Healthy Wealthy & Smart

The Healthy Wealthy & Smart podcast with Dr. Karen Litzy features top experts in health, wellness and business with a particular focus on physical therapy. We take evidence based medicine and break it down making it easier to understand and immediately apply to your life. At Healthy Wealthy & Smart our goal is simple: to provide you with the best information to live a healthy and pain free life!
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Feb 18, 2019

LIVE from the Combined Sections Meeting in Washington DC, I welcome Dr. Mike Pascoe on the show to discuss the use of social media to disseminate physical therapy educational resources.  Mike Pascoe, PhD, is a neurophysiologist and assistant professor in the physical therapy program at University of Colorado.  His scholarly efforts center around the investigation of constructivist approaches in technology-enabled learning environments (e.g., wiki usage, interactive modules, cadaver skin examination, etc..) to improve learning outcomes and student satisfaction in anatomy courses.

In this episode, we discuss:

-Research highlights in the field of cadaver anatomy

-How Mike utilizes social media and live blogging during his anatomy courses

-How the Anatomical Board serves anatomy educational goals in Colorado

-Cognitive principles of learning for success in PT school

-And so much more!



#APTACSM Twitter

Mike Pascoe Twitter

Mike Pascoe Website 

Mike Pascoe Snapchat

TedxBoulder - Mike Pascoe - The Ultimate Gift - Donating your Body to Science

Learning Scientists Website



For more information on Mike:

Mike received his PhD in neurophysiology from the University of Colorado (Boulder) in Dec 2010. He then joined the faculty of the Physical Therapy Program in the School of Medicine at the University of Colorado, Anschutz Medical Campus. He teaches clinical anatomy and in his spare time loves hanging out with his wife Stephanie and their dog Maia.







Read the full transcript below:

Karen Litzy:                   00:01                Hey everybody, this is your host, Karen Litzy and we are coming to you live from the combined sections meeting in Washington DC. And I have the pleasure of once again seeing assistant professor Mike Pascoe. I saw him late last year in Denver. So Mike, Welcome to the podcast. Thank you for coming on.

Mike Pascoe:                00:18                It's my pleasure. Thanks for having me.

Karen Litzy:                   00:20                All right, so we read your bio, but what I would love to hear from you is a little bit more about yourself so the listeners kind of know where you're coming from and what we have in store for our talk today.

Mike Pascoe:                00:32                Yeah, let me give you some things about myself that I really just drive who I am and what I do. So I am a Colorado native, so there's just a lot of fun things to do in Colorado and I've managed to stay in a really awesome place. And so there's a lot of fun to have there and a lot of that fun I have with my family. So I'm married to Stephanie Pascoe, she's a PT, so she's the clinical half of the marriage. And so we liked doing a lot of things together and we like keeping our two daughters busy as well. So very family driven and we've got a lot of fun with a five year old and a three year old girls. So I like to bill myself as a minority in a sorority. That's what things look like around my house. Lots of pink and yeah, so I basically am here at CSM with Stephanie and we both get to go do our own things and check out the various different talks, different posters, different presentations. And I've been able to come to CSM since I started at CU in 2011 so yeah, it's been a great conference. Great to catch up with old friends and make some new ones.

Karen Litzy:                   01:36                And so today we're only on day one of the conference, but have you gone to any lectures or any poster presentations that really stand out in your mind?

Mike Pascoe:                01:45                Yeah, I really wanted to see what Chad Cook and others had to say about predatory publishing. So that was very informative. I'm aware of the concept and fortunately have not fallen prey myself, but it was good to just see the numbers and how big of a problem in this, you could, you could call it an epidemic. So

Karen Litzy:                   02:03                Yeah, package that really well. Predatory journals, predatory conferences, things like that. I mean it's a thing and people fall for it.

Mike Pascoe:                02:11                Yeah, they said that the analogy is everyone's got a rich relative in Africa that just died and wants to offer you $1 billion. So it's a new spin on that old email tactic.

Karen Litzy:                   02:23                Exactly, exactly. And it's unfortunate. It's unfortunate, but hopefully they're chorus kind of gave you a little bit of insight on what to watch out.

Mike Pascoe:                02:33                Yeah. If you go onto Twitter, which if you're not on Twitter, then I don't know what's going on. It's the best way to find out what's going on, at the conference. Great #APTACSM. And that's where a lot of us are sharing the real pearls from the session. So there's a lot to catch up on there. But then following that was a real exciting meeting of special interest group with the Academy of physical therapy education. Then that's the anatomy educators special interest group. So that grew last year was the first year there were maybe 50 of us and now there's 133 so we're really growing a nice base and we're really starting to cut our teeth on what we wanted to find and how we want to really enhance PT education specifically in the anatomy domain.

Karen Litzy:                   03:16                Great. So now let's talk about that. So let's talk about your teaching background and what you’re doing over there at the University of Colorado medical campus.

Mike Pascoe:                03:27                Yeah, so about 80% of my time on campus in my role is as a teacher. So I'm really striving for excellence there. And basically I started in 2011 they hired me with very little teaching experience at the professional level, but I really had a passion for teaching undergraduate students when I was a graduate ta. So that's where I first fell in love with teaching anatomy. And then I got on board with CUPT and I teach PT anatomy. That's my main role. About 50% of my job is designing and delivering the content for the PT students. But I've also been able to extend into the physician assistant and a medical student anatomy courses. So that keeps me pretty busy. It's a lot of gross anatomy. It's a lecture in the morning and then going into the lab in the afternoon and looking at the cadaver donors.

Karen Litzy:                   04:17                I remember those days.

Mike Pascoe:                04:20                I'm telling Ya, it's the most memorable and favorite course of all PT students

Karen Litzy:                   04:26                It actually was my favorite course and I firmly believe every human being should take gross anatomy because you should know what's going on in your body.

Mike Pascoe:                04:35                You should know how the equipment operates. And there's some real good research out there and you know, a lot of people can identify where the heart is, but you ask them where the liver is and that's where we need a little bit of improvement.

Karen Litzy:                   04:46                Absolutely. So now outside of teaching, what other things are you working on? Any kind of research?

Mike Pascoe:                04:53                Absolutely. And you know what I've learned from all the excellent mentoring I've had in my role is that you should really cover your basis. It should really be optimized in what you're doing with your research as an educator. So what you do is you do education scholarships. So I walked away from bench research and neurophysiology and now my laboratory is the classroom. So I do educational research. It's every bit as rigorous as looking through a microscope and you know, modifying genes in a lab. But basically the students are my subjects and I will take an idea that I think is going to be a way to improve my anatomy, teaching, design a protocol, get my IRB approval, collect the data, get some graduate students under my mentorship to help run through the project. Sometimes we find a positive result and sometimes we don't, but we send those results out anyway and I've been able to get some projects out the door.

Mike Pascoe:                05:46                Just a couple of highlights. There's a type of photography called light field photography, so that's been really interesting to see how you could change the focal point of a cadaver photo after the photo's been taken. Lot of anatomy clustered together, so it's often hard to get everything in focus so that gets around that. But also publishing on students using a Wiki to organize their study materials and why blogging. Actually I got to do a lot of live blogging, have a PT conference and we surveyed the people using a viewing the coverage and they really had positive rankings and satisfaction with the coverage. So I'm really promoting that and hoping that more PT conference organizers jump on top of that. It's a compliment to Twitter.

Karen Litzy:                   06:31                So how were you live blogging and how is that different? I was going to ask is that, what kind of platform is that?

Mike Pascoe:                06:37                Yeah, we use a platform called cover it live. They're still out there. No conflict of interest, no disclosure, no relation, but basically what you do with live blogging as you can really issue more of a transcript of what's going on there. No character limits. Like Twitter, Twitter is usually more about the bite size pieces, but a live blogging is much more of a script and you can really capture a lot. You can integrate photos. And what's been really fun is to capture the question and answer session part of the session. People really rated that as a really good feature of live blogging.

Karen Litzy:                   07:11                So you pretty much have to know how to type well to do that.

Mike Pascoe:                07:14                Right.

Karen Litzy:                   07:16                Because for someone like me who has to look at the keys at the same time, cause I never learned how to type. Yeah, that would be my problem.

Mike Pascoe:                07:23                Hunting and pecking is hard, but the bigger skill is contextualization and knowing your audience. And it was real good for me to learn about how to interpret what a physical therapist was saying about a whiplash and the anatomy of neck muscles and how that can be put together so that way a PT audience would benefit the most. So yeah, that's a big skill as well.

Karen Litzy:                   07:47                That's awesome. I've never heard of that. I mean I don't think I can do it because like I said, I can't really type, but I love the fact that it's long form. And so if I wanted to, if, if I wanted to watch you do this, how do you, how do you do that Mike as not for you as a person blogging but as the consumer.

Mike Pascoe:                08:09                So we have to get a marketing campaign out there. And what we ended up doing was just promoting the link to the webpage through social media. So fortunately people are very aware of that conference has come with their own hashtags and people are having conversations around the conference leading up to the conference. So we took advantage of that. Now we would just publish in advance, these are the sessions Mike is going to be covering. So come back this day at this time for the live coverage. The real beauty of this platform too, as you can play them back, well you don't play them back, you, you scroll through a timeline and you get to look at the content that way. So it was really rewarding to know that you're helping people real time, but for the busy clinician that can't step of treating patients at 2:00 PM that could come in and look at it later. That's really good.

Karen Litzy:                   08:59                Sounds great. So aside from being a little more innovative in your teaching and in academia, in education, which obviously, is a must these days. What else are you doing as your role at CU or your role as an educator?

Mike Pascoe:                09:19                So another real cool role that I took over about a year ago was, it's an administrative role, but it's for the state, Anatomical Board of Colorado. I serve as the secretary treasurer. And so I oversee the day to day operations at the anatomical board. And basically this is still educational because what we do with the anatomical board, our big mission is to serve the educational goals of anatomy education in the state of Colorado. So think of every health care profession program, PT, OT, MD, dental graduate programs. Whenever a program would like to use a donor for an educational resource, they approach us, they make a request, we take a look at how many donors we have available. And we're very fortunate in Colorado that we have a very large donor pool, a large donor base, and I help assign the donors. And so indirectly I'm able to impact thousands of students a year with anatomy education simply by facilitating the use of cadaver dissection.

Karen Litzy:                   10:21                That's awesome. Very cool. I often wondered how that worked now, well at least now I know how it works in Colorado. So you had mentioned earlier the use of social media. So if people are listening to this and they're not familiar with you, I obviously suggest following you on social media, but how has your use of social media impacted the way that you teach and the way that you sort of view education in physical therapy?

Mike Pascoe:                10:51                Yeah, so I incorporate social media into my teaching directly and indirectly. So directly I have recognized that there's a real power behind this, this cognitive psychological principle called retrieval practice. So any way you can get your students to practice retrieving information without the learning materials in front of them, they're going to benefit. Studies have shown that for decades. So how am I going to, aside from doing like the polling audience response system, how can I really get their attention? And I found what's really successful is to use social media and people are doing Twitter, people are doing Instagram, but students really pay the most attention to content on snapchat. And if you're not familiar with snapchat, the thing that makes it different, what sets it apart is that the content disappears after 24 hours. So when you're doing retrieval practice, you don't need it necessarily for the student to preserve the questions and answers.

Mike Pascoe:                11:49                They just need practice interacting with the content that goes away. And they know this. So there's something about the way the brain is wired and the brain pays more attention to ephemeral content so they know it's going to go away. And so I, I push out questions during the semester and they get the question, they get the answer later. So it's great for the students, but it's great for me, the educator I found with Twitter and Instagram, it really took so much time, to perfectly create the right content. But everybody on snapchat understands that it's raw, it's unedited and it's uncurated. So as long as I put the correct information out there, it's quality enough. So it's very quick. It's very rapid. And every time the students find out that I run in anatomy related snapchat account, they can't believe it. At first they’re in disbelief like what's going on.

Mike Pascoe:                12:38                But once I convinced them that this is educationally based on sound pedagogy, they're onboard. And then I'll have a break from it and they'll bug me. We need more snaps. Pascoe put some more content out there. So if you want to check out what I'm talking about, the handle, the username on snapchat is anatomy snap. I'm all one continuous word and I'm telling you, it's been really exciting. I collected data this summer. I'm looking at the data now and hoping to see, number one, if students found it satisfactory, but number two, how did their exam scores look? They could have been the same. They could have been worse, it could have been better. The exciting thing is I've learned how to put a protocol together that will allow me to level up beyond satisfaction. And did your learning change has your knowledge base change? So stay tuned for that publication.

Karen Litzy:                   13:28                Awesome. And now can you give an example of some of your snaps? So yeah, give me a couple of examples so that people kind of get an idea of what you mean. Like what do you mean you're putting stuff out for anatomy? Like just taking a picture of like a muscle or dissected bodies. So give me an example, but before you do well give me an example for us then I have another question.

Mike Pascoe:                13:53                Yeah, no, it's good to leverage it. Leverage the principles, you can get retrieval practice and you can also get leverage examples and just to like real life examples. So you're at a table, you're just going through the upper extremity anatomy and you're between lectures or whatever you're doing as an educator. Put your hand on the table and elevate your thumb and get the extensor pollicis longus tendon to pop up. Take a picture, add text. What tendon end do you see here? Drawn Arrow. Then you can take it further. Just keep building, keep elaborating. What's the line of inquiry that the student would go through? How would you go through this at the cadaver? What anatomical region does this tendon define? Anatomical snuffbox? The next snap question is now what structures as a physical therapist are you most interested in finding in the stock box? So then you could go through that. You can step through a very sequential Socratic series of snaps, and then you can say, okay, everybody send me a snap of your snuffbox if you so choose. They'll usually do this without solicitation. But that's an example.

Karen Litzy:                   14:59                So I think that's great and it actually leads perfectly into my next question is, are you creating a curriculum for your snaps or is it just off the cuff?

Mike Pascoe:                15:10                You know, I'm very mindful and aware that doing things intentionally is the best way to go. So what I did for the summer is I did focus my snaps on a specific aspect of anatomy in the course and that was blood flow diagrams. So I do look at my learning objectives and those informed my teaching methods. So these snaps, although they seem frivolous and accessory, what they really do is there a direct extension of being able to describe the path that blood takes from the left ventricle to a distant site in the body. So it is very informed. It's very intentional, it's in the curriculum, but you have to be mindful that not all students are going to go there. It has to remain optional. I do not think it's appropriate to push your students into social media. There's a lot of valid reasons students don't want to go there, but for the ones that are there, I've found it's 90 to 95% of the students. And you know what? It's a great way to role model and show them how to be professor professional and how to use social media in an appropriate way. That's beyond tearing down somebody's beliefs and ideals.

Karen Litzy:                   16:16                Well said. So there is a method to your madness is what you're saying. There is not, it's not random like, oh, I stub my toe today, I know I'm going to do something on the foot.

Mike Pascoe:                16:28                Yeah, exactly. It's intentional and yeah, it's been out for so long that it's just time that everybody had a good understanding of how to use it appropriately and then how we can really think about incorporating it into education.

Karen Litzy:                   16:40                I think that's a great way to incorporate into education and hopefully people listening to this will now follow anatomySnap. No S. I follow you on snapchat and I can say that it's really interesting. It's really interesting even as a, a more quote unquote seasoned PT because I feel like you can never have too much anatomy. That's so great. Now, anything else that you're doing that's kind of outside of the box with your students or even without your students as far as furthering your education?

Mike Pascoe:                17:16                I think that another thing to bring up here is how there's a real need for physical therapists that are anatomy instructors to understand what is needed to know and what is nice to know. So that's my second area of work. The first area is the technology integration, but I've really developed some nice ways to look at what do anatomist that teach physical therapy students need to teach their students. So I'm just looking at the data now, but I recently put out a survey to about 200 people in the, that our stakeholders for the physical therapy programs, talking faculty, clinical instructors, recent graduates, the two most recent classes. Do you and your opinion think that in your practice you need to name all 10 bronco pulmonary segments of the lung? That was an example of an objective for which most people rated. No.

Mike Pascoe:                18:11                Like that is not essential. So I take that feedback and I improve my curriculum. On the other hand, should a PT student be able to know name every spinal segment that is serving a muscle, the myotomal innovation and most people, the majority came back saying, yes, that's neat to know. So it's been really nice not being a PT to survey a wide base of people. The next step is going to be to survey the community at large to kind of level up the methodology, get a consensus document together and then present that to the educators in the PT Community.

Karen Litzy:                   18:49                Great. Well it sounds to me like you're up to some really fun stuff and I look forward to touching base again when you have a lot of this data together and you're ready to present. So is there anything that we didn't touch on?

Mike Pascoe:                19:03                Well, Gosh, let's see here. Anything else? I guess if you're really interested in body donation, it's often, it's often confused with my driver's license has a heart.

Mike Pascoe:                19:17                But that's organ donation and that's totally separate. You do need to opt into whole body donation. And I go through this concept in a six minute ted talk and basically if you, if you just search youtube for Pascoe Ted x, you'll find a nice little talk I was able to put together for Tedx Boulder in Colorado and just kind of let people know what body donation is all about. And the title of the talk is the ultimate gift because we have extreme gratitude to the individuals that make this choice to, to give us the ultimate gift, the body that has served them all of their life. And now we'll go on to serve health care professionals as they work toward being able to take care of, to treat those patients.

Karen Litzy:                   20:04                I love it. So everyone, don't worry, we will have links to everything on the show notes under this episode. So before we wrap things up, I have one more question. Given where you are now in your life and in your career, what advice would you give to yourself as a new Grad or to your students? Like when you were a student, what advice would you give to yourself?

Mike Pascoe:                20:40                So there's two I want to give you. One is more like the life side of things and learning to say no, I had definitely gotten myself in trouble. Okay. So I'm super passionate about teaching and every time I was approached with a teaching opportunity I rationalized how I could make it work and I trick myself and I got way overloaded with teaching. So I would go back to, you know, 27 year old Mike. Like you're going to have a lot of opportunities, but there's a, there's a tactful way to say no. And even though that time may not be the right time, things do cycle back around, you'll get another pass at it if it was meant to be. And then the other more practical. For those of you that are PT students, those of you that are looking at getting into PT school, you have to look at your study techniques.

Mike Pascoe:                21:27                So I've totally revolutionized the way I do office hours. When students come in and they've had a bad performance on an anatomy exam and they say, I don't understand, I studied so much, I blow a whistle and I throw a yellow flag on the ground and I say, hold up. The penalty on the field is quantity does not equal good learning. So you have to look at these psychological, cognitive principles of learning and what got you through in Undergrad will not get you through in PT school. The volume is too much. So in the show notes, I'll give you a link to a really excellent website that summarizes these key principles of learning and you've got to look at your study habits. Then you've got to be prepared to change them. Otherwise you're in for a really painful and arduous path through your physical therapy curriculum, in other programs that you might be pursuing.

Karen Litzy:                   22:20                Amazing advice. Thank you so much. What's the name of the website?

Mike Pascoe:                22:24                So the name of the website is a learning scientist. And I believe if you just Google learning scientists, you're gonna find a website that has principles of effective learning.

Karen Litzy:                   22:36                Thank you so much for sharing that. And I'm sure the students and myself will greatly benefit from that. So thank you. And now where can people find you on Twitter? We know where they can find you on snapchat. How about Twitter?

Mike Pascoe:                22:49                Yeah, go ahead and look for me @mpascoe. You know what, if you're looking at the Hashtag for the conference, I'm tweeting up a storm here, so that will be a good place to catch some of my contributions and go from there.

Karen Litzy:                   23:05                Awesome. Well Mike, thank you so much for taking the time out at CSM where we, everybody's busy. I get it. We're all busy. So I really appreciate you for taking the time out coming on the podcast and sharing all this great info. So thank you so much.

Mike Pascoe:                23:19                Yeah, my privilege and thanks to you, Karen, for getting everyone together and being a vessel for getting this information out.

Karen Litzy:                   23:25                Thank you very much. And to all the listeners, have a great couple of days and stay healthy, wealthy, and smart.



Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Feb 14, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Shannon Sepulveda guest hosts and interviews Shayla Swanson on her company, Sauce.  Sauce was founded by a former Canadian national team cross country skier as a way to support her ski racing. Sauce founder, Shayla Swanson, was frustrated with traditional winter headwear that she found to be too hot, too itchy & too ugly. An avid sewer, Shayla set out to create functional, stylish and comfortable products that met the needs of elite athletes and outdoor enthusiasts alike.

In this episode, we discuss:

-The story behind the beginnings of Sauce

-How Sauce tailors and personalizes their products from Bozeman

-What is in the future for Sauce

-Shayla’s advice for female entrepreneurs

-And so much more!



