Treating the Complex, the Undiagnosed, and the Misunderstood in PT

0:00 Sound effect-y. All right, this episode brought to you by Brooks IHL, elevating clinician education for the next generation of physical therapists, residencies, fellowships in whatever flavor of ice cream you prefer, pediatrics, geriatrics, orthopedics, pelvic floor, get your mix. Find them online at brooksihl.org. That is brooksihl.org. Elevate your career with Brooks. Our episode today, our guest was headed for a career. I am not making this up, probably. As a reptile surgeon, yes, crocodiles, venomous snakes, but a spinal cord injury?

0:45 changed the course of everything. Now she's a clinician for humans, a coordinator, an educator who blends psychologically informed care and lifestyle medicine to treat some of the most complex cases in our profession. She's the mentor you wish you had, honest, empowering, radically human-centered, and she likes creepy crawly things. In her world, healing is more than symptom resolution. It's about showing up, slowing down, which I need to do, and seeing the patient as a whole. She might have black coffee in one hand and a tangled rope metaphor in another. She's here to remind us that doing the basics really well is elite level care. Let's welcome Faith Stokes to the show.

1:26 Faith, how'd I do on the intro? You did great. So I can't, you can't have an introduction where I talk about crocodiles and snakes without being like backstory me. Absolutely. So I was actually interested in reptiles since I was a child, as in my mother said the first time I tried to catch a snake, I was still in a diaper. Yeah. All right. So she actually taught me how to read using snake books from the library because it was the only way she could get me to sit down long enough. Genius. So I was using their Latin names before I was ten. When I went to college, I was interested in veterinary medicine and everyone that knew me said, well, of course, she's going to become a vet.

2:12 Of course, she's going to work with reptiles. She's going to go to zoos. I was already working at a zoo. In the reptile department. Where were you geographically? I was a volunteer for the Chattanooga Zoo in Chattanooga, Tennessee. So I was there first and to my knowledge, only reptile volunteer. I emailed them and said, I want to work in that department. And they said, people don't usually want to do that. Especially, yeah. Yeah. And I said, I will only work in that department. That's what I want to do. So they brought me in. I worked with the big pythons and the big boas. I got to hang out with the Komodo dragons and the alligators. My son loved coming to see me there.

2:54 So this was just a normal pace of life. My research in undergrad was on creating or finding antibiotic type proteins in snake venom. So using it to treat antibiotic resistant bacterial strains. So I was playing with that research wise, got to compete at several conferences with it. But my husband in two thousand eleven had a spinal cord injury and I was going to have to leave, obviously for specialized training to go and finish that career path. And I remember keenly. He was in inpatient rehab at the time at Siskin in Chattanooga.

3:37 They were wonderful. And I was like, I don't think I'm going to be able to go. I can't leave you guys. And he was like, I think you should try PT. They have a doctorate program here in Chattanooga. You could stay at home with us. You could still be Dr. Stokes. It's a super stable career. They have good insurance. He'd obviously been looking into this. And he said the phrase, I see you in them. Wow. And I was like, I'm standing there in jeans, Jimmy. And I had been in a stream that morning chasing hellbenders, which is a salamander. I don't know what that is. Okay, good. Yeah. Thank you.

4:17 What's their Latin name? I don't know. I don't remember anymore. Faith, you could have literally said gibberish. I would be like, God, I am not. No, no, I am not going to, I'm not going to mess that up. I've been out of it long enough. I was in a stream. I was in a stream. I had mud up like mid femur and I looked at him and I was like, they sit in a business office in business professional clothes. I have nothing in common with these people. And he's like, I don't know. I see you in them. Just think about it. So when I started my PT program, I was accepted. I lied on my application and told them I always wanted to be a PT and I related to the field.

4:58 You know, anything that you think you have to do to get into a graduate program. You wanted to be like a Python trainer. So that's PT, right? Same thing. Yeah. No, it was a lie. My first day of school, I just remember sitting in there thinking, I don't want to be here. I don't want to be. You very rarely get bitten. It's never zero. It's probably a higher impedance, but you rarely get bitten. People who do herpetology do really well with TBI patients. Why is that? Just because the TBI patients are super impulsive and aggressive. It's the same as a crocodile. That was not on my bingo card, but I bet you a bunch of TV, I bet you a bunch of neuro-PTs, I can hear them right now going, yeah, that tracks, that tracks.

