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The importance of sleep

“Humans spend roughly a third of their lives sleeping.”

Some people say that there will be time for sleeping when we die.  Unfortunately, by having this attitude, one may get to test it sooner rather than later.  There is no shame in sleeping.  Some wear it as a badge of honor that only 4 hours of sleeping is needed, but as you’ll see later this is not a good idea.  Here’s a list of power people that sleep less than the 6-8 hours per night recommended.

“…it has been recommended to consider sleep as another vital sign, as sleep can give insight into the functioning and health of the body.”

There have been multiple suggested vital signs such as pain, walking speed and now sleep.  I am not saying that sleep isn’t important, but to call it a vital sign may be over-rated.

“…between 50 and 70 million adults in the US experience chronic sleep disturbances, and 62% experience a sleep problem several nights a week.”

Sleep is vital, but maybe not a “vital sign”.  If you are having a problem with sleep, this could be a sign of something more serious, if not it could lead to something more serious.

For instance, my daughter has Down Syndrome.  This is a genetic mutation of the 23rd chromosome, which leads to multiple physical changes.  One of the changes is a larger than average tongue and smaller air passages.  This is in combination with low muscular tone.  The incidence of sleep apnea in kids with Down Syndrome is 50-100%.  One of the side effects of sleep apnea is right sided heart failure, pulmonary hypertension, and delayed growth.  These are some serious effects of a lack of sleep.  I can speak for my daughter, but she will undergo a sleep study around the age of 3-4.  I have some patients that have sleep issues and this is what I hear about doing a sleep study:

“It will be too inconvenient”

“I don’t want to know the results”

“I don’t want to have anyone watch me sleep”

In the grand scheme of things, I will not let ego override my daughter’s long term health.  I don’t understand this belief system, but will always try to educate the patients in order to ensure that my patient’s health is as good I know that it has the potential to be.

“Costs associated with insomnia, which is the most prevalent sleep disorder, are over $100 billion per year due to health care costs, accidents, and decreased work.”

Difficulty falling asleep or staying asleep is termed insomnia.  Think of how much money we spend in health care related costs.  Add musculoskeletal pain costs to isomnia costs and the total is 340 billion.

If you could save $100,000/year, it would take you 3,400,000 years to save 340 billion dollars. If you could save $10,000 every single day, then it would only take you 93,151 years to save 340 billion.

As you can see, if we can start to improve national health, then we have the potential to save more money than I could count to in a lifetime.

“…proposed that knowledge about sleep and skills to screen sleep disorders and to promote quality sleep are important components for physical therapists to promote health and wellness.”

I’ll be honest.  We don’t learn much about sleep in school.  At least we didn’t 10 years ago.  It’s hard to say if this has changed much in the previous decade, as I don’t hear many new graduates talking about sleep.  Everything that I learned about sleep and health has come from a few podcasts from people like:

  1. Dr. Kirk Parsley
  2. Tim Ferriss
  3. Dave Asprey

It’s great that there is more research being published in the field of PT regarding sleep, but this is a population health issue and needs to be addressed by all health care professionals.

“Of the 43% who reported that they do not routinely assess their patient’s sleep habits or sleep quality, the most frequently reported reason was: ‘I do not know how to assess sleep habits or sleep quality.'”

I am not surprised by this number…actually I am.  I am shocked that it is not higher.  I am shocked that half of all therapists are actually assessing sleep habits or sleep quality.  I think that most of us, in orthopedics ask whether or not sleep is disturbed, but I don’t know if this qualifies for asking about quality and sleep habits.  Actually, I hope it doesn’t because this is a basic question that doesn’t assess much other than sleep or no sleep due to pain.

I ask my patients about urinating during the night, how many hours of sleep is achieved during the night, what the environment (room) is like regarding electronic devices and lights.

This is stuff that I had to learn on my own and wasn’t even mentioned in a Doctorate program.

“sleep is critical for immune function, tissue healing, pain modulation, cardiovascular health, cognitive function and learning and memory.”

We already talked about heart health and sleep quality in the personal story of my daughter.

There is some published research regarding a lack of sleep and an increase in Substance P.

Dr. Kirk Parsley speaks frequently of the effects of a lack of sleep on cognition.

“Without adequate sleep, people can experience increased pain perception, loss of function and reduced quality of life, depression, increased anxiety, attention deficits, information processing disruption, impaired memory and reduced ability to learn new motor skills, and are at an increased risk for accidents, injuries and falls.”

I don’t think that too many people will argue about the importance of sleep.  We absolutely need it, but some can go days without sleep.  Albeit, there will be some side effects.

“People with sleep disturbances report increased sensitivity to pain, but also those experiencing high pain intensity have reported significantly less total sleep time, delayed sleep onset, increased nighttime wakening, and decreased sleep efficiency.”