Shannon Sepulveda Website

Shannon Sepulveda Facebook

20% off with code “hws19” on: Sauce Website

Sauce Facebook

Sauce Instagram


For more information on Sauce:

Sauce was founded by Shayla Swanson, a former Canadian national team cross country skier as a way to support her ski racing. Sauce founder, Shayla Swanson, was frustrated with traditional winter headwear that she found to be too hot, too itchy & too ugly. An avid sewer, Shayla set out to create functional, stylish and comfortable products that met the needs of elite athletes and outdoor enthusiasts alike.


Sauce started as a hobby for Shayla while she was ski racing and working through her degree in Exercise Science from Montana State University. She began selling Swift Toques to teams and clubs who wanted a custom item for their group. The product line evolved from there, and soon saw the additions of the Swift Headband, Ventilator Headband, and the fleece-lined Chill Toque. After several exciting seasons of ski racing full-time and a near Olympic team miss in 2010, Shayla decided to jump into Sauce full time, putting 100% of her enthusiasm and effort into the entrepreneurial venture.


Commitment to pursuing one’s goals, a strong belief in one’s own potential, and using constructive evaluation for growth, are all important ingredients for a successful athletic career. While skiing and sewing hats are not the same, it turns out that those behaviors are also the key to making it as an entrepreneur. The lessons learned in Shayla’s ski career have helped her navigate the business world and grow Sauce into a company with distribution across North America and beyond.


For more information on Shannon:

Shannon Sepulveda, DPT, M.Ed., CSCS, WCS is the owner and Physical Therapist at Shannon Sepulveda, DPT, PLLC. She is an Orthopedic and Women's Health Physical Therapist and is currently the only Board-Certified Women's Health Physical Therapist (WCS) in Montana. Shannon received her undergraduate degree from Dartmouth College, Masters in Education from Harvard University (M.Ed.) and Doctorate of Physical Therapy (DPT) from the University of Montana. She is also a Certified Strength and Conditioning Specialist (CSCS). She has been a practicing Physical Therapist in Bozeman, Montana for over 6 years. In her free time, she enjoys running, biking, skiing, hunting and spending time with her husband, son and daughter.


Read the full transcript below:

Shannon Sepulveda:      00:00                Hello and welcome to the healthy wealthy and smart podcast. I am your guest host, Shannon Sepulveda and I am here with Shayla Swanson. Can you tell us a bit about who you are and what you do?

Shayla Swanson:                                   My name is Shayla Swanson. As you said, I am the owner of a company called Sauce and we specialize in headwear and select apparel pieces for endurance athletes. My background is in Nordic ski racing. So I spent my teens and twenties training really hard to try to make the Olympics in cross country skiing. I didn't quite, but I got close and I got to do some really amazing things. The other thing is that I was always a sewing nerd and I love to sew and make clothing. So I began making headwear for my ski team and other ski teams. In the early two thousands, we found that most of the headwear we were given was really hot, too itchy, really ugly.

Shayla Swanson:           01:02                And so we set out to kind of fix that situation and things moved from being kind of a hobby or an accidental business and to being a real business. So that was pretty exciting.

Shannon Sepulveda:                              Take us from your competitive Nordic ski days to just like why you started the company, where it was, what you did, like the start of the company.

Shayla Swanson:                                   The start of the company was really just me talking to a couple of teammates saying, hey, I have this idea, let's make some hats and try to sell them to stores and then we can make a little money to help support some of our ski racing. And I had at that point made maybe a couple of orders for local ski clubs and then realized I didn't like sewing that well. So I got some people to help me.  My tolerance was about two CD's worth of sewing.

Shayla Swanson:           01:59                Like I would listen to two albums and then I was, I was done but that didn't get me very many in the grand scheme. So these teammates of mine said, yeah, we'll help. And we basically devoted a weekend to cutting and sewing and making hats to try to sell to some of the local stores and our connections in the ski world helped us. So they said, yeah, we'll put these in our store and put a little tag on them that says the proceeds benefit you guys. And so that was kind of your one. And then from there things changed and you know, some of my teammates weren't interested anymore and they didn't like sewing all that well either. And so we basically, from there it was kind of me and one of the teammates, my friend Rhonda, that continued on with the business.

Shayla Swanson:           02:49                So Rhonda and I started turning things into a little bit more of an actual operation where we would create a catalog and send out to stores and actually try to sell at wholesale. We also had a custom program that we offered to teams and clubs and events. And amazingly enough, it kind of, it worked. So that was in 2000 probably, that was from like about 2003 until 2008 and all that time we were operating under the name SOS headwear and the name SOS came from a blog that I had and my blog was where I updated results and stuff that I was doing skiing and it stood for Shayla on Skis. So we were at SOS headwear, and then in I think it was 2009 that we decided to kind of rebrand and there was a nice little phonetic connection between SOS, which you know, is phonetically pronounce sauce and then the brand name sauce, which is the topping that you use to spice something up.

Shayla Swanson:           03:54                And so we thought that are colorful, boldly patterned headwear that kind of worked. It still confuses people and I get email solicitations from India, but that's kind of where the name came from. 2009, we started operating under the brand name Sauce.  Rhonda and I were both still ski racing, trying to make the 2010 Olympics in Vancouver. Unfortunately neither of us were successful in that, although we both got really close and she knew at that point she wanted to go and work in a different field. So at that point she kind of left the business and I carried on and I started attending trade shows and actually trying to sell some product. So I would say the start of the official like 100% effort toward the business started in 2010. And it's been quite a rollercoaster ride of fun since then.

Shannon Sepulveda:      04:50                That's awesome. So I should say to our listeners, for those of you who are not familiar with Sauce headwear, if you can picture a kind of like a workout hat and really, really fun prints, that's how I would probably describe Sauce Headwear I know this podcast is based in New York and we were in Bozeman, Montana. But whenever I wear my Sauce hats in Manhattan, I always get comments like, people love them. They're like, where did you get that? And I was like, I'm going to try to get Shayla to get these in the stores in Manhattan. But I was running in central park with all my Sauce stuff and I always got compliments because they're just kind of fun. They're not muted in any way.  I did not grow up Nordic skiing because I grew up in New York, but, I did not know that.

Shannon Sepulveda:      05:43                I feel like the Nordic see culture is kind of fun in that sense. Like they tend to wear really bright, fun colors. And so that's kind of what Sauce headwear looks like. And you now, not just, you don't just make hats. Now you make other things. So why don't you tell us about branching out from hats?

Shayla Swanson:                                   We are not trying to be a huge apparel line. What I think our sweet spot is and has been, is bringing a product to the market that we think we can do a better job at, I guess do something a little different that isn't out there and really focused on kind of our elements of like making stuff that's just right, warm, really comfortable and easy to wear and you know, brightly patterned and really pretty. So we make a couple of leg where styles, one of them that I think is our most unique and really applicable to our female athlete audience is our flurry tight.

Shayla Swanson:           06:45                We've put some fleece lining on the quad and also sections of the butt where you get cold in the winter. Those are the two areas where, you know, you come in from a winter run or a winter ski and you think, Oh, I'm freezing on my butt and on my quad. So what we did was we left the rest of the tight unlined cause those areas stay pretty warm and I'm just focused on those spots. So, that's an example I guess of one of our apparel pieces. And we also do like a winter skirt and we have a summer product line that includes some tights and a tank top. And then also another product that I think I liked this one because of the name, we call it the cheeky retreat. So what it is just a nice skirt to cover up your tush if you really don't want it on display. Anyway, that's some of our other stuff.

Shannon Sepulveda:      07:29                I bet you that skirt would be really good for like changing out of your bathing suit, like on the side of a river wherever you are.

Shayla Swanson:                                   Yeah, it's an excellent, it's a great little coverup.

Shannon Sepulveda:                              Yeah, it keeps things hidden while you want to change underneath. It works out really well for that. And I have tried the flurry tights. I loved them because yes, when you're a female and you run your butt gets cold and your thighs get cold and everything else does not. So it's really nice to have, you know, your calves can breath.  What Shayla does is also takes her hat patterns and creates leggings out of them.

Shannon Sepulveda:      08:22                So they're just the really fun colors. And why don't you tell us a bit about like your custom program, because I know at least for most of the races in Bozeman and probably Missoula and probably Canada to lots of light, lots of places, in our race bags we get Sauce hats or headbands that have a logo of whatever the races generally which are awesome. So why don't you tell us a bit about that custom program?

Shayla Swanson:                                   One of the really great business avenues that we sort of happened upon by accident was custom headwear for teams, clubs and events. We do two different options for custom. One is we take our stock product, so all of the hats and head bands that we have in stock and we add a logo to them. So we call that are basic custom program.

Shayla Swanson:           09:16                And it's really great cause that allows we can do orders as few as 12 and it's really relatively inexpensive and it’s kind of a nice option for people. And then we also do what we call our full custom program. And that involves working with a customer to put a design together that is totally unique to their event or their store. We’ve outfitted orders that are like just an event order, but we've also gone as big as working with the whole, Canadian Jack Rabbit program, which is a youth scaly program in Canada that has over 10,000 kids in it. And they submitted drawing ideas to us and we held a contest to see who liked, you know, which design idea they liked best. And then we turned that little kids designed into a hat pattern and outfitted the whole country's youth programs. So that was pretty exciting for us. We currently don't do that order anymore because they have a sponsor that outbid us, but we loved it. It was awesome. Sometimes we have worked with, currently all of our product is sewn in our facility in Bozeman. In the past we have worked with manufacturers based in Los Angeles to help us out with orders that we couldn't quite handle on her own.

Shayla Swanson:           10:36                So the nice thing about it though is that with the options that we have, we can accommodate, you know, we can really be, you know, cottage industry and do something really small and unique for a small customer. And then we can also access those other avenues to produce larger orders for big groups. So it's kind of fun.

Shannon Sepulveda:      10:54                So along those lines, why don't you tell us about like your manufacturing, cause I think you do everything in Bozeman, right? Which is really awesome. So tell us a bit about that.

Shayla Swanson:                                   Sure. Initially when we started doing this, I did not really contemplate the idea of doing all of the sewing in house. I was kind of content working with the manufacturer. But then we started just running into situations where you get a batch of hats back that weren't quite right. Or you know, you wouldn't be able to tweak a sizing concern until you already, you know, had placed your order with this group. And anyway, we just were running into all these situations where I thought, man, it'd be awesome if we could just make this stuff here. And so I bought some industrial sewing machines.

Shayla Swanson:           11:41                Industrial sewing machines are interesting because they only do one thing. So unlike a home sewing machine that can do a bunch of different stitches in a programmed, you know, design, basically industrial machines only do one thing. So in order to make our products, we have four different machines that are able to do all the stitch patterns that we use in our stuff. And yeah, I was lucky enough to find some amazing sewers so, Bozeman is a funny little space in the world of manufacturing because we have several different companies that are much larger than we are, but they make all of their product here. So there's this weird little, like sims makes their waders here and mystery ranch backpacks. So we have access to are sewers in town who are, who are really skilled at what they do.

Shayla Swanson:           12:28                And I was lucky enough to actually hire on three former sims employees, sorry. Sims. And they've been awesome. So they love it. They are given super flexible work hours. They do what works for them and they just sit around the machines and laugh and talk and have a great time and they make all of our stuff and they're really fast and good at it. So it's really fun. We have rolls and rolls of fabric and the corner of our space, we have a big cutting table. We use a big upright solid to cut all the patterns out. We're able to, you know, make small adjustments to sizing on the spot, you know, which is really great.  And then they just sewed them up, finish them up, keep them in our inventory space where our office is basically a large garage. So it's not pretty, but it works really well for our purposes. And it's just really fun to think that of all of the love that goes into each thing that we ship out the door.

Shannon Sepulveda:      13:32                So I want to know how you create your patterns. And how you get that fabric made because you have fun new patterns every year. And I didn't know if that was like your brainchild or if it's a couple people's brainchild or if it's the company's brainchild or how you pick what pattern you'd like.

Shayla Swanson:                                   Yeah. So it's not all me, that's for sure. There are trending reports that come out for the outdoor industry and I don't think they're as important in the outdoor industry as they are in, you know, the fashion industry. But, but what will happen is, a couple of companies come out with these trending reports that, that show you kind of what colors they think are going to be on trend for the upcoming season. And then what we do is we are an accessory piece.

Shayla Swanson:           14:24                And so really we don't need to follow, we don't need to create our own trends, but we need to kind of follow what the other brands are doing. So if we see a company if the trending reports are coming out that, you know, really muted colors are, are going to be more prevalent than we want to try to offer some of those colors in our prints and patterns so that we can match your jacket from say Patagonia or something like that. So what we do is we just tried to I work a couple of different graphic designers who specialize in textile design and they'd come up with some concepts based on textile trends as well as color trends. And then we put that all together to try to make our line a really nice, complete offering to people cause you also want to make sure, you know, we want to make sure that if somebody loves pink, they can find a little pink in one of our hats.

Shayla Swanson:           15:11                So we try to make sure kind of every main color is offered as well. So it's something between the science and art, I guess it's not all just creative energy going into that. We have to also look at some of the other factors and figure out where we fit in the mix. It's pretty fun and exciting. I wish I, I can't, I'm not as adept to the graphic design part of things. So I don't do a lot of the actual design, but I get to pick what I like best and, and where to go next. So it's really cool.

Shannon Sepulveda:                              Especially because I love you Patagonia, but this year their colors were terrible. They were all these like muted colors. They had maybe like one bright color. And so I was like, I guess I'm just going to have to get a muted color and like wear a fun sauce hat.

Shayla Swanson:           15:58                Well, I hope you were at least able to coordinate one color out of our hat with your jacket.

Shannon Sepulveda:                              I was, yes, I was. I appreciate that you have fun colors. Oh, I'm hoping next year Patagonia, we'll have more bright colors. Bright colors will be back in season.

Shayla Swanson:                                   Right. What I've actually had to do is, because I'm always going to be wearing one of our hats and I don't want to buy a new jacket every year is I've had to resort to black and gray in my outdoor apparel, because then I know I can always look okay with whatever hat I'm wearing and not have to buy a new jacket every year.

Shannon Sepulveda:                              Yeah. I also think another great thing about Sauce hats, so, so Shayla and I both have kids is that and we both have a boy and girl is that, you can throw a toddler girl in all boy clothes and put a really fun toddler pink sauce hat, and then they look really, and then they look really cute. Yeah. So it's pretty awesome. Oh, why don't you tell us about your Kiddo?

Shayla Swanson:                                   Oh my. I have two little ones and they are really fun and really hard at the same time. But it's been kind of fun because we made a baby hat for a while. And I was sort of like, yeah, it's really super cute, but I couldn't really get behind it as far as like whether or not it was a great product for kids. But yeah, we have this little chill hat that we make and I should also mention, we call our hats tukes that stems from my Canadian background.

Shayla Swanson:           17:32                Winter hats in Canada are called tukes and it's spelled in a way that makes everyone want to say Toke or Torque even. So, it's a little confusing for people. But anyway, we make a little chill tuke for kids and it's been like the best hat for my young ones. I can't believe it. It's like I just have this constant stream there. I start them in the small move them up through the other, the other sizes. And what's great is that they're tight enough that they stay on their heads and I think they forget that they're on, which I think helps they so they don't pull them off. And the other thing is that they're warm but they're not like so hot that the poor little kid is like drenched with sweat underneath their hats.

Shayla Swanson:           18:12                So they don't try to rip it off because they're uncomfortable either. So our chill tuke for kids has been amazing. My daughter who is almost a year, wears our large and my son who is three, where's our toddler size and yeah, it's been great. I can get behind them now.

Shannon Sepulveda:                              Yeah, they're pretty awesome. Cause they have just like a fleece band. Right. And the top doesn't have fleece. So like when kids are playing hard, they don't totally sweat.

Shayla Swanson:                                   And that's kind of our whole little goal with our headwear line is just to make sure that we're keeping, you just right warm. We want to make sure that you don't notice your head when you're out there exercising. Because I know for myself, I've worn Wool hats and been drenched with sweat and miserable and then you want to pull them off and then your hair freezes and then you're more miserable.

Shayla Swanson:           18:57                So that's kind of our whole mantra is just let's keep you warm but not too warm.

Shannon Sepulveda:                              Yeah. So, along those lines, since not everybody Nordic skis or lives in a place for Nordic skiing so runners really wear these hats a lot. I see out even when I was visiting Seattle, I saw a lot of runners in Seattle wearing the hat. So why don't you talk to us about just like other sports that they're useful for?

Shayla Swanson:                                   Our line has now expanded to be a 12 month, you know, four season line we have some of are products that are ideal for summer activities. And then we also have our winter product line. So our winter product line, I would say we're kind of geared really, you know, well basically any activity really, I mean anything where you want to be comfortable and colorful and you might work up a sweat.

Shayla Swanson:           19:54                So that might be running or hiking or skiing. And also we're a great little, like if you're an alpine skier and you wear a helmet so you don't really need a hat while you're skiing. We do make a helmet liner that fits under helmets. And then we also make a lot of our products are great little like lodge hats. So if you want to cover a pure helmet head and feel like you have put a little bit of effort into your appearance our products are great for that. And the other thing that we have when we expanded into this spring summer product line, we've introduced a couple of visor styles that have really flexible brims. They can be worn under helmets if you're a cyclist. They are great for running and hiking. And then we also have a product that's like a kind of two ways visor that can be worn.

Shayla Swanson:           20:37                It's really if you're hiking and you're not sure what the weather's going to do, so you can cover, you can kind of cover up or wear less people say they love those on a boat too, because it keeps you from burning. That's our viser. I think what the feedback that I'm thinking about what's coming from this woman who said she loved, she always wore her hair in a ponytail and she always had like a part in her ponytail, in her hair, you know? So the way she would brush her hair back, she would always end up with like a sunburn in that area. But she said that with that product, she loved it because she still had plenty of room to like get her hair out the back, but she could kind of pull that piece back and so she didn't burn her head.

Shayla Swanson:           21:21                So anyway, just little random stuff. Some of the stuff that, some of the benefits we claim are things that we thought of. A lot of them aren't benefits that we didn't think of, but there were people have decided works well for them. So that's pretty nice to hear that stuff too.

Shannon Sepulveda:                              Why don't you talk about your tassels because I feel like you're the only, I don't know. I haven't seen any other hats that have flower tassels.

Shayla Swanson:                                   The Flower Tassel. Yes. So, so our idea was kind of to bring a little bit of fun and spring summer brightness to the coldest dreariest winter day. So along those lines, we started using these little tassels on the top of some of our hats. Some people love the tassels, some people hate the tassels, but there are enough that love them that we definitely keep doing it.

Shayla Swanson:           22:11                And so we offer three different styles of Tassel on the hat. And one is like a traditional kind of looks like a graduation tassel. And they're kind of popular in the Nordic world and maybe not anywhere else, but a runner sometimes or sometimes they bounce a little in your head. So, yeah. But they're cute. They're cute. And the colors are really pretty. The other type of tassels that we make is a flower tassel. And those come with mixed reviews. But again, it's one of those things that people who love them love them. We have a few stores that order exclusively flower tasseled hats because they know they will sell them because people think they're cute. In our offices I will say that we don't love the flower Tassel because while we've been able to outsource manufacturing of most of the tassels just cause they're kind of a pain, we have, we still make the flower tassels.

Shayla Swanson:           22:58                We’ve tried to find someone who can help us make them but no luck so far. So, so we have some weird weird little non transferable skills that we joke about in our space where like we're really good at tying knots really quickly because you need to tie four knots on a flower tassel. And then we have a pom pom we can put it on the top of our hats too. A little pom is really cute. We get lots of different colors and anyway, that's another piece when we try to pick our prints and patterns, we have to try to figure out if we have tassels that work with the prints and patterns.

Shannon Sepulveda:                              And so if someone wants to do a custom order, they can pick their hat print, tassel, logo.

Shayla Swanson:           23:44                And that's kind of what's nice about say working with us versus other larger businesses that do custom work is that we can really say like, you'll get, you know, get an email saying like, these are all of your tassel choices, these are your fabric choices for your hats. It's kind of very customized. Very cool.

Shannon Sepulveda:                              So why don't you talk a bit about your price point? Because for the life of me cannot understand how you make everything in Bozeman and the hats are still $30. Wow. Because that's pretty awesome, I think for a company to be able to do that.

Shayla Swanson:           24:20                Yeah. The honest truth of it is this is the healthy, wealthy, smart podcast. Let's just say I probably won't be getting overly wealthy, but I love what I do. And so it doesn't matter too much. But it is true. There's something, the reality of it is that if you want to be really profitable in the apparel industry, I think you definitely have to send your stuff to places where they don't have to pay people much to make it the reality was sewing a hat or a piece of clothing is that it's touched. Every single seam is basically driven by a person. There are a few exceptions, but in general, a person is responsible for every seam on your clothing.