5:45 I could totally tackle someone and wrestle them down and talk to them calmly the whole time and keep your blood pressure down and they're going to stop struggling eventually. But anyway, long story, very short. I was probably in my second year. I went on a residency call with the APTA to just look at residencies because I was like, if I'm going to do this, I need to do this. I need to like it is what it is. I'm here. This is not going to change. So who do I want to be? And maybe I just haven't found that version of myself yet. So that's what launched me into my training pathway from that world into this one.

6:29 But I will say that even just the work that I did with reptiles, kind of along the lines of the conversation with the patient population I work with, With a reptile, they have no attachment to you. They don't have mammalian brains. So they could kill me. I could die. They're not going to miss me. They don't care that I exist. You take care of them because it's a living creature and it deserves patience, love, kindness, whether it can reciprocate or not. And so that was what I really pulled from my reptile training into patient cares. There's sometimes there are patients who seem, and I'm gonna highlight that they seem unlovable.

7:14 And I just remind myself, if you can care for a boa constrictor that really just wanted you to die, but you did everything you could to take care of that animal because it was alive and it deserved to be taken care of, you can take care of this person and they don't have to love you back. And carrying that into care, humans respond completely differently to that approach than reptiles. I know that shocks you. This is my shocked face. I know, right? Humans respond differently to that approach when you walk into the room and you say, regardless of what I get out of this relationship, I'm going to meet their needs.

7:58 That's powerful. Did you ever ask your, I mean, you must've asked your husband, like, but what did you see in me? Like, I see them and I see you in them. I see them in you. Did you ever ask him, like, what's that mean? Like what, like, you know, he could probably word it a little bit better, but Joey has had several TBIs and words are not his strength, which was why in that moment, that was all he could give me. Um, but I will be honest, like the people, this is something I tell my mentees, the people that know you, and love you for who you are will see potential in you that you don't see. And sometimes you just have to trust them.

8:38 So now like looking at what I do and my identity and like, I hope I'm in my nineties treating patients. Like I don't, I love what I do. And so I don't know what he saw, but he was right. So I think that's, that was what I took away from it. Even now making career decisions, like I'll think, oh my gosh, I don't know that that's the best fit for me. Or I don't know that I should do that. And the people that love me are in my ear saying, no, that's you go. So that was my first introduction to just jumping blindly off a cliff when someone told me to jump.

9:19 And it's been a bit of a pattern for me lately. I love that. Um, I love the fact that like we've got, you know, what, three hundred thousand PTs in the country or whatever. And there's like stories like that. But you'd never know. Right. We just assume. Right. I tore my ACL as a soccer player in high school and my grandmother. Those are the two cliches. Right. That's a cool story, though. Thank you for telling me that. Mm hmm. Yeah. We apparently met. We're going to talk about what you're talking about, CSM. The prompt I put on LinkedIn was like, let's put some butts in seats. A lot of people, APTA has a monumentally large job. Yes. Which essentially is like communicate, all of the four hundred i don't even know bajillion sessions at this one conference we're talking about csm which is in a couple of months i remember my first csm which was la and there's a story there which i don't remember and i remember my professor had asked me like what'd you think of csm and i was like it was a circus and she goes it was and i go with a bunch of circuses in it like like twenty different circuses in the big top and i remember just being like for someone like me overstimulated but i like that sort of thing but you leave like just spent so we met at csm in twenty fifteen sixteen whenever that was when it was la it's gonna be in la so faith and jimmy are going full circle um what are you you said you remember we met i don't remember this help me out what did i did i do something bad no you didn't

10:51 You had won an award for this podcast idea. My program had won an award for a fundraiser. All of the students that had won awards for something, were all pulled together to prepare us for the ceremony so that we knew how to behave and what to say and what not to say and where to walk you know yeah they were they were corralling the toddlers um so we were we were all like grouped together at the bottom of the stairs talking and you started talking about this podcast that i remember you describing it with such excitement And you were, I don't know if you, I think at that moment you were saying, I don't know if this is something I'm going to keep doing, but it was just something you were super excited about.