As a therapist, this part plays an important role in my care.  I would estimate that about 90% of my patients are coming to me for some sort of pain complaint.  Sometimes this pain can keep the patient awake.  Knowing the role of Substance P regarding pain and sleep, I ask 100% of my patients about sleep.  If sleep is disturbed, then I know that I have to attempt to understand the problems with sleep.  If the problems go beyond sleep hygiene, then the patient is referred out to a doctor that specializes in sleep studies.

“providing interventions to improve sleep may impact pain and thus improve outcomes”

This is why it is so important for PT’s to ask about sleep!  It may affect our outcomes!

We are all (I’m an optimist) trying to get patients better and we have to look at all of the variables that we can manipulate in order to achieve this goal.

“understanding the important relationship between sleep and pain could profoundly influence the treatment interventions targeted toward changing the patient’s experience of pain”

Just by improving sleep, we may be able to decrease a patient’s pain experience and improve function as a result.

“long duration of sleep (>8-9 h per night) was associated with an increased mortality due to cardiovascular disease and increased risk of developing coronary heart disease…short sleep duration (<5-6 h per night) was associated with an increased risk of developing or dying from coronary heart disease and weakly associated with developing other cardiovascular diseases.”

This is the paradox of sleep.  Get too little and no bueno, but get too much and equally no bueno.  Looks like 6-8 hours per night appears to be the right amount.  Reading this paragraph makes me think of the three bears.

“Sleep apnea…increases the risk of developing cardiovascular disease…heart failure and stroke…breathing stops temporarily, which decreases the level of oxygen in the body alerting the brain to excite certain receptors.”

Fight or flight? When a person stops breathing, the body becomes excitable and stresses out.  This stress can raise BP, increase heart rate and cause other neurological responses.

“About 75% of people with depression experience symptoms of insomnia…almost 20% of those with insomnia have clinically significant depression and anxiety.”

This is a quick question that we can ask when someone notes that they have anxiety or depression, which is typically asked on a history intake form.

“sleep may play an important role to the development of Alzheimer’s disease”

This has to do with neurofibrillar tangles in the brain.  This is another topic of concern for me and my family.

We are doing a lot of studying in order to understand the ramifications of Down Syndrome and there is a high likelihood of developing Alzheimer’s disease.

We put some coconut oil in her cereal and oatmeal.

“…sleep hygiene has been associated with improved sleep quality in college students and in patients with low back pain…reduce pain and fatigue in people with fibromyalgia”

Sleep hygiene is ensuring that the environment and other factors surrounding the act of sleep are ideal for sleeping.

 

Sleep hygiene education

  1. “Go to sleep and wake up at the same time every day and exposure to bright natural light is helpful to set your natural biological clock”
    1. some people will use blue lights in the AM to try to help with waking or to prevent the “winter blues”
  2. Use your bed only for sleep and sex. Do not eat, work, or watch TV in bed.
    1. Getting a little graphic, but the bed needs to be a place meant for things done horizontal.
  3. Develop a relaxing bedtime routine
  4. Avoid moderate to vigorous activity at least 2-3 hours before bedtime
  5. Avoid caffeinated foods and drinks at least 4 hours before bedtime
  6. Refrain from drinking alcohol or smoking at least 3-4 hours before bedtime.  It can cause you to wake up during the night and smoking can act as a stimulant
  7. Do not take un-prescribed or over the counter sleeping pills
  8. Avoid daytime napping so that you are tired at night and can fall asleep easily.
    1. Some people advocate for polyphasic sleep
  9. Make your sleeping environment comfortable and relaxing. Avoid light, wear earplugs and use a mask if needed
  10. Avoid eating a large meal or spicy food 2-3 hours before going to bed
  11. Talk to your doctor or health professional if you still have trouble sleeping.

Thanks for reading.

You can find me at movementthinker on Itunes and if you have questions can also send me a message at Goodliferehab.com.

Excerpts taken from:

Siengsukon CF, Al-dughmi M, Stevens S. Sleep Health Promotion: Practical Information for Physical Therapists. Phys Ther. 2017;97:826-836.

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Burnout

“The interest of this project is assessing the prevalence of BOS (Burnout Syndrome) among physiotherapists who work in the Estremadura region (Spain)”

 

I can already hear the arguments from other PT’s, “Why are you reading research from Spain?” and the answer is because we don’t have enough research from America.  We will have to try to extrapolate some of the information from this article to see if it applies to our work environment.  In the end, people are people and no one article will apply to everyone, but maybe some bits of knowledge can come out of this article to help many.

 

Let’s start with burnout.  It exists in healthcare and this sector has one of the highest rates of burnout among sectors (think like education, healthcare, transportation, law enforcement etc).

 

From the other research articles that I am reading, burnout is characterized by emotional exhaustion, depersonalization, and low professional (sense of) accomplishment.

 

“LPA (low professional accomplishment) is clearly higher in the case of split shift working day as well as in private practice”

 

A split shift, in this study is defined as just that, a shift that is non-consecutive. For instance, there was one job that I was interested in that would take a two-hour lunch in order for the people working there to go to the gym next door.  As much as I was in favor of it, it would have meant another hour away from my family…so I politely turned it down.

