin says that the results you can get are very dependent upon the news cycle and what journalists are interested in covering.  Kristin says you should expect to commit to working with your PR firm at least one hour each day. There's a difference between reactive and proactive PR. Kristin specializes in reactive PR, which entails responding to reporters' requests for sources, as opposed to proactive PR, which she characterizes as going out to the media and spamming them with unsolicited pitches. When it comes to PR, its important to build up on line authority and get others talking about you so that the media sees you as a credible source. For clients looking to get started with PR, Kristin recommends that they begin by publishing content that is aligned with what they are hoping to get coverage about. This can be published on their website, LinkedIn profile, etc. The cost of a PR engagement can vary widely depending upon the scope of services and the type of media coverage that you're looking for and then the size of the firm you want to work with. A reasonable range that PR services start at would be anywhere from $3,500 or $5,000 a month, but some of the larger firms could be charging $35,000 or $40,000 a month.  If you plan to be on TV at all as part of your PR plan, it could be worth investing in media training as part of your PR package, as it will prepare you to be on camera. Resources from this episode: Visit the Ruby Media Group website Check out Kristin's person site Visit medicalpracticepr.com for information about PR for doctors Get Kristin's Ultimate Media Relations Guide Listen to the podcast to learn more about public relations and how you can use it as part of your larger inbound marketing strategy. Transcript Kathleen Booth (Host): Welcome back to the Inbound Success Podcast. I'm your host Kathleen Booth. Today, my guest is Kristin Ruby who is the founder and CEO of Ruby Media Group. Welcome Kristin. Kristin Ruby (Guest): Hi, thank you so much for having me. Kristin and Kathleen recording this episode. Kathleen: I'm so happy to have you here. You are in the field of PR and we don't get to talk about PR a lot on the podcast so I'm really excited to dig into it with you, but before we do can you just tell my listeners a little bit more about yourself, and about your company, and what you do? About Kristin and Ruby Media Group Kristin: Sure. My company is called Ruby Media Group. I have been a practicing public relations practitioner for over a decade now. I work with clients and businesses of all sizes from small to midsize companies to even Fortune 500 companies, and particularly with a lot of medical practices and doctors as well. We assist with brand building, content creation, social media, public relations, and really help people get found online. What we're really best at is taking people of thought leadership offline and translating that online. Kathleen: Great. It's interesting. When you and I first spoke what I really liked was... My question to you was obviously this podcast is all about inbound marketing, and people have mixed opinions about where PR, public relations, fits within that mix as an inbound marketer. I think there's also a lot of misconceptions about what public relations is, especially today, like as it's evolved over time. You had some really interesting viewpoints on that, and I wanted to just actually start by having you explain what you see as what PR is, and the different uses of it, because there's obviously PR for SEO, and then there's other types of PR. Kristin: I mean, so it's a really interesting question. To start with I think there's a difference between PR and media relations, so I want to also explain that to your listeners. PR can encompass anything in the communications plan and marketing plan whereas media relations is specifically about interaction with the media. To clarify, I do a lot of media relations work whereas some public relations practitioners will sort of do community outreach, and sponsorship, and a larger umbrella of what PR is. So in terms of public relations basically a publicist will help you in terms of all your interactions with the media, getting you out there, handling media inquiries, anything of that nature. When should you invest in PR? Kathleen: Okay, great. What do you see as the value of PR for the companies that invest in it? Who is it right for? When should you do it? That sort of thing. Kristin: That's a great question. PR, it really depends with what stage you're at in your business. For example, let's say you're a medical practice, and a doctor, and you've been around for 10 years, you already have a waiting list of patients, but at this point you have other goals. Maybe you want to become a paid speaker. Maybe you want to write a book, and you want a publisher, and you need a social media following for that, or maybe you're at a different level in your career where now you just want to focus on putting out educational content to reach the masses because your time is limited, and you can only see a certain amount of patients a day. For that type of practitioner I think PR is ideal, because it fits in the brand building bucket. I think if you're someone that is saying, "I need more patients in the door tomorrow, and I've just launched a practice," I would still say more traditional inbound marketing would make sense for that, including some direct marketing and advertising as well. I really think you have to evaluate are you looking for sales and leads tomorrow out of this or can you have a longer sort of sales funnel in terms of what you're doing with all of this? Kathleen: Yeah, that's a good point. I often hear about PR a lot from startups, especially B2B technology startups. There seems to be this assumption that in the beginning PR is something that you should invest in almost before marketing. I think part of it is this desire as a startup to plant your flag in the ground, in the marketplace, and get your name out there. But then, the other part of it is also, from my perspective as a marketer, it's building domain authority. That goes back to the PR for SEO thing, so I wonder if you could just talk a little bit about that. PR for brand building v. PR for SEO Kristin: Sure. I have a great case study in terms of PR for SEOs. We worked with a client, and we started everything from scratch for them with a new website, and we had not done any direct marketing, and we've only done PR for them. Their ranking right now is a 32, Domain Authority, and that's only from public relations. So all of that authority they have not done any paid advertising. It's all back links from PR articles that I've gotten them. Now, again, that was never even a primary goal of why we did PR for this person, but I think one of the amazing things about that campaign is that it just sort of compliments, and comes out, when you're not even trying for it, right? I think public relations practitioners there's often this sort of disconnect with SEO, and with PR, because they're so focused on getting the hits, and working with producers and journalists that they don't actually realize they really are building someone's back link, and Domain Authority while they're doing ... Now, of course you can never guarantee any placements, and we could talk about that as well, but if you get them it can be great, especially if you are securing it for a client in that third-party national media outlet, and that outlet has very high Domain Authority, well then, you're