11:41 And then, like I said earlier, a few years later, I was like, he did it. It's still going because I saw it pop up and I thought he will never remember me, but that's completely fine. That was a decade ago. That was. I know. I mean, that was. I know. It's wild. And like, when you turn back. You know, the stupid cliche is cliche for a reason. It's like, where did a decade go? Like, it's crazy. And then I do the math on like number of episodes, number of, I don't really care about episodes, like number of conversations, number of people you met, number of stories you've heard and shared. And you're like something like sixteen hundred episodes in ten years, which I'm not a mathematician, but I'm glad it's ten.

12:24 It's round. It's one hundred and sixty episodes about per year, which means almost every other day. That's intense. I need to get out more. I know I do. All right. So you're going to CSM. I am. You're going to be on the big stage. Congratulations. Although just because your your thing wasn't picked doesn't mean it wasn't a good submission. Absolutely correct. And I will interview anybody who had a great submission but didn't get picked. There's only so many things that they can put on the stage. They try to mix it up. So it's not the same things or same people over again. wanted to throw that psa in there a little little shot for apta to be like we i see what you're trying to do it's not easy so what what what is what how do we put butts in seats what's on the marquee what do you want who do you want in the seat who who should be there what are they going to get when they come see faith is it just you or do you have co-speakers i do i have a co-speaker So Mika and I are presenting.

13:25 Oh, now you've got different Mika. Now I've got the last names mixed up. Well, I'm going to meet this Mika. I'm going to know too. You are going to meet Mika. She's wonderful. Um, she works in the residency with me and Mika and I are presenting. So we're, we are both pelvic health specialists and we're presenting on a syndrome. That the story behind this syndrome, which I think is what makes it interesting, is males were getting on discussion boards for years talking about this topic. And what we found was that in about twenty twenty, the medical community finally said we should take this seriously.

14:05 This is a thing. Only took two decades. Yeah, it only took a while. So but in twenty twenty, the medical community said pelvic health therapists are the therapist, are the provider of choice to send these patients to. Guess what we knew about this population? Nothing, nothing. This was the first thing that was published. So these patients is called hard flaccid syndrome and it is a syndrome, meaning that it is not one thing. cluster. It is a cluster of things. Absolutely. And so what we started working on together was these patients were coming in and they were telling us it was just a, like a, just a few patients, but those of us that started seeing them started to see more and more and more.

14:58 And I What I think has been interesting for me as a clinician, now I'm going to have to look up her name because y'all, it is literally bugging me because it's Mitchell is stuck in my head. I think it's Bryant. It is Bryant. Okay. Now I feel better. Mika Bryant and I, she practices in North Carolina. We started actually doing teams conferencing on these patients because there was nothing in the evidence that The only thing that we were finding for a while were case studies. And they were looking at one component of the condition, the pelvic floor component or the direct genital approach. And what Mika and I both found was that you had to treat the whole person.

15:42 And so per my general population, pelvic health therapists who work with patients who have syndromes, who work with patients who have complicating autoimmune, orthopedic, yellow flag, lifestyle issues, pelvic floor dysfunction, sexual dysfunction. This is a patient population where all of those things merge together. And if you aren't addressing each component in some way, they do not respond well to conservative care. So what we're doing is this is our title is a little bit tongue in cheek. So it's called the syndrome itself is a partially erect penis and it stays that way.

16:31 It never fully relaxes. They never get a full erection. So we called the presentation. It's not that hard clinical reasoning in the presentation of hard flaccid. No notes. Well done. Slow clap. Because that's the point, right? You got to get attention. I try to tell people the headline is to get attention. The sub headline is to explain the context, not the other way around. So keep going. Well done. So we came up with the title and we present one of my patients that I treated for this who got better.

17:11 And we track how he did through treatment. But we talk through how do you evaluate each of these areas? How do you prioritize one area over the other? And that's where the clinical reasoning component comes in. So while it is very specifically the entire, I want to be very clear, I would welcome any specialty, but our entire presentation is about penises. Got it. What we talk through specifically is how do you clinically reason through a syndrome? How do you make the decision to prioritize the orthopedic dysfunction? How do you prioritize the psychosocial?

