If the Foundation's Off, Everything Else Compensates

I recorded this one expecting a health conversation. I got that, plus a founder story I haven't stopped thinking about.

My guest is Dr. Ashley Katzenbach, a physical therapist who spent 15 years inside the traditional insurance-based PT model before she hit what she calls her "midlife crisis" at 40. 

Three patients an hour. Twenty minutes of real hands-on time if she was lucky. A system that told her what she was allowed to treat based on a code, not what she actually saw in front of her. One sentence from a patient changed everything, and she went home and filed her LLC that same day.

We also get into why she believes almost every unexplained ache in your body traces back to one part of your body and the three supplements she recommends to nearly every woman she treats... especially through perimenopause and menopause. 

In this episode:

• Why the insurance-based healthcare model (and plenty of business models) isn't broken because of the people in it, it's broken by design
• The "seesaw effect": how your feet quietly throw off everything else in your body
• What's true, and what's overhyped, about orthotics and going barefoot
• Collagen, creatine, and omega-3s: the three most evidence-based supplements for joint pain, and why the gummy doesn't count
• Why there's no such thing as balance, just seasons and tradeoffs
• How to advocate for yourself in any rushed appointment, medical or otherwise

Resources mentioned:

• 🎙️ Podcast episode on creatine — a deeper dive on creatine's benefits, referenced in this episode. 

Connect with Dr. Ashley Katzenbach:
Founder, Cape Concierge Physical Therapy
 Cape Concierge Physical Therapy | Sandwich, Plymouth MA

Listen, then go build your own foundation.
If anything in this episode has you thinking about the "sore foot" in your own business, that's usually a Foundation conversation. Learn more about the FLOW Framework

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Transcript

SPEAKER_01 0:00

Welcome to Fearless and Unfiltered. I'm your host, Alyssa Olerud, and today's conversation is one that I think every woman, especially a busy mom or high-achieving woman, needs to hear before their pain forces them to slow down. I'm sitting down with Ashley Katzenbach, Doctor of Physical Therapy and founder of Cape Concierge Physical Therapy, who's been helping people on Cape Cod move, heal, and reclaim their lives since 2006. Ashley doesn't just treat pain, she treats people. And as a working mom, athlete, and lacrosse coach, she understands the real cost of being sidelined, ignored, or rushed through the healthcare system. Her approach is built on the powerful, powerful belief that time is our most valuable resource and we should care and respect that. So Ashley, thank you so much for being here with us today.

SPEAKER_02 0:46

Thank you. That was so lovely. I love having the words.

SPEAKER_01 0:50

The bio that you submitted was great. It was easy to write wonderful things about you. Oh it's great. Um, but that is just a little bit like that's the nutshell of your story. So before we even dive in, I'd love for you to share a little bit more about your journey and how you got to where you are today.

SPEAKER_02 1:06

Yes, I'd love to. I have always been an athlete. I love sports. I'm so excited to see that female athletes are having a bigger moment right now. Professional sports, women's sports. I love just seeing how the attention is given equal opportunity for everyone. It's wonderful. So being an athlete, you know, you see your share of injuries yourself. And I went to physical therapy and I was like, this looks like so much fun. This is a blast. I can do this. I could see myself doing this. So I went to college, I played lacrosse in college, I got my master's in physical therapy, then I went on and got my doctorate in physical therapy, and I was hooked. It was just so much fun learning about the body, helping people. I'm a fixer. I just I love to solve a problem. So I lived on the Cape, I grew up on the CAPE and I came right back to the CAPE. My husband is also a physical therapist. So we met in school, we came back here, and I started practicing in outpatient orthopedics, and I did that for 15 years. I worked in a traditional outpatient clinic, and it was great. I learned so much, surrounded by amazing people, colleagues, continued to take classes, have like sharpened my tool set. But it got old quickly because the traditional PT model is you ended up seeing three patients each hour. And um, it was great. You know, you could stay positive, you really still helped people, but I fatigued really quickly and I started getting to the point where I just didn't want to go to work anymore. And that is just not me. That's not who I am. So I turned 40. I called it my midlife crisis. I'm like, I can't do this for the next 25 years. So I thought there has to be another way. I happened to be treating this female internist at the time, and she saw me struggling, and she said, Ashley, all you need is what's in your brain. Just go for it, just do it. Just go out on your own. Your brain is like a human MRI machine. Just you can do this. That's all you need. So I went home, I filed for my LLC, and I was like, okay, let's do this. What else do I need to do? So I started slow, put the pieces together. I mean, I'm sure it's more complicated than I'm making it sound. And slowly but surely, patient after patient after patient, it grew. And a few months later, I was able to kind of give my full-time attention to that. And nine months later, I was able to hire an employee, and then a year later, another employee. And now, almost four years later, we have four full-time employees, two part-time employees, and an administrator.