 

Private practice is private practice.  We have this here in the states.  Private practice is traditionally seen as a capitalistic venture, in which the owners are trying to make as much money as possible.

 

“…more than 40 hours of direct attention (patient contact) is linked to higher scores in EE (emotional exhaustion), and that more than 20 patients treated per day is associated with higher scored in both EE and Dp (depersonalization)”

 

Are you surprised?

 

We treat sick people day in and day out.  We treat people in pain day in and day out.  We are constantly taking the burden of others in trying to help these folks.  It can be exhausting.  The other option that could happen when a person becomes emotionally exhausted is to just “shut it down” and then depersonalize work and simply “go through the motions.”

 

Is this what you want in a health care provider?

Be on the lookout when you go to therapy to see if the therapist is seeing one patient at a time or more than one patient at a time because it can start to give you insight into the PT’s mindset.

“Physiotherapists included in our study had a moderate level of BOS (burnout syndrome) in its three dimensions: EE (emotional exhaustion), Dp (depersonalization) and LPA (low professional accomplishment).”

Although I don’t believe that I fit into this category, it is becoming more obvious from talking to other PT’s in the profession that this is a major problem that will have to be addressed in the not-so-distant future.  Think about it! The population is becoming older, we have a shortage of PT’s and there will be a higher demand for our services.  There are only so many of us to go around and if the PT works for a company that values $$$ over quality, then the PT’s will be asked to see more and more patients per day.  This appears to be leading the charge for burnout, based on the conversations that I have with other PT’s.

 

I did an informal survey on FB to determine the primary cause of burnout among the professionals and the primary answer was productivity demands.  For those of you that aren’t in healthcare, this means how many patients are you billing per hour.  WE DON’T MAKE WIDGETS!!!! We can’t treat people like WIDGETS!  It makes sense that some PT’s are getting their ethical buttons pushed and start to depersonalize.  One PT that I spoke to literally said that he was exhausted from TREATING PATIENTS!

 

Are you kidding me?!

 

It’s only getting worse out there.  As a patient you need to know what’s happening in the profession and choose a PT that is giving you undivided attention when you are in the clinic (THAT’S WHAT YOU ARE PAYING FOR!) and as a PT, you have a choice to work in a place that is asking more from you than you can deliver or you can leave and find something different.

 

“…the age of physiotherapists does not seem to have any influence in the syndrome. However, there is an adjustment period, at the beginning of the physiotherapist’s professional development, where they are especially vulnerable to the development of BOS (burnout syndrome).”

 

Old and young alike feel stress.  We all have ethical buttons.  Some that have swam the waters of this profession for years have learned to live with it, but those coming out are facing challenges that are considered taboo to speak of in school.  It’s only due to social media that these topics are becoming more mainstream for students to learn about.

 

“…physiotherapists who work split shifts and more than 38.5 hours per week are those who present the highest level of BOS (burnout).”

 

I don’t know any PT’s, minus those that don’t choose to work full-time, that are consistently putting in less than 39 hours per week.  I am personally putting in a ton of hours per week of direct patient care and indirect care through notes, blogging and doing videos.

 

“Burnout syndrome reaches its highest levels in those who dedicate more than 40 hours per week of direct attention to patients…”

 

Should we even bring up student loan debt?

 

If you want a comfortable/stable life, then you will work more than 40 hours per week.  Otherwise, you will pay your student loans off over decades.  That ball and chain will always be there.  Click  here to learn more about the ball and chain.

 

I personally receive income from three different companies, which I wished that I did sooner instead of waiting almost 10 years to work multiple jobs.  On the flip side though, had I done this sooner, then I may have experienced burnout and not be in the position that I am in today.

 

“…more than 20 patients per day have the highest levels of EE (emotional exhaustion), Dp (depersonalization) and BOS (burnout)”

 

PTs: Does this fit the description of the person and therapist that you want to be? If so, go forth and treat 2+ patients per hour.  Just know that you are making that decision and there is no sympathy for you in the end.

 

Patients: Does this describe the person that you want treating you? Emotionally exhausted, depersonalized and burnt out? If not, look around.  How many patients are there per therapists.

 

YOU ARE NOT A WIDGET!

 

Excerpts from:

Gonzalez-Sanchez B, Lopez-Arza MVG, Montanero-Fernandez J et al. Burnout syndrome prevalence in physiotherapists. Rev Assoc Med Bras. 2017;63(4):361-365

Police ride along for the day

The Joliet Police Department was gracious enough to allow me to do a ride along. I had an eventful night and learned about adrenaline and the following adrenaline dump. I was so exhausted and only did half a shift.

If you get the chance to go on a ride along to see how well they work together and how well they patrol the area, you should take the opportunity to see the city from a different perspective.

