Flashback: Year 1 of Interviews!

I want to say a big “THANK YOU” to all my interviewees and readers. I’ve learned tons from all of you. The following are some of my favorite quotes from the interviews. Enjoy!

Dr. Nick Nordvedt:

I think an insatiable desire to learn and grow professionally has been the backbone to my evolution as a physical therapist.  Being happy with the satus quo is something that has never felt right to me, so I believe this has given me the desire to grow professionally.  The biggest influence on my thinking and treatment of patients has been the mentors I have had over the years.  I have had several mentors emphasizing different aspects of physical therapy along the way: everything from scientific reasoning to patient satisfaction to business, but all leading to a patient centered approach to care.  Providing mentorship to students and new grads is naturally the next part of this process, which again, helps me grow professionally as well.

Dr. Monique Caruth:

Life is an adventure for sure and I see my life as an ongoing journey. I’ve had many trials and tests, lessons learned and memories created. I always knew I wanted to be a physiotherapist, but never in my wildest dreams did I conceive that little precocious girl growing up in a rural village on the tiny island of Tobago would one day separate herself from her family, her source of comfort, strength and joy, leave behind the world as she knew it to pursue her dreams in a huge and whole new country, graduate and begin and grow a business all in 13 years…this has been and still is the most memorable adventure so far and I thank God for placing the right people, at the right time under the right circumstances to make this all possible. This has been great. I enjoyed it. Thank you for allowing me to share.

Dr. Ben Fung:

I make being a minimalist a mental state and operational life choice. I try not to make things too complicated – always holding the bigger picture greater than the details that comprise them. Many times life circumstances are not complicated. Many times the solution is easy. We just make it complicated because its more “fun” – it fuels some type of elemental desire embedded in human nature.

Erica Meloe:

Speaking of differentiation, creating a “unique” you, will be your answer. This brings me back to the story and how people will remember you. I am not a branding expert, but if you exhibit and do what comes naturally to you, that will authenticate and brand you. Because, in the end, if you don’t rely on your strengths to succeed, you will only flaunt your weaknesses and that is foolish.

Dr. David Browder:

One of the most professionally satisfying periods in my professional career was leading the PT/OT clinic at the second largest field hospital in Iraq during Operation Iraqi Freedom III in 2005.  This was a great deal of responsibility for a Captain, and definitely forced me to grow into a leadership role perhaps faster than I otherwise would have.  Working in mass casualty situations and leading a small team in high stress situations in my military career is something that I think makes it easier for me to deal with the (comparably low stress) operations of even a dramatic private practice day.  The Air Force also paid for a bachelor’s degree, two masters degrees, a fellowship and my tDPT.  I’m proud of my service but consider myself blessed to have been granted the opportunities the Air Force gave me.

Dr. Sandy Hilton:

Learn to separate the idea from the person that has the idea, and to not be afraid to gently discuss errors in thinking – we all have them.  There is much biologically unsound medicine… things that appear to help but are likely not helping by the way they are explained (homeopathy, acupuncture, ultrasound…. specific manual therapy techniques)… I think we need to be the most efficient providers instead of the most complacent providers.

Dr. Erson Religioso, III:

Catching 2 of my 4 daughters, the 3rd in the hospital – instant Niagara Falls coming out of my eyes, seriously the most emotional I have ever been. From dry to huge tears of joy stat! My fourth and most recent daughter, was a home birth. Watching my amazing wife going through labor, coaching her when needed, reassuring her doubts, was really breath taking. It was all her, with very little coaching needed this time. Our midwives suggested she labor in the tub for a bit, then she got the urge to push, and in two pushes, out comes Leila into my hands in the water! Life is an adventure, and I can say I am a baby catcher!

Jerry Durham:

My business partner was the first one I heard say that “balance” means there has to be a negative. So, to ask about “Work/Life Balance” is implying that there is always a negative occurring. I dont want to approach it as a Negative/Positive. I like to approach it as ‘How do you prioritize your work and Life activities on a regular basis, Daily, weekly, monthly… So, this is where I start the discussions with myself, my wife and with my biz partner.  The question to them is “What do YOU need from me?” Obviously I already know what is expected or I’ve already had the discussion of what I can deliver. I can then make decisions based on my priorities and let people know when and if I can follow through. So, no surprises for anyone. Where people go wrong?, they don’t have frequent conversations with their spouse/partner/significant other to be discussing these weekly at a minimum. Priorities shift daily, weekly, monthly those affected HAVE to be kept in the open conversation. DON’T assume anything.  20 yrs married, 13 years business partner this still holds true

Todd Hargrove:

At some point in my legal career, I noticed online that there was some sort of seminar in Seattle on low back pain. I wanted to attend, but of course I couldn’t because I was a lawyer not a PT. This was just a while after I had spent a couple days bored out of my mind at a continuing legal education seminar. It occurred to me that it might be a good idea to have the kind of job where I was actually interested in the continuing education. It was a good thought!

Heidi Jannenga:

I hope you’ll join us in our efforts to better brand private practice physical therapy. We’ve talked a lot about the possibilities and the potential to take our branding to the next level, but none of this is doable without a united front and a unified effort. All of us would benefit from more patients seeking physical therapy more often. I want to set aside the silos and forget specialties for the moment and focus on one singular goal: getting patients through the doors of private practices across the country.

Bruce Wilk:

Trying to fix my own running injuries is what led me to become a physical therapist.  As it turned out, I did not actually learn anything about running injuries in physical therapy school, but I did learn a lot about injury management in general. PT school also taught me the value of good, competent manual therapy — and I still emphasize that to the young physical therapists I teach in my clinic today.  Becoming a physical therapist was just the first step on my lifelong quest to understand running injury management.

Dr. Edo Zylstra:

This is a seriously funny story. I was teaching a course in Columbia, Maryland, for about 36 people. We had a staff of six instructors, as we like to keep an average instructor to student ratio of 1:7. One of our instructors walked up to me in a very excited way and said, “Do you know who is taking this course?” I said, in my typical sarcastic way, “Uh 36 people? Bob Duvall is taking it!”  Bob Duvall from Atlanta Sports Medicine, a good friend of mine and relatively well known on the east coast. “No” he said. “Gray Cook!” I looked at him with a blank stare and said, “Who’s Gray Cook?” He was dumb struck and said, “Only one of the foremost experts in strength training and functional movement! You seriously don’t know who he is?!”  “No.” I said, “and by the way, he is taking our course like everyone else, so don’t treat him any different!” He walked away with a grin on his face and a bit of a star struck look. I really didn’t know who Gray was. Never heard of him, let alone what he was known for. I think that is why we became fast friends. He was tired of being treated like some kind of celebrity and I treated him like everyone else, like he actually is.