Shayla Swanson:           25:11                Unlike an injection mold plastic piece or something like that where it's, you know, where it's really mechanized and automated. And so, yeah, as far as our price points go, we have to maintain some level of competition or competitive, you know, placement in the industry. So, yes, it is true that our profit margins are not as great as they could be, I suppose. But then we couldn't offer, we really, I think that we wouldn't have a business if we outsourced to somewhere like Asia or places because they have high minimums. They can't offer the flexibility that we can. So I feel as though, it's an interesting situation because I don't think we could do what we do using a different type of manufacturing model. Yeah. So what's really been great for us is that we have, this year in particular, we have really streamlined a lot of our production processes.

Shayla Swanson:           26:07                I think we're getting faster and faster at everything we make, we're cutting down on complication and skews and things. Anyway, everything we can do to basically improve our efficiencies and make sure that we can be competitive with our price point and also be a healthy business. Yeah. So, yeah. So it's interesting.

Shannon Sepulveda:                              Can you talk a bit about the contest? It seems like you have every year where someone designs a hat.

Shayla Swanson:                                   Yeah, that's a fun one. So one thing that we have started to do, well I guess it's been probably five years of the contest now. We have a contest that runs every year in August or September, we call it our special sauce design contest. And what it is, is we basically send out a little pdf template and people can download it and basically send in a design idea.

Shayla Swanson:           27:04                And what's really great is that we used to get comments, people would email us and be like, hey, why don't you have any hats that are blue? Or why don't you do this, this, this, or the other thing. And so it's been really great to be able to put the ball in our customer's court and have them tell us what they want to see. Every year we receive entries and we put them up on Facebook and we also allow people to vote on our website. You know, Facebook may or may not be a great avenue for that but yeah, people vote for their favorite designs and then we make them. So this year we had two really beautiful, we had a really beautiful floral that came through. We had basically two that were really neck and neck for first and second, so we decided to produce them both.

Shayla Swanson:           27:49                And this graphic designer in town here in Bozeman that submitted this ridge line mountain design. And then what's really cool is that at the end of the year we kind of tally up how much we sold and then a percentage of the sales go back to the winners chosen charity. So yeah. So this year one of the hats we'll be donating to a foundation called the neo kids foundation. It's up in Sudbury, Ontario, which is where the winners of the contest live and that's where they wanted their proceeds to go. And then one of the designs here is going to go back to basically a fund for the Bozeman education. That foundation that supports kids that are homeless basically, who come and need some assistance that way.

Shayla Swanson:           28:41                So we're really excited about that part of the contest too, cause it just gives us a chance to give back.

Shannon Sepulveda:                              So we can find you in Bozeman. We can find you online. So why don't you tell us a bit about like where you're located in the country, what types of stores and like if people want to check out your products, where would they go?

Shayla Swanson:                                   We are carried by about 200 retail locations across North America. So if you go to our website does have a store locator, which I will admit is about 90% complete. It's really hard to stay on top of all this stuff. We are distributed in the types of stores that carry us or generally like running shops. More like outdoor stores.

Shayla Swanson:           29:32                Also anything that's kind of got a Nordic edge to it. Those shops typically carry us. So yeah, so we're available online. They're available about 200 retail locations and if somebody out there can think of a store that we should be in in that we're not, we always take suggestions for wholesale accounts that we should be reaching out to. So that's where you can find us.

Shannon Sepulveda:                              Yeah, I was thinking about that when I was in Manhattan in November. I was like checking out stores. I was like where it just be as so many people complimented me on my hat. Cause I feel like New York is a lot of people tend to wear more muted things. Or in big cities in general, I think it's more muted. It's more muted.

Shayla Swanson:           30:22                And that is one thing I will say is that we do, well, a lot of our patterns are kind of bright and colorful. We always make sure we have a black and white option. We always make sure we have a gray, you know, it's like we try to make sure we can also appeal to the more subtle Palette. Our winter product line has men stuff. And we always carry a black plain old basic black as well too. Our neck gator product is called our frosty. Kind of like the buff is sort of the Kleenex or the bandaid.  The brand that became the thing. So, my parents used to call it a chill choker.

Shannon Sepulveda:      31:10                That was a new brand, like back in the 80’s. But we as children, I was growing up, we used to always call the chill choker. And I feel like it was wool and we wanted to just like rip your neck off and awful. And then they were like turtle fur, do you remember that?

Shayla Swanson:                                   Well and that brand is still that brands still around there. You see them in places that carry us as well. Occasionally. But turtle fur is still around. We have a product coming out next fall. We currently make a like a neck breeder, but it's a lightweight net gate or color frosty for the neck. Next season, next fall we have a product that'll be coming out called throat coat. It's our aligned neck warmer.

Shannon Sepulveda:      31:57                Oh, that's such a good idea. My son had, I think I got it at your clearance sale at the Cammo.  But it's really good idea to get, um, like a fleece lined one for the really cold days for, especially for downhill skiing.

Shayla Swanson:                                   And the product we're, we're using the liner, we use them polar tech products to line our stuff. So for installation their fabrics and we're using a kind of a mid weight style, so it's like warm, but it's not going to be like saturated with breadth and moisture, like a fleece might be. And then it like freezes and it's stinky. My team might still be stinky, hard to say, but yeah, there anyway, all this stuff you try it, you try to think about, but it's something that's just a reality.

Shannon Sepulveda:      32:49                There’s a place in Bozeman where you can Nordic ski and it's like all sourdough, right? So it's all up for nine miles, go all the way up for 10 all the way up for 10 miles. And so you get super sweaty all the way up and then you come down and you pretty much don't really have to ski on the way down and you're buff just becomes like an icicle because just like knock knock, by the time you get to the trail head because you've sweated all the way up and then you just freeze, freeze all the way down, all the way down. That's a tough, tough trail to dress for. You have to have like a backpack of layers to it. Right. To get down, to get down comfortably. I typically choose to just be really, really cold at the bottom. Yeah. And then turn on and then get in your car and turn on your seat heater. By the time you get to the house, then the cars finally warmed up and then you feel pretty good. What's new in the future? What can we look forward to?

Shayla Swanson:           33:50                We have a few new products next season. We have really cool new patterns that are kind of basically images of our natural world that are going to be placed in the hats and the headbands anyway, so we're venturing out a little bit from what we typically do, but I'm really excited about. It's been well received by the stores that have seen the line already. So we have some new prints and patterns. It's usual. And then we have a couple of new headwear products that are sort of like hybrids of stuff we've already been doing just to I guess diversify the line a little bit and make sure everyone can find products that are aligned and warm enough for them.

Shayla Swanson:           34:37                Anyway, that's kind of confusing. But I guess just in general, I'm our main product designer and I've been having children for the last few years and I haven't been feeling overly creative. My mom brain has, has really, I would say, shut that down for me. So I'm feeling like I've turned a corner here. I have a nearly one year old and I can, I'm feeling like I can start to think again. And so I'm looking forward to seeing what that, what that brings because it's always when I'm outside skiing or outside running or hiking that ideas come to me where I'm like, Ooh, this is, this would be a great product. So I'm looking forward to that. And so as far as what's coming next, I have a few things on the immediate horizon and then after that we'll see.

Shannon Sepulveda:                              Cool. Yeah, I feel like you need like for at least for headwear winter headwear I feel like you need like the fleece line warm hat for like walking around town. And then you need like the thin hat for exercising and then you need the thin headband. Cause sometimes it's just your ears it get cold. And then you need the fleece lined headband. And then you probably need more stuff, but those are like my four go tos for like winter. But you definitely need the like non, it's nice to have the nonactive totally fleece lined hat for like warmth.

Shayla Swanson:           35:30                The two products that we make that I think are good for casual or activity on a cold day. If you will athleisure headwear, we make a slouchy beanie. It's kind of like a slightly more, styled hat I guess. And it's, and it's really warm and cozy. So I, that's my like where around Go to and then we make our chill.

Shayla Swanson:           36:19                Tuke is another one that you can wear casually in and look pretty cute, but it also works really well if you're skiing on earth, doing something on a cold day. And that's the one that has our little swirl closure at the top where you can kind of create some space and vent a little bit if you get too hot or you can throw a topknot out there if you, if you're so inclined. I never have hair long enough to do that. And that wasn't an intended benefit. The ponytail through the hole. People have figured out how to do that. Ooh, it's really cute picture of that on our website. And right now actually of someone doing that who had long, beautiful hair and just put the hat down over top of it and it's like, anyway.

Shayla Swanson:           36:55                We have products that have more of like a standard ponytail hole right at the back of your head. But this one is kind of more at the top, which makes it a little weird, but it's still pretty cute if you have the right length of hair. I have recently kind of refallen in love with is our Bandura and it's basically like a kind of a pocket band. But what's nice about it versus some of the other brands that make more of like an active pocket band is this one. It doesn't, it looks more like an intentional addition to your outfit. So it's something you can work casual or active and basically it just looks like a little tank top sticking out from underneath whatever your layer over top is.

Shayla Swanson:           37:39                So it's kind of hard to explain I guess on audio but it's like a fabric piece that goes around your waist. Elastic. Yeah, it's like a, it's kind of like a tapered fabric piece that goes around with the band around your waist. And it separated into six pockets and all the pockets are kind of semi secure, so they have a little flap over top and then they have an elastic drawstring waistband, so it's got some nice integrity. If you do pack it with stuff, it's not going to fall off. And like uses that. I, you know, I've been using it recently to cross country ski and I've thrown my water bottle in the back. And then I put my keys and my snack and my kick wax and my cork and I'm all, I've got everything I need.

Shayla Swanson:           38:23                And what I also like is it's not tied around my waist. So that's really comfortable for me too. And then but other things I've heard people say like I've been at events where someone will come by and say, Oh, I wore this and while I was backpacking in Europe, I need another one. It was amazing. Like, so she said that she wore it everyday in Europe as kind of a money belt, but what was great is it just looked like a little black layer sticking out from under her shirt. So she's just, it was funny, she came, I didn't expect such a rave review from somebody, but she came back and was thrilled. And then it can also turn like any, it's great for cycling because if you want, if you want extra pockets but you don't want to wear a jersey that has pockets. You can throw that around your waist and then you can turn any shirt into a jersey.

Shannon Sepulveda:      39:11                How about the sports bars or you're going to start making sports bras?

Shayla Swanson:                                   I don't know. People ask me to, the two questions I get a lot. Are you going to make sports bras and then also are you going to make like cycling shorts with shammies? Oh, the thing I feel about both of those products is there's a lot of r and d that goes into making the perfect shammies and making the perfect sports bra and, and I'm just not sure we're, we're up for that. I don't want to throw something out to market and then being like, oh that actually is really not as good as the other ones you can find out there. So you know, maybe maybe it would be like, uh, yeah, probably not is realistically the answer.

Shayla Swanson:           39:49                But I think what would be interesting is maybe we can find a way to supply people with like cute little shammy containing underwear that, you know, I can buy from someone else and then they can make sure that they can wear it under our shorts and then it would be kind of work for that as well.

Shayla Swanson:                                   So to answer, I guess I should probably clarify like that's the kind of sports bra that maybe we could make, but if, but when it comes to making something that's really supportive and actually does a great job for women who have larger breasts, I don't think that would be hard.

Shayla Swanson:           40:33                Yeah, there are some really great brands. Like there's actually a Montana based company called Anelle and it was founded by a woman in a small town in Eureka, Montana who I think she, well their company's based in Eureka. I think that's where she's from, but they make this amazing Bra for women with large breasts and like sports bra. They do a really great job and they're there. I see them at some of the trade shows I attend and am friends with some of the people that work for that brand, but so yeah, I think we'll leave it, leave it to the experts.

Shannon Sepulveda:      41:06                Awesome. Anything else you want to add or talk about as far as Sauce and your company, Bozeman? Did you start it in Canada and then came to Boseman?

Shayla Swanson:                                   Yeah. I moved here in 2003 to go to school. So I think we had made hats for one year before I moved here and then I moved here and I kind of became the US distribution center. Rhonda was still in Canada. But no, I guess, I mean it's become this really great and exciting thing. I didn't ever really anticipate for my hobby to grow into a business that would actually pay me a wage and it does. So it's pretty awesome. And I really like what I do, although I do wish every now and then, there wasn't a day when I learned, like, I kind of would like to like not learn an important lesson every day, be nice to have one or two days where I didn't think to myself, oh, that's something I need to remember.

Shayla Swanson:           42:01                You know, I'm sure that's the case for most of us that you, I mean, you never want to stop learning, but sometimes you just wish it was a little bit easy for most entrepreneurs. I have been pretty good. I think one thing that has really helped me is that I truly have this, I learned how to lose early on, I guess with my ski racing. Like it's, you know, it sounds like a weird thing to say, but it's true. You know, you win some, you lose some. And I think it's important to learn how to lose and understand that it's not the end of the world and understand that really every time you try something, as long as you learn something from it, it's a success, you know?

Shayla Swanson:           42:43                Yeah. So that's kind of how I try to move forward. I've only made one or two, like really expensive mistakes, so these ones are harder to deal with. But you know, we're all doing our best, so you gotta just have to do what you can and, and move forward.

Shannon Sepulveda:                              Do you have any advice for any other female entrepreneurs?

Shayla Swanson:                                   Oh, I think one thing I'm not doing a great job at, so this is I guess me telling someone to do different. I love every part of my business and the problem I'm having right now is that I'm trying to do too much of it. And I've heard that that's a kind of a common thing, probably also a barrier to really making it big in some of these things as I have a little trouble letting go of certain aspects of my business.

Shayla Swanson:           43:30                But truly it's not necessarily because I am like super type A and can't let someone else do it. It's more just cause I really liked doing it. So anyway, I have to, I have to figure that out for myself. So I guess my advice to someone would be if you can, you know, delegate and do a good job of getting someone else to take care of some of this stuff off your plate is probably a good idea.

Shannon Sepulveda:                              What I find is, I mean, after I started my own practice, it was great and I love it, love it, love it. But you can't turn off. No, there's no, especially with kids too, it's like I would love to be able to turn off, be present, and I'm trying really hard to do that. But it's hard. There's always something to be done.

Shayla Swanson:                                   And that's one thing, you know, having kids, like before I had kids, it was, I worked long days, I liked what I did and then I went home and that we didn't even have internet at our house at that time.

Shayla Swanson:           44:21                We did that on purpose. My husband and I just decided like, we want to work when we're working and we want to not work when we're at home. And so we had this great little like work home separation was really helpful. And now I can't have that because there and we don't really, we, my husband and I swapped to take care of our kids. So basically I'm either working or I'm taking care of the kids and there's never enough time to do either one. And then you have to sleep because if you don't sleep, you get cranky. So yeah, I don't have a great solution for that. I think you just have to do what you can to try to turn off when you're with your kids and keep a list. I think a list is really critical because then you can turn off your brain as long as the stake has been planted somewhere where you know you won't forget what to take care of.

Shayla Swanson:           45:05                I read that in a great book. It was called, I think it was called getting things done and that was his main, main, main advice was you only have, like if it's, you have one place where you keep track of that kind of stuff and only one, like you don't have a phone and then a calendar and a little mole skin notebook. And then you have one place where you keep track of things and you always write down what you're doing and what you need to do. And then that way when it's time to not think about it, you don't have to think about it cause you know where it is. And you know that you won't forget because it's in that one place.

Shannon Sepulveda:      45:40                That's such a good idea. It's really helpful because like last Friday it was late. I was trying to get all my paperwork done and I knew I had all day. Monday is my admin day, but I still felt like I needed to get it done on Friday. But if I had just re wrote it down, these are the things we're going to do on Monday, then I come back on Monday and I finished that. Right. All there.

Shayla Swanson:                                   Thank you. Getting things done. Book. I don't remember who, that was helpful. It was a good book.

Shannon Sepulveda:                              Why don't you tell us where we can find you? Social Media, etc. And how we can get in contact with you.

Shayla Swanson:           46:32                Sure. So I'm online, we are at I'm on social media. You can find us at Sauce active on Facebook. That's Facebook and Instagram primarily when we actually post. And if you want to get in touch with us by email is probably the best email address.

Shannon Sepulveda:                              So if someone who is listening has a great store that says, Hey, they should carry sauce, we should email you.

Shayla Swanson:                                   That would be great. That would be great. If you have anything to anything to say, we'd love to hear from you.

Shannon Sepulveda:                              Do you have a newsletter?

Shayla Swanson:                                   Oh Great. Yes, we do have an email newsletter that we send out. It's not super regularly regular, so don't, don't be afraid that of a bombarded inbox. But there is a newsletter sign up at the bottom in the center of our website, so we do send that out.

Shannon Sepulveda:                              Cool. And why don't you tell us about the gift to our listeners.

Shayla Swanson:           47:23                That is great idea. So if you want to buy something on our website, we would love to offer you 20% off if you enter code hws19. So that's hws19 20% off online

Shannon Sepulveda:                              That's a good deal. It's a really good deal. Especially, like I was saying, I don't know how you make hats for $30 in the US because they're awesome and we support the local community

Shayla Swanson:                                   And you're supporting our sewers, Linda, Laura, and Karen, which I think is pretty fun. So you're not just, you know, buying a hat. You're actually supporting Linda, Laura, and Karen and Shayla.

Shannon Sepulveda:                              Well, Shayla thank you so much for coming on the program and we really thank you, it was really great talking to you.

Shayla Swanson:                                   Thanks. Thanks for having me. It was really fun.


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Feb 11, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Sarah Haag on the show to discuss pelvic health for the non-pelvic health PT.  Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health.  Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.


In this episode, we discuss:

-Intake questionnaires to screen the pelvic floor for patients with low back pain

-Pelvic health red flags

-How to address pelvic floor health with a conservative population

-Assessing the pelvic floor muscles without doing an internal exam

-And so much more!



Oswestry Low Back Pain Disability Questionnaire:

Sarah Haag Twitter

Entropy Physio Website

Home Health Section Urinary Incontinence Toolkit


For more information on Sarah:

Sarah graduated from Marquette University in 2002 with a Master’s of Physical Therapy. Sarah has pursued an interest in treating the spine, pelvis with a specialization in women’s and men’s health. Over the years, Sarah has seized every opportunity available to her in order to further her understanding of the human body, and the various ways it can seem to fall apart in order to sympathetically and efficiently facilitate a return to optimal function. Sarah was awarded the Certificate of Achievement in Pelvic Physical Therapy (CAPP) from the Section on Women’s Health. She went on to get her Doctorate of Physical Therapy and Masters of Science in Women’s Health from Rosalind Franklin University in 2008. In 2009 she was awarded a Board Certification as a specialist in women’s health (WCS). Sarah also completed a Certification in Mechanical Diagnosis Therapy from the Mckenzie Institute in 2010.  Sarah has completed a 200 hour Yoga Instructor Training Program, and is now a  Registered Yoga Teacher.

Sarah looks at education, and a better understanding of the latest evidence in the field of physical therapy, as the best way to help people learn about their conditions, and to help people learn to take care of themselves throughout the life span.



Read the full transcript below:

Karen Litzy:                   00:01                Sarah, I was going to say doctor Sarah, hey, it just feels weird because we've known each other forever. But Sarah, thank you so much for coming on the podcast to talk about pelvic health for the non-pelvic health PT. So there are a lot of physical therapists who I think are interested in pelvic health, but maybe they don't want to like dive in literally and figuratively. So what we're going to do today is talk about how we as physical therapists can treat people with pelvic conditions, with pelvic issues without necessarily doing internal work. What are the functions of the pelvis, really important for bowel and bladder health, right?

Sarah Haag:                  00:49                I mean, it is very important for survival, sex, very important for quality of life and propagation of the species. So these are all things that matter. But also when people come in with low back pain, when people come in with hip pain, I always find it very interesting that people say, but I don't do the pelvis. You know, the pelvic floor is only a musculoskeletal structure. We're not trained in most programs to palpate or to touch. It's just skeletal muscle. That's all we're assessing for really as pelvic floor PT’s. So I just think it's interesting. It's like a blurry void when you're looking at a body diagram.  Oh, there's your knee. So it's really important I think to understand what's there and you don't have to go there, but you have to know what's there and know that some people need help there and help them find the help.

Karen Litzy:                   01:34                So if someone, let's take this person that has low back pain because that's a diagnosis that we can all agree that we see on a regular basis. So what are a couple of questions you can ask during your initial evaluation?

Sarah Haag:                                          So the subjective part of the initial evaluation that perhaps a lot of people are missing or that can take in that pelvic area. There's a couple of ways that you can kind of like cheat your way in where you don't even have to think about what to ask to begin with. If you have a red flag questionnaire, there is a bowel and bladder question on there. So, it’s really interesting because people will sometimes circle yes on those and then never discuss it. Like, wait a second, we asked the question, they said yes, it's a thing.