Monk and the Merchant: a personal perspective

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Part 2 of the Monk and the Merchant.

five “Take responsibility for problems that are the result of your own bad decisions. Don’t displace the blame”

 

I’ve taken accountability for my actions for as long as I can remember.  Growing up, my dad was a huge influence on me.  There were many sayings that he would consistently use and I’ll list them here to give you an idea what growing up in a household with my dad was like:

  1. If it was after 6 AM and I wasn’t awake, this phrase would always come out “You’ve already slept away half of the morning…Are you planning on sleeping your life away?”
  2. “Either get busy living or get busy dying”
  3. “We send you to school, buy you books and THIS is what we get?!”
  4. “I just don’t understand…and I don’t think I ever will”

Mind you, I started hearing these phrases at an age of 5, probably sooner, but that is the earliest recollection of these phrases.

 

I haven’t always made good decisions.  When I was 13 I was caught shoplifting.  I was a chronic shoplifter and I kept it hidden from everyone.  I would steal for no other reason than the thrill of the challenge.  It didn’t matter what I would steal, as I would typically throw it away or give it away later.  Mind you, these were bad decisions and I don’t condone it.  I was making mistakes and it took getting caught to actually see the error of my ways.  I was actually proud of myself for getting away with it for so many years prior to getting caught.  My mother couldn’t understand and we had a long discussion about this.  She tried to understand the motivation.  My dad on the other hand didn’t even try to understand.

 

Let me paint you a picture.  My dad is a Vietnam Veteran.  He was a Medic for the 101st Airborne (Screaming Eagles).  He was a light sleeper and would wake up every night at 1 AM to do a check throughout the house.  He would wake up between 3:00 AM and 3:30 AM every day, even on weekends.  When I got home from getting caught shoplifting, my mom woke up my dad to inform him of what happened.  He pulled me into the room and had a short conversation with me.  There was no punishment.  He simply said, “Son, I’m disappointed in you”

 

You have to understand my background.  I am the youngest of seven and the one that was supposed to stay out of trouble.  Those words that my dad, my Superman, said to me that night completely changed my life.  I have never done anything and would never do anything to make my dad feel disappointed in me again.

 

I had to pay back a $2,000 fine to the place that I was caught and have been straight-laced since.

Principle six “See challenges as stepping stones, not as obstacles”

Joliet Junior College is the oldest community college. One of the few classes throughout my academic career that was my bane was Chemistry 101 with Dr. Matthews at JJC.  I dropped this class twice, although the second time was because someone stole my lab work for the semester and I wasn’t able to complete all of the work on time.  I was working 2 jobs (Sam’s club from 3-9 PM and Eagle [no longer exists] from 10PM to 6AM).  Because of all the hours that I was putting in, I chose to take one semester of just chemistry with Dr. Matthews and made it through with an “A”. Knowing that I could tolerate discomfort made the rest of undergraduate “easy”.

Principle seven, “Be meek before God, but Bold before men.”

Getting back to some of the prayer conversations that I had with God (I highly recommend the series  of books regarding conversations with God), I was humbled before God when making my decision for a career. In this career, I have had to stand my ground many times.  As someone that cares deeply about the profession of physical therapy, I stood my ground many times and lost multiple jobs because I wouldn’t sacrifice my morals.

Principle eight, “Live debt free and below your means”

Hello Dave Ramsey! This is where the Ramsey influence comes into play.  I actually purchased this book at EntreLeadeship One Day.

 

You know that saying, If I knew then what I know now then there would be so many changes in life.  Like many, I am coming out with student loans and made some poor financial decisions over the years.  I am now digging out of the hole of debt.  Luckily, we have a big shovel to start digging out of the mess.

If you are in debt, this is a great plan to start following.  I paid off more debt in the previous year than I did in the 5 prior.

 

Principle nine, “Always keep to your budget”

This is something that is very difficult and takes practice.  It takes time to understand fixed and variable expenses.  Trying to cut fixed expenses is hard, but there are companies out there that work to reduce fixed expenses such as Bill Shark.  This company reduced our internet and phone bill.

Variable expenses such as going out have been greatly reduced as my family is attempting to get out of debt.  I’ve been out of school for 10 years and still have student loan debt around my neck.  We are planning on getting out of debt in the next two years, all except the mortgage for now.

 

Principle ten, “Loaning money destroys relationships”

I’ve never borrowed more than $20 dollars from friends or family because the guilt of being in debt to them changes the relationship.  I don’t think that it affects everyone the same way.  My brother has owed me $100 dollars for years and it’s just never going to be paid back.  I realize that, and it was the best $100 dollar lesson I could’ve learned.

Principle eleven, “set aside the first ten percent to honor God”

I have been much better at this over the years, but am no where near tithing.  Honoring God doesn’t mean that I have to give to the church.  I now donate to so many of the local charities and purchase gifts for kids in need during Christmas.  This was the first year that I did the kid’s gifts, but it felt great.  The thought that a kid wouldn’t have a gift to open is heartbreaking.  Pairing that with the fact that the only gifts that this particular kid wanted was winter clothes, jackets and boots made me sad.  Knowing that there are kids in this country that don’t have the basic necessities is heartbreaking.