17:52 How do you get these patients in counseling? and help them find a counselor who can have a conversation about sexual dysfunction with compassion and recognize there's even an addiction component to this. So that's where Mika's specialty is. Her background prior to being a PT was working in the counseling arena with addiction. What kind of addiction? So there's a substance issue? It can be substance. It can even be masturbation. So they, yes, this is very much a pelvic health topic, but I think it represents well, even across orthopedics, when we are talking about the fact that these patients have to be managed holistically.

18:41 And as you evaluate each of these components, what Mika and I both have found is that the these patients often have some type of past medical history of trauma. And so when you are approaching the addiction, when you are approaching the issues that these patients face, the compassion has to be completely different and they may not tell you. So my patient didn't tell me his trauma till nine months into treatment. Mika's patient, it was over a Those are things that if you aren't aware that it might be there, or you're just assuming they'll tell you if it is, especially given that it is individuals likely to identify as male, they just might not talk about it.

19:35 Um, I've never talked about this in the show, but I, I have a penis. And if I had this, like, I'm just trying to picture, cause that's what we do, right? We try to empathy, not sympathy, empathy, empathy. So I'm just like, gosh, that would be, that would be devastating. Right? Like, and what you said, then of course I go to what you said before, which is like, what do we do? We ask for advice. You can't ask one of your buddies, right? You're probably not going to, you could, but hopefully you're probably not going to, you're going to do this, go to the, Reddit, you're going to log in with your burner account, right? The account no one can track you with. And you're going to find nothing. And then you're going to go, I'm the only person who's dealing with this.

20:16 Absolutely. And then you're not going to go anywhere else because no one ever put down an exit sign that said, actually, if you have this, go this way. So for a long time, this was happening. That sounds awful. It was definitely for these patients. They were having to self-support one another when they did find each other. Yeah. Even if you did find each other. So like that is sort of how the internet, right? Cause even in the, in the medical community for a long time, this was discredited and they've even started doing studies now and they're still providers who don't believe this is a syndrome or an issue. Yeah. And it is devastating. Quite literally, there's visible proof of this.

20:58 There is. You're talking about what you're talking about. You're seeing. You can see it. You can see it. It's difficult to fake. I mean, I have one of these. That'd be difficult to fake. Correct. No, that's... I think in medicine, and this is a faith soapbox, and it's something I had to get over with as someone who practices in complex cases, we get really comfortable being the expert in the room. And anytime we are not the expert in something, it makes us uncomfortable. And our discomfort as a human is going to cause us to respond in a certain way. So each individual is going to have a different response to that. And I find that in the medical community, especially with sexual dysfunction, and that's why Mika and I were so excited to present this together, is she messaged me and said, Faith, no one is presenting on male sexual function.

21:51 There's a lot of stuff on females. Last year, they only had, I forget how many male talks. And she's like, this is an issue. This is a problem. We've both struggled with this. We need to present on this. And so we we put in to do it together. But just the medical providers I speak to now, when they say I'm not comfortable talking about that. Mika and I will tell them, that's fine. That's fine. If they start talking to you and you're uncomfortable, send them to me. I will screen them. If they are not appropriate for my office, I will let you know where they need to go. But if this is not a conversation you're comfortable having, that is, I don't know where that provider is coming from, either from past experiences experiences or training.

22:34 I am trained to talk about this. I am comfortable talking about this. So just send them to me. Please do not send them back to the internet. Yeah. So this is a talk that's going to be about a case study. This is a talk that's going to be about a syndrome that like maybe a lot of people, I mean, maybe a lot of people in the room won't know. But this is also gonna be a talk about how you reasoned your way through this. So even if you're like, I don't treat pelvic, I might never see a patient like this, there's still gonna be a component where you're like, hey, here's this thing that no one knew anything about, and here was what we saw, and then here's what we did, and here's what happened. And PTs, I mean, from what I know, PTs love stuff like that. So even if you're like, this doesn't make any sense.

23:15 I love things that don't make any sense looking forward, like someone who's going to work with reptiles, but now as a PT. And then you look backwards and you're like, oh, all the dots line up. That makes perfect sense. So even if you're like, ah, male pelvic, no thanks. Feels like there's still some gems. There is, especially for the orthopedic component. That's something I've... Which section is this in? This is in pelvic health. Got it. Okay. But it's sneaky. Cause it's like it's in pelvic health, but you're like, Hey, just don't overlook it. That's the, that's the cool part about CSM is like it got, and for people don't know each section puts forth, there is allowed X number of talks per day, whatever, because capacity and money and that's how it works.