SPEAKER_01 3:43

And it's a dream come true. That's so wonderful. That's such a great story of having an initiative or something in mind, and then actually taking action on it. Because I think as you were telling the story of the conversation you had with a patient, it would have been so easy to just say, yeah, you know what, that does sound nice and continue on the path that you were already on. So where did you find the bravery, so to speak, to just do it?

SPEAKER_02 4:12

Well, to be honest, the employer I had at the time, super wonderful person, great clinician, super caring, but wasn't the best at business. And I thought, well, if he can do this, I can probably do this, right? Which I know sounds so silly, but I'm like, this I can figure this out, right? I can figure this out. I've gotten this far. Now, in hindsight, business was much harder than I actually thought it was going to be. And so many stumbling blocks along the way. But it has worked out a lot of learning. But I guess at the end of the day, at least in physical therapy, right, the business is taking care of people, right? And so I do know how to take care of people. And I've been able to surround myself with other people, other support teammates that have been able to help me learn about business. So I know how to take care of people, and I have been able to find other people that have taught me about business. So it's working.

SPEAKER_01 5:10

Yeah. Have you heard the saying that being a business owner is like personal development more so than anything else that you can do in life? You know, I haven't heard that expression, but that is resonating deeply. Yeah. Yeah. I remember when I started my business, I didn't think, I guess it I was in a similar place. I didn't think about the business component. I was like, I do social media marketing, and that's great. I'm gonna do that now. And then I found myself having to look at a budget and taxes. And I have a friend who started a therapy clinic around the same year I started my business. So her licensing is I don't have any licensing. She has like countless licensing requirements, and she still every so often will text me and be like, Don't forget your estimated taxes due. Don't forget to renew the LLC. And I'm just like, thank you for being you, because my creative brain is not there.

SPEAKER_02 6:08

Right.

SPEAKER_01 6:09

There's so much that goes into it.

SPEAKER_02 6:11

And you want to do the things that you're passionate about and you're excited about, right? I love patient care. That's what I want to do. Um, I want to learn about other people that can help me with patient care. I don't want to do those other things. So connecting with people that can help me and that you trust, it's invaluable.

SPEAKER_01 6:30

For sure. I want to go back to what you said about seeing three patients an hour because when you said that, I thought you were going to say three patients a day. So when you said an hour, I'm still recovering from that. What does it look like? I know you talk about being a concierge practice high level. Can you walk us through really what the difference is between traditional seeing three patients an hour to moving into a more holistic concierge style practice? Absolutely.