I realized that giving to others is selfish in that the way that I feel after giving hasn’t been recreated by anything else I’ve done.

 

Principle twelve, “Understand the power of partnership”

The ship that won’t sail is a partnership. Understanding the power of partnership is important.  This principle goes beyond business.  A marriage is a partnership in which both individuals work to make the unit stronger over time.  I am still curious as to the power of the business partnership because one person always has more leverage than the other.  This leverage can be dangerous to the partnership because it can always be held over the other’s head.  If there is a 50/50 partnership, which includes 50/50 work ethic, I may be convinced otherwise.  I just haven’t seen it yet.

 

Thanks for reading and I hope you get something from the links provided in the article.

McKenzie Method and back pain

I recently just read a case study, which I will be referencing a lot in the future paragraphs, regarding the use of MDT in the treatment of a patient with pain.  This is not uncommon, but what makes it special is that that the patient has a diagnosis of recent transverse process fractures in the spine.  Hope you find it interesting also!

 

First, Mechanical Diagnosis and Therapy (MDT) is also known informally as the McKenzie Method.  You can read more about the method with this link.  Also, this method is used by therapists all across the world as seen  here. Finally, if you are looking for more in depth information on the method, it can be found here.  There is so much information out there regarding MDT that there is no need for me to go back and explain it all again.  Read the previous stuff that I did. 

Patient characteristics

  1. 24 y/o female referred with left sided back pain
  2. 10 week previous involved in accident in which she was hit by a car while walking
  3. Transverse processes fractures from L2-L4
  4. Evaluation occurred about 10 weeks following accident

Examination:

  1. PT and MD agreed to patient generated forces only
    1. This is important! The most important part of this statement is the communication that is taking place between the PT and the physician prior to the patient entering the clinic. Also of importance to note is the trust that the physician has in not only the therapist, but also the method, as the patient was specifically referred for an MDT assessment. 
  2. Left low back tightness and numbness constantly
    1. Pain was intermittent
  3. Sometimes worse with sitting and tenderness when sitting against a hard-back chair, sometimes worse with activity and waking a few times per night due to pain
    1. The above is also important as this indicates high irritability as the symptoms can be constant and pressure can increase the symptoms. Also, the patient is waking during the night, which is historically correlated to an inflammatory process, but can also be position related. 
  4. The patient was better with standing, walking and lying
    1. This could mean that the patient has a directional preference for extension, prefers to be unloaded or is better with movement. The only way to figure out how these variables play a role in her symptoms is to start playing/manipulating the variables and watch the outcomes.  This is no different than any other science-based projects.  We have the opportunity to work with patients that trust us.  We have a responsibility to work with the patient in order to educate them as to the process of attempting to narrow down the variables at play regarding the symptoms.  Once the patient is agreeable to working together, we can change the inputs to the brain and assess the outputs in terms of physical changes and perceived changes from the patient. 
  5. Worse with postural correction, but no worse with using a lumbar roll.
    1. Postural correction, when performed according to the book is a hands-on technique and in doing so may be too much for the patient to tolerate. The fact that the patient is no worse with a lumbar roll means that extension, in and of itself, may not be bad but increasing the range in a loaded position may not be preferable at this time.
  6. Patient was issued back bends, repeated extension in standing, after the first session due to her complaints with flexion based movements and improving with standing and walking.
  7. Visit 2 overall unchanged and the patient was instructed to lean against a countertop to provide a fulcrum to lean against during the movement. This is, theoretically, to allow for increased force during the movement.
    1. The worst response to any movement that I can see in the clinic is “no overall change”. If we can’t change the patient’s symptoms or movement patterns, or strength, then it is hard to predict if the patient will respond to therapy over the course of care.  If the patient gets worse during the evaluation, it is not good/bad, just a response.  The thought is that if the patient is able to change for the worse, then the PT should be able to create a change for the better.  It’s simplistic thinking, but in the presence of a mechanical and not chemical issue, it is a common response to see in the clinic.
  8. Patient was better with either the countertop version of backbends or when doing pressups
    1. This is a version of progression and alternative versions of the same exercise. For example, the thought is that during a pressup, the patient is able to move further into the range of extension than during a back bend.  This may be because of eccentric loading of the global flexors or because of gravity assistance during the pressup on the lumbar spine.  I haven’t seen any research that definitively states why, but these are the thoughts.
  9. By the third visit, the patient reported 80% improvement with no pain.
    1. This is very common to see when a patient presents with a mechanical response and is categorized as a derangement (see all of the links above). It’s not uncommon to reduce symptoms in less than 7 visits. 

 

The big picture lessons from this case are:

  1. Don’t be afraid to assess a patient systematically.
  2. Communicate with other members of the health care team.
  3. Be willing to change your plan when something isn’t progressing accordingly.