23:58 And, um, Even if you're like, I'm an ortho PT, I would say you're doing yourself and your patients a disservice if you stay only on the ortho track. Right. Like, hey, man, you bro out on that. Three hundred and sixty two days a year, maybe it's called combined sections, meaning they're all there. dip man like touch a little like you know remember remember trivial pursuit don't just get green wedges like get a blue get a yellow get a pink so when you leave your pie is full so if you were considering taking jimmy's approach which i do i do agree with the reason why a talk like this can be so important is specifically as as someone who identifies as female this can be incredibly hard for male patients to speak with me about And they may talk to someone who appears to identify as male.

24:55 This is a conversation these patients bring up. And Mika and I both had the experience where we were learning how to navigate these conversations to ask appropriate questions. Like these are challenging conversations to have with patients. And if you've ever had the experience where a patient has brought up an uncomfortable topic, and you didn't know how to respond in a way that was going to be the most supportive of them, that is what we go through in this talk is how did we learn to communicate to these patients to normalize what they're feeling, to reassure them, to talk them through the process, to get them to the right specialist, but recognizing that in syndromes, a lot of times the PT is becomes the PCP.

25:44 We are the provider in the middle that is comfortable talking about everything, but knows, okay, it's time to send you to this person. Okay, it's time to loop this person into the equation. So I'm excited because I enjoy talking through clinical reasoning. I think that's one of those topics that we need a class on, but a class on clinical reasoning doesn't usually sell. And it's usually hard to frame into a curriculum because it's best done when we're doing it on live patients or on real patient case studies. So for me, I think the thing that's exciting about this is to take the patient case all the way through to recognize that the standard clinical presentation now has some variation.

26:32 And to be able to reason through, is this condition present? Recognize medical providers in your area may tell you it's not even a real thing and not want to treat it. How do you help them find the right provider? But then for me, as I was in my fellowship specifically, I was exposed to some training. I believe her name was Hughes in twenty twenty. Christina Hughes. She did a paper on patients who had been in pelvic health and failed pelvic health like they did not recover. Sexual function, prolapse, urinary incontinence, et cetera. She took an exhaustive approach to the spine.

27:14 and all of them got better. And it really challenged me to say, how good is my spine exam? And when we look at this syndrome, there are two places the spine can really begin to play into their presentation. And that's something that Mika and I both have found clinically is that we have to be exhaustive. We have to progress through full range of motion with overpressure and make sure we're addressing any type of source of those symptoms just because of where it can get disrupted. And again, there's a lot of wonderful researchers that specialize in sexual medicine only doing research in this population now trying to understand those mechanisms.

27:59 I love theory. but i want to know what i need to do monday because they're going to be here on monday so there's a lot of theory going around right now um we will briefly touch on that in our talk but we are mostly talking boots on the ground what do you need to do on monday what do you need to hand them when they come in the door what message do they need to hear what's their prognosis How long is it going to take to do an evaluation on this person? What should you allocate for time-wise if they are uncomfortable with a certain type of provider? How can you supplement care in that area to keep them moving forward?

28:41 So our hope is to make it a really practical approach to a challenging case, pulling all of those components in. Do you know when it is? When's your talk? It's on Thursday. I don't remember the date yet. Thursday. I think Valentine's Day is Saturday. So, fourteen, thirteen, twelfth. The twelfth at two. At two. And say the name again, just so people will mark it down. I'll put it in the show notes, too. It's not that hard. Clinical reasoning in the management of hard flaccid. You got to earn their attention to get them get butts in seats. I'm not going to lie. I was a little disappointed not to get Valentine's Day because I thought like a penis talk on Valentine's Day was actually going to be pretty fun. But I'll take Thursday.