SPEAKER_02 6:58

And and keep in mind, I am comparing a for-profit traditional outpatient clinic versus a for-profit concierge physical therapy clinic, right? There is hospital-based physical therapy clinics, nonprofit physical therapy clinics that are a different model, right? So I'm I just want to be clear I'm comparing those two things. Insurance-based physical therapy clinics, right? You you can only pay a physical therapist based on what you're being reimbursed from insurance companies, right? You have to keep the lights on, you have to pay for an administrator, you have to pay for liability insurance, you have to pay for staff to track down those insurance referrals and help you get paid, right? So if the average insurance reimbursement rate is $80 a person, right? So if I see three patients an hour, we're being reimbursed on average, $240 for that hour. So that's if we get paid, right? That's if everyone's paid their copays, that's if that insurance company doesn't deny any of the claims. That's if all those patients show up. That's if none of them happen to be working men's comp claims or motor vehicle claims, or who knows? Well, all kinds of things could happen. But let's say all those things work out. So of that $240, you're paying an aide, you're paying a front staff coordinator, you're paying an insurance uh referral liaison. So you have to see that many patients in order to get paid yourself and to pay all your support staff. The model and right, I'm only getting to spend of that hour, if I'm lucky, 20 minutes of hands-on time with that patient before I am then handing them off to an aide or physical therapy assistant to go through their exercises. And that's fine. I worked with some amazing physical therapy assistants and rehab aids, really great people that were wonderful. But I didn't feel like I was helping that person. So now, this model, I am spending that hour with my patient the whole time. I am working on one-on-one, hands-on care, whatever they need. Um and let me back up a second. The insurance-based model, I was only allowed to treat what the insurance company told me I was authorized to treat. Wow. So I was dependent on the insurance company approving X amount of visits for that diagnosis. So if they came in with a diagnosis of shoulder pain and the insurance company approved four visits for shoulder pain, that's what I could treat. If I happened to think that that shoulder pain really was coming from their neck, well, I was gonna have to wait. I had to treat their shoulder. So now if a patient comes in with shoulder pain, I'm gonna look at their whole body and figure out what I think the root cause is. And then the patient and I together are gonna come up with the treatment plan. So if we think together based on their history and their presentation, that the issue is really coming from their neck or their thoracic spine or trauma that happened from years ago, we're gonna treat that together. And if we uncover a few of the things along the way, we'll shift gears. So it's much more of a collaborative approach with the patient and educating them. So there's much more buy-in from the patient because we're empowering them with knowledge, they're gonna do the things at home and they're gonna get better faster. And the symptoms aren't just gonna return because they understand what's happening in their own bodies now.

SPEAKER_01 10:36

Yeah, that's fascinating. I feel like just from a consumer standpoint, so to speak, I've seen more and more of these style practices across various industries pop up. And you can always tell when the provider is doing what they do because they care about the patient. And for me, I'm like, okay, again, as the consumer, as the patient who doesn't know anything about healthcare, I would much rather put my health in the hands of someone who I feel like is gonna look at the entire picture, not just try to get to the next patient. Because we've all, I mean, I did it for tomorrow. I have a doctor's appointment and I'm like, I need to get the 8 a.m. slot because I know that I need to be their first patient, or else I am not getting out of there for at least two hours.

SPEAKER_02 11:23

I know, I know, I know. And that's hard. And so, and so we're kind of helping patients too navigate within the healthcare system. So if I have a patient and they they know, okay, I'm gonna go see my orthopedic surgeon. Okay, well, let's come up with a list of questions together. Let's write that list down so you can go in and make the most of your visit. Let's find out what are the three things that we want to find out, or I'm gonna contact your surgeon ahead of time and try to talk to them, or I'm going to refer you to this person who I think would be a good fit for you. In this setting, right, I have the time to kind of figure things out and think more critically, right? When you're kind of in the trenches, it's like the creative part of your brain that we were talking about, it just turns off and you just kind of go into survival mode. Right. All those other physical therapists that are in this kind of insurance-based model are fantastic physical therapists. It's just the model they're in. They didn't have any less education than I do. They're great physical therapists. It's just, it's just the model, right? And hopefully, I would love to take insurance, right? Everyone has insurance and you should be able to use it. It just wasn't letting me help people the way that I wanted to help people.