Sarah Haag:                  02:22                So there's your in, it was like, I noticed you, you marked yes on the bowel and bladder changes. Can you tell me a little bit more about that? Most of the time it is not truly a red flag. Most of the time it is not a sign they need to be referred to a physician.  Most of the time it's like no one's ever asked me that. Yeah. Stuff is different. There's your in. And then also if you use the classic Oswestry. So it was modified I think in 2001 or 2002 to take off a sex questionnaire. The second question of the questionnaire and it was revalidated and all of those things, but if you use the original, it's pretty awesome because now they're like, Huh, nobody's asked me about sex. And then you'd be like, ah, I see that this is an issue.

Sarah Haag:                  03:06                One of my favorite Twitter stories is I get a direct message from someone asking me about a patient who was having pain with intercourse and I was like, thanks for reaching out. Absolutely. Can you tell me more about when they're having trouble and where it hurts? Would you like to know where it hurt their knees in one particular position? And I said, fantastic. You can help with that. So, so it's not always, it might be a sex problem, but it's not necessarily that problem. So we have to not be shy about asking those. Low back pain is the most expensive health care problem we have in terms of multibillion dollar, probably millions and millions worldwide. And so of course addressing back pain, we're still working on the best way to do that.

Sarah Haag:                  03:52                But there’s a high prevalence of urinary incontinence and people who have low back pain. So if you're seeing people who have low back pain and after, if anyone else went to the pregnancy talk this morning, after vaginal deliveries, the prevalence of incontinence goes ways up, goes way up. So if you're seeing someone with back pain, if someone has had babies, all you can eat what you can do. So we were like, well I see this in your history cause that's pertinent history for back pain. Correct. And then it's like, Hey, I noticed this, any issues with this? And here's the reason I'm asking because you can't just go, do you pee your pants? Because people like, do I smell like what happened? Like, so if you're just like, you know, there is a really high prevalence and the nerves in your back go to your pelvis and all of these things.

Sarah Haag:                  04:32                So I'd be really curious to know are you having any issues in this area? Cause there's help if you are. And then kind of go from there.

Karen Litzy:                                           And I want to backtrack for just a second. When you were talking about red flags and said some are truly red flags and some aren't. So just so that we're all on the same page, what would be those truly red flags?

Sarah Haag:                                          Truly in the pelvic world or in the entire rest of your body world is any unintentional weight loss or weight gain, 10 or 15 pounds over a short period of time. Also like fever, like temperature issues, loss of appetite when you have those other constitutional symptoms that go along with it. So just having some quirkiness with your bowel and bladder, it's really no reason to panic. But if you have also a fever and also a recent traumatic event, no, no, we want to just make sure everything's okay.

Sarah Haag:                  05:26                And the cool thing is that if you go to the doctor, it's like you don't have a UTI. Everything else is looking fine. Awesome. Then I can help with that. But the red flags, there's been a couple of great papers that have come out where it's like, it's not like if you have pain at night, freak out. No, no. If you have pain at night but also a sudden bowel and bladder change and also, okay, now we need to check in for it. But don't panic if it’s the only one.

Karen Litzy:                                           And now let's say you're using these questionnaires and someone puts on bowel, bladder or someone circles sex as something that they're having difficulty with. And I love this question because this was something that was brought up last year at CSM. So there was a physical therapist there who said, well, I live in the south and these are not easy questions to ask because people are more conservative or they don't want to talk openly about their bowel and bladder issues or about sex with their partners.

Karen Litzy:                   06:28                And so what do you say to those people? Those therapists that, are dealing with a population that's maybe much more conservative and they're not sure how to approach those subject matters.

Sarah Haag:                                          I always say just always with kindness and with a good intention and with a good explanation. So you can't not do it because it's awkward for you. You should be asking for a medical reason, right? So quality of life is in our wheelhouse, right? Like we're doing all sorts of quality of life questionnaires. Pee in your pants is a huge detriment for your quality of life in many cases, not being able to have sex can impact your relationship with your partner, your feelings of ability to even have a partner, having babies. All of these things that end up being huge stresses, which is gonna make a lot of other things not as good either.

Sarah Haag:                  07:28                Just start simple if you're asking questions. So if someone comes in with like straight forward knee pain, I'm like, how sex, no, that's not how, that's not where we go with that. But if someone's coming in with low back or pelvic issues, the way I usually approach it is to bring it up anatomically. So this is the anatomy. This is what we're doing. These are where the muscles go. Most people don't think about them. And when they're, if they're having issues like incontinence or have had babies, those pelvic floor muscles are muscles. Like everything else. We're going to work in PT. So I'm going to ask you some questions and I try to do it in a spot where you have some privacy. I know some PT places you're like in the middle of a gym.

Sarah Haag:                  08:06                If you can find a quiet corner, do everything you can to put them at ease. But just to be like this is why I'm asking. And if you can see that resistance be like all right, like it's not necessarily the number one priority for this treatment anyway, but if those things happen to be issues there is help, it can get better and you just let me know if you have any questions. Cause not everybody wants to talk about it and it's not my job to convince you to deal with it. It's my job to help you if you want help.

Karen Litzy:                                           And if you're a physical therapist that isn't specializing in pelvic health, it's a little bit different. Cause if you're specializing in pelvic health and people are going to you because you specialize in pelvic health it’s way easier, you know, these questions are going to come up.  But for those of us who don't specialize in pelvic health, then those questions can be a little bit more sensitive. So I just want you to make that distinction there for people.

Sarah Haag:                  08:48                Yeah. And also if you're going to ask if you're going to take that step and be like, all right, I'm going to ask about the incontinence. I mean cause sometimes you're in situations where it is an obvious issue. Other times it's like, well, based on their history they're actually at risk for it. Then you can talk prevention, which has always been kind of fun. But just if they give you some information, especially if you got up the guts to ask them, then please, please do something with it. Don't just be like, oh yeah, so great incontinence noted in the chart. I'll put it on the diagnosis list, like how the plan and there are some things you can do without doing a pelvic floor exam that can make amazing changes.

Karen Litzy:                   09:49                How can you evaluate pelvic floor muscles without having to go internally? I think that's a question everybody wants to know.

Sarah Haag:                                          Great question. I'll be honest, some people don't want you to touch him there like full stop. And so I will actually give people, I would say it's kind of like a choose your own adventure. So we can actually, we can all check our own pelvic floor muscles right here. And I would basically talk you through it. You would tell me what you felt. I keep an eye on everything else to see what else you were doing. But it would be very honest that my assessment is going to be, I believe you, it seems you're doing it correctly. Right? But I have to believe you, but you can actually palpate externally. As a clinician you can actually do it and you can do it in sidelying.

Sarah Haag:                  10:33                You can do it in hooklying and some people will do it in prone. I'm not a super big fan cause I can't see their faces. And also it can be kind of a vulnerable position. Basically if you just palpate, if you find the ischial tuberosity, you know about where the anal sphincters are. Okay. There's normal human variation. So I always say move slow and make sure you're asking for feedback. But you know, mid line is where the sphincters are going to be. We're not going midline. So you just kind of find that ischial tuberosity and palpate your way around to the medial part of it. And that's where the pelvic floor attaches. So then you can kind of talk them through, like I'd like you to squeeze and there's a bunch of different cues.

Sarah Haag:                  11:22                One of the most common cues, especially for the back end, is to like squeeze. Like you don't want to pass gas and that's awesome. But if you're a main problem with urinary incontinence, that's the back side, back side, not the front side. So how do we get it up there? So another cue that has been found to be very helpful, it's only been studied in men, but it is, shorten your penis. But what's interesting is ladies, I know we don't have them, right? Imagine that feeling, right? So like just imagine like pulling in, right? It totally changed where hopefully if this is a class, it would have asked where did you feel it? But like it, it changes it from the back and biases it towards the front of it. So find a cue that gets them to go, oh my God, I felt something.

Sarah Haag:                  12:07                You're like, awesome. So if you're doing a Kegel and like this happens, you're probably not doing it right. If that's happening, you're probably not doing right. But if like I'm Kegeling now and then I let go, you shouldn't have seen me get taller or tensor or breathe funny. It should be very sneaky. So as you're palpating on the medial side of the ischial tuberosities your feeling for those muscles to contract. So it's kind of like a gentle bulge and you can totally feel this on yourself here if you're comfy or somewhere else. But when you feel it, it's almost like when you're feeling like if you have your biceps slightly bent and you kind of like contract and you feel at tensioning and like a little bit of a bulge, that's what you're feeling for.

Sarah Haag:                  12:51                Okay but it can always be tricky cause I use the word bulge. Some people will have people push down. So we should also be able to like relax your pelvic floor and push down, like having a bowel movement. That shouldn't happen when you're trying to contract. So like when I say bulge, you should feel like a gathering of the muscle. That's what you're feeling. If you feel your fingers get pushed down in a way they're doing the opposite of a contraction. So there they're relaxing.  It would kind of depend on what they were doing and the cues you were giving. So it could just be like, I'm pushing down like doing a Valsalva. But it is basically a lengthening into the pelvic floor. I don't know if it's always a relaxation, so to speak.

Karen Litzy:                   13:33                It's kind of lengthening. And what is the difference between that Valsalva or lengthening and that small bulge? Like why is that significant?

Sarah Haag:                                          When you feel it, you'll know it's significant because if they're pushing down in a way that's not a contraction. So if you're going for strengthening or more closure to hold things in, yeah, you want that kind of like tensioning and bulge. But if you're actually the problems, constipation, I can't get things out, you want them to be able to relax and link them.

Karen Litzy:                                           Got It. Okay. All right. So now we know how we can kind of feel our pelvic floor muscles without having to do an internal exam. So once you figure out, and kind of what you said sort of leads right into the next question is if you have someone that's coming in with incontinence and you are looking for that sort of tightening or gathering up of the muscle, which I think that's a nice cue for people to understand because bulge can sometimes be a little confusing for people, but I liked the cue you're feeling the gathering of that musculature.

Karen Litzy:                   14:45                Is that something that you are then going to add into a home exercise program or like once you find that the pelvic floor muscles working or it's not working, what next? What do you do?

Sarah Haag:                                          Well, so I'll be honest. It's always I like him and people are brave enough and the patients were brave enough to be like, sure you can have a feel like let's figure this muscle thing out. I usually try it in a normal active kid in a normal setting. So not a public one. No pelvic settings are normal too. But in like just a normal like say outpatient therapy, be it or orthopedics or neuro, I would actually have them ask more questions about incontinence before even checking the pelvic floor muscles. Because the different types of incontinence are going to kind of tell you a little bit more about what you should do.

Sarah Haag:                  15:35                So some people have incontinence when they tried to go from sit to stand or when they cough or when they go running. So I want to know a little bit more about when is it happening because if it's only ever when you're putting your key in the front door or when you're running into the bathroom, that's more urgent continence. Would pelvic floor muscle exercises help? Maybe, but also probably looking at their overall bladder health, which is where a voiding log would come in very handy. And actually a shout out to the home health section and they have an incontinence urinary incontinence toolkit. It's free for members for sure, but I think it might be free for everyone.

Sarah Haag:                  16:15                So it's a pdf that actually talks you through the different types of incontinence because the most common form of incontinence urge incontinence, which is you're an urge incontinence is proceeded by a strong urge to go. So this is one of those things where, so there's a bathroom at the end of the hall. So if you're like, I'm totally fine, but then your eyes wander, you're like, oh, I could go and I didn't have to go. And then I would get up to go and I got to the bathroom and all of a sudden it's like, oh, where did that come from? Like all of a sudden it felt like your kidneys did a big dump, but they don't, that's not how kidneys work.

Sarah Haag:                  16:59                It's just how it feels to you. So what that really is, is your detrusor muscle kind of going, I'm so excited. I imagine a puppy, like have you ever like gone to let a puppy out the door? Like, so they're like, hey, I want to go out and you get up and you make a move for that door. And they're like so excited. Your bladder is like that sometimes. So that's more of a behavioral thing because what would you do with the puppy who's now like, wait, every time I do this, she lets me out. Pretty soon you're letting that puppy out every 10 minutes because yeah, because that's what the puppy trains you to do. So that's kind of more of a behavioral thing. And so that's proceeded by a strong urge. So it's not just when you're going to the bathroom, but if you get a strong, unexpected urge and leak, and that's usually a lot of people also experience some urgency and frequency.

Karen Litzy:                                           So if you feel like you're not getting to the bathroom in time, what would be a really logical plan to that?

Sarah Haag:                  17:52                You'd go more often, you're like, Ooh, maybe I need to not wait so long. But the thing is that then you're training yourself to go more often, your bladder is perfectly capable of holding more that kind of sensitivity and those signals you're interpreting or like, ah, no, I should go now. And then pretty soon you're that person who can't make it through a movie. You're that person who can't make it past a bathroom without needing to go. And you're the person that no one wants to go on a road trip with because you're stopping every like hour on the hour and every rest stop. But now is that because your brain is interpreting this as such? I know that there's a physical manifestation obviously, but is that like have you trained your brain and to feel that way to interpret that as such? I would say yes because most of the time, even if it wasn't intentional, like it's kind of like a slippery slope. It's like I almost didn't make it that one time. I'm going to plan ahead. And then what starts to happen, especially if you're like, all right,

Sarah Haag:                  18:54                your bladder is filling up. You kind of feel like you need to go and you go to the bathroom and it came out and it's like, all right, so that was nice and normal. But then imagine that time where you're like, hold on, I almost didn't make it, but you were stretched this much. You're going to start going when the bladder stretches this much. And then pretty soon if you let it so you're like, Ooh, now I'm going down here. Now I need to go sooner. And this is one way you can tell this is happening. And it can happen sometimes without ending up with a diagnosis of urgency, frequency or incontinence. But where you get to the bathroom and you feel like you've got a goal, but then nothing happened. Goals, like it's the smallest tinkle and you're like, I thought it wasn't gonna make it, but that's ah, that's all that's in there. And so that was like big urge little output. That's kind of a mismatch. And that'll happen sometimes.

Sarah Haag:                  19:48                But like if you're paying less than that, that's not much more than your poster board then a nice healthy post void residual. So you don't have to empty at that point if you're bladder’s saying, empty me now. And that's all that's in there. Yeah. So it's kind of like you're the sensitivity of your bladder has turned way up. Just like how we would compare that to the pain. So the sensitivity is turned way up so that it takes less of a stimulus in the bladder itself to trigger that feeling of you have to go, even though the bladder is barely full.

Sarah Haag:                                          And there's actually some interesting conversations with urgency and frequency in that feeling of extreme urge, can that be considered a pain? And so it's kind of interesting conversation because there is normal, there is a normal sensitivity of normal urge, but when that urge becomes pathological, yeah.

Sarah Haag:                  20:47                Too bothersome. Does that crossover into it? Distressing emotional experience? I would think so. Like can you imagine if you're like on a train or something like that and you have to really, really, you have, you're having that urge. I mean, that's very distressing dressing. That's very distressing. That's like you're suffering. So if you have someone like that what do we have them do? So they keep a diary, which you can get on the home health section and we'll have a link to that in the show notes. You basically ask them to keep track of things for a couple of days. I tend to keep it simple with what are you drinking and when and when, when are you going to the bathroom? If people are willing to measure, that's the best, but not many people are willing to measure.

Sarah Haag:                  21:37                So what I try to have them do is to kind of come up with their own plan. And I tell them this is not an exact science because you're not measuring, but that's okay because if you have a strong urge, which is kind of a lot, but you have like a little tinkle, that's kind of a mismatch. If that only happens after your third Mimosa, okay, that might actually be like a normal bladder thing. Do you know what I mean? So we kind of look at things that they're bringing in that may or may not be irritating to them. We look at are they getting enough fluid and bladder loves, loves water. But the first thing most people cut out if they're having urgency, frequency or incontinence is water is they cut out their water. It'll almost always backfires.

Sarah Haag:                  22:19                So don't do that anyone watching. It also makes you constipated, which you can increase your urgency and frequency. So, so yeah, so surprise. Everything needs to work well to work well. Okay. But yeah, so you kind of look at that and I just look for patterns and then I have people try to change one thing at a time. If all you're drinking his coffee all day, but actually you have good data, good parts of your day and bad parts of the day. Is it the coffee? Because if you're drinking coffee all day, you're probably not going to be very nice to me if I say, how about you stopped drinking coffee? Um, emotional response up. So you just kind of look at it. It's like, Oh, when does this happen? What do we need to change? And it can really help you narrow down. Is it really urge incontinence? Is it actually just frequency and they're not leaking like they thought they were or you know, is this primarily a stress incontinence issue?

Karen Litzy:                                           Well, so it sounds to me like there's not a lot of hands on work there.

Sarah Haag:                                          No, no, it's more behavioral.

Susan:                          23:27                Do you ever use pelvic tilting to get the posterior versus anterior pelvic floor?

Sarah Haag:                                          So that's a neat work with from Paul Hodges Group. So however you're sitting, most of us are Slouchy, just do a pelvic floor contraction, however your brain tells you to do that, do it and just feel where you feel it. But then if you get yourself in a situation where you like get more of that Lumbar Lordosis, and so like you stick your tail out, you get more lumber lordosis and then you do the exact same thing. So you're not changing your cue. For most people it's cuts to the front. And it's kind of neat because one of the things, one of my pet peeves is when we were talking about earlier is my pelvic floor therapist get tunnel vision and are just doing pelvic floor exercises, but not reintegrating it into how they're, they're using their body.

Sarah Haag:                  24:18                So if you have a runner who's a chronic but Tucker and she's leaking out of the front, obviously, how would it feel if you like got those glutes back a little bit? Because you can't run and Kegel at the same time. You can't, you can try. It's not going to go well. And certainly not for like a 5K and let alone not a marathon. So changing how that is biased because most of us don't think about the pelvic floor until you have a problem, right? But they've been working, right? They've been doing their thing. You're using them when you walk up those stairs you're using them when you're getting up off the floor. So they do something, the key goal is like your bicep curl. You want a stronger bicep, you're going to do some curls, you want a stronger pelvic floor, you're going to have to do some pelvic floor exercises.

Sarah Haag:                  25:07                But that's not your management plan. You kind of want to, someone said it yesterday, kind of like the core muscles are there like automatic, like when you get ready to do something you don't think, okay transversus were good. Like it just all happens and you want to kind of get the pelvic floor back into that system and make sure it's strong enough and coordinated enough to do its part. So you don't think about it.

Dave:                            25:37                So along those lines then, would you say that if somebody is more lordotic, they're more likely to engage the anterior floor and then flat back more of the posterior floor?

Sarah Haag:                  25:47                That tends to be what they're finding on like EMG studies and what I will see clinically with people if they do a ginormous buttock. It’s really interesting if you're like, how's your breathing when you do that and, and how good is your squat, let's say when you do that. And it's like, Eh, it is what it is. I'm like, okay, so what if we do kind of take it into where some people, especially if they've been told by other practitioners to like watch your Lordosis, it's kind of huge. Which isn't really a thing. But you know, they kind of, they're kind of like going in there, they're like, I'm so scared but it kind of feels good and then you have them do that movement or try that exercise. Usually they're like, that was way easier than I thought it was going to be.

Sarah Haag:                  26:30                But again, if it's not working, then we try something else cause everyone's anatomy is different. Sometimes if they have a lumbar issue, getting into the ideal position for their pelvic floor, may or may not be easy for them, at least at first. But I think you need to play around with how it feels and how it's functioning as opposed to, I mean, I've been guilty of it in my career of like, ah, you need more or less of what you're doing with your spine and were just different. So it's where it works best is where it should be.

Jamie:                          27:03                So for a lot of the outpatient conditions and orthopedic setting, there's still an emphasis on giving some kind of qualitative documentation to the muscle contraction, whether it's a manual muscle test or something like that for payment purposes. So what are some strategies or tips for clinicians to be able to take that palpation externally and then relate that into their strengthening documentation?

Sarah Haag:                  27:29                So if you're just checking externally, like just palpating outside, it's like a plus minus like, Yup, I felt it. Uh, they couldn't find it. So kind of plus minus, cause you can't give it more than that. We also have to remember, so when I write about pelvic floor strength in my documentation, I have a number I can put and you can grade it. You have to do that internally, which is why if you're like, ah, we need to know more, refer him to a friend or go to the training. But I usually give a lot more information. So like, all right, so they, you know, they had like a three out of four, three out of five squeeze. The relaxation was not very coordinated and kind of slow, but then their subsequent contractions were five out of five.