29:22 It's pre-Valentine's Day, little surprise. Yes, it is. We got to pay some bills. Hang tight one second. Episode is sponsored by Empower EMR. It's built by physical therapists for physical therapists with customizable templates, lightning fast documentation and scheduling that actually makes sense in this world. Empower EMR is the EMR your team deserves. Learn more, take a test drive, kick the tires, light the fires. Empower EMR. And we want to make sure you know about this organization. If you haven't heard about them, my first exposure was at an APTA national conference. It was called Go Baby Go, supporting pediatric mobility and play for children of all abilities through those little modified, you know, the battery powered cars.

30:08 You modify them and make it's like a hackathon. And this way, kids have mobility devices and they don't have to, like, pay for wheelchairs that cost thousands and thousands of dollars. And they're awesome. And then you can help build them. It's all open sourced. Let kids be kids, even if they roll a little different. Learn how to donate or get involved at GoBabyGo.org. That was Cole Galloway who kicked off that initiative. And I saw him in an APTA event. That was the first time I ever heard him speak. All right. So you have a meeting. But I want to make sure that we get to this. I post on LinkedIn. I now treat LinkedIn like Twitter. I posted something. You didn't disagree with me, but you were like, hey, and I think we probably most likely agree on what I said, but we'll bring it on.

30:49 We'll learn. So I will read the post. I said, hey, unpopular opinion. Nobody cares about what you did. Not on LinkedIn, not on Instagram, not on Facebook, nowhere. I wrote a book. I launched a podcast. I posted a video. Cool, great, fantastic. But what does it have to do for me? This is the lesson that I'm trying to show people. I'm trying to grab their attention, faith, and then teach them the lesson. I got to get their attention first. I continue to say social media isn't your trophy shelf. It's a value exchange. People care about four main things. Does this save me time, make me money, make me better? Does this make me laugh for a second? If the answer's no, then your post is just a digital pat on the back. And congratulations, you're seconds away from dislocating your shoulder.

31:30 Don't dislocate your shoulder patting your back. Want people to listen? Want your stuff to sound like it matters? Stop announcing your accomplishments and start explaining how what you do lifts other people up. When you help someone rise, suddenly everyone starts paying attention. And then you said counterargument. And I love counterarguments. Do you want to read your counterargument in your voice? Expand it for me. All right. So my counterargument... was to ask, what if this individual is a minority, marginalized, or atypical in their field? So these individuals inspire others who identify with them to see these accomplishments as achievable. I often work with students who are first-generation college graduates.

32:11 Posting means that our community, so our PT community, can support and cheer for them in a way that their environment can't because they don't understand their experience. And for me, this could certainly fall under how does this make me better? Yeah. But I want to see their accomplishments. I want to promote them. I want to cheer for them, especially in these cases. But then the flip side of that argument is when we're trying to fight for equality. we can't decide who that goes to. It has to be for everyone. So I'm okay with posting accomplishments and maybe that's my unpopular opinion, but if I, I don't know if someone is a minority, if they're atypical, if they're marginalized in some way.

32:57 Um, so it's, it is easier for me to say, you know what you post it, what you do is on you. What I do is on me and I'd rather clap. Yeah, yeah. I don't disagree. I think we probably are more... So thank you for challenging me because I'm not here to just post stuff and have everybody agree with me. I agree, a hundred percent. I'm struggling with like, that's what I meant, but it isn't what I said. But I don't disagree with you. So I'm just like, where... So maybe if I had added like to motivate others, because like I did something amazing. I'm here for it. I guess my problem is... Especially PTs.

33:39 When they wrote a book, it takes them months or years. Faith, I'm excited when I read a book. I pat myself on the back when I finish reading a book. I cannot imagine or fathom writing a book. My problem, what I'm trying to get people to see is, I agree with you, You took nine months to write a book and fourteen seconds to post about it. You said, I wrote a book. What I want you to say is, look what I'm able to help you unlock. Because that will get people to go, hang on a second, what does that mean? So you're right. Your critique of what I said was right. What I'm trying to figure out is how do I say it better?

34:19 Because what I meant is if someone did something from a minority, how do we make sure everybody recognizes, lifts that person up so that what you're saying is more people see it? I was doing it more of a reframe, which is like, I see what a lot of you are doing. I wrote a paper. Tell me what I'm going to get if I give you eleven minutes to read the paper, if I could even access the paper. Please give me free access to. I got to see so much greatness going around. Like I launched, I published another podcast episode. Cool story, Jimmy. That's about you. What I want to say is we're going to make sense of lizards and clinical reasoning with mildly flaccid penises, and you're going to walk out not feeling uncomfortable if this ever comes to you.