SPEAKER_01 12:29

Yeah. Yeah. Well, that's very inspiring. I'm glad that there are people like you out there. Yeah. We all need the. I think more and more. So you mentioned the root cause. So I'm going to go back to the example of if someone comes in for shoulder and it ends up being their neck. I've I've never thought of it that way. And then that brought me very quickly to what you shared with me prior to us starting the call about how most everything starts in your feet. Yeah. And when I read that message from you, I was like, I can't wait to talk about this part. So let's just dive right into the feet. What's going on there?

SPEAKER_02 13:03

Oh my gosh. Well, feet are my favorite, just first and foremost. Like some people will, they'll, they'll contact me and they'll talk, they'll say it's a foot issue. I'm like, I love feet. And they think I'm being sarcastic. They're like, oh, really? I'm so sorry. I'm like, no, no, I love feet. This is great. Let's, let's, let's get the dogs out. Let's talk about it. And um, I really do. We um stuff our feet into these tiny shoes all day long. And um, so many, so many of our underlying issues are caused by our feet because it's the first thing that hits the ground, right? These are our shock absorbers. If our feet don't hit the ground and distribute the forces evenly throughout our body, something's gonna be off. So, for example, right, if we are wearing high heels, let's say women, we like to wear our high heels. Not this woman, but a lot of women like to wear heels, right? And so it kind of pitches our body forward. So then in order to not fall over, we have to pull our shoulders back and arch our lower back a little bit. And then in order to see, we have to tilt our head up. So we think about all the strain that that's causing our neck and our shoulders and the distribution of forces going through our back, it's just it's misaligning our spine. So that's just from changing the the um our footwear. If we have an ingrown toenail, right, which happens right a lot of times, or you have a callus, or you just you drop something on your big toe and it's sore. Now you're gonna put more weight on the outside of your foot, which is maybe gonna make you turn that hip outward, which is maybe gonna make the opposite side of your back sore because you're putting more weight on the opposite side, which now you're gonna carry groceries on the other side of your body. You know, so it's just it's like this um seesaw effect, right? You've got to balance out the load somehow. So, I mean, how many times if you can, if you can picture this, right? You've got a mom that just stepped on a Lego, right? There's a bunch of Legos on her floor, she's got bare feet, she steps on a Lego. Oh, this hurts. But now I've got to pick up my toddler, but that foot hurts, so I'm gonna pick them up on the other side. But now I've got to carry these laundry up the stairs, so I've got to put it on the side of my body that hurts. It's just this big seesaw. And if our feet are taken care of, everything else works. If our feet, if our if our base of our pyramid is off, the leaning tower of Pisa, right? Another example, we're gonna tumble. So I love feet. We can tell we can learn so much from the calluses and the corns and the um the dry skin on our heels, right? It tells a tale.

SPEAKER_01 15:47

That is so interesting. And I can't wait to go put on a pair of high heels after this, just to like feel it in my body, because I've never thought about the fact that we like lean forward and arch our back and do all of those things that you just named. I literally was like, oh my god, I gotta get upstairs to the closet right now. And well, just try try walking around on your tiptoes. Yeah. Yeah. Yeah. Now, to that point, as someone who spends a lot of time on social media for my job, I have a lot of different algorithms. So I see a lot of different information depending on what client account I'm logged into. I've seen, you know, it's best to run barefoot, flat feet, or you need to have arch support. And I'm like, okay, these are totally two contradicting things.

SPEAKER_00 16:37

Yeah.

SPEAKER_01 16:37

So when it comes to how you support your feet, is there a standard best practice or is it solely dependent on the person?

SPEAKER_02 16:45

Oh my gosh, such, such a great question. And I will tell you that for a good part of my career, right, I put everyone in orthotics. I was like, we need orthotic. Your foot's flat, you've got plantar fasciitis, you've got a heel spurt, everyone gets northotic, right? But this is the wonderful thing about medicine. We learn new things. I was wrong, right? I was wrong about that. Just like I was wrong about a bunch of things that I thought that was the best information at the time, and now we have new information. And so we have to change our ways, we have to evolve, we have to adapt. So now I know that that is not the best advice. An orthotic is a tool, right? So we shouldn't be in orthotics unless we have a very specific reason to be. For example, during pregnancy, during like the last trimester of pregnancy or the fourth trimester after you've given birth, the ligaments in our feet are very lax, right? Because of the hormonal changes. And so our feet need more support because the ligaments are stretching out. That's why our feet grow um in size during that period of time. So we need an arch support.