benefiting from that. Kathleen: Yeah. It is tremendous potential if you have a well known media entity. Those back links can be worth a lot. Kristin: Yes. What should you expect from a PR engagement? Kathleen: I want to talk about expectation setting because that can seem very alluring, and I'm sure you have clients who come to you and say, "Get me mentioned in the Wall Street Journal, or on TV, et cetera," so can you talk me through when you first start working with a new client how do you, A, determine what's possible, and B, how do you set expectations around that? Kristin: Sure. The first thing that we ask a prospect that's interested in working with us for public relations is what does PR success look like to you? So how are you going to evaluate the engagement here, and what do those metrics and KPIs look like? For example, if they're saying, "We want to be on the today show, within a month." Obviously that's going to be an unrealistic expectation. If they're saying, "We're looking for around three or four press placements, and digital mentions a month." That's a realistic expectation with my firm. I'm not sure if it is with every firm, but for us I know that I can deliver that. If they're saying, "I want you to guarantee a set amount of bookings whether that's on radio, or television, or any outlet." That's something that's not realistic, because no PR firm that's worth their salt is going to be able to give those guarantees, and the reason for that is because we are working with the media. The media dictates what they want to use and what they don't want to use. I think the problem is that people hire publicist and think that the publicist have much more power than they do. I don't know if that's because PR just misrepresents what they can do to try and close a deal, or what it is, but it's just not realistic, right? We are working with the media at any given time. For example, if you look at any week on the news cycle there's a lot of political stuff happening, whether it's Trump, and whether he should be impeached or not. What if you had a client that's booked on TV this week? All that's going to be canceled, because of the news cycle. Kathleen: And if it wasn't canceled no one would probably pay attention anyway because everyone's attention is diverted somewhere else I would think. Kristin: Exactly. But this is why it's so important if you're doing PR right now, especially in this news cycle, people need to understand that the news cycle, and breaking news, dictates what's being covered. It's not your client that dictates it, right? So if you can come up with some great tie-in to the news, or if your client's a political expert and they can comment on what's happening, then great that adds value to whatever story's happening. That lends itself back to your original question, which is how do you sort of determine if someone's going to be a good client? In this heavily political climate that we're in right now a lot of PR people will definitely gravitate towards clients, or prospective clients, that can comment on those things, because they know that they can get them booked, and get hits for them. So you have to think about that as well. So we sort of go through an internal checklist about who's going to be good. It has to do with expectations, are they realistic? The next is, do you have at least one hour daily to work with your PR firm if you hire them? People make the mistake of hiring a firm and then they don't give them what they need to do their job. You have to supply content to your firm so that they can get you out there. You have to let them know if something's going on that you can comment on, tell them. If there's a link that you think is interesting share it with them, but this notion that you're going to hire a PR firm, and then you're not going to talk to them, and they can get you hits is just very unrealistic. What makes for a newsworthy story? Kathleen: Yeah. Now, someone comes to you, and their expectations are realistic in the sense that thy say "Hey, I would love to get four press mentions this month." I'm assuming that as you say there's some kind of content that's needed, like you can't just call up a reporter and say, "Hey cover this company," full stop, period. There needs to be some kind of a story. So how do you work with clients to determine what that right story is, and kind of cultivate something that's newsworthy? Kristin: Sure. There's two different types of PR. There's proactive PR and there's reactive PR. I'm a specialist in what I call reactive PR. So reactive PR is when you're using different databases, whether it's a HARO or a Profnet, or Cision. There's a lot of new ones coming out right now where those journalists are saying, "We're writing this story, do you have an expert to speak on X?" That's when I plug my clients in to be able to comment on those stories, reactive. Proactive PR is I think a more traditional old school approach where you're sort of just going out to journalists and I would call it spamming them, which is saying, "I have this great idea, why don't you cover it?" But the problem is they may or may not be writing that. So I think just the success rates are significantly higher when you practice reactive PR, which is what I call it. Because you're giving them what they want, want they're already working on and it makes their life easier. Kathleen: Okay, so you really, in that case then, don't have to necessarily have a breaking news item or a piece of content. It's really just authority and expertise that you're pitching? Kristin: So it's authority and expertise, but it's also answering a lot of questions, and usually those questions tie into something. So if someone is working on a vaping story. Right? You could have authority and expertise, but you also need to have expertise in that new's component that's happening with vaping in the country right now. So I think it's a combination of all of those factors together. But to answer your other question about, how do you sort of package that? I have a motto. My motto is, "Package, pitch, promote." Phase one when working with someone is how can we package this story. Who are they? What do they look like? What does their brand look like? The first thing I'll do is do a deep dive on Google. I want to look at their website. Do they have a usable working site? If not, that needs to go up before we even work with them because journalists are going to look for that. Next, what has been written about them online? Do they have a critical mass of authority online? If they don't, again, that needs to sort of be created. Third, who are they? What do they want to be known for? What is their area of expertise? If there is going to be a lower third for their title tag on television, what would it say? Expert in what? Right? So we need to sort of figure all that out. Finally, do they have a higher res headshot for the media and do they have an executive bio? All of that sort of has to be done in the first two months of us working with someone. Even though it sounds sort of simple, most people don't have all of that ready to go. So we definitely get that lined up for someone before we start with them, and then next we start putting together an FAQ document in Microsoft Word. I actually just put together a helpful media 101 pitching checklist that I can definitely share. Kathleen: That would be great. Kristin: With your listeners. Kathleen: Yeah. Kristin: That would be great. As well as a media guide