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All right, welcome to today's episode of She Changed Her Mind.
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On this episode, we're going to talk about back to basics.
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And I want to start with a clinical story.
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Let me tell you about a patient named Molly who was a seven-year-old girl who had osteosarcoma that had relapsed and progressed and was metastatic through much of her body.
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And I got called as a palliative care consultant to come and help Molly because her oncology team was really sad and frustrated that they couldn't seem to relieve any of her symptoms.
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They were working as hard as they possibly could to treat her cancer and attain a cure that would allow her to live for a long time.
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But along the way, she was getting significant pain, nausea, constipation, and mood dysregulation that the team just couldn't seem to handle or couldn't seem to resolve.
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And so they called in a palliative care consultant, which is the specialty of medicine that I practice.
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And our team got to solve the puzzle of this intractable symptom.
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And that can be very frustrating when we know that we have a patient who's suffering and we have a team who has been doing their very best and believes that nothing better can be done because they believe that they have done everything.
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So what I will most often do in those cases is do what I call back to basics.
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Have we done everything we could possibly do from a foundational standpoint?
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Have we addressed the pain as well as we possibly can?
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Meaning, have we addressed the diagnosis?
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Have we scheduled pain medication?
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Have we really thought about what non-medication interventions can be done?
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And then we'll do that for each symptom, making sure that we're addressing each step along the way and not just skipping to one intervention that we hoped would work and then when it didn't, calling it failure.
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So I think of this sometimes as a complicated problem wearing a basic problems costume.
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So, or a basic problem wearing a complicated problems costume.
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You know, sometimes we can get confused and these things masquerade.
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And the reason why I'm talking about this here, because this isn't a clinical podcast.
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This isn't about me teaching you how to do symptom management in children with cancer.
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This is about you managing your own life.
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And the thing that I want to change your mind on is when we feel like something is intractable or when we feel like a problem cannot be solved, can we go back to basics?
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What steps have we possibly skipped?
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Can we be courageous enough to go back and examine the foundations?
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So I want to talk about why boring foundations often matter more than we would like to admit, why so many smart and capable women skip them.
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And then the question that is often underneath it that we skip is am I really in crisis or am I in a rehab situation?
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Because I believe that most of us are still in crisis, but we really haven't said so yet.
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So making the correct diagnosis is the first basic, and identifying, correctly identifying where you are is going to be important.
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So let's get into it.
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Why do basics matter?
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Well, basics are kind of like the load-bearing pillars of our lives, right?
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If you could picture a building and there's a crack in the ceiling on the third floor, you could plaster and repaint it for years.
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But if the cause is that the foundation is cracking and the house is sinking, it's just going to keep coming back.
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The problem often shows up far from the source.
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And so that's kind of the first mental shift for us to make when we're looking at something in our lives that we want to be different, instead of going right to where that problem is and saying, How can I?
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I just need better time management, I just need a different meal plan, adjust, adjust, adjust, right?
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Or lots of things outside of ourselves.
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We love to say, I just need my kids to be older, I just need my boss to be different, I just need my husband to be different.
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But what if we go back to the foundations?
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So we can think of some examples from the clinical realm.
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You know, think about really basic things in not too distant history.
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We could go back really far, like the pump handle on the cholera outbreak.
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But, you know, thinking back to even to the 2000s and looking at central line infections in the ICU, which are often serious and deadly, um, can we just do a checklist?
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Write a simple checklist, wash our hands, use sterile barriers, clean the skin, chlorhexidine, wash, avoid ephemeral sites when possible, and remove lines that are no longer needed.
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Can we just have this simple process and reduce central line infections, thereby improving survival rates and outcomes from the ICU?
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Every physician already knew these steps, but just being willing to do a foundational principle of making a checklist, which now sounds so simple, now sounds so intuitive.
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But at that time it was quite revolutionary to even suggest that.
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Because the knowledge wasn't missing, right?
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It was kind of the implementation.
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So a foundational principle of like, what's a really simple thing that I can implement in that kind of way?
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Because the trap is sometimes we have competency, we have insight, we have knowledge, but we're not really implementing.
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And the more we know, sometimes the easier it is to assume that knowing counts as doing.
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I see this constantly in high-achieving women.
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They can tell me all the things that they know are consistent with healthy lifestyle, sleep, rest, proper nutrition, proper hydration, creative outlets, hobbies, connecting with others, you know, all of the things that they can say, meditation, yoga, they can cite the evidence on these things, but they don't do it.
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They could teach a class on it, but then when we actually look at what they're doing, they're not living that.
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So where's the disconnect?
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That's because we're skipping the basics.
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So what are the real basics when we talk about our bodies?
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Sleep.
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I know I need it, but then we're doing five hours a night for months.
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Or we're looking for the right, just the right brand of magnesium that helps us sleep instead of doing something foundational and simple, like giving ourselves up bedtime.
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That's what I'm talking about.
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Food, granola bar as breakfast, coffee as lunch, and then whatever the world comes out by the time we get to dinner.
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That is not sound nutrition that helps our minds and bodies run its best and perform in the way that we want it to, right?