SPEAKER_01 17:54

Wait, I want to pause there because I want to confirm that I'm understanding you correctly. Are you confirming the myth that your feet grow during pregnancy? I am confirming it. Do you go back? Or are we just we're just up a shoe size now?

SPEAKER_02 18:07

Oh no, you go back. Sorry. You do go back. Interesting. Well, here's a good point though. If you support your feet during that period of time, right, you're really gonna allow yourself to go back in size. So you're giving yourself the support so that your ligaments don't permanently stretch out. Now you could, after pregnancy, you could stretch your feet. I mean, you could strengthen your feet and you could go back in size too, right? So we're just we're giving our feet the support, the tool during the period of time that we need it, right? Just like if we had an injury to our foot, right? Let's say that we tore or strained our posterior tibialis tendon, which is a folligament tendon that attaches underneath our foot. We would want to give our foot some support during that period of time when it's healing so that it wouldn't stretch out. But in general, we don't want to be in an orthotic permanently. If we had some weakness in our feet and they weren't yet strong enough, and we want to do a lot of walking, we could put an orthotic in for that period of time. When we get home, take that orthotic out, be barefoot, walk around the house, strengthen your feet. And we're working towards spending more and more time outside of that orthotic. Because our feet will adapt. If we give them an orthotic all the time, they're gonna need an orthotic all the time. They will, however, we train them, that's what they'll need.

SPEAKER_01 19:30

So I'm looking at the slippers that are underneath my desk right now. Um, I have all hardwood floors in my house. And I for Christmas asked for a pair of slippers because I was like, my feet hurt from walking around all day, and I don't want to have to wear sneakers inside the house. So are the slippers considered a tool, or is that something where I am essentially just weakening my feet by not walking in through it?

SPEAKER_02 19:59

I mean, are the slippers you're wearing are they causing your toes to bunch up in your slippers to keep the slippers on? Okay, well that's good.

SPEAKER_01 20:09

They're very I'll show you. They're very grandma. Okay. Grandma-esque.

SPEAKER_02 20:13

Okay. Well, I mean, as long as you don't feel as long as you feel like, let's put it this way, you'd be better off barefoot. Dang it. Well, you could wear some socks. Okay, noted. You're the doctor, I will take your advice. You could wear them while you're sitting there to keep your feet warm. Uh-huh. But maybe when you're standing and walking, you'd be better off getting that feedback from the ground.

SPEAKER_00 20:37

Right?

SPEAKER_02 20:37

Every time your foot's on the ground, you're giving your brain input. Right. And so if the input you're giving your brain is that my feet have to work, what am I feeling? You're gonna give your brain more input.

SPEAKER_01 20:49

Yeah. Isn't it wild the things that we are taught growing up that we then learn and have to unlearn? Yes. Yes as medicine advances.

SPEAKER_02 21:00

Oh yeah. I feel so terrible. Some of the advice that I gave early on that was the best advice. I'm like, if only I could tell you now, I am sorry. Yeah. I gave you like women and frozen shoulder, right? Now we know that it's it's from menopausal changes and estrogen changes. And, you know, at that time we didn't know that. And I feel so badly. I'm like, I wish I could have told you that that's what this was from, instead of, you know, cranking on your shoulder and causing you more pain. You know, we just we we know so much more now. Yeah, you know, but having been in this field for 20 years, imagine what we're gonna know in another 10 years. You know, I can't wait to find out.