35:10 You know what I mean? I recorded a podcast episode, as the kids would say, cool story, bro. Tell it again. So I don't disagree with you. I have two thoughts for you. Okay, go. Okay. One, you're coming at this perspective as a mentor. You do this for a living. Okay. So you in that post were mentoring us, mentoring potentially people who do not know how this currency works. Got it. So I didn't understand the audience enough. You were mentoring to say, Hey y'all, You're coming into your own. You're doing great things. Fantastic. This is how you leverage that because deep down inside, I don't know anybody that didn't become a PT to be really good at what they do in whatever avenue they do it to help people.

35:58 Like it was too much work to not come in to help people. So I think you were coming to it from a mentoring perspective. what I've had to learn from a mentoring perspective is that if someone has never had this modeled for them, so say they have never been in an environment where they've had a platform, this is the first time they've been given one and they get up there with a microphone and they're just sweating and like, they don't know what to do. And like, you're up there trying to help them and ask them questions like you're doing now with me. I've learned that when they post those things and it's really comes across as bragging, I can either walk away from it or I can say, no, this is another mentoring opportunity for me where I can get in the comments and say, wow, I can tell why you're so proud of this accomplishment.

36:48 What was the biggest barrier you hit and how did you solve that problem? Help me understand how you did. Yeah. What is the biggest lesson? But I was trying to be funny and sarcastic. So now what I'm going to wait, what you said, you had two things. Was that two things or one thing? Those were the two things. So you, that was the perspective was the mentoring. And then as we try to elevate our mentoring, we can either walk away and say, I'm not mentoring this person. They're not a nice person. Or I could say, you know what? I'm going to assume. That they just don't have the knowledge of a skill. Well, I say that all the time. I used to say. When I got into this profession, I looked around and PTs were bad at communicating.

37:29 And then I was like, I amended that. I was like, oh no, you know what? That's not it. Um, I think you're trained to communicate certain ways and you do those things and you, and surprisingly the things you're trained in and you do a lot, you're good. You're better at, right? And then when you look at mass communication, faith, it's almost as if it's an entire degree in college. And I have one of those mass communication, but not the same. It's not. And then I come to the defense again and say, PTs aren't bad or healthcare providers aren't bad at communicating. I'm using air quotes on a podcast. You lack the T's and P's. Did I ever talk to you about the T's and P's? I think you talked about it on your last episode. Tools, training, time, people, process to then generate the product, which is the thing.

38:17 That's work. That's work. Yes, it is. And I, I recognize that like, Hey man, I'm sharing this thing and I'm doing it while I'm on the bus or just between whatever's. And yeah, I what I hope to do is not give a lecture. I want to give a bunch of little digest. I'm just going to be the guy who's like, let's make you one tenth of one percent better today. But I see where my sarcasm might have missed it a little bit. I was close. Here's the best part. Got a degree in communications in two thousand one. Been doing it a lot. Still a process to get better at it. You could still miss the mark. You always have to be evaluating that because, because you, even if you know the audience, well, the audience is so vast and so wide, like you're, it's not going to land.

39:02 It's a bell curve again. It's going to land with a lot, but then also there's going to be, well, what F and what actually, and then faith comes in the comments. Like what I'm like, Oh, you know what? Yeah. Okay. No, she has a point. So here's what I'm going to do. I'm going to take this lesson. I'm going to go back to that post and I'm going to remix it as the kids would say and see if I can make it better because that's all we do. Were you great with your first? Do you remember your first patient? No, I really don't. I don't remember mine, but I remember just like being like, I would probably apologize to my first one hundred. Right. Wouldn't we all? No, I'll tell you this. I can tell you one of my first ones. And it's probably one of the reasons why I don't remember like the initial patients.

39:45 He was a stroke patient and he came in and man, he was having a hard time like through his paperwork. When he left, I was like, he's not coming back. You know, we're almost nine years later and we still have lunch every month. Really? So hold on a second. You had to have asked, like, what was it to go from throwing your papers to nine years? Like, did you just give him enough compassion? Like, what was it? I didn't get upset at him. He said he was going to come back in. He was someone who kept his word. And I just kept trying. I kept trying to work with him. We ended up working together for two years.