Sarah Haag:                  28:09                All right. Do you know what I mean? We have to, because of payment and insurance and all of those things, we have to write something down. So what I do is I write down what I find and I'm happy to talk about it. So if you want to deny it, I can talk vagina all day with you. And I have, and their questions usually get shorter and shorter. Um, because really they're asking for information that isn't necessarily the most helpful. So if you're checking an externally plus minus, but also I've had people who five out of five but still incontinent,

Sarah Haag:                  28:41                So then they're like, well they're not weak but you put down, you're going to do strengthening. I'm like, well yeah, because it's more of a strengthening, not just a strengthening with a functional goal attached to that, if that makes sense. So sometimes it's more words, but don't be shy about one. Well, first of all, please be honest, be as accurate as you can be, but also don't be shy about doing the best care and be willing to stand up for it. If it gets denied. It's not cause you gave crappy care likely. I mean, do you know what I mean? I'm like, I dunno how long you practice, hopefully. Good. But if you get denied, it's not necessarily key because you gave bad care or even did a bad note. It's because they decided they weren't going to pay based on something. Hopefully logical that you can talk about. You can always appeal. So don't let payments scare you away from giving the best care.

Sarah Haag:                  29:36                Sorry. Another soapbox of mine.  So that was urge incontinence. Stress Incontinence.

Karen Litzy:                                           So let's talk about that because I think that gets the more airtime, so to speak. So that's when you see the crossfitters are the weightlifters or there's a great gymnast pitcher yesterday going backwards where you there backwards over the pommel horse, not the pommel horse. It's the worse just a horse. A spurt. Like it was, yeah. And you're just like, that could be photo shopped, but also it probably isn't. Yeah. Or like we've all seen like the crossfit videos where women are peeing and then everyone high fives them because they worked so hard that they peed, which, you know, not normal. We know that that's been addressed by a lot of a pelvic health physical therapists.

Karen Litzy:                   30:32                So I would like to know first I think we just gave the definition of stress incontinence, but I'll have you give the definition quickly. But then I'd like to go back to something that the question that Dave had asked about the positioning and how that works within weightlifting or within, you know, waited or loaded movements. But go ahead and give the definition of stress incontinence first.

Sarah Haag:                                          So stress incontinence is basically when there's an increase in intrabdominal pressure that is greater than the closure of pressure of the urethra. And you have some sphincters as well as the pelvic floor helping keep all of that closed. But if you increase the pressure enough on the insides, and that's why you hear, and again, it's primarily women, but also a lot of men after prostate surgery, they cough and you get a spurt or you know, you jump and you feel it come out.

Sarah Haag:                  31:21                Those are usually because the closer pressure has gone down or the intra abdominal pressure has gone up.

Karen Litzy:                                           Okay, great. So now what does that look like? For the average physical therapist who's not a pelvic health therapist. And let's say they are seeing someone for hip pain and you ask them, are you ever incontinent? Or if they are, you know, heavy lifters are, they are adding load and they say, oh yeah, but that's normal. Or they have low back pain and they say, yeah, but that's normal. Everybody does it at my crossfit box or whatever at my gym. So how do you then, if you're not you, you are someone who's not a pelvic health therapist, how do you address that?

Sarah Haag:                                          Well, first of all, what all of us should know while incontinence is super common, it is not normal.

Sarah Haag:                  32:16                Not ever being dry is normal. So we need to get away from this idea that like, well, everyone's doing it. It's like does that make you want to do it? Like I feel like, no, I feel like no is the answer. So first of all, just, and sometimes they don't know that. Like, I know that in some like young girl gymnastic teams, like the color of their leotards are chosen to like, not show the pee because they're incontinent that young. Yeah. And I see a lot of women as adults sometimes before they've had babies sometimes after, right? So like what's the, what came first? But they've had lifelong issues with what's essentially public flourish. She's with incontinence, sometimes pain with intercourse, all of those things. Competitive gymnasts, competitive cheerleaders. Dancers tend to be probably the biggest, runners or another group.

Sarah Haag:                  33:12                There's been some studies, there's one study and I cannot recall it. I mean, it's probably like 15 years old now. We're 100% of this division one female track team reported urinary symptoms. 100%. Like every girl. So common. Heck yeah. Normal. So many girls. Yeah. So the biggest thing if you're not a pelvic floor therapist is to check out their function. So if they can identify when they're having issues, it's when I get to this particular weight or it's when I get to mile 17. Okay. And I usually throw in, like if I ran 17 miles, I'm not really sure what my body would do. Like I dunno, but it still shouldn't leak. But if you can find out where that breakdown in the coordination in the endurance and the strength and whatever it is happens and look at what's happening there.

Sarah Haag:                  34:04                Because if you can run 17 miles or you can lift 200 pounds without leaking, but then you do, you're not, you're not weak. Right? Like if you can do all of that, something's happening there to make this happen. Cause if you can lift 200 pounds in that league, something's working, it's just not still working when you try to live 210. Okay. So let, let's look at what's changing or number of repetitions. Right? That’s what you're looking at.

Sarah Haag:                  34:52                So if you collapse your chest and which I would probably do after running 17 miles and I'm like this. And now what happens when I collapse what happens to my bottom half when I collapsed my shoulders? Well my butt just tucked. Cause I'm just trying to get through now. The funny thing is the breathing is also harder. So while I'm doing this as kind of a mechanism to keep going, it's harder to breathe because nothing's working diaphragm to have a full excursion, right? Yeah. So, so I like to look at if you're running fine for 17 miles, I want to see you at mile 16. I want to see what's changing over that mile. I want to see what you looked through my team. And can you, when you start to get to that point, can you make an effort to change something?

Sarah Haag:                  35:32                Do you notice a change in your breathing when you're lifting 210 instead of 200 and kind of look at it from that way cause you're not going to kegel why you do that. What do you mean? Oh well say to like precontract and prime and all these things and, and that's fine, but it's like if we go back to the running, you're not kegeling and all that time your pelvic floor after like 30 seconds is like, dude, you don't want me to get that tired. Like it's going to be like, we're going to stop that now. So yeah. So the way I would approach that, if you're not me, yes and not going to do a vaginal exam, is you look at their performance. So if they said, I have knee pain when I do this, when I go from 200 to 210, they're my squat.

Sarah Haag:                  36:13                How they do, they're looking at the mechanics. You would look at what's happening, what is different? Cause you know, the joint can do it, you know, the muscles can do it. What's changing. And you would address that. So it’s really no different if they can tell when they're leaking, you're just looking what can, what are the things that can change it? Usually the tail lift and looking at their breathing or two really easy ways to go about it.

Karen Litzy:                                           Okay. All right. That's great. And, and, and that goes with that. Does that also work with, let's say instead of you're not a runner weightlifter, but you’re like a new mom or something like that and you're okay, but then by the end of the day after you've been maybe lifting the baby or you know, doing whatever you're doing it, it doesn't necessarily have to be sport related is what I'm saying.

Sarah Haag:                  37:06                I think about like function, but definitely, I mean, you asked about, but no, just everyday if getting out of a chair makes you leak, that's, but then it's basically a squat. So you are, you're looking at the activity that they're having difficulty with and making small changes got in most cases.

Karen Litzy:                                           So I think the biggest takeaway here for me is that not everything is solved by doing a kegel.

Sarah Haag:                                          I think a lot of non pelvic health PT’s may have that, that misconception that if someone has incontinence, well Kegel time. Right? And that's all you gotta do. That's what most people do. If they go to the doctor and they mentioned it's like, ah, you know, that's pretty normal. It's not, it's common. And then they'll be like, do some kegels and, and a lot of women and men don't know how to do them.

Sarah Haag:                  37:53                So then they're just, I'm squeezing stuff and it didn't work. And it's like, Oh, before we get too far, can we check and see how you're doing them? And I think that's kind of a beautiful segway. So let's say you have your new mom or you have your athlete or whatever and you are, you've tried some stuff, right? Cause none of this is life or death, right? I mean it's fine to try some things. So already not doing anything about it. So trying to change up a couple of things is perfectly within your purview, especially again, you're seeing them for hip or low back. It all, it's all together. You're good. But if it's not changing, if it's not getting better, if when you ask them, you know, can you contract your pelvic floor, what do you feel? They're like, I got no idea.

Sarah Haag:                  38:33                And they're like, but please also don't touch me there. Or are you touching there and you're like, yeah, I don't feel anything either. And I've used all my cards but I don't know what to do. That's when you refer. Because just like any other things, somebody coming to see you as a physical therapist, you're going to do some things. And if those things are not working or they're getting worse, you're going to try something different. Or call the doctor or refer to a friend. Right? So if you change some things and you're like, I'm amazing, they're all better. Awesome. Do they need to go to pelvic floor therapy? I'd say no if their incontinence resolves or their pain resolves. But sometimes with especially we see it a lot more in I would say the more active athletic population is a pelvic floor that's more like this.

Sarah Haag:                  39:19                So it's like tight and there's a hundred people call it hypertonic or high tone or short pelvic floor and all these things and basically in my brain, the way I categorize it is like you should be able to contract your pelvic floor and you should be able to let it go. And we can all get better at that. But if you're like, I'm here, how good is my contraction going to be? Because I'm not showing you my pelvic floor. Like it's not going to, it's going to taste like it's going to not move very much. But if you get them to relax more or they're like, oh, I didn't know that was there, that's better. Then you all of a sudden you have a good contraction.

Karen Litzy:                                           How do they relax? Do you just say relax?

Sarah Haag:                  40:01                Before somebody tells him to relax, the worst thing to do is be like, can you just relax? So I try to have them feel the difference between contracting and not contracting. Because what will happen and people use what the traps all the time is like. So like, ah, so much tension. All right. Again, telling you to relax your shoulders. Things I didn't think of that. But if you squeeze and let go like as a little bit of like, Oh, I feel that, oh, oh there's some more space there. So I start with that. Okay. The pelvic floor. But again, if they're like, I just don't know, that's something that is so easy to feel with a vaginal or rectal exam. So that's where it's like, ah, you're having some trouble. I would recommend, would you see my friend for one visit have this exam, they're checking out your muscles and just see if he can feel that relaxation and then come up with like cueing or a plan that works for them.

Sarah Haag:                  40:54                Cause it's not just about like slacking everything out. It's really feeling that that relaxation, that lengthening of the muscles there and being intentional about it. You don't want to lie there would hope like maybe it'll let go at some point.

Audience member:                               So you talked about kegeling and what about dosage or prescription and quality versus quantity and how you prescribe that to your patient.

Sarah Haag:                                          There is no hard and fast rule as to like how many, how much. So that's where, again, I would have them do some and see how the coordination goes. Cause if they're otherwise neurologically intact and they're kind of getting it, how many do they need to do?

Sarah Haag:                  41:57                I would say it's not unreasonable to go kind of basic strength and conditioning principles of, you know, like I know eight to 12 reps three times a day. That's an okay starting point. And actually, I don't know if you know this, so I'm writing a book on incontinence and the PT people have it, but it's the editor just asked me, she's like, well, since we don't have like a hard and fast number, do we, should we put that in there? And I said, I think we do. So that's a good starting point. Not everyone would be able to do that right off the bat, but also some people be able to do that and they're not getting better. So it's kind of like let's start here and see what happens. And then you can kind of titrate it up and down. If I do an exam on somebody and they can't contract for 10 seconds, they can only contract for five, I'm not going to have them contract for 10 seconds at home. I would probably honestly in that case, have them go, I need you to make sure you can feel the good contraction. So you actually also asked about quantity and quality. I want quality, because all of us can do 100 crappy ones. I'm not sure how much it would help. So really looking to be like, okay, so I feel that contraction and I'm breathing

Sarah Haag:                  43:10                and I usually actually have stopped counting seconds. I've had people go by breath, so if you, let's do it. We're going to squeeze our pelvic floors and you're just going to keep squeezing as you breathe in and breathe out normally. Nothing, nothing fancy. And then keep squeezing while you breathe in and breathe out and let go. And what I hope you felt was a squeeze to start with maintaining the squeeze. Some people will feel kind of like a little, a little wave as they breathe, which is not unusual. But then when you stop the breathing and you let go, you should feel that let go. So if you didn't feel that, let go. I usually say that's one of two things without feeling right. I can't tell without feeling is that you got tired and you lost it or you forgot to let go.

Sarah Haag:                  43:51                So that's okay. Have a wiggle reset and try again. Because if you're not feeling the contraction, what are you doing? Like you might as well take a walk because then you'll actually be using your pelvic floor. I like going with the breath because a lot of people like to hold their breath when they're like, they'll do like they'll just suck at it and it, you'll feel a lift, but it's just a vacuum. It's not really your muscles doing their thing. So by doing the breathing, if you breathe in and out twice nice and slow, it's 10 seconds. You don't have to count. So if I have you do four of those, you just have to like count on fingers, two breaths come and arrest for two breaths. So much easier to keep track of. And then people actually do them. Cause if I could tell them to do ten second holds, one, two, three, four, five, six, nine, done. And that's not really helpful either. So like the too slow breaths. Now you're breathing and don't have to count and you're going to stay honest.

Audience member:       44:57                So trying to bring this into the neuro world for someone who's post stroke and has stress incontinence or they've had neural damage of some sort and have stress incontinence, Are there any PNF techniques where you can incorporate the pelvic floor to help with that?

Sarah Haag:                                          I haven't had PNF stuff since college. And I'm old. So what I would say is, is if I'm recalling that they go through movement patterns and as you're doing those things, there are things will be happening on the pelvic floor. It seems to make sense. What specifically, I don't know, but if you're kind of working more with that tone in general, I've only had a couple of patients come see me like post CVA and feeling their pelvic floors is amazing because while it makes perfect sense that one side might be like hypertonic are nonfunctioning until you feel it.

Sarah Haag:                  45:49                It's like, wow, that's so cool. Like once I totally normal springy, they can contract and relax the other side just like they're, they're hemiparetic arm. It's cool. With stuff like CVA or neurological involvement, you really want to make sure you're on board with the physicians and you know that bladder function is still intact because depending on where the stroke is and what exactly happened or where the spinal cord injury is, you don't want to mess around with screwing up the bladder or the kidneys. So if they're not going to the bathroom or they're only leaking during transfers, that could be stress incontinence or it could be overflow incontinence because their bladder is so distended with the effort. So that's something you would really want to make sure you talk with their nurse or their attending physician and make sure, so how are things working?

Sarah Haag:                  46:38                Because the other thing we need to remember is a lot of things we're still working on people who have had neurological insults, right? So once you're like, okay, bladder is relaxing as it fills, contracting, as it empties, it's emptied fine. We're not worried about this being overflow incontinence. I would actually start to incorporate stuff like blow before you go. Where you're managing it the same way you would for someone not having a stroke, but half of that, the beam continent and actually going to the bathroom it seems, I can make it sound very simple, but I have a slide and of course that I teach where it has all the like the tracks up to the brain and all the tracks who, the spinal cord to the bladder. But we got the sphincters, we got the detrusor, all of this stuff just happens.

Sarah Haag:                  47:25                And when I click the slide from this beautiful simple picture, it's just font about this big, explaining all of the complex things that are happening so far as we know. So again, as long as they're, bladder is functioning on that basic level where it knows when to empty and it can empty, I would treat him like a anyone else and not assume that it's just because of a high tone pelvic floor on that one side. That's the issue. But if you get that person and you do your PNF, please tell me what happens. And if it changes their incontinence, I would really like to know.

Karen Litzy:                                           And when you're looking at the bladder function, that is something the physician is doing through an ultrasound, is that how that works? How did they do that?

Sarah Haag:                                          They can do it through an ultrasound so that that they are, they can look mostly at like post void residual.

Sarah Haag:                  48:12                But then also there's a test called neuro dynamics. And this is a test that involves, a catheter and there you're a threat. And then a probe and another orifice down there to help measure for intra abdominal pressure. And it's kind of a neat test. If someone wanted to do it on me for free, I would probably do it. But they're also looking at an EMG the whole time. So they start to fill up your bladder was sailing so you know how much is in there and you're awake for this test because they go tell us when you, when you feel the first urge to go and they mark where that is. And so you can see how much fluid is in there. And I'm like, tell us when you get like the, I should go to the bathroom now urge. And they mark that and then they're like, okay, tell us when you can't take it anymore.

Sarah Haag:                  49:00                And they mark that. So then they know how much your bladder can truly hold. But also looking at what's your detrusor doing, which is the smooth muscle around your bladder, what's happening to your pelvic floor, where is the weakness? And usually when they're full, sometimes they'll have people cough to see if anything leaks or if any sphincters happen or sphincters what they're up to. But it's, it's involved. But there's a lot of good information. And interesting side note is that if you do so, that's really I think really helpful for like a neurologic population just to make sure. I did have one patient I was lucky enough to work with a PT who became a physiatrist who specialized in neurogenic bowel and bladder and she let me come down to watch  urodynamics of one of my patients who was really against cathing.

Sarah Haag:                  49:46                He didn't want to cath. So she came down, she brought him down to the urodynamics and as it and cause he's like, I am voiding 400 to 600 milliliters every time I have a bowel movement. And like that's pretty good. I mean like most are four to 600 CCS and turns out it was only under very high pressure. He was already getting reflects into his kidneys and after he voided four to 600 CC's, he still had four to 600 left, which is too much. So even though he was having some output, that was the test that really made it clear to him like, oh, it's coming out, but it's not healthy. Like I need to cath.

Jamie:                          50:41                What are some of the considerations that you might go through in your thought process when you're dealing with a male versus a female pelvic pain or incontinence issue?

Sarah Haag:                  50:53                That's a lot. I could talk for days on that. Well I'm not sure. When you're talking about considerations. We need to take into consideration our patient preference and what they're comfortable with. We can tell when our patients are uncomfortable or we should be able to but then kind of try to work out, they might not want to talk to me about this, but who can I get that they would, cause a lot of people would assume that men aren't really comfortable talking to females. But a lot of the men who come to see me, just want help, and we've had several male students come through and you know, they run into like women not wanting a male therapist to do it.

Sarah Haag:                  51:36                It's just finding that, right? Just like any other body part, finding the right person to help. But then if we go to, you know, bringing up those subjects, I don't know that in my brain it's so, so different. Male to female, you're going to take into consideration their history for sure. I feel happy saying that because now with we have kind of like a gender spectrum, right? We have people who, who have transitioned in varying degrees and we have people who haven't transitioned but totally identify with the gender. They weren't assigned at birth and all of these things. So basically I take it functional. So can you just walk me through the issues you're having, your questions, concerns when it's a problem, if anything makes it better, does anything in particular make it worse? And then we problem solve from there?

Sarah Haag:                  52:26                So I guess I didn't really have a good, a good answer, man. Male to female. Their situations are usually different, but it's kind of different across one gender or the other. Anyway. Is that kind of answer it? Yeah. Great question.

Karen Litzy:                                           Well, thank you so much. Thank you. I think we covered a lot and I thank you guys for being here and I hope that you guys got a lot out of this and can kind of take this back to your patients now. So last question that I ask everyone and it's so knowing where you are now in your life and your career, what advice would you give to yourself as a new Grad?

Sarah Haag:                                          Ask more questions. To be honest on, I came out of school pretty much like, like the teachers know best and what I learned is right.

Sarah Haag:                  53:16                And then when you get into the real world, I ended up thinking I was not very good at my job for awhile because like you would do what you were taught to do but it wouldn't work. And then, you know, some things happen and I got older and more comfortable and when you start asking questions you realize there isn't one answer. So if you start asking those questions, you're part of, you're part of the solution. By kind of pushing those boundaries and not like, I wish I would've just asked more questions sooner. I'd be so much smarter than I am now.

Karen Litzy:                                           Where can people find you on social media if they want to get in touch with you?

Sarah Haag:                                          Sarah Haig, PT on Twitter, you can find me on my website, and um, I mean Facebook, Sarah Hague.

Sarah Haag:                  54:07                I don't know what my picture looks like right now, but I'm friends with Karen, so if it says I'm friends with Karen, that's probably me.

Karen Litzy:                                           Awesome. And just so that everyone knows a lot of this stuff that Sarah spoke about, we will have links to it. We'll have links to the home health section. We'll have links to the testing, the urogenic testing. Is that neurodynamic testing? You could just send me a link or something about it. So we'll have it all in the show notes. Thanks everyone for watching the live. We appreciate it and everybody, thanks for listening. Have a great couple of days. Stay healthy, wealthy, and smart.




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Feb 7, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jazz Biancci on the show to discuss the power of tuning in to your body.  Jazz Biancci, CAPP, founder and creator of The Consciousness Project 2020, is an Author, Speaker and Channel, helping people access their invisible influences to discover what they don’t know they don’t know, to have a greater impact in the world.

In this episode, we discuss:

-The importance of tuning in to your body’s awareness and emotions

-How to live with more integrity during your daily interactions

-Why you should shift your inner dialogue towards kindness

-And so much more!