Brad Beer:

Success is developed through the navigation of an array of challenges and various learning opportunities that life both professionally and personally generates.The degree to which you succeed and progress will be determined by the degree that you stop to evaluate your learnings and lessons.It has been said that experience is an OK teacher but evaluated experience is an even better teacher.

Jessica McKinney:

Our children are surrounded by people who love them and are invested in their development consistent with how we are. I talk to my kids a lot about why I work – not, “Mommy has to work to buy groceries, school supplies, and pay for our home”, but “Mommy helps take care of other people, especially other mommies, so that they can be healthy and do what they want in life”. When they complain about homework, I talk to them about homework in the context of preparing you for meaningful work later in life.

Dr. Seth Oberst:

We need to move away from dependence on 3rd party payers and referrals as we are letting that dictate how physios operate. Fee-for-service and direct access are great for the profession as they make us more accountable. Stop providing a KIA and asking to get paid for a BMW. We need to take the banner of movement experts and the tremendous opportunity that comes with truly understanding and treating movement dysfunctions (NOT pathoanatomy) and run with it, own it before someone else does.

Dr. Laura Neuburger:

The biggest take away was not to stress over the little things. Learning the natural ebbs and flows of business has been a little challenging but I have become much better at not stressing out when my schedule is not full for the following week. More times than not, by the time Monday comes around the schedule is full and I have the opposite problem of trying to find appointment times for patients. I have learned that if you are working hard and doing the right thing, success will follow.

Andy Lodato:

Remember, we all got into this profession because we felt a calling to help people. When you are in the hospital, clinic, etc. remember it ain’t about you, its about them.This is a profession, not a job! Professionals are constantly updating, improving and honing their craft to make themselves the best they can. I really believe if more PTs treated physical therapy as a profession vs. a job, we would eliminate a lot of the problems we face right now.

Ann Wendel:

The big lessons I’ve learned are to welcome change and endings as a necessary part of life, and to be decisive and act, so that you can stay successful in both business and personal relationships.

Julie Wiebe:

Step outside your typical population and learn from the other specialties. I have gained so much from my partnership with pediatric specialist, Shelley Mannell. We jokingly refer to our collaborations as our own private Combined Sections Meeting. How many shoulder courses can you take, really? Explore neuro or peds or womens health and see what a different perspective can do to shake up your clinical reasoning.

Thank you everyone!

@Cinema_Air

Efficient Communication Saves Lives…

While many medical professionals spend their days juggling patients and insurance companies (and more!), they are also expected to keep up with the latest research. Research that might save lives and improve quality of lives are obviously important, but what about the integration of new or novel data?

Change in the medical world takes years. Possibly decades. This passage from Atul Gawande’s The Checklist Manifesto speaks to the difficulty and delay in adoption of new or novel data derived from research:

     Sometimes, though, failures are investigated. We learn better ways of doing things. And then what happens? Well, the findings might turn up in a course or seminar, or they might make it into a professional journal or a textbook. In ideal circumstances, we issue some inch-thick set of guidelines or a declaration of standards. But getting the word out is far from assured, and incorporating the changes often takes years.

One Study in medicine, for example, examined the aftermath of nine different major treatment discoveries such as the finding that the pneumococus vaccine protects not only children but also adults from respiratory infections, one of our most common killers. On average, the study reported, it took doctors SEVENTEEN YEARS to adopt the new treatments for at least half of American patients.

What experts like Dan Boorman have recognized is that the reason for the delay is not usually laziness or unwillingness. The reason is more often that the necessary knowledge has not been translated into a simple, usable, and systematic form. If the only thing people did in aviation was issue dense, pages-long bulletins for every new finding that might affect the safe operation of airplanes – well, it would be like subjecting pilots to the same data deluge of almost 700,000 medical journal articles per year that clinicians must contend with. The information would be unmanageable.

(Emphasis mine)

While we cannot deny the importance of medical research, it is just as (maybe even more) important that the information is structured into an actionable architecture for efficient practicality.

@Cinema_Air

The Space Between Cause & Effect

We often find ourselves hooked on finding straightforward explanations for why things turn out the way they do. Sometimes we’re right, but other times explanations can be difficult to forge despite the manifestation of its effects. This seemingly straight arrow of Cause and Effect can get complicated pretty quickly in a Complex System. From Michael Mauboussin’s Think Twice:

Humans have a deep desire to understand cause and effect, as such links probably conferred humans with evolutionary advantage. In complex adaptive systems, there is no simple method for understanding the whole by studying the parts, so searching for simple agent-level causes of system-level effects is useless. Yet our minds are not beyond making up a cause to relieve the itch of an unexplained effect. When a mind seeking links between cause and effect meets a system that conceals them, accidents will happen.

We seem to be obsessed with offering explanations and acting on them. Foregoing explanatory theories while obtaining the benefits of the process is not in vogue…but it might be useful when sifting through our data-driven age. From Taleb’s Antifragile:

For a theory is a very dangerous thing to have.

And of course one can rigorously do science without it. What scientists call phenomenology is the observation of an empirical regularity without a visible theory of it…. Theories are superfragile; they come and go, then come and go, the come and go again; phenomenologies stay, and I can’t believe people don’t realize that phenomenology is “robust” and usable, and theories, while overhyped, are unreliable for decision making – outside physics.

Taleb later continues:

We are built to be duped for theories. But theories come and go; experience stays. Explanations change all the time, and have changed all the time in history (because of causal opacity, the invisibility of causes) with people involved in the incremental development of ideas thinking they always had a definitive theory; experience remains constant.

… Take for instance the following statement, entirely evidence-based: if you build muscle, you can eat more without getting more fat deposits in your belly and can gorge on lamb chops without having to buy a new belt. Now in the past the theory to rationalize it was: “Your metabolism is higher because muscles burn calories.” Currently I tend to hear “You become more insulin-sensitive and store less fat.” Insulin, shminsulin; metabolism, shmetabolism: another theory will emerge in the future and some other substance will come about, but the exact same effect will continue to prevail.

The same holds for the statement Lifting weights increases your muscle mass. In the past they used to say that weight lifting caused the “micro-tearing of muscles,” with subsequent healing and increase in size. Today some people discuss hormonal signaling or genetic mechanisms, tomorrow they will discuss something else. But the effect has held forever and will continue to do so.

Mauboussin (again from Think Twice) offers some actionable points (in bold, followed my paraphrasing of his explanations) on how to improve the odds of making better decisions in complex systems.