too, with a lot of answered questions that for them that are helpful. Building online authority Kathleen: Now, I think it was the second thing you mentioned there, was they need to have... After the website, they need to have some sort of critical mass of online authority established. What does that mean? What are you looking for there? Kristin: I'm looking to see that other people have talked about them and have quoted them. Right? I think that sorts of lends itself very nicely to the new Google... I recently put up an article on this since we last spoke about the Google's authority and what they're looking for in this term called Eat. It's very important. It's all about having authority online. That's where PR can really help if you're trying to increase your Eat on Google, you need authority. So Google, one of their quality raters what they look for is, it's not... I'm going to actually say this. It's not about just you saying that you're great. When we look online we need to see that other people are saying you are great and that you are an expert in what you're saying you are. So I think this is a very interesting time, and this is sort of changing the game in general for PR. So you can't just pivot. You can't just say that you're an expert in everything anymore. You have to say you're expert in one thing and it doesn't matter how many times you say it. If no one else does it, you're not an expert. So this is going to be a major game changer for PR. How to get started with PR Kathleen: So if somebody comes to you and they don't have a lot of mentions online, can you work with them? Can you get them coverage? How do you start? What's that first step? Kristin: So the first step is that I feel like for them we have to do more of a brand audit and it's sort of different campaign where we're building that out for a longer period of time before we ever pitch anything to the media, and I think how you start with that is definitely content marketing. So if they want to show their expertise, they have to put out content that aligns with that expertise. So the best place to start if they don't have other people mentioning them is to start putting out their content on their own site or on LinkedIn where they're showing what they know, or doing an Ebook, or any sort of other inbound campaign, which I think is just very important. Having people link back to that to start to build up the authority even if they have no other outside media coverage. Right? That's where I would start for something like that. Why inbound marketing is necessary for PR Kathleen: That's helpful because when you think about how inbound marketing and PR go together, like I've said, I've talked to lots of companies that think you start with PR, then you do inbound and then maybe you do PR again. But if what I'm hearing what you're saying is correct, it sounds like it does make sense to begin with some inbound marking first so that you have that content already created. You have potentially gotten mentioned, you're starting to establish some authority. Is that accurate? Kristin: Yeah, it is accurate because here's the thing. You can say that you're an expert and have no content to back that up and expect people to write about you. Kathleen: Mm-hmm (affirmative). Kristin: Because you're only... At that point, you're just a self-proclaimed expert. If a PR person is going to pitch you and that journalist looks you up, and they don't even see content written by you, how are you an expert? It doesn't make any sense. So I think that's a major mistake that a lot of people make. So there are some PR people who obviously skip this whole content marketing part and that's not really practicing the new method of PR. I would say that content marketing and inbound is critical to work in silo with public relations. I don't think it should be separate. What does PR cost? Kathleen: Yeah. Now one of the questions I'm sure that anybody has if they haven't worked with a PR firm before is, this sounds great but what does it cost? I'm not asking what do you charge, but can you give me a sense of if somebody's considering beginning to do some PR and they're going to work with somebody outside of their company to do it, what sort of budget should they have just to get started? Kristin: Sure. It really depends on, for example, are you willing to work with a public relations freelancer? Are you looking to work with a larger size firm? So the scope of services and the type of media coverage that you're looking for and then the size of the firm all dictate the answer to that question. Typically, I would say a reasonable range that PR services start at, you can see them anywhere from $3,500 or $5,000 a month and then up. For some of the larger firms, they could be charging $35,000 or $40,000 a month. So it really, again, depends on the size of the firm. It also depends on the other ancillary services. So for example, do you nee media training? That's typically going to be a cost. If you need a press kit, that's going to be an outside cost. If you need a personal branding website, that's going to be another cost. If you need photography and head shots, another cost. So a lot of times those costs are not actually built in to the ongoing campaign. I think that managing scope creep is also very important in PR to understanding what the role of a publicist is, and if not, it definitely matters too. What is media training? Kathleen: Let's talk about media training for a minute because this actually came up in a conversation that I recently had. Can you explain what happens in a media training and what are you being trained about? Kristin: So media training is really supposed to prepare you, a lot of the times for on camera interviews, and how can you be prepared, particularly in television in a breaking news environment. How can you answer questions? How can you not say things like um while you're doing interviews. Anything like that. So typically when I do media training with executives, I will record them and we'll go play back what they sound like. If they do a segment, we will sort of rigorously critic that segment, and say, "This is great, but here are all the things you need to do to improve that." So for example, can they maintain eye contact. That's what we look for or are they sort of looking all over the place? Are there a lot of transition words? Can they cut back on that? Are they using modifiers like in my opinion. That can be cut and that don't add to the interview. Are they talking for way too long and have they not been trained in speaking in sound bytes. So all of those things are components in media training. Kathleen: It's so funny because listening to you describe it, it makes me think of podcasting because I've been doing this now... I'm on episode 110, and when I podcast, I always send my audio off to be transcribed and then I have to edit the transcription for the show notes. Reading the written version of what I say is the most horrifying thing in the world. I have discovered that I start just about every sentence with yeah. My guest says something and I'm like, "Yeah, let's talk about that," or, "Yeah, and I have a question." It's just so funny and I imagine it's the same thing with media training when you play back a recording. All of a sudden you're like, "Wait, I say that, that much? I had no idea." Kristin: Yes, exactly. That's why it can be scary and that's why it's really important though. For example, in addition to running a PR firm, I'm also a