SPEAKER_01 21:34

Yeah. Wild. So that's an interesting point you make about frozen frozen shoulder and hormones and all of that. Again, because we we don't know much about it, especially those of us who don't study it. Yeah. We see I always go back to what I'm seeing on social media because unfortunately I feel like that's how a lot of us get our information these days. And collagen and supplements and everything that you see marketed online. Similarly to flat feet versus support, it's all different. It's all different information. So, what do you think that women, especially who are mothers who have been active their entire life, I think a lot of my audience falls into that category? What do we truly need to know about how collagen and our ligaments and our bodies work before we find ourselves injured?

SPEAKER_02 22:25

Oh my gosh, I love this question so much. So, similar to feet in menopause or in perimenopause, right? Our ligaments, as we lose estrogen, right? Our ligaments lose collagen. So when we decrease estrogen, we decrease collagen. Our ligaments are made up of collagen. So this would be another good time where you may need an orthotic because as we're losing stability in our ligaments, our feet may need a little bit more support. So that's another potential time for orthotics. So women, as they're going through perimenopause, menopause, postmenopause, we lose estrogen, which means our collagen decreases. So we are prone to our ligaments being less stable. So we're going to have shoulder pain, hip pain. Um, those are the two most common areas I see it because our shoulders and our hips, if you can imagine, right, they have the most amount of mobility, right? They move in all directions. And so when you have a joint that is extra mobile, our ligaments give those joints extra stability. So when we have less stability, because we have less collagen, because we have less estrogen, they're more painful. So it's like when you get out of a car after a drive and you're like, oh my hip, it just doesn't want to move. It takes a little while to get going. Or you get up in the morning and you feel like, why do I feel so old right now? You know, those aches and those pains, and it just all of a sudden hits you. It's a very common complaint. I hear it daily and I feel it daily. So we need to support our joints with strength and mobility. We also need to support our joints with collagen supplementation. There are so many supplements out there, um, and we could talk about all of them, but I'm gonna say the three supplements that I think women should be taking are collagen, creatine, and omega-3s. Right? I mean, yeah. So obviously, the earlier you can take those, the more you're gonna support your joints. There are so many supplements, and but those are the three that are the most evidence-based. There's been the most amount of research on them, and they are the most supported. So take what you want, but those are the three that are gonna give you the biggest bang for your buck. I have a lot of follow-up questions.

SPEAKER_01 24:56

So I was not surprised to hear you say collagen. I was surprised to hear you say creatine. Can you talk a little bit more about that? And immediately where my mind went was like, okay, this is what I see marketed to bodybuilders. And I personally tried to take creatine once and blew up like a balloon. So I was like, bye. What uh there.

SPEAKER_02 25:17

Okay, all right. So the recommended dose, right, is just one serving a day. But I have noticed that some women do experience some bloat the first time they take it, right? Because creatine is going to hydrate your muscles, which is a good thing. We do want hydration in our muscles. So back in the 90s, there was a big push for creatine. Everyone was taking creatine. Like I can remember I was in high school, and all the high school seniors were talking about their creatine. They were going to the gym, they were getting their pump on, and they were all like loading on creatine. They had no idea what they were doing. But and a lot of people do still use creatine for bodybuilding. What we as females need to be taking it for is muscle development and brain health. I recommend everyone take one dose a day, every day. But what you can do is if you are experiencing that bloat, you can break it up and take half in the morning, half at night, or start with half and then take a second, you know, you can try to increase. But it is so beneficial. So beneficial. It is, with the exception of caffeine, the most researched supplement in the world. So the evidence is everywhere, especially with females, because women, as we're going through perimenopause, menopause, right? We lose skeletal muscle mass at an alarming rate. So we need to do everything possible to hang on to as much skeletal mass and build as much skeletal mass as possible. Because we need to stay strong and resilient. We do not want to be frail. And it's not fair. We lose, we lose it so quickly. So everything that we can do to give ourselves a little bit of edge to be able to build muscle, retain muscle is critical.

SPEAKER_01 27:00

Is there a certain age that you say at this point this is when you need to start?