1. Consider the system at the correct level. Basic idea here is to differentiate from examining the trees from an examination of the forest. If you want to study the forest (system), then study it at the level of the forest as a system instead of getting seduced by the intricacies of the trees. Consider the levels of organization and study the level of organization that you wish to influence. Systemic versus Reductionist.

2. Watch for tightly coupled systems. The more diverse the system, the better the wisdom of the crowd. With a reduction in diversity the system is much more susceptible to influences between the components of the system. The system may tend to couple together in these circumstances; therefore, it might be worth watching.

3. Use simulations to create virtual world. This one seems straight-forward: simulate the scenario to test the strength of your ideas and pull lessons that may apply to the complex system you want to engage. This one (I think) is a bit tricky since the real world and a virtual/simulated world might not level out on the layers of complexity.

Are you too attached to theories?

@Cinema_Air

On Complaining, Pain, and What to NOT Focus On…

The following excerpt from The Tim Ferriss Show where Tim interviews Tracy DiNunzio is fantastic!

Tracy DiNunzio: Yeah, I tried like complaining and being bitter. It didn’t
work. It was just terrible and I was definitely bitter. I
definitely went through my ups and downs. Okay, so
Stephen Hawking actually has the best quote on this and
also the best like legitimate story of, you know, has the
right to complain probably more than anybody. He says
that when you complain nobody wants to help you and it’s
like the simplest thing and so plainly spoken. Only he
could really say that brutal honest truth, but it’s true, right?

If you spend your time focusing on the things that are
wrong and then that’s what you express and you
projection to people you know, you don’t become a
source of growth for people, you become a source of
destruction for people. That draws like more
destructiveness. I think that because that was how it felt
for me when I was thinking about how I was in pain and
talking about how I was in pain, it started a momentum
that went in a negative direction in my life. At one point, I
would say, I don’t know, probably in like 2006-2007, I just

decided to, it’s kind of like Tim Ferriss challenge, but I
didn’t know you then. But, I put myself on like almost a
complaining diet, where I said like, “Not only am I not
going to say anything negative about the situation I’m in,
but I’m not going to let myself think anything negative
about it.” This coincided with, I had lost feeling in my feet
because of the surgeries, so I don’t have any feeling in
my feet, so I have to keep my eyes open when I walk.

At the time, I was reading about how plastic the brain is
when it comes to filling in the gaps where you’re losing
information and starting to understand just scientifically
how plastic the brain is, I thought, “Well, I refuse to have
negative thought and I only let myself have a positive
thought, eventually that’s going to change my brain, I
don’t know how long it’s going to take thought.” It took a
long time and I wasn’t perfect at it, but I definitely feel like
… Not only did replacing those thoughts helped me start
moving my life in a better direction, where I wasn’t
obsessing about what was wrong and I was just thinking
about what was right, it also made me not feel physical
pain as much, which is very liberating and kind of
necessary if you want to do anything because if you’re in
pain, it’s really hard to do anything else but feel it.

You know probably more about this than I do the way that
the body processes pain and how pain is in a way just a
thought. Yeah, I did this experiment where I tried to
control my thoughts for some time. It just started things in
the right direction. It doesn’t mean that everything is
always good. I definitely have days where I am still like,
“This sucks, I wish I just had like normal feet and could
go, run around and not think about all the little things that

I have to think about.” But for the most part, I just don’t
think about it anymore.

Pair the Interview with this blog post by Tim: The 21-day No Complaint Experiment

@Cinema_Air

My Morning Routine

This is something that has interested me for at least the last year. How can I optimize my day so that I feel productive by the end of the day?

Morning rituals have been a popular topic in the last year or so, and it was my first exploration. I’ve found my preferred waking time lies around 2 hours before I have to leave the house. What I choose to do with these 2 hours is, essentially, my morning routine. The following is a list of my attempts to fill these 2 hours in order to optimize my day starting from when I first wake up.

1. Block off the internet. This was my first attempt at altering my morning routine. At face value it is seems very simple, but in practice it can get a bit tricky. Here’s the rule: no social media, email, or internet before 10AM.

2. Read or Write. The first 30-45min might just be the best time to work on that book you wanted to start (or finish). You could also spend this time exercising your idea muscle by trying to come up with 10 new ideas every morning. This, just like everything, else is hardest at first, but after a few days or a couple weeks you’ll be surprised at the connections you can make. If 10 new ideas are too much, then do not settle for less than 5.

3. Liquids. There’s something about rituals that provide a sense of structure and framework to think (about anything). This isn’t new to you; in fact, you probably do this already. What do you do when you’re stressed? Exercise? Sleep? Watch TV? Grab that pint of ice cream? These are routines that you’ve created for yourself without intentionally fostering an end result. So why not create a routine intentionally? A morning routine of making tea or coffee, or simply making breakfast fits the bill.

4. Shower. Not everyone prefers morning showers, but if you are, then consider the James Bond shower. This just involves taking your usual warm/hot shower, followed by a minute or two of cold shower. How cold? As cold as you can tolerate. Ease into it. You’ll be more awake than you thought you could be at this hour of the day.

5. Clothes. Will-power is limited. Minimize decision-making in the morning by doing one of two things: 1. wear the same clothes every day (like a uniform), or 2. decide what you’re going to wear before you go to bed. This step should not involve having to decide which shirt, socks, shoes, etc. to put on in the morning.

Mea Culpa: I haven’t stuck to this 5 step routine as consistently as I hoped I would, but I can say that having some routine puts your day on the right track from the start. You might include other activities in your routine; maybe running, exercise, yoga, meditation. Whatever you chose, it should probably be something that you want to do in order to become the person you’ve always wanted to become.

What’s your morning routine?

@Cinema_Air

Deliberate Practice

Michael Mauboussin (from Think Twice) on Deliberate Practice:

Let me emphasize one point. I suggested that people become experts by using deliberate practice to train their experiential systems. Deliberate practice has a very specific meaning: it includes activities designed to improve performance, has repeatable tasks, incorporates high-quality feedback, and is not much fun. Most people – even alleged experts – do not come close to satisfying the conditions of deliberate practice and, accordingly, do not develop the necessary abilities for reliable intuition.

@Cinema_Air

Interview with Julie Wiebe, BSc, MPT

Julie Wiebe’s ongoing professional evolution is simultaneously unique and motivating. I was fortunate enough to interview Julie and, as expected, the topics were wide-ranging – from Pelvic Health to Physical Therapy Residencies to Teaching Abroad. As you may already know, Julie is a heavy hitter in the #PelvicMafia. Read her blog post for more info: The #PelvicMafia: How It All Began...  She runs a #cashPT clinic in Los Angeles and has a wonderfully informative website that’s well worth your time.