television commentator. So I've personally been on TV more than a hundred times on Fox News or other outlets, and still even if it's segment 101, I'm still rigorously assessing what I sound like because if I'm not doing that I'm not learning and I'm not getting better. So I think that people don't realize that people that are on air all the time are still doing this very same thing. It's not just something that you start when you hire a PR firm. You have to keep doing it. How to handle the tough questions Kathleen: Yeah, and one other... See there I did it. I said yeah. One of the other questions I had is... Because this is part of what came up in the conversation I was having, how do you advise people to handle it when they don't want to answer a question? Is it, "I don't comment on that"? Is there a certain way to gracefully avoid answering. Kristin: So I think there's two things. One, I'd call bridging. So if you don't necessarily want to answer something or if you're not sure how, I would bridge it and transition it into something else. So you can say, "This is a really interesting question, however I think this is the larger question." So that would be bridging. That's one option. Two is always be honest. So if someone asks you something and you are not qualified to speak on it, literally just tell someone that. Say, "That's a really interesting question, however I'm not sure I'm the best one to answer this, but if I had to take a stab, here's what I would say." You can say something like that as a modifier or you can say, "I'll get back to you on that one" I don't have time to Google it right now but you could do what Mark Zuckerberg did at the congressional hearing, which every single question he said, "I'll have my team get back to you on that." That's a perfect question of answering your question. Which PR opportunities are worth responding to? Kathleen: Okay, that makes sense. So circling back to PR for SEO and in tandem for inbound marketing back links. When you're pitching and you mentioned that you do reactive PR, how do you screen through which opportunities are worth responding to and which ones are not? Kristin: Sure. The first thing I will do is I will look at the outlet. Is it a well-known outlet, or is it a random blog? I'm not actually the... The back linking part I don't really like look at until the very end until something comes out because you don't really know if they're going to include a link or not. For me, if I'm going to send something to a client, I'm looking at it to think, is this an anonymous query? If it is, we're not replying. Is it a large national media outlet that we've heard of, which would be great to get a mention in regardless of the back link? Then yes, I'll send it to them. Is it worth their time to answer this? How many questions are on there that they want answered, and do I realistically think the client can answer it by the deadline that's given. So all of those things factor into whether or not I think that they should look at that. Again, I look at back links as great added bonus of doing PR, but if people come to me and say, "You need to guarantee back links." I tell them, "There's no way any public relations professional can guarantee back links. Reporters don't even know." So there's a lot of scams out there right now where people will... I'm sure you've received them too. Where they send you this nice long sheet and go, "Oh for X thousand dollars, for this one off I'll get you informed for this mention." Well Google's changing the game right now, rather, with how all of that's handled and if you look at the quality rater's guidelines, they also clearly mention that they can tell and that those links, they're very aware of that and they don't count for much. So I would say that's a waste of time and a waste of money. Spend your time and resources doing PR the right way, and if you get links out of it then that's an added bonus. Kathleen: Now you mentioned anonymous queries, and this is something that I've always wondered about. So I look at HARO all the time and like you said, some of the calls for sources they say, "I'm with this particular news outlet," and then others are just anonymous. I've always wondered about that because sometimes I think, "Oh, well if they're anonymous they're some podunk place." But then other times I think, "If they're anonymous maybe they're someplace big, but they don't want to let people know that." I don't know. What has your experience been with that? Kristin: It's a gamble. It's 50-50. It can go either way. So sometimes it could be like a major outlet, but they have an internal editorial policy, which may state we don't want someone else scooping up this story or we can't use HARO. So that reporter may put it in as anonymous. So technically they're not using HARO. That's one option. Another thing is that it really is a much smaller site and they know that no one is going to answer their query if they say, "This is for my hole in the wall blog that no one has ever heard of." So, it can go either way. How to identify PR opportunities Kathleen: So for somebody who's listening and thinking, "Gosh, I'm not ready to hire a PR firm yet, but I might want to dabble in to trying this out for myself." Are there... There's obviously HARO, which is Help A Reporter Out, which is a great free source that you can read and respond to. Are there any other really helpful places that somebody can go to on their own to see what kinds of stories other reporters are working on and potentially respond? Kristin: I think the best thing that they can do is really just read the news. I know that sounds so simple. So many people don't do it. Everyone is looking for this cheap quick fix on how they can do something, which is why I'm not really a fan of do it yourself PR for a number of reasons, but the main one is that people really... Do it yourself PR can actually be quite dangerous. I've seen people make major mistakes because they're not media trained. They say all sorts of things. They don't really know what on the record versus off the record even means, and then they want someone else to fix it. And that part... And they can't. Right? Because they read some advice somewhere and told them to try it and then it hurt them, and then their CO is not happy. I would say you have to be kind of careful. However, if you're interested in sort of figuring out, "What is the media really writing about?" So maybe you're a digital marketer and you want to get quoted in the news. Go into Google and then click news. Then put in digital marketing. That's the first step I would take. If you don't want to hire a PR firm, that's what I would do and I would set up Google Alerts for that and set up Google Alerts for your name. I would use a site like Mention because a lot of times Google Alerts doesn't pick up everything it needs to now. Then I would start seeing... For example, let's say I comment on Instagram. I have Google Alerts set up for Instagram. Or for Trump's tweets or anything relevant to what I talked about, and then I get... that's just becomes part of my day. So maybe you're a cardiologist and you're speaking on artificial intelligence and cardiology. I'd set up an alert for AI Cardiology. So you start having... That's more of an inbound approach to PR really because it all comes to you. Then you start formulating an opinion on that. I would then take that opinion, write content around it, put it on your own site, and then I think what you're going to