Speakers Who Dare

Jazz Biancci Twitter

Jazz Biancci Website  

Jazz Biancci Facebook


For more information on Jazz:

Jazz Biancci, CAPP, founder and creator of The Consciousness Project 2020, is an Author, Speaker and Channel, helping people access their invisible influences to discover what they don’t know they don’t know, to have a greater impact in the world. Jazz has been a speaker at the Fit, Feminine & Fierce Conference in NYC, the Speaker Salon NYC, and a panelist at Soul Clarity & Abundance Live. She is currently the online host and co-producer of, co-host and producer of Spiraling Inspiration on, producer of Healing & Becoming The Divine Masculine, and producer and moderator of The Summer Series LIVE: Anchoring During Troubled Times, and Conscious Masculinity Part ll: Diving Deeper.

Read the full transcript below:

Karen Litzy:                   00:00                Hey Jazz, welcome to the podcast. I am happy to have you on. And for those of you who have not listened to the podcast before and have not heard me talk about the speaker salon that I was involved in over the summer last year and the mastermind that I continue to be involved in through Trisha Brouk, then you need to go back and listen to some of the episodes I did with Trisha Brouk because that is where Jazz and I met. So we met last summer. We were a part of a small group of this speaker salon. And for me it was a real big shift in mindset in life. And I always credit all of the people in the group, not just Trisha for being the leader of the group, but everyone else in the group, and Jazz was one of them. And so that's how she and I met.

Jazz Biancci:                  00:53                Oh, thank you. That was probably a crossroads in my life. It was definitely a game changer.


Karen Litzy:                                           Yeah, I agree. I, um, it changed my life and all aspects of my life, not just speaking, not just business, but personal confidence, everything. It was just this big, big, yeah, crossroads for me as well. I just absolutely loved it. And Jazz was just this amazing public speaker getting up on stage. Like I was saying, I remember the first time I went, everybody got up on stage. And I was wondering, I'm like, is everyone here a professional speaker?

Karen Litzy:                   01:37                What is this? And I was very, very intimidating, but at the end I think we all definitely got so much out of it. And the support and the love, the community was great. But today jazz is here to talk about the power of being in our body. So Jazz, my first question to you is, what the heck does that mean?

Jazz Biancci:                                          It means fully inhabiting your body to allow to provide some feedback that it's meant to provide. So I believe the body is a biological computer and it plugs us directly in to this energetic grid that lays across all things. And so when we're in our body, our sensory system is at work. And we receive messages. So the language of the body is very different from the language of the mind because there are no words. And so to understand and interpret those messages, it requires us to inhabit our body versus, you know, a lot of people live life from the neck up and it's all logic, linear thinking.

Jazz Biancci:                  02:47                And there's a level of detachment. So when their body has a response to something, a person, a situation, they're slower on the uptake if they even feel it at all. Because we can feel residents, we can feel when something is a no.

Karen Litzy:                                           So is this like an excuse my kind of layman's terminology here. Is this what people would refer to as their gut feeling? Or is this something more?

Jazz Biancci:                                          It's a combination. So there's a, there's a heart intelligence and there's the gut feeling and they all worked together.

Karen Litzy:                                           And how do we tap into this? So I feel like I am certainly hand raised one of those people that's probably more head up or neck up then the rest of your body. I fully admit that I am. So how can we tap into those other parts to the heart, to the gut feelings and how can we do that?

Jazz Biancci:                  03:54                I used to be a linear, logical head person too. And I found my way back into my body as an athlete and a dancer. And I started noticing when I was at the gym and in dance class, how the reach of my arm connected me to my heart. And so a great way to start is just to get physical if you can, and if not to take a moment and just put your hands over your heart in the morning. Take 10 seconds to remind yourself that your heart is not only beating to keep you alive, but it's also feeding you information. And then as you move throughout your day and you're having interactions, notice how you feel when you're ordering your coffee and they call your name. How does it feel? And without judgment, but start to pay attention to your responses to people, to the things you're saying and how it resonates in your body.

Jazz Biancci:                  04:58                Because often people will ask us questions like, uh, do you mind helping me with this? And sometimes the answer is no, but we say maybe because we're being polite and feel how that resonates because that lie resonates much differently than the truth.

Karen Litzy:                                           Interesting. And, and I, I think we've all been in these situations, like you said, someone asks you to do something and you say maybe are you say yes. And I was in a situation a number of years ago where I said yes to something, but it was literally giving me stomach pains and you know, it was making me so anxious because I knew deep down this is not right, but I am a bit of a people pleaser. And so I said yes.  So for those people like me, which I, I think there's a lot of us out there and a lot of the people that listen to this podcast are, you know, we work in healthcare.

Karen Litzy:                   05:57                We want to stay healthy. You want to stay fit. And oftentimes were big givers, right? Because we're, we want to heal people. You know, we want to help people, but then it kind of backfires on ourselves. So what do we do in those situations where someone asks you to do something, you feel it in your gut. It's not, it's literally making you sick, but you say yes anyway.

Jazz Biancci:                                          Well it's, it's baby steps, right? It's a process. So the noticing is a start. Like I used to tell myself, yeah, workout in the morning. I am not a morning person. I have never been a morning person. And so starting to notice how that felt in my body, whether I was able to change it or stop saying, oh I'm going to work out in the morning. It was a different story. So we start by noticing how it feels and then we start asking ourselves, well, why did I say yes?

Jazz Biancci:                  07:05                So why did I say maybe when I met and start delving into that because it takes a while before we are in grace enough to say, I would really love to help you with that, but my plate is full right now. Can I help you find someone else?

Karen Litzy:                                           That's great. That's a very, very nice way to say no. And the offer of saying, can I help you find someone else or I have someone else in mind I think is a great way to, from the people pleaser standpoint, again, I'm going to be selfish and go from the people pleaser stand point that you still feel like you're helping even though you're not the one who can do it.

Jazz Biancci:                                          Exactly. And you're in your heart. Because sometimes when we don't understand how to do something and we're, we're getting our legs about us, we can be short or curt or rude just to try to get that boundary laid down, you know? And we don't have to do that. We can take our time with this process and notice what we're doing when we're doing it, understand why we're doing what we're doing, when we're doing at being graced with that and sit in our hearts and give us an answer that's a win win for everyone.

Karen Litzy:                   08:32                Yeah. So when we're talking about, you know, being in your body, we're, I'm just going to recap the steps because I'm a step person. I'm a checklist person, kind of. So noticing first what's happening in your body. And like you said, it doesn't mean you have to sit and meditate for 20 minutes or 30 minutes. It's just take a moment to remind yourself where you are and how you feel in that moment. And then delve into the, why did I say yes or maybe when it should have been a no, and delving into the why is something that we've been talking about a lot lately on the podcast and that why goes pretty deep. So it's not just why did you do this? Oh, because I didn't want to. And that's the end of the conversation. And then finally being graced with your decision. And then the most important is to come up with a win-win response for everyone. Got It. Well that seems easy.

Jazz Biancci:                  09:38                It does seem easy. The hardest things usually do.

Karen Litzy:                                           That sounds like I've got it down pat now I just have to practice it. And I would assume just like, you know, you were an athlete and a dancer. How many times did you practice certain movements in order to perfect them? Or to feel comfortable with them. Right. So I would assume that this process is just a lot of practice, right?

Jazz Biancci:                                          Ongoing. And it's not about judging ourselves or being mean or shaming ourselves. It's not about that. It's just like, it's a scientific experiment. That's all it is. How can I improve? How can I shift?

Karen Litzy:                                           And so if you're, let's say you're working with a client and you're working with them on this sort of shift, what pieces of advice seems to resonate most with your clients? And again, knowing everyone is different and has a different path, but are there exercises or things that you do with clients that you're like, you know, this is pretty powerful. This is something that seems to work.

Jazz Biancci:                  10:55                I have them keep a journal. First I just do like the tick system. So noticing how many times a day that you lie. Like when you're like counting and you're like putting like marks and then you get to the five and you cross it over. So it's just that easy to start noticing how many times a day you lie. So you have a notebook and you just make a tick or use your notes on your phone and you just put a one Monday, one, two like you just keep adding ticks and you count it up at the end of the day. Because it's fascinating because we lie a lot, this self-deception is astounding and it does no service to anyone when we're out of integrity because that's what that is. We're being inauthentic in a moment because we are taught to be polite before we consider ourselves and we can do both without being disingenuous.

Karen Litzy:                                           So yeah, it'd be like little white lies or maybe, yeah.

Jazz Biancci:                                          Yeah, because it's all about the observation and understanding what kind of situations prompt us to lie. Noticing when we have fear, because fear is huge. If you're afraid of retaliation or punishment, you're prone to lie to get approval.

Jazz Biancci:                  12:40                So it's like noticing those moments that that turn up the volume and then noticing how that makes you feel. Because there is a different way. We just haven't been taught what that way is.

Karen Litzy:                                           So you start, you have people get a journal or like you said on their phone and write down how I'm going to do this because I wonder how many times do I even say a little white lie. I'm going to do this. I would encourage the listeners to do this as well and we'll see what we come up with. It's really fascinating. Yeah, it sounds really, really interesting. So, all right, let's say I do this system for a week and I like five times in a week. What do I do about it? What does that mean? What does that lead to?

Jazz Biancci:                                          Well, it leads to noticing what kind of lies you're telling it to whom, right?

Jazz Biancci:                  13:30                Because they may, they may be the lie that like, hi, how are you today? I'm fine and you're not, you know, and then reconstructing that answer so that it feels right in your body and appropriate for the social situation. So someone may say, hey, how are you? And you could say, well, I'm hanging in there, you know, that's acknowledging what you're feeling without giving too much information.

Karen Litzy:                                           Yeah, because I would think that you can acknowledge it, but giving too much information, people will be like, why is she inappropriate? So you have to kind of know where that line is between, you know, allow like divulging information but then being like, what is wrong with like why is this person saying this in this context at this time?

Jazz Biancci:                                          So you're honoring and acknowledging and being aware of your environment at the same time because the residents of truth and creating the habit of truth for yourself.

Jazz Biancci:                  14:43                As you begin to notice how that frequency vibrates, the way a drop of water into a glass of water does, you see the ripples, you can feel it. And over time it's, it's a purification. It's a gentle way to start the purification process because the body is an incredible instrument. What I found in doing these practices, I know when someone's lying to me because it feels different than truth. And so it's a confidence of knowing that I can rely on myself and my instrument and my body to provide information that I can rely upon because being able to rely on the body because there are no words attached to it, the body doesn't lie. And so those moments I've had moments. I'm sure you have too, that an alarm has gone off within you that you don't necessarily understand. And do you follow? Do you not follow it?

Jazz Biancci:                  15:52                Is your imagination, are you having an anxiety attack? For me it happened in queue boarding an airplane and I've been flying all my life and I was going to Haiti for work. It was my fifth trip to Haiti. I was excited, our whole team was going and we were waiting in queue and all of a sudden something happened in my core and I was terrified and I went to my friend and my coworker and told you, I'm like, I am not getting on this plane. I'm not going. And of course she was like, what are you talking about? We have a job to do. And I'm like, no, something doesn't feel right. And so we went to the director and she's like, you can sit by him and you've heard me speak about this. And I let myself be peer pressured and I wasn't competent in that feeling yet that alarm is one of the first times I felt that.

Jazz Biancci:                  16:48                And so I got on the plane, I was sitting next to the director and I buckled in and I'm like, what am I doing? But I still didn't have the courage to say, I’ve got to get off of this airplane. I sat there. So we take off, there's this huge commotion and the commotion is moving forward. The stewardesses cannot get the situation under control and the plane has to turn around the air marshals come on the plane and escort the situation off the plane. So the grid that we have within us in our hearts, that electromagnetic energy pulse connects to what's going on in our environment. And I was connected to that woman because she was in my environment and it was an alarm going off for me to get off the plane. It was also a great moment to take notice. Okay. So when my body does this, I now have evidence to listen and thank God it was just the air marshals and an escort off the plane.

Karen Litzy:                                           Sure, sure. That's Crazy. And you know, we've all had these, oh, why am I doing this? Why am I doing this? And then oftentimes that feeling ends up being validated somehow. Now through this work, through this, you know, learning how to be in your body, what has that done for you? So what has that done for your life or for your career that you can share?

Jazz Biancci:                  18:34                It allows me to stand in my power and I'm still in awe of it because it's like there's this super power with that we never learned about. No one tells us about that we can fall into by accident. And it's always there. I've always had this ability to be keyed in. And then, you know, you hit puberty and you're a teenager and you're rebellious and you fall away from yourself because you're trying to fit in and then you fall back into yourself somewhere along the line if you're lucky. And so for me, it's really being able to stand in my body, in my strength and know what is right for me. Because when situations happen, the tendency is to go outside of ourselves and have, a caucus about, well, this happened. What should I do? What should I do?

Karen Litzy:                   19:36                You always reach out to our friends or family and say, okay, what do I do now? What do I do? I want to do this, but I don't know if I should do this. So what do you think? What do you think? What do you think? And you know, it's like too many cooks in the kitchen.

Jazz Biancci:                                          It's too many cooks in the kitchen and it pollutes the truth for us. And so being able to be in our power is about being in authenticity and integrity and in truth so that you don't go to outside counsel because the reality is no matter how many angles I give you of a story, they're not going to give you the full picture. You aren't there and you don't know what I feel inside my body. You don't know the energy of the situation and I'm not going to have that much time to go into depth with you.

Jazz Biancci:                  20:22                So it's being able to hold your own counsel and, and stand in that council because everyone's going to have an opinion about that. So whether it's the choice you make in your career or it's a love relationship, there are going to be outside influences that want to put seeds in your ear. But the reality is only you know the truth. Only you have to deal with the consequences of your actions and only you can know what's right for you. And so being in my body and being in my heart and learning to trust this incredible mechanism has allowed me to do that. And it's changed my life cause I'm not wavering or trying to please anyone because even though we don't think we're trying to please anyone. Well we ask for advice. You know there's like, I remember this was really big for me back in 2005 when like sex in the city and and this whole dating thing and no, there was like the whole Mr. Big and it's a cultural thing, right?

Jazz Biancci:                  21:37                So we can think that we're supposed to behave a certain way and believe that that behavior is right and us, it's who we are. I'm a New Yorker. This is what I do when the reality is if you take a moment and you drop into your body, well maybe that isn't how you feel and that doesn't feed what you ultimately want and you're doing a disservice. Are you strong enough to make another decision and then strong enough to stand in it?

Karen Litzy:                                           Yeah. Doing a disservice to yourself.  And that's hard. It is. That's hard to, to make a decision and stand in it and be confident in that decision and confident with your own self and your ideals that this is what is correct. This is what is good for me when, yeah, you have the peanut gallery and either ear telling you otherwise or maybe agreeing or not agreeing or what have you.

Karen Litzy:                   22:36                But that's hard and I feel like I just want to acknowledge how difficult that is.

Jazz Biancci:                                          It is hard, but you know, it gets easier because you share less things with less people, you know? Because I don't really need to ask someone what I should do in my relationship. I know what I need to do in my relationship. I may need to vent, I may need a hug, I may need to pass an idea over with one of my friends. But it allows me to preface to preface the conversation and say, Hey, I would've had something by you and I want to know what you think about this specific point right here. Or I need to vent. So I really don't need any feedback right now. Are you okay with that? It lets us frame how we need people to show up for us because I don't necessarily want everyone's opinion.

Karen Litzy:                   23:41                Yeah, but you want and an ear to listen sometimes

Jazz Biancci:                                          If I know that I have the deli across the street and I want coffee and all I have to do is go across the street and get the coffee and come back, that's much easier. Okay. Then asking the doorman, the person in the elevator, the fire guide, the fire department guy standing outside, I'm the person holding the door for me when I go into the Deli and the Deli person, what kind of coffee I should get. You know this the same way when we have problems, we bounce like a pinball in a pinball machine back and forth. We know what we want to do. We're just trying to get comfortable with it. But if we are in our bodies and in our hearts and we, we feel the resonance because when something doesn't vibrate properly, like when alive vibrates in your body and you have been doing this practice for a while, it feels violent.

Karen Litzy:                   24:51                That's interesting. I'm kind of thinking on your, I love that example of why do I need to ask every person I come in contact with from my apartment to the Deli across the street, what kind of coffee I need to get. And when you say that, anybody would be like, well that's ridiculous. And yet that's what we do with big decisions in our lives, our relationships in our lives is we ask everyone.

Jazz Biancci:                                          We give our authority away when really we know the answers. It's just working that confidence and that trust in ourselves and the best way to work that confidence and that trust is to sit with what's going on and see what resonates, what choices feel right.

Karen Litzy:                   25:43                So it's really taking time out of your day. Not a lot, but working through those steps that we mentioned earlier. And the more you practice it, like we said, the better and perhaps more efficient you will get at tuning into your body and knowing what that feeling is like, because I would assume if you're new to this, that you're not even maybe sure what you should be feeling. Like how do you know what you should be feeling?

Jazz Biancci:                                          You don't because everybody is different. But if you had a friend who lied to you all the time, you couldn't count on them for anything. That's how it feels from the outside. And you would probably not be friends with that person. Once we start to notice how often we lie to ourselves, we realize that we’re that friend, except we can't get away from ourselves.

Karen Litzy:                   26:51                And so you need to be making some changes.

Jazz Biancci:                                          Because you need to trust yourself above all others. The relationship that you have with yourself is the map you take out into the world. And so part of this practice is seeing how it feels. And at first you may feel nothing. At first it's kind of amusing. Uh, it may make you like a little sad like, wow, why did I just do that? I didn't even have to lie in that scenario and I just did it completely unconscious, you know? So it, it helps you in that consciousness as well. So you can start making informed decisions and start listening because sometimes our mouth is on automatic and it's saying things that are completely detached from our truth. It's the talking of Shit.

Karen Litzy:                                           And only until you can kind of be in your body, can you really get a sense that's what you're doing?

Jazz Biancci:                  27:54                Yeah. That sometimes we talk ourselves out of the things we want. We pretend that we want something that we don't want.

Karen Litzy:                                           Yes, absolutely. Absolutely. That happened to me last year. I kept thinking I should do this. Someone told me to do this, I should like it, I should like it. And in the end I was like, this is not for me. And I just changed the entire thing for me like a year to figure that out here to kind of realize, wait a second. Oh, okay. No, I have a little more confidence and I know how I want this to go now I get it.

Jazz Biancci:                                          Yeah. Because you know it's okay to take your time. There's no rush. We think there's a rush, there's no rush ticket where we're going. We have to figure out how we want to do things.

Karen Litzy:                                           Absolutely. And I think that is a great, great piece of advice. And you know, I have one more question to ask is what I ask everyone. But before I do that, is there anything that we missed or anything that you really want the listeners to take away from everything we spoke about?

Jazz Biancci:                  29:10                I would say engaging with curiosity and practicing tenderness with yourself is epic because we're not tinder, especially if you're in New York. It's very, very rare that you get a tenderness, but it starts to allow you to discover more things about yourself because you start integrating and making space for the child within you. And it's really quite magical. I mean, your life can really change with a little bit of tenderness and it starts with you telling yourself the truth and how you do it.

Karen Litzy:                                           Yeah. That's such great advice and something that over this past year I have definitely started to do more of. We were speaking before we went on the air about how we are always like so harsh to ourselves and it got me thinking like I feel like we are the biggest assholes to ourselves. You know what I mean?

Karen Litzy:                   30:30                Like sometimes like you would never be friends with yourself the way you speak to yourself.  We put up with it, but now I can see through the tips that you've given today, how we can change that. That's a big shift for people and I hope that they use some of these techniques and steps to kind of stop being such an asshole to yourself and instead be the friend that you always needed. We should be able to be all of that to ourselves, like you said. So you can kind of stand in your power and know what you need and know what you want in your life. And I realized that doesn't happen in like a week, but it takes as long as it takes. Right?

Jazz Biancci:                                          Well, I mean it's a commitment, right? It's just like any commitment the gym, your career, they're all commitments and they're all a process.

Karen Litzy:                                           100%. And now before we go, I have one more question for you and that is knowing where you are in your life and in your career, what advice would you give to your younger self?

Jazz Biancci:                  31:51                I used to be, so I still am very sensitive, but I would break my own heart. So I would say I would tell my younger self to be less cruel and more kind.

Karen Litzy:                                           And that's great advice. And I think anyone listening to this can take that advice as well. Now Jazz, what do you have coming up in 2019 and where can people find you?

Jazz Biancci:                                          Oh, I'm so excited for 2019. So if you want to hear me speak live, there is speakers who dare, which is March 26 at the triad theater in New York City. It's going to be amazing. Um, they can find me and I'm working with an editor now, so I expect that my book will be out mid-summer, hopefully sooner. Yeah, I'm so excited. I'm so excited. It's been like a lifetime of making this happen. You can always check my website.