SPEAKER_02 27:05

Or is this high school athletes and I give it to my kids who are 12 and 15. I think you should take it. There's no, there is no, there is no negative side effect to creatine. Okay. So I would give it as soon as you can. Okay. Do you have any brands for the three that you mentioned that you suggest? So I love Momentous. That's the brand I like, or Thorn. You just want to make sure it's third-party tested, right? And that that is the only ingredient in there. Okay. So it should say creatine monohydrate. That's the only ingredient. There's and the gummies do not work. Don't get the gummies. It needs to be the powder. Momentous did come out with a chewable. It's kind of chalky, but if you can't handle the powder, you could do the chewable, not the gummy. And the reason is if it's the gummy, you can't ensure that the adequate amount of creatine is in that gummy just because of the way they make them. So if you're taking it, you want to make sure you're taking, you're actually taking it.

SPEAKER_01 28:02

I'm going to blame the gummy for the fact that I blew up then.

SPEAKER_02 28:05

Well, but it does happen, right? Because if we're we're asking our muscles to hydrate so that we can build more muscle, right? Because you know, our skeletal muscle has like 70% water, right? So if our muscles are dehydrated, they're less likely to perform. So the creatine allows us to have uh better capacity in the gym, lift weights, run, walk. So maybe you just were really hydrated that day to begin with. And the create, you know, who knows? But I would say it's worth another shot.

SPEAKER_01 28:37

Yeah. Or maybe I just listened to my husband who was like, you have to load this in the beginning. Take 10. No, take five, five grams. I was doing it before going on a beach vacation because I thought it was gonna make my muscles look better. And I was like, I hate everyone.

SPEAKER_02 28:54

It just it makes it makes it easier for you to build muscle when you're lifting some weights, right? Yeah. But even if you're not lifting weights, it's great for your brain health, for your cognition, decreased dementia risk. Five grams once a day, right? Though, or or in your case, maybe you take half and half. Noted.

unknown 29:12

Okay.

SPEAKER_02 29:13

Noted.

SPEAKER_01 29:13

So let's talk about you a little bit now. We we know you have this unbelievable amount of knowledge. You've built a successful business. Outside of your business, as a mom, as a coach, what does what does that look like for you on a day-to-day? How do you juggle everything that you're doing right now?

SPEAKER_02 29:31

I mean, the truth is I don't. Like I am a terrible juggler. I mean, I want to juggle better, but the reality is if I am succeeding in one area, I am probably failing in another. I'd love to tell you I'm juggling it, but I'm not.

SPEAKER_00 29:46

Yeah.

SPEAKER_02 29:46

So, you know, if I'm doing a really good job with my business and being creative and I'm helping a lot of patients, I'm probably doing a bad job with my friendships. Or if I'm spending a lot of time with my kids, or I if I block off time to go to their sporting events, I'm probably not having a date night. So I don't think I can do it all. I guess just trying to like, if I look at the year as a whole, I'm trying to even it out. You know, in Cape Cod, our busy season or our our season where our population grows so much is the summer, right? So from May to like October is our crazy season, you know, no vacations. Like we just kind of like hunker down and work really hard. So I know if that's the season that I'm gonna see a lot of volume, then I try to prioritize in the off season that that's when I'm gonna take family vacations, and that's when I'm gonna try to prioritize more family time or friendship time or you know, husband time.

SPEAKER_01 30:44

Yeah.

SPEAKER_02 30:44

So because I don't think there is a balance.

SPEAKER_01 30:47

Yeah. I love that. Thank you for sharing that so openly. I think that's a message that more of us need to hear because it's easy to think that everybody has it all together when a lot of times we're all just doing our best. Yeah, it's definitely not. So the last thing I want to ask you is about advocacy. And I'm going back a little bit to now, now the health realm. So as a patient who say they hear this episode and they're like, oh shit, maybe I should address my feet, or maybe I should ask these type of questions. And say they go into an office and they're rushed through the appointment and they don't get to even talk about half of their concerns because we've all been there, right? What's the best way a patient can advocate for themselves?