start to see is that if its good content and you optimize that content, you can be found for that content by a member of the media. I will say this, people always say, "How did you get started in television?" I got started in television because of content. I wrote a really cool article on how social media was impacting the world of dating and it was for Jdate.com, and this was like 10 years ago. I tweeted that article. I did not have a PR firm at that time and I was still more so in social media. A producer found my article on Twitter. Again, no PR firm. They found the content, they liked the content, and they said, "This would make for an interesting segment, would you like to come on the show?" That's literally how I got started in my career in TV was because of content. I would urge your listeners here to consider that when you're thinking how to get there. That's sort of a do it yourself PR approach, but it's not dangerous because you're not necessarily reaching out to the media directly. It's a content first approach. Why Twitter is key for your PR strategy Kathleen: Now do you find that there are certain channels in which you can publish your content that make it more likely that you will be found by a reporter? Kristin: Twitter. Kathleen: Really? Kristin: Yeah, Twitter and LinkedIn. I mean, just 100% because journalists are the biggest users of Twitter. We have clients that say to us, "I don't want to be on Twitter," and I say, "You don't have a choice. You have to be on twitter because if I'm getting you hits, I need to tweet those hits because reporters want traffic to their articles." So that's my end... Like, I have to do that. Right? That's the other thing. This old school notion that PR is just take, take, take and not give is so antiquated. You can't expect that someone's going to write about you and then you're not going to help push traffic to those articles. Which is why whether it's a podcast, or it's a reporter at a different outlet, they want to see that you're pushing it out too. Social media's an integral part to that process. Kathleen: Twitter is so incredibly misunderstood. I find that with every client I've ever worked with... I was in the agency world for, oh my gosh, 13 years and almost everyone, including the heads of many agencies would say, "Twitter is a waste of time. I don't want to be on Twitter." It always blew my mind because not only is that where all the reporters are, but it's the only platform where you can directly reach out to anybody regardless of where you're connected with them. So the access on Twitter is unbelievable. Kristin: I mean, if you want to get on the radar of journalists, they're on Twitter. The other thing you could do is create a favorite list and look up some reporters and then add them to a favorite list and start favorite them for what they're doing, or replying to them and get on their radar in that way. It's a great way to use Twitter, and obviously, it's strategically hashtag. If you really want to learn how to use PR, go on Twitter and use #PRfail. They will actually grill different publicists or do it yourself PR people, and you can learn from that. You learn a lot. It's just amazing. They'll put out bad pictures on there. I think there used to be a blog called Bad Pitch Blog. I don't know if it's still around, but I mean, you learn how to do PR the right way by looking at it the wrong way. Kathleen: Yeah. See I still say yeah. Even though I try to get myself not to. Now I've also heard that YouTube is really valuable. Especially for getting picked up for television because that allows people to see your on camera persona. Have you found that? Kristin: I think that definitely makes sense more so in the entertainment space. I think it adds to credibility and I think anytime you do a TV segment you should put it on there. Do I think that like, for example, would I have gotten discovered from YouTube if I was just doing something on my own? I don't necessarily think so, no. But entertainment, yes. If you're a singer, if... So that's just a whole other area of PR. You don't as much as I think is valuable for that, and sort of the corporate world, I think it's a little bit different. Kathleen: Interesting. And you mentioned LinkedIn. How do you see LinkedIn playing into this? Kristin: I think publishing articles on LinkedIn is very valuable and using hashtags on LinkedIn can also be very helpful to get found for your content. LinkedIn is at this amazing point right now where they are really almost giving away views in organic traffic, more so than Facebook is at this point because they want to become more of a social network. So there's this massive opportunity, especially with video on LinkedIn right now, if you want people to find what you're doing. So from what we've learned with clients, video definitely does the best. And you could put the same video on Facebook, or Twitter, and Instagram, and you're just going to see the views are so much higher on LinkedIn. Kathleen: Absolutely. I have been testing out LinkedIn Video now for several months, and I did a LinkedIn video recently about it because I looked back at all of my posts and the posts that had video in them, almost in every single case got 10x the number of comments and views as a post without video. It was so starkly obvious what a difference it made. So I completely agree with you on that. Kristin: Yeah, but I mean, they want to incentivize users to be doing more videos. So that's why you can see it. If you look at the analytics, you'll see that that's what they're trying to do. Kathleen: And it won't last forever, I'm sure but right now it's a great opportunity. I want to talk a little bit about results. Obviously, you can't divulge client names and things like that, but can you just, in an anonymized sense, can you give me a sense of what kind of results companies that you've worked with have seen from PR? Kristin: Sure. For example, one company that we work with, they have received over 35,000 visitors in search alone over the past year. Again, we're not doing any paid marketing, any paid advertising. That's just because of content marketing and PR. That's all inbound traffic. Another company is actually ranking in search engine results on page one for specific... In the snippets, which everyone is trying to get in right now. There is content that we created for them years ago that's ranking now. That content hasn't even been historically optimized yet, and it's still ranking. Why? Because we answered questions. That has to do with our approach that we started on Facebook where we grew that audience from zero to over 5,000 fans right now, and basically used their business fan page as a community and group page. Because of that and because we took the time to answer their questions and sort of ask the expert type of format, that has just skyrocketed their search engine results. So I would definitely say that that's something people should be doing. Answering questions is so underrated. People spend so much time on SEO but don't actually answer questions. If you want to appear in snippets you have to do that. I would also say podcasting as been, for that client, a big part of their growth strategy, in terms of being a guest. They've probably recorded over... I don't know. Over 900 minutes of time on podcasts and I can see the analytics for that and I can see the conversion rates. I see people's like, "I heard you on this podcast. I'm interested in coming to you now." I see on their