Jazz Biancci:                  33:11                I do a conscious masculinity panel the first Wednesday of every month and the panel is amazing. I am so blessed to have such brilliant men participating. So that's on a facebook live and you can find me on facebook at Jazz Biancci, conscious consciousness architect.

Karen Litzy:                                           Jazz. Thank you so much for coming on and sharing all of this good stuff with us.  And everyone, thanks so much for listening. Have a great couple of days and stay healthy, wealthy, and smart.



Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Feb 4, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Mohammad Rimawi on the show to discuss foot and ankle health.  Mohammad Z. Rimawi, DPM, AACFAS, brings a wealth of knowledge and expertise to Grand Central Foot Care in Midtown East, Murray Hill, and the surrounding New York City area. As a board-qualified foot, rearfoot, and reconstructive ankle surgeon with specializations in traumatic foot and ankle injuries and complex deformities, he is able to offer his patients top-tier care no matter what problem they bring him.

In this episode, we discuss:

-The anatomy of the foot and ankle

-The most common foot and ankle injuries

-The differences between a high ankle sprain and low ankle sprain

-The importance of the diabetic foot check

-When surgery may be an appropriate intervention

-And so much more!


“If your body says something is wrong, chances are it is.”


“Proprioception is very key for me in the rehab process.”


“Preventive medicine is the best medicine.”


“Establishing ties with other professions is important.”


“The feet can be a window into your overall health.”


For more information on Dr. Rimawi:

Mohammad Z. Rimawi, DPM, AACFAS, brings a wealth of knowledge and expertise to Grand Central Foot Care in Midtown East, Murray Hill, and the surrounding New York City area. As a board-qualified foot, rearfoot, and reconstructive ankle surgeon with specializations in traumatic foot and ankle injuries and complex deformities, he is able to offer his patients top-tier care no matter what problem they bring him.

Dr. Rimawi earned his doctorate from the New York College of Podiatric Medicine, where he made his mark. Not only did he graduate above the 90th percentile of his class and serve as class president for four years, but he was also recognized with the Student Service Award. That award goes to the student voted by the graduating class as making the biggest impact on the field of podiatry. Beyond his peers’ recognition, Dr. Rimawi was inducted into the Pi Delta Honor Society for his achievements in his research and his studies.

With those accolades to his name, Dr. Rimawi continued on to a three-year reconstructive foot and ankle surgery residency at DeKalb Medical Center and Jefferson Health. His colleagues and the hospital staff at the latter named him the Podiatric Resident of the Year.                             

It’s no surprise, then, that Dr. Rimawi is still impressing in his field. He’s a published author and accomplished lecturer, as well as an associate of the American College of Foot and Ankle Surgeons.                                                                                       In the spare time Dr. Rimawi manages to carve out, he loves to read, hike, and root for his favorite sports teams.


Resources discussed on this show:

Grand Central Foot Care Website

Mohammad Rimawi Instagram

Address: Grand Central Footcare

122 E 42nd Street, Rm #2901

Midtown East and Murray Hill

New York, NY 10168

Phone: 212-697-3293


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Have a great week and stay Healthy Wealthy and Smart! 


Xo Karen



Jan 28, 2019

Ashley Micciche is the CEO of True North Retirement Advisors, an independent financial advisory firm managing $230 million in client assets, and located just outside of Portland, Oregon. Ashley specializes in helping small business owners exit their business & retire with financial security by crafting and implementing a custom-designed exit plan.

Whether you’re looking to retire in the next few years or you’re on draft one of your business plan, you should plan for the end in mind. Ashley is going to walk us through the 3 universal, must-do steps to help you get what your business is worth so you can retire with confidence and financial security!


Press play and get ready to take some notes!


More about Ashley:

Ashley Micciche is the CEO of True North Retirement Advisors, an independent financial advisory firm managing $230 million in client assets, and located just outside of Portland, Oregon. It’s a family business, that she owns with her father. 

Ashley specializes in helping small business owners exit their business & retire with financial security by crafting and implementing a custom-designed exit plan.

She started her career as a financial advisor in 2007 after graduating magna cum laude with a Bachelor of Science degree in Business Finance from Portland State University.

Early in her career, Ashley developed expertise in 401k consulting for small businesses, and she quickly realized that business owners nearing retirement were not taking the steps necessary to exit their business. She watched several of her business owner clients walk away from their business at retirement without the financial security they needed.

Today, she is on a mission to transition 300 small business owners successfully into retirement in the next 10 years.

Ashley started her first business at the age of 8 years old, taking care of her neighbor’s pets & plants, and picking up their mail when they went on vacation – for $3 a day. She ran that business (a complete monopoly with 100% profit margin!) for 3 years.



Karen Litzy:                   00:00                Hey Ashley, welcome to the podcast. I'm happy to have you on.

Ashley Micciche:           00:04                Thank you so much for having me, Karen.

Karen Litzy:                   00:06                Sure. Now before we get to the meat of our interview, I would love for you to fill in the blanks a little bit from your bio that we read to introduce you so that the listeners get a little bit better sense of where you're coming from.

Ashley Micciche:           00:21                I know one of the things that was mentioned in there was I started my first business when I was eight years old. I didn't know it at the time, but you know, I was very entrepreneurial growing up and I started this business where I would pick up your paper and your mail and water your plants and feed your dogs and cats if you went on vacation. I found out really early on that if I worked really hard and I posted flyers and put flyers on mailboxes, put stuff in the newsletter and our neighborhood advertisement that I would get business from that. If I didn't work hard, if I didn't post flyers or do any of that, I got nothing. So I learned these really awesome lessons about hustle and working hard and making $3 a day doing all this work early on. And so that was a really neat experience because it taught me a lot that I have carried with me over the years and now starting my own real business.

Karen Litzy:                   01:32                And those are lessons that you know you can take with you for your whole life. And now you are at True North Retirement Advisors as the CEO and retirement plan specialist. So today you're going to share with us three universal must do steps to help you get what your business is worth so you can retire eventually which is something we all want to do. Well, maybe not everyone, but most people want to retire and we want to be able to retire with confidence that we can live a lifestyle that we want to live. So let's go through these three universal must do steps.

Ashley Micciche:           02:13                So what we do is exit planning for business owners. And I think what's really unique about that is that we don't have any skin in the game. Like it doesn't matter to us who you sell your business to or you could sell it to a family member, another employee, you could sell it to an outside third party. We don't have any skin in the game in that regard. So what we do is we really just work with our clients to identify those goals and what's important to them and what the value of their business is so that they can achieve what they're looking to do when they exit their business.

Karen Litzy:                   02:50                Oh, I was going to say, because I'm assuming everyone's got a different goal to exit their business. Right? And so it has to be personalized and individualized.

Ashley Micciche:           03:00                Yes. And so we have a step by step process for this. But what I found is that the process really diverges after the first three steps based on who you end up selling your business to, what that timeline looks like. But there are three universal steps to exiting your business. And so the first universal step is valuing your business, understanding what your business is actually worth. And it's kind of like if you know, you want to retire, Exit Your Business, sell your business in five or six years or whatever that is, that's sort of like the destination on your GPS. And if you don't put a starting point in, if you don't put in where you are today, what the value of your business is today, it's almost, your GPS can not tell you how to get where you want to go. So you really have to take inventory of what your business is worth today.

Ashley Micciche:           04:00                And I find that a lot of people don't do this vital first step because they have a lot of misconceptions about what's involved in value in a business. So they think that it's going to cost them thousands of dollars. It's going to take weeks or months. Someone's going to come in to disrupt their business because they need to ask questions and you know, dig into the books and records and all of a sudden, so they're like, no, I don't want to do that. Like I'll just use a rule of thumb or hey, I know this other practice across town that's close in size to mine and they sold their business for this much. So I'm just gonna, you know, I'll go with that. But you know, if you don't start with an accurate valuation, it's nearly impossible to take the other steps necessary to exit your business.

Karen Litzy:                   04:52                Okay. So I will admit, I have no idea how to do that. Yeah. So what would you say to someone like me and I am a business owner? How do I even start valuing the business?

Ashley Micciche:           06:07                Yeah, so that's a really good question. And you're not alone, Karen. There was actually a study done about three years ago by the business exit institute. They do a lot of research in this area and they found that 98% of business owners have absolutely no clue what their business is worth and how to go about doing that. So, the neat thing about valuing your business is that more technology tools exist today. So there's a software tool that we use to value a business and anyone can access this. It's free, but really with a pie with eight pieces of information, like your revenue, what you pay yourself, what your compensation is, your debt and certain other things like if you rent or own the space where your business is occupied, but there are a critical pieces of information to value your business.

                                                            And if you get those, if you can get those eight pieces of critical information and enter it into the valuation tool, then it will spit out an evaluation for you. It'll tell you, you know, Karen's practice is worth $689,000 or whatever it is based on those parameters that you put in. And it doesn't take long. It takes like five minutes to do it. Once you've gathered the data, the toughest part is gathering the data. When you use this software tool, there's 50 pieces of information you can put in. But what we did is we went back to the software developer and we said, okay, tell me the bare minimum pieces of information that I could put into the software tool for it to spit out the valuation for my business. And so we use that, what their advice was to us.

Ashley Micciche:           07:03                Plus some of the other things that we know from what we know moves the needle on valuation. And we came up with this checklist like, Hey, if you can get these eight pieces of information, what your revenue is, your pretax income, if you owe other people money, if you have bank loans, if you rent or own the space that you're in, those are the things that have the largest impact on what your business is worth. And then once you enter that into the software tool, it'll spit out your evaluation. It's fantastic. And I'm so excited about it because what I found, this is not our core business, like this is it. So we actually make this tool available to anyone who wants to use it for free. Because what we want them to do is get unstuck, get out of the head mind space of using a rule of thumb or a really inaccurate estimate.

Ashley Micciche:           08:01                Because once you know what your business is worth, it unleashes the rest of this process. And when you see that number tangible, you know, Karen's business is worth this amount, then you can start to make some important decisions about, okay, so is this going to be enough that, you know, if I want to exit and a year or two years, you know, what do I need to do if this isn't what I hoped it would be? So it really influences a lot of the other decisions we make in the process. Valuing your business and knowing how to value your business is step one. So what is step two? Step two would be establishing what your timeline is and your goals. So you know, a lot of people have this idea in their head, I want to retire and exit my business in 10 years or five years.

Ashley Micciche:           09:00                Or maybe it's like January 25th you know, 2021 like they've got it dialed in down to the day. And so that would be the first thing. And not just when you want to leave, but figuring out, okay, how were you involved in your business today? And then how do you see that involvement evolving over time? Because the reality is for most people who are not business owners or entrepreneurs, they have a very specific set retirement date and they go from working full time to retirement date and then fully retired. But for a lot of business owners there, they sort of have this phased out exit. And so it's important to kind of think about how to do that, which is great for a business owner because if you have somebody else who's taking over ownership at or who's doing a lot of the day to day management or seeing patients or whatever that may be, you can pull back over time a little bit and have this phased out retirement so that you can test the waters and make sure that whoever that person or those people are are fully equipped to be able to run things in your absence.

Karen Litzy:                   10:16                Yeah, that makes perfect sense to me. And also I would think it's really hard for some business owners. Have you found that with the clients that you work with that that's not easy?

Ashley Micciche:           10:28                Yeah. I mean, cause your business, it's like your baby, you know, blood, sweat, tears. You've made so many sacrifices, a lot of it too.  It is very much a part of your identity and who you are. And that's okay. You know, I totally get that. I think that the important thing about this establishing your timeline and goals is what feels right to you and what do you want. It's not up to me to tell you what you should do. It's up to you to figure that out.

Karen Litzy:                   11:00                Not Easy, not easy. But this is good. As you're saying all of this, I'm kind of thinking in my head like, okay, I should probably be thinking about this stuff cause it's not even something that's on my radar right now. But I guess it's never too soon.

Ashley Micciche:           11:14                No. And actually the best exit plan starts when you start your business, but most people are so heads down focusing in growth mode that rarely if ever happens because it really does require this mindset shift. But you have to start it before you're burnt out. So I've seen a lot of business owners who, because they didn't plan, they didn't start this process, you know, five, 10 years out, which is really an ideal timeframe to be doing this. They wait until they're sick and tired of working and they're ready to retire. And so they don't have the time to be able to craft that ideal accent or maybe they sell their business to somebody who in a fire sale where they just want out and they don't care what they get for their business, but if they would have planned more, they could have got, you know, what they wanted in a lot of cases.

Ashley Micciche:           12:18                I didn't work with this person on their exit, but I know somebody who just retired this past summer and he was a third generation owner of his family business that his grandfather started. It was a good business, a good cashflow, it was a solid business. But he didn't do any planning and didn't identify a successor and he just got way too burnt out and literally just walked away and shut the doors and left with nothing. And that, to me it was really sad just because it was, you know, third generation. And he was fortunate because he didn't need to sell his business in order to retire. You know, it wasn't a must do, but for most people, you know, your business is your largest asset. And so it's so important we plan for all these other things, like when we're going to take social security and investing in all these things, but a lot of times the business and the value of the business gets neglected.

Karen Litzy:                   13:29                Yeah. There's no question. I am in a lot of different entrepreneurial groups and this is a topic that never comes up.

Ashley Micciche:           13:39                Oh really? That's surprising.

Karen Litzy:                   13:40                Yeah. It's a topic that never comes up and it really should because now that as you're speaking more and more on this, it's got me thinking about my sort of long-term plan and where do I see myself and what should my goals be. So this will be something for 2019 for me to really sit down and give it the time and space that it needs. So I think it's great. Okay. So, number one, valuing your business. Number two, establishing a timeline and goals that I'm assuming are realistic. We don't want to say, well it's January, so I want to retire in three months and now this is it.

Ashley Micciche:           14:25                And actually before we move on, can I give you a couple of other questions that I think your listeners may not say. So obviously it's important to consider the WHO. So who is best suited to take over the ownership of your business after exit. Now a lot of times, especially in family businesses, there are family considerations and we'll just kind of a trick question cause there was always family issues, like maybe somebody is involved in your business, like one child out of your three children is involved. And you know, most parents want to do what's fair for their kids and so it can create a lot of strife in the family, when there's family involved. So we want to be really careful about that. And I think a lot of business owners make some not so good decisions because of that family element.

Ashley Micciche:           15:20                Like I'm sure we've all seen it where you have a second generation who doesn't have the same mindset, doesn't have that same fire and isn't very well equipped to, maybe they were a good employee, but they're not very well equipped to run the business. So that's really important as well. And then the other thing that I think really drives who you want to look at to be your successor is whether or not how important it is for the business to stay in the community. So a lot of business owners are really heavily involved in their community and no matter what an outside buyer tells you, that dynamic is going to change. So it's really important, especially if you're looking to sell to maybe like a competitor or someone like that outside of your immediate community. It's definitely going to change, you know, that experience from your client or your patient's point of view.

Karen Litzy:                   16:21                Oh yeah, definitely. Especially in health care because if you're in any sort of healthcare business, you are deeply entrenched into that community and they depend on you. Yeah, that's a great consideration to think about during this timeline and goal step. Anything else that we really need to think about in this second step?

Ashley Micciche:           16:48                You know, a couple of other things have to do with the financial element. There was this other study that was done that looked at most business owners want to retire in the next 10 years. And that same study that I mentioned before from the business owner acts or business exit institute said that they found that 75% of business owners would exit today if their financial security was assured. So most entrepreneurs, business owners who aren't looking to exit, aren't doing so because they feel like financial aid, they're not ready yet. So that really plays into the next step that's universal in that process, which is to determine if you have a gap financially. So you know what your business is worth, you know, what your other financial resources are. And when you look at all of those things, is that going to be enough to, do you have enough to retire?

Ashley Micciche:           17:51                Is that going to be enough to provide the income needs that you have and your family has in retirement or not? That's really the third step. And so what we do in this step is we look at what are your assets? We know what the business is worth, but we also have to consider the after tax business value. Cause that's a big surprise, right? Then you have what you get to keep after Uncle Sam does. So you know, we have to plan for that. And then you might have other assets like your investment portfolio or rental properties and all of these things are, or social security, you know, all these things are providing income for you in retirement. And so you have to replace whatever income you were getting when you were working in the business.

Ashley Micciche:           18:45                That’s usually the challenge is because most people, they do have a gap. The business or their personal financial resources are enough to provide the income that they want and desire in retirement. So, we have to start making some decisions about what levers we can pull. So sometimes you can pull levers to increase the value of the business. Depending on what the business looks like, sometimes there's not as much flexibility there. So it might be, you know, rethinking what your plan was for retirement. Like are you willing, you said you all work five more years, are you willing to work six, seven or eight more years if that's going to help fill the gap. So understanding if a gap exists or not, and discovering your gap, that's the third step because it really leads to how much are you either going to need to grow your business value or on the personal side, your personal assets and income in order to make sure that that gap is filled.

Ashley Micciche:           19:55                I would think that that third step is where you really have to start making some hard decisions depending on how you want to live your life when you retire. And actually one of the things that comes up a lot is if sometimes people get revenue from very limited sources, you might have, you know, five or 10 clients that provide 50, 60% of revenue or maybe you have a practice that especially on the medical side, maybe are more dependent on insurance reimbursement. And so one of the things that can increase value is if you can convert or incentivize more of those people to pay with cash. Know that can be something that's more attractive now to an outsider versus relying on insurance reimbursements found that true for dental practices. I would imagine it's true pretty much across the board for most medical or physical therapy type companies.

Karen Litzy:                   21:00                I would agree with that. And I think there is a big trend moving towards a cash based therapy practice. That's what I have. So I don't take insurance. I'm out of network. I'll help you get reimbursed. But my clients pay me cash for my physical therapy services. And I think there's definitely a big trend to that, especially now with rising costs of healthcare and large deductibles. Everybody's cash based at this point because some people have deductibles of $10,000, which needs to be paid before you can get reimbursed anyway. So everybody's paying out of pocket.

Ashley Micciche:           21:45                Yeah. Well good. Karen, you've already increased the value of your business by doing that.

Karen Litzy:                   21:50                All right. Yeah, go through this tool and look at my goals and all that other stuff and get at least a rough idea of the value of what my business is. I even think about retiring and I always said, you know, Oh, I've got like 30 more years before I retire, but I feel like I said that like 10 years ago and I'm 10 years older. You know what I mean? So this is a good reality check for me and hopefully for the listeners as well to really start thinking about your business and how you want to, like you said, how you want to exit and how you then want to move on into retirement years at whatever time frame that is for you. Do you have examples of clients, you don't have to obviously say their names, but clients that you worked with that did a really good job at all of this and how that ended up improving their retirement?

Ashley Micciche:           22:50                So one of the clients that comes to mind is somebody who's actually still in the process of exiting, but I think the key for this client was that they really started early on. So this is actually another medical practice and they have two other partners and both of whom are younger, but one of them is in their early forties, and then the other one's in their 50s and then the one who's retiring is in his sixties. So the trick is, the younger people have to be able to afford to buy out this older owner, but they have a great relationship. They've talked and communicated with each other along the way to minimize any misunderstandings or potential lawsuits or breakup of their partnership, so they've done a really good job of planning that and having those discussions.

Ashley Micciche:           23:46                He’s a planner by nature, so he's done a really good job in making sure that, this is what the practice is worth, this is what I need when I exit. And he's most likely going to get that just because he's done all this planning and all the partners are on the same page and they're structuring his buyout in a way that they can afford and they're not going to rely on bringing in somebody new or doing that before he exits. So just the planning element and the communication is really helping them out. We’ve had other clients in that same boat who did successfully exit. And it all started with just understanding what was required to exit the business. What do I need to do? What are the levers I can pull to increase either the value of my business or the value of my personal assets. So I'm not relying so much on the business now. Some people, their business is so huge as far as their net worth, the percentage of their net worth that they have no other choice than to really focus and hone in on that to maintain the same lifestyle that they had or provide a legacy or you know, satisfy some of those other exit goals.

Karen Litzy:                   25:15                Yeah. And it sounds like aside from these three universal steps to exit, that communication with other stake holders within your business and your family and business partners is paramount to having a smooth exit. So there's no surprises.

Ashley Micciche:           25:33                Yes. And actually that is something that we tried to do. So if we're working with a client x in the business before we ever draft the exit plan, it's kind of like the strategic plan, but it's for your exit. So before that's ever drafted, we bring everyone together the team. So family is involved, especially the spouse and if your children is in the business, we want to involve them early on in the discussion so we make sure everyone's on the same page. And then also all the others like CPA, attorney. There's a lot of people who have a role in making this process as successful as possible. And so part of our job is to facilitate all that and to help move the process along by getting the attorney or the CPA involved at the right stage of the game.

Karen Litzy:                   26:31                Yeah, absolutely. If you're not an entrepreneur or you're not a business owner, you don't realize how many people are on your team, how many people are working behind the scenes to make your business successful. And so it's obviously important to involve all of them in your exit plan cause everybody's going to be affected in one way or another. Now is there anything that we missed going through these three universal steps?