SPEAKER_02 31:35

I I always think it's best to go in with a list. And I know some people, you know, some providers are gonna hate that answer, right? And like, oh, here she comes with our list. But the reality is we get sidetracked, right? We go in and we have these questions and we get an answer and we forget the rest. So if you go in and you have your list and you only get X amount of answers, you could give the provider, these are the questions we didn't have time to answer. Could you review these? And can we make sure that you could either, could we have a phone call about them? Could you email me about them? Could we set up a Google um meet about them, a telehealth about them? I mean, there has to be a way to discuss them. Or if you're not able to answer these questions, can you refer me to a provider that can? That would be one start, one way. I think sometimes there just isn't enough time. But if you approach it in kind of a respectful way, like these are all my questions and concerns. What is the right way to make time for these? You know, and you kind of put the ball in the provider's court, that could work. It is really hard because they're they're trying to, they've got 15. If it's a if it's a physician, they have 15 minutes with you, or maybe eight in some cases. If it's a physical therapist, they maybe have 20. Or, you know, the other thing is maybe you have to go to a physical therapist that's like a not-for-profit or maybe a hospital-based group. They may possibly have one-on-one. Or you could call and say you could ask the question when you're calling around to find a provider. What kind of appointments do you offer? Are these one-on-one appointments? Will I have the same physical therapist every time? Because continuity of care is so important. Educating yourself, what am I looking for in a physical therapist or or any provider? What will I expect at my appointment? So you can go in and have more clear expectations. What's going to happen? What should I expect in my evaluation? Will there be any hands-on care or will it just be collecting information? You know, will I have a home program? What am I expected to do outside of here? What is my diagnosis? What is going on with my body? Should I get better? How long will it take me to get better? You know, so I guess instead of just being kind of passive, just empowering yourself with as much information as possible. And I would also say maybe don't start the conversation with, you know, WebMD told me or ChatGPT told me. You know, like you can definitely go and look those things up afterwards. Chat GPT is amazing. But um, I think it would be better to just go in with an open mind and bring all your information, right? Make bring your, you could even, you could even bring a typed list of your medical history and all of your events and hand it right to the provider. And then they can review it later and you could maximize your time together that way.

SPEAKER_01 34:33

Yeah. That's all great advice. And I'm laughing because I'm guilty of someone told me that, or I read on social media and just want to like shoot myself in the foot for for lack of a better term, right then and there. Um that's funny.

SPEAKER_02 34:52

You can still do that, just maybe don't say it.

SPEAKER_01 34:55

Yeah, yeah. Don't don't offend their knowledge. That is great advice. And Ashley, I've really enjoyed our conversation today. Thank you for sharing all of your wisdom with us. Uh for those listening, what is the best place for them to find you?

SPEAKER_02 35:11

Well, um, Instagram, Cape ConciergePT, we put up tons of informational videos, educational videos. Again, I if nothing else comes of this, I just want people to have as much information as they can. Because if you have information, you're going to take care of yourself. Something will resonate. And that's at the end of the day, that's that's what I want for everyone to have information to educate yourselves. Instagram Cape Concierge PT, Facebook Cape Concierge PT, our website Cape Concierge PT. I mean, you know, it's it's it's pretty much the same thing everywhere you go.

SPEAKER_01 35:44

Yep. Good branding. We'll link those in the show notes as well. Um, and I I can't wait to go stalk your Instagram, see what else I can learn from you. So thank you so much, Ashley. I really appreciate being here.

SPEAKER_02 35:57

And thank you because I learned from you how to update my LinkedIn profile. And I learned from you about the um how to create my flow. And I listened to a recent podcast of yours, and now I'm gonna go create um a YouTube channel, which I hadn't before. So thank you. Heck yeah, that's so fun. I can't wait to see it.

SPEAKER_01 36:17

Thank you. Good stuff.