social media page where they say, "I read about you in this article." Well, I know what those articles were because I placed them. So that's PR. I read about you. Are you taking on new clients or new patients? I can actually literally track it from the PR hit to them then going to the social media pages to saying, "Are you taking on new patients?" Or direct messaging that, and then to a new lead going through the contact form, and becoming a patient or a client. So I would say, again, that's not any sort of... that's happened across the board for several clients. Kathleen: It is interesting how it snowballs too, right? You get your name out there and that is almost a self-fulfilling prophecy because you're building that Domain Authority, which helps you get found more. As you said, the content that you create that lives in the snippets can live forever. Kristin: Yes. PR is an investment Kathleen: So it is sort of an investment as opposed to, you think about paid advertising and it's like a drug. You can't ever stop. But this is more like an investment. Kristin: It is, and I would say... I mean, you're right. It does snowball. Media snowballs in other media. That's what people have to understand, and I think people that have the short-term approach to PR, then they shouldn't hire a PR firm. If you're going to hire a firm and you're thinking, "You know what, I need you to do X, Y, Z by this date, and I need it now to do X." It's just not going to happen, and even if it doesn't happen, it's the wrong approach because you're not building a community. You're not building anything that has intrinsic value to others. So you just getting hits is good for you, but how is that good for others. So the clients that I've had great success with are... The one thing that they all have in common is they are other-centric, they're not me-centric. So when you're other-centric it allows us to do the best job we can for them because they're building out something larger than themselves and all of it is around education. So I always say, "Egocentric PR is not a PR strategy." It's very important for people to understand that. The PR strategies that we deploy are education focused, and I think clients get the best results, and again, even if it's education focused sound very similar to inbound marketing. Kathleen: I was just going to say, that's basically the premise of inbound. It's a give before you get kind of mentality. Kristin: Exactly. What's so funny is that these people that work with me and hire me, they just really wanted to get great educational content out there into the world and build up their brand. When they're working with me they're not necessarily saying, "I need more clients or patients or people in the door," because they've achieved a certain level of success and they want to do other things. The most amazing things that happens is all of this happens as a result of it. But it's not because they were even trying to achieve that goal. It's because they put their users and their audience first, in terms of just giving, and giving, and giving great advice and content. Kathleen's two questions Kathleen: Right, well that's so interesting and thank you for explaining all of that. I want to shift gears now and I have two questions I always ask all of my guests and I'm curious to hear what your responses will be. The first one is when it comes to inbound marketing, is there a particular company or individual that you think is really killing it and doing it well. Kristin: I thought a lot about this, and it's hard for me to say that any one person is doing inbound well is because the way I look at this is I look at different attributes of how someone is doing something well. So I can't necessarily point to one person. I can give you all the answers that I think everyone else points to all the time. I could say Gary V, and Gary's great, right? Of course Gary V is doing it. I'm sure every single guest in your show says that, so I want to give you a more unique answer. I think that doctors that are taking the time to answer patients questions are doing it well. Again, I don't want to name any specific ones, but I think that in general if you take the approach where you look at the most frequently asked questions that you're asked all the time and you write them down, and you write content around it, I think it helps you and it helps your patients and it helps your clients. Kristin: So anyone that's doing that gets a gold star in my book. Kathleen: I've always really admired Mayo Clinic for that. They are like the Wikipedia of medicine. It almost doesn't matter what you Google, they pop up with an educational article on that thing. Causes, symptoms, treatments, yada, yada, yada. Though we can not name specific doctors, I would say the Mayo Clinic, in general, is an institution has really done a great job and committed heavily to inbound. Kristin: I think if people wanted... just a tip for inbound is use the notepad in your phone, and when people ask you questions or if a prospect emails you a question, literally save that question. That can be a great part, a foundation of your content marketing strategy. People spend so much time trying to figure out, what do I write about? Well, just write about what you're already answering. Kathleen: Yes. Yeah. It's staring all of us in the face, right? Kristin: Exactly. Also, when you write that, write how people are... The language that they are using to type into Google when they ask you those questions. But I think something that most people are not doing today is that they're just missing the boat on optimizing their content for questions. I think that's something that... The term is called historical optimization, which I think is critical of any sort of PR SEO campaign right now where everyone has to do it. Refresh older stuff that you've written. And also, I would say, use PR to amplify the content that you've written. So if you've written a great blog post and maybe you've done a podcast, you should include that podcast link into whatever relevant content that you've already written around that. So you're constantly just adding value to your audience. Kathleen: Yes. It's so funny because I 100% agree with everything you just said, and it's so interesting to me that it's like, somebody from the PR world who so intuitively gets what it is to do inbound marketing correctly because that's really what it is all about. Kristin: Well, I just want to say one thing about that. What really amazes me is I don't understand how people can practice PR today and not have an understanding of inbound because if you don't, you're not helping your clients. Those clients are setting their money on fire. You can not be doing all of this stuff and have SEO in a different area and content and inbound in a different area. It doesn't work. It doesn't help your clients. So you need someone when you're interviewing a firm, you need to make sure that they have an understanding of all of this because what I see is, you could hire a firm and they could get you all these hits, but if you do nothing with the hits then it's all a waste. It's not just about getting press covered. It's about what you do with the press coverage. If you do a podcast and no one hears the podcast, was there any point to doing the podcast? No, there was not. You have to mark it the coverage that you get. Kathleen: Yes, yes. Totally agree. Second question because you are a PR person who clearly understands marketing. The world of