Ashley Micciche:           27:00                No, I don't think so. It's about sally in your business. First and foremost, figuring out where you're at and then get most important goals and what that timeline looks like and then figuring out if there's a gap or not and then what to do about it if there is.

Karen Litzy:                   27:15                Well, this was great and I have to tell you, I am really going to start looking at this more seriously now after having this conversation. Hopefully the listeners will as well who are entrepreneurs or even for people thinking about being an entrepreneur. So maybe you haven't started your business yet. Like you said, the ideal time to do this is when you start. So they'll have like a leg up on all of us entrepreneurs who have not done this yet. I'm a little jealous of those new bees. Now before we end, I always ask everyone the same question. And that's knowing where you are now in your life and in your career, what advice would you give to yourself as a new Grad out of college?

Ashley Micciche:           28:00                Gosh, that is such a good question. It's funny cause when I graduated college I pretty much, I didn't have a lot of fun in my twenties. Honestly I didn't, I didn't travel. I started in what I'm doing today straight out of college and that was 11 years ago now. So, I think if you would've asked me that question a few years ago, cause I always regretted not having a bit more fun in my twenties and now that I'm in my thirties, I actually am glad that I did. I did what I did and I didn't travel more and I just really focused on my career because I think I'll have a few more options down the road. But honestly, to answer your question, the thing career wise that I wish I would've done when I first started as a fund generalist financial advisor, one of the things that I was told by a lot of mentors who had been advisors for 20, 30 years was that the best way to grow your business when you're new is to cold call.

Ashley Micciche:           29:08                And so I did that and I cold called for two years, I made over 25,000 calls and I wouldn't say it was a total waste, but when these people who are giving me this advice very well meaning advice, they were genuinely trying to help me. They built their business cold calling in the eighties and nineties before the do not call lists before, people hated you if you were calling them cold. And so it's a different world today. So I think I learned career wise is that I wish I would have been a little bit more creative and trying other things in order to grow my business early on because I feel like now if I would have done that, I would've obviously done some other things and not relied so much on a strategy that for me it just didn't work very well.

Karen Litzy:                   30:07                Yeah, I think that's why the advice to give to yourself and we've all been there definitely doing things that looking back on it, you're like, what was I thinking?

Ashley Micciche:           30:17                Yeah.

Karen Litzy:                   30:19                Where can people find you? Where can they find true north? Let us know where we can connect with you online.

Ashley Micciche:           30:28                Sure. So the website is for the free unlimited lifetime access to the valuation tool where you can enter that information, go to If you go there, you'll get access to the checklists. So it's a pdf checklist that explains to you here are the eight pieces of information to gather, where to find it quickly and easily. And then from there you'll get access to the valuation tool. And the beauty of this is you could go in and do the valuation for free and then you can update it in six months or a year or you know, if your business changes and see how some of those adjustments have changed or valuation. So it's cool. It's not a one and done and it's totally free because we really want people to just, we found that if they can figure out what their business is worth and that's the key to unlocking the rest of the steps that are so necessary to exiting.

Karen Litzy:                   31:41                I'm going straight to that url and I'm going to get this valuation tool because I think it's awesome. So thank you so much for sharing that. That's such a generous share. And how about social media? Where can we find you?

Ashley Micciche:           32:10                Yeah, so our YouTube channel where we go a little bit more in depth on some of these exit planning, retirement planning topics. We have our biggest presence on LinkedIn.

Karen Litzy:                   32:29                Yes. And just before we went on the air, I said, is this how you pronounce your name? And I got it right, but only because I watched your YouTube videos. I knew how you pronounced it, but don't worry, everyone will have a direct link to the youtube and to linkedin and to of course the free gift that Ashley has so generously shared with all of us. So Ashley, thank you so much. This was eye opening.

Ashley Micciche:                                   Thank you so much, Karen. This was a lot of fun. And I'm so happy to share this with your listeners. Awesome.

Karen Litzy:                                           And to all of you listeners, get that free gift and we will be back with you in a couple of days. Have a great few days and stay healthy, wealthy, and smart.



Thank you for listening to this episode with Ashley Micciche!


  • Share your thoughts with the Healthy, Wealthy and Smart family in the comment section below!
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  • Show your support for the show by leaving an honest rating and review on iTunes!


Have a fantastic day and stay Healthy, Wealthy and Smart! 


Xo Karen


Jan 21, 2019

On this episode of the Healthy Wealthy and Smart Podcast, Dr. Evangelos Pappas joins the show to discuss the editorial in the Sports Medicine Journal, Time for a Different Approach to Anterior Cruciate Ligament Injuries: Educate and Create Realistic Expectations.  Dr. Evangelos Pappas’ research interests are in the areas of sports medicine, biomechanics and musculoskeletal physiotherapy. Specifically, his interests are in the areas of etiology of lower extremity sports injuries, effectiveness of injury prevention programs, motor control re-training for the prevention and treatment of knee pathologies, epidemiology of ACL injuries, rehabilitation of lower extremity injuries, and dance medicine

In this episode, we discuss:

-How patients interpret the practitioner’s language and use of medical terminology surrounding ACL injury

-Strategies to communicate the medical management of ACL injury to set realistic patient expectations

-The limitations of the research in determining who will benefit from surgical versus conservative treatment for ACL injury

-Physical therapy utilization and patient outcomes

-And so much more!


“We have identified a big discrepancy between the expectations of the patient and the research and the outcomes that we know are produced after conservative or surgical treatment.”


“It is very frequently a life defining moment.”


“We do fail to communicate accurate information to our patients.”


“It is really risky to advocate to all patients conservative treatment including those who want to return to high level pivoting sports.”


“We don’t have good data to know who’s going to do well with conservative management at this point.”


For more information on Dr. Pappas:

Professor Evangelos Pappas trained as a physiotherapist in Thessaloniki, Greece before pursuing a Masters in Orthopaedic Physical Therapy at Quinnipiac University and a PhD in Orthopaedic Biomechanics at New York University in the USA. Prior to coming to the University of Sydney, He taught for 11 years at Long Island University-Brooklyn Campus in kinesiology, clinical decision making and musculoskeletal pathology and physiotherapy. His excellence in teaching was recognized by his nomination for the Newton award for excellence in teaching. A/Professor Pappas joined the University of Sydney as a Senior Lecturer in 2013 where he continues to lecture in the areas of musculoskeletal physiotherapy, and particularly as it relates to the upper and lower extremities.

Professor Pappas is also active in musculoskeletal research. His research has been funded by the National Institutes of Health and intramural grants. He has presented his work in more than 50 national and international conferences and he has been interviewed on the radio as an expert on knee injuries. His publications appear in top journals in the fields of physiotherapy, sports medicine and biomechanics. One of his publications received the T. David Sisk award for best review paper from Sports Health; a leading multidisciplinary journal in sports medicine. In addition, Professor Pappas has served on the research subcommittee of the awards committee of the American Physical Therapy Association.

Resources discussed on this show:

Zadro, J.R. & Pappas, E. (2018). Time for a Different Approach to Anterior Cruciate Ligament Injuries: Educate and Create Realistic Expectations. Sports Med. doi: 10.1007/s40279-018-0995-0.

Episode 227: Dr. Evangelos Pappas: ACL Rehab & Research 101

Episode 048: Physical Therapist Dr. Evangelos Pappas

Evangelos Pappas Twitter

Evangelos Pappas Facebook



Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Have a great week and stay Healthy Wealthy and Smart! 


Xo Karen



Jan 18, 2019

F. Scott Feil chats with Mike Connors, Mark Milligan, & Dana Tew regarding the upcoming opportunity for the state of Texas to have Direct Access passed along with how PTs in Texas can get involved and contribute to making this a reality.

Texas Physical Therapy Association Website: 

TPTA Capital Area District Facebook Page: 

APTA Direct Access Page on Website: 

APTA Action App on APTA Website: 

 Texas House Bill 29: 


1. Texas Department of State Health Services. (2018) Texas Projections of Supply and Demand for Primary Care Physicians and Psychiatrists, 2017 – 2030. Austin, TX: Texas Health and Human Services 

2. Timing of physical therapy consultation on 1-year healthcare utilization and costs in patients seeking care for neck pain: a retrospective cohort
ME Horn, JM Fritz BMC health services research 18 (1), 887 
3. Physical Therapy as the First Point of Care to Treat Low Back Pain: An Instrumental Variables Approach to Estimate Impact on Opioid Prescription, Health Care Utilization, and Costs. Frogner et al Health Serv. Res. 2018 
4. Denninger TR, et al. The influence of patient choice of first provider on costs and outcomes: analysis from a physical therapy patient registry. J Orthop Sports Phys Ther. 2018;48(2):63–71. 
5. Rhon, D. I., Snodgrass, S. J., Cleland, J. A., Sissel, C. D., & Cook, C. E. (2018). Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule. Perioperative medicine (London, England)7, 25. doi:10.1186/s13741-018-0105-8 
Michael Connors, PT, DPT, OCS, PhD received his Master of Physical Therapy degree from University of Medicine and Dentistry of NJ-Rutgers University in May 2003 with honors.  Dr. Connors obtained his post professional Doctor of Physical Therapy degree from Temple University in December 2008.  He became a board certified specialist in Orthopaedic Physical Therapy by the American Board of Physical Therapy Specialties in June 2011. He completed a PhD degree in Physical Therapy from Texas Woman's University in August 2017. Dr Connors is the current President of the Texas Physical Therapy Association. He also is an assistant professor within the UNT Health Science DPT Program.

Mark Milligan PT, DPT, Cert TPS, OCS, FAAOMPT

Mark Milligan is an orthopedic manual therapist that specializes in the evaluation and treatment of musculoskeletal and spinal conditions, both acute and chronic. He is Certified in Therapeutic Pain Science, Applied Prevention and Health Promotion and dry needling, Board Certified in Orthopedics and a Fellow of the American Academy of Orthopedic Manual Therapy.  He earned his Doctorate of Physical Therapy at the University of the Colorado School of Medicine in Denver, Colorado.  He went on to complete an Orthopedic Physical Therapy Residency and Orthopedic Manual Physical Therapy Fellowship with Evidence in Motion (EIM). He is a full-time clinician and Founder of Revolution Human Health, a non-profit physical therapy network and he also founded a continuing education company specializing in micro-education. He is currently a physical therapist with Encompass Home Health in Austin, Texas. Dr. Milligan serves as adjunct faculty for the Doctor of Physical Therapy Programs at South College and The University of St. Augustine.  Dr. Milligan is also primary faculty for Musculoskeletal Courses for EIM. Mark has presented and spoken at numerous state and national conferences and has been published in peer reviewed journals. He is an active member of the TPTA, APTA, and AAOMPT and is current the Capital Area District Chair for the Texas Physical Therapy Association and has great interest in public health and governmental affairs.  

Revolution Human Health is a non-profit physical therapy network in Austin, TX that transforms the healing experience by offering access to treatment, education, and movement based therapy for all. 

Continuing education division specializes in customized, micro-education for physical therapists across the country. Customizable options of courses include manual therapy, spinal and extremity manipulation, dry needling, clinical reasoning, and preventative care and population health. Please contact us about customizing a course for you and your team!


CEO/ Program Director of OPTIM Physical Therapy and OPTIM Fellowship Program. Dana specializes in orthopaedic physical therapy. His experience includes clinical management of patients with both acute and chronic orthopedic injuries in the outpatient environment. His practice is focused on integration of manual therapy and exercise into a holistic, evidence-based and biopsychosocial approach to physical therapy treatment. He is the residency manager of Harris Health System’s Orthopedic Physical Therapy Residency Program. He was honored by the Texas Physical Therapy Association Southeastern District, as clinical instructor of the year in 2013. He is also a guest lecturer at Texas Woman’s University and has presented at multiple conferences. Dana earned his APTA Board Certification in Orthopedic Physical Therapy and is also a Fellow, in the American Academy of Orthopedic and Manual Physical Therapists. He has served locally for the Southeastern District, as a delegate for the TPTA, and nationally on the American Board of Physical Therapy Residency and Fellowship Education credentialing council for the APTA.
Jan 14, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jamey Schrier back on the show to discuss business fundamentals.   Jamey is sharing his practice freedom methodology to practice owners all across the country who are looking for financial prosperity and a better quality of life. His book, The Practice Freedom Method: The Practice Owner’s Guide To Work Less, Earn More, And Live Your Passion, has been an Amazon #1 best seller.

In this episode, we discuss:

-How to establish a clear vision and find the why behind your goals

-Why comparisons to others will keep you small

-The importance of sharing the narrative behind your practice with your team

-Planning and budgeting for the bottom line that aligns with your goals

-And so much more!


“Measuring your progress, measuring your success compared to where you are now and where you’re going—when you do that—you stay in line with who you are.”


“When you put a pen to paper, it’s powerful.”


“Alignment is everything in our business.”


“Not knowing the answer isn’t the problem, it’s asking the right question.  The answer is out there.”


For more information on Jamey:

In 2004, Jamey Schrier was facing the soul-crushing struggles of private practice ownership. He couldn’t figure out how to grow his business without sacrificing family, income or time.

Armed with an insatiable curiosity, Jamey invested the next 9 years and over $300,000, to learn how to free himself from his practice. At the end of his journey, Jamey finally discovered the formula to creating a self-managed, profitable and stable practice that allowed more time with his family and more time to work “on” his business.

Jamey is sharing his practice freedom methodology to practice owners all across the country who are looking for financial prosperity and a better quality of life. His book, The Practice Freedom Method: The Practice Owner’s Guide To Work Less, Earn More, And Live Your Passion, has been an Amazon #1 best seller.


Resources discussed on this show:

Jamey's FREE training on howto generate referrals

The Practice Freedom Method Website

Jamey Schrier Twitter

The 7 Habits of Highly Effective People: Powerful Lessons in Personal Change

Start with Why

The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing

Free online community for NetHealth



Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Have a great week and stay Healthy Wealthy and Smart! 


Xo Karen



Jan 10, 2019

On this episode of the Healthy Wealthy and Smart Podcast, I welcome Jeanette Bronée on the show to discuss mindfulness.  Jeanette helps leaders and companies rethink performance by asking the “Right Why®.” She teaches them how to create a culture of care by unlocking what truly drives performance, engagement and motivation from the inside out. For 15 years, she has coached clients and delivered speeches about how physical health and emotional-mental wellbeing affect performance and prevent stress and burnout. She shows how focusing on how our mindset affects our self-care habits at work and at home and believes, that when we leave our humanity at the door when we go to work, we leave behind our most valuable resource for success. She incorporates her background in integrative nutrition, mindfulness and hypnotherapy to help people work better by working healthy.

In this episode, we discuss:

-How to ask the right why to find a way forward

-Practical exercises to ground yourself in stressful situations

-The use of metaphors to describe experiences

-How mindfulness can facilitate change

-And so much more!


“If we can refocus our question, then our unconscious mind will help us find the answer.”


“We find solutions by acknowledging what’s not working and then moving into curiosity.”


“If we don’t pause for a moment, we can’t even listen.”


“We’re not running out of time, we’re running out of focus.”


“We don’t solve problems in a new way under stress, we just repeat what we’ve always done.”


“Our self-talk really creates our experience.”


For more information on Jeanette:

When Jeanette Bronée’s parents both died of cancer just one year apart, she was told it wasn’t a matter of if, but when she would get cancer, too. So she took charge of her health and wellbeing, sharing what she learned about the power of mindfulness by founding Path for Life in 2004. Since then, she has taught more than half a million people how to ask the “Right Why” to unlock the answers that prevent burnout, fuel peak performance and create a culture of care.

Now, she helps leaders and companies rethink performance and culture to create sustainable success by supporting our most important resource -- our human resource. She has delivered TEDx talks, as well as keynote speeches and workshops at corporate events and workshops around the world.

Her book, EAT TO FEEL FULL, a guide for eating to thrive, gained nationwide recognition in the news media as a new approach to health and eating that helps us break with our dieting mentality and focus on eating to fuel our performance. 

She holds a business, marketing and communications degree and is a certified Integrative Functional Nutrition and Meta-Medicine Health Coach. As a Hypno-Therapist, she uses the power of the mind to create change (but don’t worry she doesn’t do tricks). She is also a Certified Felt Sense Focusing Professional, which she has found to be the key to learning what drives our choices and how we can take charge of our wellbeing.


Resources discussed on this show:

Path for Life Website

Jeanette Bronée Website

Jeanette Bronée LinkedIn

Jeanette Bronée Twitter

Free Gift: Use code “Healthy” for 30% off the yearly online program Get Healthy Online


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Have a great week and stay Healthy Wealthy and Smart! 


Xo Karen



Jan 7, 2019

Happy New Year from the Healthy Wealthy and Smart Podcast family! On this episode, I welcome Shanté Cofield on the show to discuss how to set achievable goals for 2019.  Dr. C. Shanté Cofield, aka The Movement Maestro, is a former Division I athlete with a passion for movement surpassed only by her passion for learning. Shanté graduated from Georgetown University and then continued her educational pursuits at New York University, graduating with a Doctorate in Physical Therapy (DPT) and becoming a Certified Strength and Conditioning Specialist (CSCS). Shanté is a board certified Orthopedic Clinical Specialist (OCS) who practices in Los Angeles, California with specialties ranging from CrossFit injuries to pelvic floor dysfunction.  Shanté is the creator of The Movement Maestro, a website and social-media based platform devoted to all things human movement and mobility related.

In this episode, we discuss:

-The importance of understanding the why behind a goal before setting the goal

-Why boundaries are important to set before pursuing your goals

-How to bring human connection into social media

-Building a supportive community that will serve you

-And so much more!


“People don’t know how to set goals.”


“We tell our patients all the time you have to be patient, and yet we don’t apply that to ourselves.”


“What social media has become is another language –it’s another way to connect with people.”


“We don’t attract what we want, we attract what we are.”


“You have to be ok with the fact that not everyone is going to love you.”


“If you’re selling something—you’re marketing—you have to push it more than you want to.”


For more information on Shanté:

So, this is the place where it’s standard practice to give you a sterile glimpse into my professional life and hopefully convince you that I’m qualified enough for you to let me treat you. But, you should know, I’m anything but traditional. Before you keep on reading, I’d love it if you could take a few moments to watch the video from the home page (if you haven’t already) and learn a little bit about me. I know that four minutes is a lot to ask of someone in 2018, but, that video IS me.

I’m a firm believer that everything in life is about connection. As it relates to our bodies, we are a united whole, with all the parts working together and affecting each other, and as such, that is how I treat. As it relates to the universe, we are all connected in some way, be it blood, physical proximity, belief systems, or energy. And as it relates to choosing a provider, choosing to listen to a podcast, or choosing to attend a course, I believe that it is paramount that you are able to connect with that person. As such, I teamed up with a close friend to film something that I felt would give you a better understanding of who I am, what I’m about, and hopefully make you realize that I am an actual person, not just a picture on a screen, a voice in your headphones, or words on a piece of paper. 


Hometown: Summit, NJ

High School Sports Played: Soccer, basketball, lacrosse, ice-hockey (for real), javelin

College: Georgetown University (’07)

Sports Played: 4 years of Division I soccer, rugby (1 season)

Graduate School: New York University

Date Graduated: 2010

Degree Earned: Doctor of Physical Therapy

Additional Certifications:

OCS – Orthopedic Clinical Specialist

CSCS – Certified Strength and Conditioning Specialist

CF-L1 – CrossFit Level I Trainer

SFMA – Selective Functional Movement Assessment Provider

FMS – Functional Movement Screen Provider

FRCms – Functional Range Conditioning Mobility Specialist

NKT – NeuroKinetic Therapy (Level I) Provider

FMT B/P/B/A – RockTape Basic/Performance/Blades/Blades Advanced Certified (I am a RockTape Lead instructor, I had better be certified in all these things!)

Other Hobbies and Activities: CrossFit, ex-marathoner, indoor rock-climbing, professional meme viewer, guitar, sneakerhead, SoCal lover

So, if you’ve made it this far, I commend you. I’ve got my fingers crossed that if you didn’t know anything about me before, you’ve now got enough to formulate some kind of picture and make a decision about our future together. Be nice. If you want to rendezvous, contact me. If you want to hear me talk, subscribe to the podcast. And if you want to be like Aerosmith and never miss a thing, subscribe to my newsletter. Thanks for your time.



Resources discussed on this show:

The Movement Maestro Website

The Movement Maestro Instagram 


Maestro Courses

Rocktape Courses


Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter, instagram  and facebook to stay updated on all of the latest!  Show your support for the show by leaving a rating and review on iTunes!


Have a great week and stay Healthy Wealthy and Smart! 


Xo Karen