You’re in for a treat. Enjoy the interview!


First, what did you have for breakfast today?

Eggs, Toast and fruit.

What initially sparked your interest in Physical Therapy?

As long as I can remember I wanted to be in medicine. I was always the doctor when we played hospital and Emergency One was my favorite television show (revealing my age!). My dad was a medical researcher and I remember him coming home with a blood stained lab coat, it fascinated me and fueled the dream. I was planning my path to medical school, and took a Health Careers class my senior year in high school. I was excited to see doctors in action as we rotated through different departments of the hospital. Never once did I see a doctor work with a patient. But when I rotated through the physical therapy department, I saw the practitioners face to face with patients, physically interacting with and guiding them. They were in the trenches, that’s where I wanted to be. It clarified HOW I wanted to do medicine…I wanted to walk the path alongside the patients. Physical therapy was a perfect fit. More on my my dads inspiration here: Ode to My Father…

Pelvic Health is a growing niche, and that’s a good thing! All professionals go through a growth trajectory. What was yours? How did you end up in Pelvic Health Rehab?

I came to pelvic health from the outside-in, starting as an orthopedic and sports medicine practitioner with a hazy memory of giggling through the 2-hour women’s health lecture in PT school. Then I had my first baby (now 11). I was quickly humbled by the physical challenge of recovery and the sense that something just wasn’t right inside my body after I had my daughter. My ortho skills and background were not cutting it to help me recover or return to fitness. I recognized that if I was having trouble recovering with my professional background, the climb for other women had added challenge.

I began to investigate what happens to a woman’s body during pregnancy and beyond. The “core” was just coming on the scene around then. It was clear that the loss of connection with the deep core elements was a critical and underlying issue for many of the typical pregnancy and postpartum orthopedic complaints, as well as common women’s health issues. The pelvic floor is a part of that core system, so there was an existing, natural link between the women’s health and the “core crazy” sports medicine worlds. Bringing those two worlds together became my passion. My clinical niche became helping women across the lifespan recover from injury and pregnancy and return to fitness and sport through programming that integrated the pelvic floor vs isolating it. What I have learned from helping women rebuild a solid central foundation, can be applied in multiple populations, because everyone needs central stability for efficient, effective and powerful movement and fitness. Oh, and everyone has a pelvic floor.

My ‘trajectory” has given me a unique path and voice in pelvic health. I am not a traditionally trained internal pelvic health practitioner. I intervene externally with a focus on treating the pelvic floor like we treat all the other muscles in the body to return them to fitness and sport: functional training, neuro re-ed, coordination, form, plyometrics, sport specific training, imagery, etc. Because I came into the pelvic health world backwards, I didn’t know you “weren’t” supposed to do that. So I unintentionally pushed the boundaries out of pure naivete.

You had the tremendous opportunity to teach in Oman. Now that you’ve had 9 months to reflect on the adventure, what are your biggest take-aways from the experience? How has it changed the way you view the world? (Readers, click here for Julie’s blog post on the trip.)

I have done mission work domestically and in other parts of the world, Africa and Mexico, and have a true heart for populations that are underserved and marginalized. An experience in Africa before I became a PT, committed me to not just caring for folks hearts but their bodies, too. My experience in Oman only confirmed that desire. Women’s health and maternal health are areas of great need here in North America and throughout the world. Here we do have resources, and lots of us working towards educating and empowering women towards optimized health, wellness and fitness. Oman is a great example of a highly resourced Arab country, with very progressive attitudes towards women (education, employment, driving, etc.) but limited practitioners to help. There are TWO pelvic health practitioners for 2 million Omanis and 1 million ex-pats (lots of Europeans live there). There is great need. I am trying to support them from afar.

When I returned I talked to my Missions pastor about my trip and we began a conversation about creating medical teams from within our church. The first one to meet a request he had received from an Egyptian partner church.  They needed practitioners to go into Kurdistan to a Syrian refugee camp for those who had fled the conflict in their home country. One of the major needs was for women’s health care givers because it is primarily women and children that have been displaced. September 2014 was the month we had kicked around going. Various things got in the way, and the trip never got off the ground. But it has not escaped me that ISIS is parasitically enveloping that part of the world right now. I am glad we and others (especially other Arab nations) are stepping in to stop the horror. Love that the lead pilot from UAE is a woman. Chicks rock! We had folks from many of the Gulf Coast Countries at our course . That kind, funny, smart, amazing group of people is who I see when I watch ISIS gain ground. We only see a perspective of the Arab world that highlights the extremists. ISIS is not representative of all Arabs or the warm and welcoming Arab culture and people I was exposed to.

You also had the opportunity to spend some time abroad prior to re-establishing your practice in the US. Tell us about this experience and its impact on you.

My Canadian husband, our two Can-american anchor babies (aka half-breeds as my husband calls them) and I  moved to the Greater Toronto Area from Los Angeles in 2006. We lived there for about 3.5 years for a job for David. We took the opportunity for all sorts of reasons, but one of the biggest was it gave me a chance to stay home full time with our little ones. I LOVED it! I kept my professional brain moving by spending their nap times reading research and books. It was actually my organic food habit that drove me back to work, so I started seeing patients a few mornings a week once my son went to preschool. I patterned my practice after my friend and now teaching partner, Shelley Mannell, who saw patients out of her home. Canadian PTs have so much more autonomy than we do here in the States. I could hand patients an invoice and they would hand me a check, it was like a dream. Also, they have very reasonable documentation expectations on practitioners. It was an awesome little part time gig I could work around my motherhood. Honestly, the system I teach was built in the basement of my house in Oakville, ON. I could treat the way I wanted to, take my time, not worry about insurance, not charge for theraband (a huge pet peeve)…it was awesome. My practice slowly grew, and I took on more patients as my kids went to more and longer school days.

When the opportunity came to return to the States, my husband and I acknowledged that our shared nationality is Californian. When I got back I worked briefly for a previous employer at her great clinic. It was fun to try out the strategies I had developed on women with a more generalized ortho/sports med population. I slowly started seeing a few patients on the side and started teaching more, allowing me to make the leap to seeing patients again on my own….and I haven’t looked back. My time in Canada really gave me the know how and confidence to pull it off. My time out of the madhouse of a traditional outpatient ortho setting gave me the chance to build the clinical model I teach. I am so grateful for that period of time.