Elenburg JL, Foley BS, Roberts K, Bayliss AJ. Case Report: Utilization of Mechanical Diagnosis and Therapy (MDT) for the treatment of a lumbar pain in the presence of known lumbar transverse process fractures: a case study. JMMT. 2016;24(2):74-79.

If you are having back pain and want to be evaluated by a certified MDT therapist, you can find me here.

A personal synopsis of the Monk and the Merchant

My take on the Monk and the Merchant

Let me first say that I read through the first 30% of the book and got nothing from the book.  I was tempted to put the book down and just be done, but remembered that it was recommended by Dave Ramsey for a reason and just continued to trudge through it until the book piqued my interest.

This was my first lesson from the book: If I can build up my reputation and gain the trust of people, I will be able to lead them.  Had I not trusted in the words of Dave Ramsey, the author of many books and a highly ranked  podcast, I would have stopped reading.  If I can gain the trust of people in my immediate area and truly am altruistic in my teachings and business, then I can also achieve this type of success.

“Principal one: work hard and God will prosper you”

Hard work has never been an issue. As the son of a laborer, who never missed a day of work unless he had a fractured bone, work is expected. I never thought of work as performing God’s will. We were given the ability to bless those around us with our talents and through those blessings we receive thanks in the form of dollars. This aligns with Rabbi Daniel Lapin‘s theory that those that are paid much are only paid much because they affect many people. Watch the video here.

“It’s easy to have an idea. But it’s another thing to commit time and effort to it. “

This very much describes me. I have the attention span of a squirrel. If it can’t be done in 20 minutes, it’s probably not going to be done. Doing things like writing the blog, scanning paperwork into the computer system at work, creating presentations etc. etc. are not my strong points. In an average day I have so many ideas that it’s hard for me to even capture them. Acting upon those ideas is where I have difficulty. If anyone has ever listened to Barbell Shrugged I can very much relate with Mike Bledsoe. If you haven’t listened to it, I highly recommend it.

“… There are a lot of great ideas. But if we allow the negative influences of others to stop us, then we will never accomplish anything.“

This one is a great quote but doesn’t necessarily apply to me. Naysayers and negative influencers provide more fuel for me to perform the activity that they’re telling me that I’ll fail at. I think that if a person is so easily swayed by a negative influence, then the idea that they have is not very convincing. It’s easy to fight for something that you internalize, but hard to defend a fleeting thought against pressure from those held on high.

“So, the first principle is basically, ‘Seek God and decide what you want to do, and then do whatever it takes to make it happen.’ Oh, and work hard at it.”

I like that the quote mentions seeking counsel in God.  A long time ago as a student at Joliet Junior College, I was torn between going to medical school and becoming a teacher.  My prayers were answered in that I was to go to school to become a teacher.  During these prayer meditations, God spoke to me not to just become a teacher, but to also follow the path that it takes me to have an impact on many people.  At the time, I assumed that this meant that I would be able to affect many at once with my time as a teacher, but alas, I was wrong.  The path from studying education led me back to healthcare as a PT.  In this field I have influenced over 18,000 people with a blog, over 60 students, thousands of patients and multitudes of people through volunteering my time in this profession.

By the way…none of that would’ve happened without hard work in the process.

“Principle two: Financial prosperity is often connected to soul prosperity”

It’s so simple.  It doesn’t have to be difficult. Find that thing that lights up your heart and follow it.  It will not let you down!

I’ve never had a single position for more than 7 years and even that’s a stretch if you consider how many times I left that position and return.  Again…squirrel.

I have an obsessive demeanor.  I do that what I enjoy and do the hell out of it.  At some point, the joy dissipates and then goes away altogether.  At that time I go find something else that lights up my heart.  Some people love challenges; some people love helping others; some people love to be recognized; some people love to be paid.

Go find that thing that makes you smile. I find it incredible how many people that I come in contact with that do not know what makes their heart sing.  It must be hard to live like that.  How can one ever be satisfied? Happy? Complete? If one never finds that “thing” that makes their eyes shine, heart sing, and face light up, how hard must life be?

There are many ways to help people. Many ways to be challenged. Many ways to be recognized etc.  Once I feel completed at one version of helping others it’s time to move to a different version of the same theme.

It does become harder as one has more responsibility because each move affects more than just you.  For instance, it was easy to transition from pushing carts at Sam’s club (helping people) to putting on tires (helping people) because I had no responsibilities to anyone other than myself.  It was a much harder decision to go from a financially lucrative position at a local hospital to a private company with less financial incentive.  I had to have a conversation with my wife and we discussed how it would affect our family.  In the end, this change has allowed me to help more people than I ever could had I stayed at the hospital.

“Principle three: A man must do whatever he can to provide for his family”

This goes hand-in-hand with the last principle.  I have to provide for my family and that ranks right up at the top with personal satisfaction.  Because of the decision to leave the financial stability of the hospital, I’ve taken on a second job to try to narrow the gap between what I used to make and what I make now.  Again, work is not the problem, but other problems do arise.  For instance, it is now one additional day that I am away from my family.  One additional day that I don’t get to recharge.  One additional day in which I have responsibilities outside that of just my family.