40:25 He had a stroke on his dominant side. I literally helped him handwrite and fill out his disability paperwork. Again, I worked with reptiles. I was used to things wanting to bite me when I was trying to help it. So it didn't upset me that he was upset at me. I was like, okay, he needs help. He's scared. How do I calm him down? What does this patient need from me? And he needed help with disability paperwork. That's not in the playbook, but you recognized it was necessary. Because I walked in the room and said, this organism, this living thing needs this.

41:06 This is not personal. It is a response to something in the environment. And so we worked together on and off for two years and he is still one of my dearest and closest friends. So I love to tell that story to new grads because they think that when you come out of school, like you don't know anything and you've got to hide the fact that you're a new grad and you've got to wait till you get all the letters. And I'm like, no, my biggest cheerleaders to this day are patients that I treated in that first six months. There are four of them that I still stay in touch with. And like I said, they're my biggest cheerleaders and I have told them I had no idea what I was doing.

41:47 And they said, we knew, but you figured it out. So figure it out. It is okay to not know what you're doing. Yeah. Ryan Clark, before we do your parting shot, because I know you've got a meeting. I don't want to be the reason for a meeting. Ryan Clark was a former NFL pro bowler. Awesome. Played for the Steelers and the Giants. I saw him at a healthcare medical conference in D.C., he had this i forget what the condition was i think it might have been sickle cell anemia he had some condition where it was not every test he was being given you're fine man and he's like i am losing weight i can't get out of bed it's like i'm a defensive back in the nfl i can't get out of bed so this was the team dot also you're an nfl defensive back you have the best doctors in the world and this one doctor might have been great But he was like, no, you're good.

42:37 Go ahead. Get out of here. And he's like, I'm wasting away to nothing. I think he said go out of pocket and go to a new doctor. And the doctors did all the same tests and said everything came back negative. And then Ryan Clark was like, and he goes, I don't know what's going on, but we're just going to keep doing stuff till we figure it out. And Ryan Clark goes, that's all I wanted. That's all they want. Just tell me that you believe me. Look at me. I'm a defensive back. I'm dripping weight. I'm dropping weight like Creed. Not normal. Everything's normal. He goes, I don't know what's going to happen, but we're going to keep doing it to figure it out. Someone just wants a wingman. It's not an assembly line. There's going to be a lot of typical things in your career.

43:18 Read and recognize when it's inaudible. See, I could do this all day. Yes, you can. Are you ready to do the parting shot? Your parting shot? Sure. Our parting shot brought to you by Get the Message Out, a full service storytelling shop. It's a small creative agency with a big mouth. We help healthcare professionals turn their ideas. into impact for podcast launches, social media strategy. They help you speak your truth and connect with your audience. And by they, I mean me. It's my company. I do this. This is me. Just drop me an email, jimmy at ptpinecast.com. I help APTA sections and academies do this.

43:59 I help private practices do this. We just help you make your good work well known. So your parting shot, last chance, mic drop moment, soapbox statement. What do you want your parting shot to be? I want to loop back to something you said at the start of the podcast when you were talking about the tangled rope. Oh, yeah. is what moves patients forward. And so if we're looking at a tangled rope and it's a small, simple knot, many of us feel really comfortable using our basic skills to tease that apart and untangle the rope.

44:39 And a complex patient is not any different. It is a larger knot. It is the same basic approaches. It's the same humanity. It's the same skills that we have been taught since we were in PT school. It takes longer. which is what makes us nervous. And sometimes we have to have people help us hold the rope up while we're teasing it apart. But we do it the same way. So try not to make really complex things complex. Find the simplicity in them. Use your training and what you've learned to do. It just may take longer.

45:19 Mike drop. Boom. Faith Stokes, we'll see at CSM. I'm going to be there. I'm going to be doing something ridiculous probably, but maybe we'll recreate like where we met because it'll be the same venue. We'll try to figure it out. That's exciting. And we'll take a selfie for ten years under the influence. That's a decade under the influence is what the podcast is. That sounds fantastic. Let's do that. FaceDokes, appreciate the time. Thanks for doing this. Absolutely. Have a great day.