What is your response when you hear this question: “Why doesn’t your clinic participate with my insurance?”

I know because I talk about the pelvic floor I am quickly identified as a pelvic health person (and usually folks assume I am an internal therapist). The approach I take is truly integrative with multiple systems in the body: breathing mechanics, sensory input, balance, alignment, muscular coordination, gait, and so on. So I am kinda out of the box and non-traditional in my approach to all sorts of stuff. I don’t just treat pelvic health, I treat the whole body/person that the pelvis/pelvic floor just happen to be in. I say that to say…by the time folks get to me they have usually done a traditional course of PT somewhere (and all sorts of other things). So folks are willing to try something new, out of the box and willing to pay for it. And because it is my own biz, I can modify my charges if the cost is a challenge.

So, honestly, I can’t say that I have been asked that question that much. I explain to people that as a solo practitioner managing the whole insurance thing is beyond my capacity, I’d rather just do the PT part :). Most of my patients have had a decent return from their insurance for my services as an out of network provider (50-60%; varies of course). I also have a consultative approach. I don’t see folks 2-3x/week. I see them once every week or two, with longer stretches as we progress. My goal is independence and I start working toward that at day one with a model of care that keeps them in the drivers seat with education and exercise (brain work and bodywork). I am not getting them better, I am guiding them through their steps to recovery.

What is your perspective on PT residencies? (Good, bad, necessary, excessive?)

I remember the day before I graduated from PT school I wasn’t allowed to treat a patient and the next day I was. But I guarantee I didn’t know anymore the day after graduation than I did the day before. That’s sort of crae-crae. I was incredibly fortunate to work at an awesome clinic and all the experienced PTs mentored me going over my schedule with me once per week. But not everyone has that kind of first gig. So yes, I am pro reforming our educational model. I think we have all acknowledged that the DPT thing hasn’t quite worked out like we thought it would. Particularly the expectation that being called doctors would some how change the public or co-professional (doctors) perception of us. Creating a true entry level degree that led into a residency program, modeling the path physicians must tread or similarly in Canada where new lawyers have to “article” for a few years, might have really established our expertise in a new and noteworthy way. These professions acknowledge that new grads only understand things to a certain level. Experience is the best teacher, guided experience even better. But to reconsider this we need to think about the expense of the programs, deferring loans through the residency programs, salary scaling, etc.  It is complicated to consider a re-vamp, I get that, and I don’t have all the answers. But I think our model needs to change, somewhere.

Congratulations on “The Pelvic Floor Piston: Foundation for Fitness” DVD! What were the biggest challenges of this project? What would you do differently if you were to make a 2nd DVD? (Click here to read Julie’s blog post on the DVD)

Thanks! It was honestly the culmination of years and years of work with many stops and starts. I am very grateful to all the people and challenges that brought it to life. Some of the roadblocks that kept it from happening sooner allowed me more time to learn, more time to sort through cues, to fail and try new things with patients, to think through how to present it, how to piece it together. The whole thing was one big, huge learning curve. I had no idea all what was involved in production, editing (SO much editing), printing, graphic design, scripting, cost, etc. Roadblocks, and mishaps all along the way. The fact that we got to a real live DVD was nothing short of a miracle. I’m still learning, mainly about marketing, another huge learning curve.

DVD #2 and hopefully #3 are in the works, at least in my head. The goal is for this to be a series. The first one was designed to be a part of a research study (another HUGE learning curve) so I had to limit how much info to give so that it could be achieved independently in a short amount of time. I had to keep it very focused on incontinence. But the reality is the continence control system is the same system that creates central stability, which impacts all sorts of issues-balance, gait, joint mechanics, performance, diastasis, prolapse, etc. Next time I hope to hit some of the topics I couldn’t really explore that might have muddied the water for someone trying to interact with the material in the research study.

I am also hoping that a pediatric series is on its way. Parents are left holding the bag with helping their kids with challenges. My peds partner, Shelley Mannell of http://www.heartspacept.com, and I hope to meet some of those needs with a peds focused program for home.

You give 10% of business profits to charitable causes. Andrew Carnegie said “It is more difficult to give money away intelligently than to earn it in the first place.” How did you narrow down the choice of charities to the two that you selected?

Honestly, I look for women, mom, and childrens charities that tug on my heart strings. Groups that deal with women’s and maternal health really hit home. I also know lots of folks that are involved in compelling charities and I try to support their amazing work. I do try to do a domestic and an international charity, but that doesn’t always happen. Some notable groups/causes that I have interacted with recently include: One Girl Launchpad campaign to help girls get feminine products to manage their periods, otherwise they miss school for a week (http://www.onegirl.org.au/what-we-do/launchpad) . She Dances supports a home in Honduras that rescues girls from sex trafficking (http://shedances.org). James Store House helps kids in Los Angeles and New Orleans transition when they age out of the foster care system. http://jamesstorehouse.org

Unfortunately, all this isn’t as impressive as it seems, I don’t make that much money :). Please consider helping them out!

The profession of Physical Therapy has seen its share of fads and themes in the last couple decades. Which ones were the most memorable to you?

VMO, Iontophorsis, phonophoresis, empty can, Isokinetic machines, TA isolation vs trunk bracing, patellar tracking, Q-angle, lumbar stabilization (the world before the core). The big theme/fad I am on a mission to change is the idea that the pelvic floor acts alone to perform its traditionally understood functions (control pee and poo, sexual performance, and keeping our organs in). The pelvic floor is just one piece of the puzzle and does SO much more. It is a part of every move that you make and a part of the “core”. We need to start treating it that way.

Private Practice, teaching, DVD, webinars… You’re a busy lady! How do you manage to make time for yourself & your family? What advice do you have for someone as busy as yourself?

I have a very messy house.

Honestly, I am not sure I can advise or share any wisdom here because this is a constant challenge for me. I just try very hard to keep my priorities in check. It is a daily choice and it is hard, and I am not awesome at it. I turn down more work and opportunities than you can imagine, it took me three weeks to return these answers to you, I need to exercise more, my labrador retriever could use more exercise too and my kids eat chicken nuggets more often than I would like to admit (they are organic and gluten free…but still).  My work day is the kids school day, and it isn’t always enough to keep up. But bottom line, I love what I do and  the way I get to do it. I am so incredibly grateful I get to participate in both meaningful work and still get to be present and available with my kids.