We must question our decisions and determine if we are on the right track.  I am sure that I made the right decision to take the job at the lower paying position, but not sure if I need to keep the second job or choose a different path.

“Many men have robbed themselves of their destiny because they have allowed discouragement to rob them of their dreams”

I’ve been blessed throughout my life.  A good friend, Mary Jones, described my life like this. It goes beyond me though.  I’ve been blessed with a support system that treated me fair and always encouraged me to just keep going forward.

Not everyone has been as blessed and we all start the race at a different starting line, but we all must run.

Principle four “Trials develop your character, preparing you for increased blessings.”

As long as you don’t stay down, you will grow stronger and more resilient.  When you become stronger, more people will follow.  I’ve had many trials in life but was too dense at the time to know that quitting was an option.  I was too dense to know that there were other possibilities and that failure was an option.

These trials and difficulties, we all have them, have led me down the path.  We all have fears and skeletons in our closets that push us or create chips on our shoulders.

 

HOW one responds to those fears, skeletons, and chips will define WHO one becomes in life!

Excerpts from The legend of the Monk and the Merchant

Progress isn’t always linear

I went months without setting a PR when I was powerlifting. It was horrible. When I first started, I made gains weekly just by walking into the gym and breathing the musky air from the dungeon. I could stand next to the strongest guys, and women, in the world and get stronger from their aura. It wore off over time and I had to come out with some tactics to get stronger. I’ve used chains, rubber bands, static holds and changed the tempo of the repetition. I did what I had to in order to make progress, albeit slow progress at times.

Now, I’m a Doctor of PT and I am managing a clinic. During the Fall, times were a boomin’, but the winter brings with it a season of decreased want to leave the house. People don’t want to come to therapy multiple times per week in order to alleviate pains that have been there for years. “It can wait another month”, they think. “It can wait until winter’s over”, they think. If they only knew that the solution could be easy!

Wait…that’s my job to educate them!

I was once told that if you build it, they would come. Well, that guy was wrong and I’m busting my behind in order to get them to come.

These times of scarcity allow for some time to create my brand, donate my time to the communities and allow me to learn more about the people that I will serve. It’s hard to watch the numbers go down in the gym, but it’s very frustrating to know that I am going through these patterns over again 10 years later.

There is a light at the end of the tunnel. Here’s the light from 10 years ago.

“Dealing with the temporary frustration of not making progress is an integral part of the path towards excellence.”

Christopher Sommer from the book Tools of Titans

Marathon or sprint

“Customers and employees come and go. Supporters are with you for the long haul.”

Blake Mycoskie, Founder of TOMS shoes

I recently took over as a manager in an outpatient physical therapy clinic. I would love to say that I came in and that business is booming, but it’s not so…yet. I’m busting my tail and those patients that have come into the clinic are no longer just patients. They are supporters. Heck, they might as well be a giant billboard walking around town. I’m getting new patients coming in and their doctors are telling them that they are hearing great things about me and the clinic! This is exciting. It takes a small event to create a ripple in the ocean. That one patient telling the prospective patient about me and the clinic is the rippling effect that I need.

Not everyone needs PT. It’s a shock to hear that coming from a PT! I’m telling you that you may not need my services, which in turn means that you won’t spend your hard earned money on my services. Financially, this statement hurts, but I learned from a wise business man that service to the people is the most important part in business. I had the opportunity to hear his story and ask questions about his journey. This man has a following, with me included in that line. He built a career on serving his customers and creating supporters.

This guy is one that I will attempt to emulate in the coming years. Doing good deeds can’t hurt anyone. When I go back and review these blog posts next year, I’ll give an update on my attempt to emulate the best businessman that I had the opportunity to chat with this year.

Thanks for reading.

“Fear can be useful”

As you can see, I’m in the middle of reading the book from Blake Mycoskie, founder of TOMS shoes.

I have never really had to work hard for anything. At least I don’t consider what I did hard work. I was comfortable. I had goals, but knew that they could be achieved with just a little bit of time and a continuation on the trajectory of life that I was on. BOY WAS I WRONG!

Things changed dramatically after our second child. Let’s paint a picture.

My awesome wife is a PTA and wants to go back to become a Doctor of Physical Therapy. We had our tentative plans on place for her to apply (and of course get accepted) into one of the two programs in the country that allow for this transition. We, meaning she, was pregnant at the time and were expecting to love after the baby was born.

Life happens and sometimes there are situations that you can’t predict or prepare for in life.

Our second daughter was born with Down Syndrome. We weren’t aware of it until the next day, as we were parents enjoying the birth of a child. Our lives changed that day. I can speak from my perspective.

I became afraid.

I wondered how will I support this child through adulthood?

I see and try to prepare for worst case scenario at all times?

Will my child be able to take care of herself?

Will my child be able to hold a job?

Will my child be able to live alone?