digital marketing is changing so quickly. You talked about Google updating its quality rater guidelines. How do you personally stay up to date and current on all of these things? Kristin: Sure. So I read a lot of different search engine blogs currently. So I think one thing is Search Engine Land. I have a lot that sort of come in that I've subscribed for that are kind of helpful. I know even just a PR... I think there's PR Daily that I get. I get so many of these different newsletters. The other thing, again, is that I truly go to Google News and I look for the terms. I will actually go. I will click Google, I will click news, and then I'll put in SEO or I'll put in Google or I'll put in rankings. I mean, that's my own approach because I want to see things that are happening by the hour and not everyone is necessarily searching that way. For me, I think it's important. Same thing with PR, with everything else that I'm researching. I think the reason I got into that habit is from doing news segments. I could literally be booked to talk about something and then two hours later that story has changed. So I constantly... It's one thing to sign up for newsletters, but it's another when you're in a breaking news environment and the story could have changed. Kathleen: That's a really good point for anybody who's preparing to be interviewed to just do a quick Google news search right before your interview to make sure that nothing has changed. Kristin: Yes. Because a lot of the time everything changes. And then you could be- Kathleen: So true. Kristin: ... watching a teaser and they go, "Coming up, so and so is talking about this." And you don't want to be caught off guard by saying, "Who is so and so," and they go, "That's you, and you're live and go." Kathleen: Right. Kristin: You want to avoid that from happening, which again, goes back to the importance of media training and being prepared. I'd also say try not to check your email, especially from clients right before you go on air. Kathleen: Yes. Kristin: Because that can really throw you. A really important media training tip. How to connect with Kristin Kathleen: That's a great piece of advice. Well, so many good nuggets here Kristin. I really appreciate you sharing all of this with us. If somebody is interested in connecting with you or learning more, what's the best way for them to reach out? Kristin: Sure, so if you want to reach out my website is rubymediagroup.com and my other site is krisruby.com. And then I have a third site for PR for doctors at medicalpracticepr.com. You can also connect with me on LinkedIn and let me know you heard me on this podcast or email me at kruby@rubymediagroup.com.  Kathleen: Fantastic. I will include links for all of that in the show notes so head there if you want to reach out to Kris. You know what to do next... Kathleen: And if you're listening and you learned something new, or you liked what you heard, of course, please leave the podcast a five star review on Apple Podcasts. That's how we get found. And if you know somebody else who's doing kick ass inbound marketing work, tweet me @workmommywork, because I would love to interview them. That's it for this week. Kristin: Thank you for having me.  

Let's ruin our childhoods by doing a dive into Cryptozoology with special guest Tyler! That's right, this week we are covering our top 5 Cryptids of the Americas. But wait, what's a cryptid you ask? Well Google defines a Cryptozoology as: the search for and study of animals whose existence or survival is disputed or unsubstantiated, such as the Loch-Ness monster and the yeti. So buckle up and prepare to hear about some bullshit. The list starts at 26:30 We also give you some life updates. Vinny got carded at a work function. He watched Midsommar and had a great time! His office has become an apocalyptic wasteland of holiday decor. Tyler read the ‘Three Body Problem', played Overwatch, and has been running non-stop in anticipation of his half marathon in November. He also let us know that science is still going well. Grayson is still fighting fleas 24/7 in his apartment. Please send all thoughts and prayers his way in this trying time. Stay strong Grayson. Recorded 10/1/2019. Be sure to follow us on Twitter and Instagram @slightlybiased_ Also check out our home on the web at www.slightlybiasedpodcast.com

Create faster site that Google can't help but love We all know the feeling as we wait, and wait, (and sometimes wait some more) for the page to load. Do we hang around or do we click away and find a faster site? Well Google feels the same way, the school of thought is that while Google doesn't reward faster sites, it probably doesn't give slow sites a whole lot of love and this could see them slipping down the ranks. In this episode I chat with Vahe about simple tips we can use to speed up our lazy old websites. Tune in to learn: Why having a fast site is important? What is the impact of having a slow site What is a fair load time benchmark for a small business website Which Content Management System is the fastest Our favourite speed testing tools What is caching and how to does it help How to reduce server response time Episode: https://therecipeforseosuccess.com/speed-speed-sluggish-website/ Website: http://www.therecipeforseosuccess.com

With a career in online community spanning more than 25 years, including 20+ leading influential online community The WELL and 13 as director of communities for Salon, Gail Ann Williams is a pioneer of our industry. On this episode, the inside stories and lessons that Gail shares, from The WELL, weave together to create an overall theme of how to protect, respect and inform the communities that we serve. Including: The right and wrong ways to close a community Understanding privacy and confidentiality in community spaces What happens when your community software reaches “religious significance” Big Quotes “Cliff Figallo, who hired me at The WELL, said that a community is a complex network of relationships that endure over time, and I found that really profound because that’s one of the differences to me. What makes something a community? Let’s say some people get into an elevator together. You can get really metaphorical and crazy and say this is a family that lasts for three minutes. That’s kind of nonsense. I don’t know what kind of elevator rides you usually have, but there’s a point where you need to have time and you need to have a complex relationship, and I think part of that is that there needs to be an ability for some people to go deeper and know each other much better than others. It’s really important to have sort of key people who anchor the conversation with different kinds of degrees of connection to one another, because that’s what makes the community, and that’s what makes it feel like it’s a place, like a town where some of the people have very complex close relationships and others just like kind of live there and say hi when they go by in the street.” -@wellgail “A couple years after I joined Salon, Table Talk, which was an amazing, huge forum site and free and not paying for itself, in an ad situation, was just something that was very familiar to a lot of people. One day, [I was told,] ‘Hey, I think we’re going to close Table Talk on Monday,’ and I’m like, ‘No, we don’t do this. We don’t close a community with no notice.’ [They said,] ‘It’ll be less traumatic for people. It’s kind of like pulling a bandage off.’ No, it doesn’t work that way.” -@wellgail “As consumers in online communities, we need to start asking people who run the community, when you close, how do I export my data? When you close, how do I contact all of my contacts and tell them where I want to go and find out where we’re going to be talking about where we land off your site? Where do we talk elsewhere? I’ve gone through this. I think many of us have.” -@wellgail “Maybe [efforts to save online communities] don’t matter to ownership groups, but they should. I mean, this is your legacy. These are the people who trusted you, and if they can pull it together and keep it going as a membership operation, then you as the founder or you as the current steward of that community, I think you’re kind of obligated to cheer them on and support them to the degree that you can. … It’s not mandated by capitalism. It’s got to come from a sense of actual community responsibility to other humans and actually understanding the value and importance of what we do.” -@wellgail “In the original software, [when a post was hidden on The WELL,] you would see something that said ‘censored.’ It was a little bit dramatic. That was something that we changed to say ‘hidden.’ It’s hidden. That’s the language we use. If you think it’s censorship, go ahead and bring that up, but let’s not tell everybody it’s censorship from the get-go. They might [recognize something was wrong with their post]. It might not be a fight. … Let’s be neutral, let’s not start fights we don’t have to, in the software itself.” -@wellgail “People would be very open in confiding in one another and then saying, ‘Wow, if my boss ever read this, I’d be fired.’ And you’re thinking, ‘Okay, some people here don’t like you. Your boss could pay $15 for one month, get in here, and see this.’ The people who don’t like you, if they’re really mean, they could tell your boss to sign up, and they’re still not personally releasing your material. But you’re making all these assumptions. Don’t put yourself at that much risk.” -@wellgail About Gail Ann Williams Gail Ann Williams is a collaboration and problem-solving fanatic. A professional in the online community sector since 1991, when she became the conferencing manager at The WELL, Gail set out to solve nitty-gritty puzzles of how social networking can best work in our lives, and how online community toolsets and practices can work better. Her stewardship of that legendary community space, through two decades of challenge and community drama, led to a deepening of both idealism and practical skepticism. Now she primarily consults with media, storytelling and social sites. Gail especially enjoys overall strategic planning for new ventures along with practical problem-solving for those that are choosing or evolving the most appropriate tools and cultural norms for their members. She also writes for craft beer publications and is a certified beer judge. Related Links Gail’s website The WELL, influential online community launched in 1985, which Gail led from 1991 through 2012 Salon Media Group, best known for Salon, where Gail was director of communities for 13 years, when the company owned The WELL Gail’s user page on The WELL “Terse outline” of Gail’s “On Being in the Community Business” presentation at 1994’s IEEE conference TechSoup, formerly Compumentor, who sent a volunteer to the nonprofit arts group where Gail worked to help them setup a modem, helping to facilitate her discovery of The WELL Google search for “ecology,” the first definition of which reminds Patrick of community Cliff Figallo, who hired Gail at The WELL John Coate, employee #2 at The WELL and “the first online community manager” The WELL: A Story of Love, Death & Real Life in the Seminal Online Community by Katie Hafner “The Epic Saga of The WELL” by Katie Hafner for Wired Bruce Katz, former owner of The WELL “Salon Magazine Buys a Virtual Community” by The Associated Press Stewart Brand and Larry Brilliant, co-founders of The WELL “Users Bet $400,000 on The WELL, an Original Online Hangout” by Don Clark for The Wall Street Journal, about Salon Media Group selling The WELL to a group of community members Cindy Jeffers, former CEO of Salon Media Group, who opted to sell The WELL shortly after joining the company Pete Hanson, long time developer at The WELL, who Gail describes as one of the community’s “champions” “Au Revoir, Table Talk” by Mary Elizabeth Williams for Salon, about Salon’s closure of their Table Talk community Fotolog, a photo sharing site “It’s Time for Online Community Software to Allow Members to Download Their Content” by Patrick Community Signal episode about IMDb’s message board closure ipernity, a photo sharing site used by Gail’s mother Wikipedia page for PicoSpan, the software that powers The WELL “Don’t Piss in The WELL” by Earl Vickers, a folk song about The WELL “Online Community Building Concepts” by Gail (written in 1994) Transcript View the transcript on our website Your Thoughts If you have any thoughts on this episode that you’d like to share, please leave me a comment, send me an email or a tweet. If you enjoy the show, we would be grateful if you spread the word. Thank you for listening to Community Signal.

Welcome to another episode of the Crypto Basic Podcast, where today we’ll be talking about -surprise surprise- the COVID-19 pandemic. It’s not a random commentary episode though, no general rambling, but a discussion on what we think might be a possible solution for the coronavirus crisis: Contact Tracing. Decentralized, blockchain based, anonymous and, as far as the data predicts, VERY effective. Tune in now to learn the ins and outs of it, and how it would revolutionize pandemic management.Relevant LinksNCase.me Website that has the covid playable simulatorsSource Code for DP-3T LabsA website we've referenced on the show before - ncase.me. This is a great website and it takes you step by step through the process of epidemiology. Why is the virus acting like it does, what ways could it act if things were different?You can play with the simulations to see how even one little thing about the virus changes, and it brings everything into or out of balance.After going on and on down the line, they come to this conclusion - the lockdown doesn't do anything but flatten, and then inevitably reset the curve. Testing doesn't solve the problem, and neither does herd immunity.Enter contact tracing.So what is google building with contact tracing? Well Google isn't exactly building it, but they are funding it.This is being created by a company called DP-3T. Which is a cute short name for Decentralized Privacy-Preserving Proximity Tracing.It is being worked on by cytologists, but it isn't using blockchain.Phones will broadcast via bluetooth what looks like a wallet key every few minutes.If you're close to another phone, your phones will exchange strings.Both phones store those strings for 14 days.If someone gets covid, they're marked as being in a hospital / doctor. The doctor can put in a one time passcode that confirms that the phone holder has been diagnosed with covid.Positive strings get stored in a database, and phones check the database every 5 minutes for any strings that they've heard recently.It's compatible with anyone's app that uses the source code, and the code is public.I see an interesting future, where if this were implemented properly with a public database and zero knowledge proofs, it would solve the problem and keep liberties in tact. The Nuance of the argument.Why it's hard to know where to stand.Fuck Plandemic