I have taken steps to try to keep it managed. I try to only teach one weekend per month, because it is a lot on the fam when I travel. Although, the kids are really starting to dig daddy weekends. Let’s just say they aren’t as organic and gluten free focused. But I try to balance my travel by consistently volunteering in my kids classroom on Monday AM so that they can count on mommy being right there the next day even if I was gone for the weekend.  Also, I did cut back my clinical schedule to make room for the bigger projects that ultimately have a larger impact like teaching, creating resources, research and writing.

My husband is also incredibly supportive of me and my mission, and our family as a whole sort of approaches it that way. He funds the mission with his work and solo parents when I travel, which allows me to work the way I do and have flexibility to be with the kids. So if anyone has ever received benefit from what I do, you honestly have David Wiebe to thank. He’s a catch and I am grateful.

What big ideas/simple ideas/basic concepts do you believe will help all Physical Therapists become better/smarter/wiser?

Step outside your typical population and learn from the other specialties. I have gained so much from my partnership with pediatric specialist, Shelley Mannell. We jokingly refer to our collaborations as our own private Combined Sections Meeting. How many shoulder courses can you take, really? Explore neuro or peds or womens health and see what a different perspective can do to shake up your clinical reasoning.

You’ve just traveled back in time to when you were 20 years old, and are sitting face-to-face with yourself. What advice would you give yourself?

Change is an evolution, not a revolution. Be patient, and stand strong even when you are swimming against the tide.

Never stop learning.

Stop cursing like a sailor.

Stop dating that guy. Wait for the Canadian….(I would sort of trail that last one off into a whisper, then slink back into the shadows….)

Favorite books and/or authors? Recommended readings?

Pubmed. Enough said.

Life is an adventure. Describe one of your most memorable adventures so far.

I love to travel. David and I went to Hawaii for our 15th anniversary, our first trip like that since our honeymoon. And the kids and I drove from California to Texas stopping at the Grand Canyon, Petrified Forest, Painted Desert, and Carlsbad Caverns on our way to spend Thanksgiving with my mom and brother. If we won the lottery,  I would honestly homeschool my kids while travelling the world….and maybe get my PhD. Never stop learning, darn it.

What a phenomenal interview! Julie, thanks for taking the time to share your experiences and perspectives. Congrats on your amazing & supportive family, and I wish you the best of success on your current & future projects. Let’s do this again someday.

Follow Julie on Twitter @JulieWiebePT, and be sure to check out her incredibly informative website.

Get in touch with me @Cinema_Air

 

The Inside-Outside View to Better Decision-making

Decision-making isn’t always the easiest thing in the world. While many errors may seem obvious in hindsight, they’re rarely as crystal clear during the decision-making process. Even worse, we have a tough time imagining the opposing view. As Michael Mauboussin states in his book Think Twice, we have “a tendency to favor the inside view over the outside view.” He goes on to explain,

An inside view considers a problem by focusing on the specific task and by using information that is close at hand, and makes predictions based on that narrow and uniques set of inputs. These inputs may include anecdotal evidence and fallacious perceptions. This is the approach that most people use in building models of the future and is indeed common for all forms of planning.

Compare that with The Outside View:

The outside view asks if there are similar situations that can provide a statistical basis for making a decision. Rather than seeing a problem as unique, the outside view wants to know if others have faced comparable problems and, if so, what happened. The outside view is an unnatural way to think, precisely because it forces people to set aside all the cherished information they have gathered…. The outside view can often create a very valuable reality check for decision makers.

He goes on to list three illusions that lead one to the inside view: the Illusion of Superiority (I’m better than them), the Illusion of Optimism (that’ll never happen to me), and the Illusion of Control (I can make this happen). Obvious question: “How can we get better at adopting The Outside View?”

Mauboussin pulls from Kahneman and Tversky, and distills their 5 step process into 4 steps.

  1. Select a reference class: “Find a group of situations, or a reference class, that is broad enough to be statistically significant but narrow enough to be useful in analyzing the decision that you face. The task is generally as much art as science, and is certainly trickier for problems that few people have dealt with before. But for decisions that are common – even if they are not common for you – identifying a reference class is straightforward.”
  2. Assess the distribution of outcomes: “Once you have a reference class, take a close look at the rate of success and failure…. Two other issues worth mentioning. The statistical rate of success and failure must be reasonably stable over time for a reference class to be valid. If the properties of the system change, drawing inference from past data can be misleading…. Also keep an eye out for systems where small perturbations can lead to large-scale change. Since cause and effect are difficult to pin down in these systems, drawing on past experiences is more difficult.”
  3. Make a prediction: “With the data from your reference class in had, including an awareness of the distribution of outcomes, you are in a position to make a forecast. The idea is to estimate you chances of success and failure…. Sometimes when you find the right reference class, you can see the success rate is not very high. So to improve your chance of success, you have to do something different that everyone else.”
  4. Assess the reliability of your prediction and fine-tune: “How good we are at making decisions depends  a great deal on what we are trying to predict. Weather forecasters, for instance, do a pretty good job of predicting what the temperature will be tomorrow. Book publishers, on the other hand, are poor at picking winners, with the exception of those books from a handful of best-selling authors. The worse the record of successful prediction is, the more you should adjust your prediction toward the mean (or other relevant statistical measure). When cause and effect is clear, you can have more confidence in your forecast.”

The more probabilistic the context, the better these step will work. Now you know how to take The Outside View to increase the odds of a better decision.

The main lesson from the inside-outside view is that while decision makers tend to dwell on uniqueness, the best decisions often derive from sameness. – Mauboussin

— @Cinema_Air

Exclusive Interview w/ Ann Wendel, PT, ATC

Some things benefit from shocks; they thrive and grow when exposed to volatility, randomness, disorder, and stressors and love adventure, risk, and uncertainty. Yet, in spite of the ubiquity of the phenomenon, there is no word for the exact opposite of fragile. Let us call it antifragile. Antifragility is beyond resilience or robustness. The resilient resists shocks and stays the same; the antifragile gets better – N.N. Taleb

Ann Wendel, PT, ATC, CMTPT of Prana Physical Therapy and growing Twitter-fame is a real-life example of Antifragility. I admire her not simply because of the fact that she won the acclaimed #sexyPT Award in 2014, but also for her resilience and ability to adapt to life’s vicissitudes.

We had a chance to pull together an interview recently and I was shocked by what came out of it. You’ll learn quite a bit from the read, and yes, there’s also some Exclusive Breaking News regarding Prana Physical Therapy. Ann’s response to this latest challenge is pretty amazing. Enjoy!


First, what did you have for breakfast today?

I was rushing out the door this morning to catch a flight to Kansas City, so I had eggs and a banana with almond butter.

Hard-boiled eggs for breakfast can get a bit boring after a while. What do you do to keep breakfast from turning mundane & repetitive?