All of these questions have to be faced by parents with a special needs child. I don’t like to wait for things to happen in life, but like to prepare and over prepare.

I was afraid that I would fail my child and therefore fail my family, my wife and my children. That fear lit a fire under my ass that I have never had before. There is more focus now than I’ve ever had previously.

Here’s the sad part…it’s not hard to shoot to the upper echelon of our profession. Since my daughter’s birth, I worked and worked on creating myself as a brand. This was to prepare for a move that had to happen. I now need to create a legacy for my family. I was comfortable at my previous job, but it wouldn’t have provided the amount of financial stability that I needed to possibly support a child through retirement. I had to make a move.

I worked on building a brand and within 1 year was named among the top 40 influencers in our field by Updoc media. I started mentoring PT students and other PTs throughout the country. I started a Facebook show called People you should know. I doing more volunteer work now than I had in the previous years.

I thought that I was “busy” before Natalia was born, but now I’m no longer busy…I’m productive. I opened a clinic in Joliet with the purpose of trying to give back to the entire city. It’s been said that if you want to make a million dollars, you have to help a million people. My mission has been set to help as many people as I can because I know that this is the only way to face my fear of failing my family.

If you found this to be inspiring, informative, or entertaining…share it so others can read and learn from my experience.

Thanks.

Story

“Having a story may be the most important part of your new venture…”

We all have a story. I actually have spent a good amount of my time recently learning about other people’s, group’s and mission’s story on my FB page People you should know. My story started a long time ago, but I won’t bore you with the details. The one part of the story that is most important is that I always look for the next opportunity to succeed. At Sam’s club, I was named employee of the year in 2013 and quit soon thereafter because I had reached my ceiling. There was no other Hill to climb or challenge to face. I know that it sounds like a small feat, but I worked hard to reach that status. Unfortunately, the journey was worth more than the victory, because my journey seemed complete.

My PT career has taken a similar trajectory. I started in a clinic, that I was excited to work at, in order to learn as much as I could. After 2 years, I lost that zest because I was more like a robot than a sponge. I wasn’t learning…growing…as much as I was simply going through the motions of treating patients. It sounds horrible, I know, but I was pretty good at using the McKenzie Method back in those days. If you’re familiar with Mariano Rivera, you know that he had one pitch. It was an unhittable pitch for a long period of time. He built a career on throwing his “cut fastball”. I spent more than two years honing my craft as a McKenzie based PT, but after 2 years I felt like the game wasn’t any fun anymore. I remember taking the trash out after 18 months on the job and thinking that I was “bored” with my job and could treat patients with back pain while dreaming.

Not soon after, I left that job and took a hefty pay cut in the process (you’ll start to see a pattern that I didn’t see until recently). I switched to a hospital-based outpatient department. Mind you, for two years I saw nothing but patients in pain with a generic diagnosis of: low back pain, neck pain, shoulder pain, knee pain, hip pain so on and so forth. I don’t mean to demean the patient’s pain, but c’mon “low back pain”?! Is t that what the patient told the doctor at the beginning of the session. The doctor then turns around and gives the patient a referral to PT stating back pain. (Venting a little).

At the hospital, I encountered something that I hadn’t encountered in the two previous years…a protocol! A protocol is similar to the old book “paint by number”. There is. O significant thought that goes into treating these patients post-surgically because we are bound to treat the patient by following the directions given. I had the hardest time treating patients post-surgically because I spent the previous 2-3 years with constant algorithms floating through my head. Think John Nash from “A Beautiful Mind”. I may be exaggerating, but that’s what it feels like at times. For those two years I was playing a chess match with the patient’s symptoms and pain. I was always playing 5 moves ahead with an answer for every patient move. (A patient move is considered his/her response to a previous exercise or intervention. For instance, a patient can only always respond one of three ways: better, worse, same). I had a response for each of these answers and just worked through this chess match with each patient. My biggest fear was “paint by number” because the patient would come in and…game was already over because I couldn’t make any moves.

I digress.

I matured while working at the hospital. I learned to be a team player instead of playing clean-up or closer. I learned that when horses pull in the same direction that they can pull harder than they could as individuals. Unfortunately, I also learned something else about me…I hate when the game is over. I continue to search for ways to grow and be better day-day. I reached the end of my limit at the hospital because the opportunities to play and grow were no longer available.

This is where my story starts again. This time, this time, the game is much bigger. The chess board has expanded. The moves I can make are multi-variable. I liken my current position in the profession like playing a continuous chess match in which the boards are suspended above each other like floating plates. When one piece gets taken it gets placed on the board above the previous board. The game ends when all of the pieces make it to the top board and only one piece remains. There is no tipping pieces. There is no quitting. Only moves and reactions. This is the equivalent to the biggest algorithm I have ever got to play inside. I can make on”wrong” moves, only temporary losses.

Life is pressure, but the game is fun.

Goodnight all.

Thanks for reading some of the late night ramblings.

Btw, the quote was from Blake Mycoski in “Start Something That Matters”.