Most mornings I eat leftovers from dinner the night before (protein and veggies); but, now that my kids are teenagers, there aren’t many leftovers anymore! On weekends when I’m home I try to make something that will last most of the week like a quiche or casserole. I make myself eat something every morning, even when I’m not hungry, because once I get going with patients, I might not get a chance to eat for several hours. I always eat some sort of protein and try to eat a vegetable like butternut squash or something. Many people have trouble with the idea of eating vegetables for breakfast, but butternut squash or sweet potatoes are slightly sweet and taste like comfort food to me.

You finally became an APTA Member last year. You’ve had your reservations and have been very open about it. What catalyzed the change?

Jerry Durham and Matt De Bole. Seriously. We all met up in DC for dinner and not even halfway through dinner they called me out on not being a member. They told me I had no right to complain about anything if I wasn’t going to be part of the solution. And I thought about it, and realized they were right. Both Jerry and Matt are very active in the APTA and are passionate about advocacy. I decided that I would get involved and try to work toward change from the inside. Since then I have been active in APTA and in both PPS and SOWH.

You recently joined the Editorial Board of PPS Impact Magazine. Why did you join the board? And, what does your role entail?

As you know, I have a real passion for writing about issues that affect our profession. When I joined PPS there was an opportunity to volunteer for different positions within the section. A position had just opened up on the Impact Editorial Board, and I jumped at the chance to participate. I want to learn more about the entire process of writing, editing, and publishing a monthly magazine. As a board member, I am responsible for content at least twice a year. My first assignment is due in October. I am contributing two feature articles, a member spotlight, and a tech review. I wrote one of the feature articles, and I have another PPS member writing the other, on his area of expertise. I think they will come out in early 2015. We have a very dynamic group and I’m excited to attend my first board meeting at PPS in November.

You just returned from the WebPT Ascend Conference! How was it? Why is it an important conference? And what is one of your biggest take-aways from it?

The Ascend Conference was fantastic. It was a one day conference focused on the business of therapy. We had some really amazing speakers on topics ranging from starting your practice to developing a website to preparing your exit strategy to sell your practice. I was there to provide social media coverage for WebPT and I was fortunate enough to sit on the final panel with all of the presenters. It was an important conference because it filled in the gaps of what most physical therapists would admit are their weaknesses: branding, marketing, networking, and business skills. We come out of our PT programs well prepared for a career of working as a physical therapist; but, we are terribly underprepared to run a practice. We need conferences that focus on how to be an effective leader, and how to grow a private practice.

During the conference, the subject of chiropractors and their marketing techniques kept coming up. I Tweeted that, “Chiropractors are taught how to brand, market, and run a business from day one. Let’s teach #DPTStudent about #bizPT.” That tweet received so many retweets and favorites, and is still being shared a week later. My point was that instead of looking down our noses at other professions (who are thriving, by the way), perhaps we should learn from them. We don’t have to use fear tactics and soft science to lure people into physical therapy; but, we could learn a thing or two about how consumers think by studying how consumers respond to marketing messages from other fitness and healthcare professionals.

SPEAKING OF CHANGE, PRANA PHYSICAL THERAPY IS UNDERGOING A MAJOR TRANSFORMATION! Tell us about what we can look forward to from you in the near future.

Yes, your reaction when I shared the changes with you was priceless. You said that you had to re-read my email several times to make sure you were reading correctly. I have debated about how to share the news with everyone, so when you asked me to do an interview, I figured I would give you the exclusive scoop.

I had been thinking a great deal over the past 6 months about the direction I wanted to take my business. When I reopened the practice in 2011, I was focused on providing physical therapy services. I started writing and blogging out of my experiences with getting the practice off the ground, in a very different environment than I faced the first time around in 2003. I have always loved writing, but I never did it on a regular basis until I started my blog. As the months went on, I realized how passionate I was about writing and connecting with other therapists through social media. Out of that passion, a whole new branch of my business grew. I am so fortunate to have connected with companies like WebPT, BossFit Magazine, Girls Gone Strong, and MedBridge as an outlet for my writing and speaking.

After growing the writing side of my business fairly quickly, I struggled a great deal last year with trying to balance running the PT practice and growing the writing and speaking side of my business. I was undecided on what I wanted to do long term.

In late July I found out I would be losing my office space (I was subletting) with only 5 weeks notice. I was devastated at first, and tried to scramble to find new office space on such short notice. It was difficult, because it didn’t make sense to find a large office and sign a 5 year lease, as we want to move out of the DC area once my kids are in college 5 years from now. I also thought about the implications of hiring staff and growing the practice, only to want to close it or sell it in 5 years.

Once I calmed down a bit, I sat and really thought about what direction I wanted to go in for the next 10 years, and I realized that I couldn’t keep up the current pace. As much as I loved my clinical practice, I am currently more passionate about sharing what I know through my writing and speaking. I made the difficult decision to close the in-person, patient care side of my business, eliminating the need for office space. Once I did that, it opened up new possibilities.

I have cleared time and energy for multiple projects I am working on and have been able to say yes to more of the type of work I want to be doing. In addition to joining the Editorial Board of Impact magazine, I have recently joined the Advisory Board of Girls Gone Strong, an organization run by my friend, Molly Galbraith. GGS is dedicated to providing the most current information to women in the areas of fitness, health, and nutrition, and through GGS I have the opportunity to reach thousands of women with good information about injury risk reduction and treatment. I was also honored to recently be asked to join the Clinical Advisory Board of Perfect Fit Health, joining my friend, Chris Bise. Perfect Fit is going to be doing some amazing things and I’m so excited to be part of the company. Additionally, I am continuing to produce webinars and provide consulting services to individuals and practices looking to learn more about marketing directly to consumers.

In an effort to continue to learn about #bizPT from a slightly different angle (to add to the experience I have with running a cash based practice), I have taken a position as a Clinic Director. This will allow me to gain experience with Medicare documentation and billing, as well as the opportunity to mentor new therapists and take students through clinical affiliations. Taking a position as a Clinic Director allows me to stay up to date on current clinical practice without the 24/7 stress of running my own business right now. This will allow me to develop the writing/speaking/consulting side of my practice without financial strain.

You recently joined the Advisory Board of Girls Gone Strong. What drew you to GGS and how did this relationship begin?

I have been drawn to GGS from the beginning. When they first announced what they were doing, I told my husband, “I want to be a part of this!” I believe so strongly in their mission, and knew that I could contribute to the organization. I became friends with some of the “girls” over the past few years, and continued to support what they were doing. I had dinner with co-founder Molly Galbraith last spring, and she shared with me that they were undergoing some organizational changes, and that she was looking to put together an Advisory Board. When she asked me to be part of it, I had to force myself not to jump up in the air! I am so fortunate to contribute a monthly column to the blog called “Ask Ann” where I answer a reader question related to physical therapy. I was also asked to speak at The Women’s Fitness Summit in Kansas City this weekend, co-hosted by GGS. I’ll be speaking alongside some amazing women at a conference with all female presenters and only female attendees. I am so looking forward to empowering women to take care of themselves!

You write for a variety of media outlets – MedBridge, BossFit magazine, and WebPT. (I heartily recommend you to read her articles. They are fertile grounds for ideas and conceptual thinking in your practice, including your practice of healthy living.) How did you establish these relationships? How can I establish similar relationships?

It all started with WebPT. I use WebPT as my EMR for my practice, and they asked me to do a member spotlight piece in 2011. They interviewed me by phone for the article and I talked with them for a while after the interview was over, mentioning that I would love to write for their blog. We came up with a contract, and I have been providing an article every month since then. That relationship continued to grow over the years, as I really love the culture of WebPT and their commitment to our profession. I met co-owner Heidi Jannenga at PPS last year, and got to know her a bit. I was thrilled to be asked to participate in Rehab Nation, a think tank type meeting hosted by WebPT, and the Ascend conference this year.

My relationship with MedBridge began in a somewhat similar fashion. I followed them on Twitter, and enjoyed talking with them through social media. They reached out to me last year and asked if I would like to contribute an article. My first article was on the kettlebell swing, and I included a video. I met the whole MedBridge crew at CSM in Vegas, and talked with them about doing more work together. I am happy to support them because they provide high quality educational products. We have some really exciting projects in the works, but I can’t share about them yet!

My association with BossFit started with following Chris Brogan on Twitter. His writing and speaking really resonated with me, and I frequently shared his articles and commented on his blog. When he announced on Twitter last year that he and Jacq Carly were starting a sister magazine to Owner Magazine, called BossFit, I started paying attention, as BossFit is a magazine dedicated to the health of busy business owners. They tweeted that they were looking for writers to contribute, and I reached out to them and sent some samples of my writing. Fortunately, I was chosen to contribute, and have been writing for BossFit monthly since then. I had the pleasure of meeting Chris and Jacq in Boston, when they hosted an Owner/BossFit Live event last March. I was interviewed by Chris on the topic of physical therapy, and got to share with the audience a bit about what I do. Since then, both Chris and Jacq have become dear friends.

In all these instances (and every other writing opportunity I’ve had), the constant is that I pursued the opportunities. I never waited for someone to approach me or ask me if I wanted to contribute. I offered to contribute and provided samples of my work. In the writing world, this is called a query: you write to an editor or contact at a publication, and share your idea with them in a way that attracts their interest. I only reach out to companies that I resonate with – if I feel passionate about their mission and about the topics they cover, I pursue the relationship. For anyone who wants to get started writing, my best advice is start writing! Don’t wait to be asked, don’t wait to send it out until it’s good enough – just do it. Decide where you want to contribute and start building those relationships.

I really admire how you’ve leveraged the many changes you’ve experienced over the last 7+ years. What lasting truths have you distilled from these experiences?

Everything changes, and I’m strong enough to turn it around and make it work. I think that we run into trouble when we resist the natural changes that occur in life. In the natural world, everything has a season. Work, life, and relationships also have seasons; yet, we resist this truth and it leads to failure and unhappiness. If we can acknowledge that changes are natural and endings are normal, then we can recognize a necessary ending and make a decision in a timely manner, allowing us to pivot our business or life in a way that serves us best. When I lost my office space, I talked with my friend, Sandy Hilton, and she recommended the book Necessary Endings by Dr. Henry Cloud. It was such a helpful book, and I highly recommend it. It clarified things for me and made me realize that it was healthy to change the way I was running my business, and to view it as a normal evolution of my passion.

The big lessons I’ve learned are to welcome change and endings as a necessary part of life, and to be decisive and act, so that you can stay successful in both business and personal relationships.

Tell us about your biggest take-aways from the Ancestral Health Symposium that you attended a couple years ago.

Because of my diagnosis with Hashimoto’s Thyroiditis about 7 years ago, I developed a keen interest in reading research about the effects of nutrition and lifestyle on health. As I read, I was drawn to the Ancestral Health movement. The first AHS was held in 2011, and I wanted to be part of the experience the next year. I was thrilled to present a poster on the Effects of Ancestral Nutrition on Type 1 Diabetes, at Harvard in August  2012.

The biggest take aways for me (from the entire movement) are that we have to focus on health in a whole person/lifestyle manner in order for changes to be lasting and effective. We need to encourage our patients to eat whole, nutritious food, engage in healthy movement, sleep for 7-9 hours a night, minimize stress, and build a sense of purpose and community into their lives. We can’t just treat a shoulder or a knee. With Direct Access, we are often the first healthcare provider that a patient has seen in years. We need to ask questions about general health in our initial evaluation and then provide resources for patients to make lasting changes.

I know you love The Alchemist & A Wrinkle in Time. Any other favorite books? 

I’m a bit of a history nerd, so I loved Joel Achenbach’s book, The Grand Idea. The book detailed George Washington’s business and personal life  immediately after the War of Independence. It detailed his plan to transform the Potomac River into the nation’s premier commercial artery. Given that I live only about 4 miles from Mount Vernon, I was fascinated to read about the area surrounding my house, and how Washington developed all of his holdings in the area.

You’ve just traveled back in time to and are sitting face-to-face with your 20-something self. What advice would you give yourself?

I would tell myself that it’s all going to be ok. That no matter what happens, I can turn it around and make a really satisfying life for myself.

What top 3 things can everyone do to live a happy, healthy, and fulfilling life?

Sleep. Go to bed by 10pm and sleep in a cool, completely dark room for 7-9 hours.

Eat. Eat a whole, unprocessed food diet of protein, vegetables, and healthy fats. And eat three good sized meals a day. It helps to regulate your blood glucose, insulin response, and hormones.

Lift heavy weights. Start light, learn good movement patterns, then increase weights appropriately. We need to continue to lift heavy things as we age – skeletal muscle is protective and necessary as we age.

Ann, thank you very much for sharing your time & lessons in this interview! I wish you the best of luck in your latest adventure – I’m sure it’ll be a great one.

Follow Ann on Twitter @PranaPT

And find me @Cinema_Air