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It's not going to help us feel the way that we want to feel.
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But instead of saying I need to eat breakfast, lunch, and dinner every day, what are meals that I actually like to consume?
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And can I make sure I'm actually just getting food, actual food?
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We are spending all our time looking for the perfect adaptogen or the is keto better than Mediterranean diet?
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We're really focusing on the window dressing and not on the foundations.
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Important conversations.
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One direct conversation avoided can lead to numerous workarounds and numerous like rethinkings.
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So, what can we do from a communication standpoint that is foundational to make sure that we are keeping open lines of communication with the people that matter most and not avoiding conversations that lead to then all of this other stuff?
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Great place to look for foundations.
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Our calendars.
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If your calendar is just back to back to back to back to back, or your to-do list every day is like 40 things, but then like 37 of them are left undone at the end of the day, we are having some kind of problem here.
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We have a foundational problem of expectation.
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And so we really don't need a new time management system.
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It's really not whether you're using system A versus system B or this brand a planner or that brand a planner.
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It's really that we have too many things on there and we have unrealistic expectations for ourselves.
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That is the foundation.
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And then how about support?
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Are you diving into something that's not supportive enough?
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Are you trying to do personal development when you don't really have a firm foundation of self?
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Are you trying to take on something that's going to help you teach other people when you don't really have the foundation of practice of skills within yourself?
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And I have been guilty of all of these things myself.
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The reason why I can speak with them so competently is because I have lived them.
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So absolutely no shame.
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I am inviting you to courageously come back to basics, to courageously come back to the foundations.
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Because let's notice what all of these have in common.
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Fixing a basic would mean confronting something, right?
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It would mean changing something about ourselves or within our lives.
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To fix my sleep, I have to admit that I'm wasting time doing things that are unimportant, like scrolling or watching TV or whatever.
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And I would have to admit that my schedule load may be too heavy.
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Maybe I'm working too many shifts.
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Maybe I'm staying too late at work.
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So my whole evening is messed up, whatever it must be.
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I have to have a conversation, maybe just with myself, maybe with other people about what I'm going to stop doing.
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I have to take the risk of that conversation.
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A new system or a new supplement that just lets me keep everything the same and avoid every challenging thing and gives me the illusion that I'm doing something.
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But let's do a quick test.
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Could you describe your last week of sleep, meals, and movement without guessing?
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Like could you tell me what you did?
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If not, your foundations are not in place.
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Because one of the elements of foundation is predictability and repeatability.
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And so if you can't tell me what your bedtime is because it's not the same every night, or you're embarrassed about it, then we have a we need better foundations.
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If you can't tell me what you eat, and I don't mean every single food, but like the kinds of food that you typically tend to eat, the style of eating that you tend to do, what times you tend to eat, we have a foundations problem.
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And movement.
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What style of activities do you tend to do?
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Do you work out in the morning, work out in the evening?
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Do you like walking?
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Do you like to work out outside?
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Do you like to work out inside?
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Like those types of things should be able to kind of come off the tongue very easily.
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I walk almost every day for at least 10 minutes.
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I practice yoga twice a week and I lift weights twice a week.
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Like we know these things, unless we have a foundations issue.
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So those are a little bit of quick checks.
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Again, no shame, no shade.
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You're starting where you're starting.
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And then the question that I want to invite is that sometimes why even going back to basics feels hard when we're thinking about lifestyle change is that we're actually in a crisis.
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So if you're in a crisis, that's an acute phase.
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The system is beyond capacity already.
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Your system, your internal system, your family system, your work system, like every system is kind of overloaded.
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And in crisis, we can't think about optimizing.
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We can barely even think about starting small.
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What we need to think about is stability.
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We need to remove what's causing it, just like we do in the pain patient.
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We need to bring in support.
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What do we need to stabilize?
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What do we need to treat?
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In what order?
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We need to relieve the load on the schedule instead of just waiting for it to like to pass, because it's never going to.
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How many times have you said, when I just get through this season, only for another busy season to come?
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So crisis gets handled differently than the way we would approach incremental lifestyle change when we're in a more stable place.
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Rehab phase begins once we're stable enough to rebuild.
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So for that patient that I mentioned at the beginning, once we have done our good foundational crisis management basics, we've made the proper diagnosis, we've removed anything that's causing pain, we've positioned the patient so that we're no longer exacerbating the pain.
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We've turned down the temperature on the entire nervous system by calming the environment.
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We've scheduled pain medications so that the body can finally experience comfort and doesn't have to re-experience pain every three to four hours.
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The pain medicine is just there already.
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And then we're considering adjuvants if and only if all of that doesn't work.
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We titrate incrementally.
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So once we have comfort, then we can start to rehabilitate.
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Now we can try to walk.
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Now we can try to challenge the system to see what we're capable of from a functional perspective once the crisis has been stabilized.
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That's a rehab phase in a clinical context.
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At that point, we're starting from zero and we're trying to get to 10.
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When we're in crisis, we're in a negative.
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And if we're trying to walk while we're still in a negative, the most logical result is that we're going to fall.
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Just think about a patient who's lying in a bed in an ICU for the past seven days.
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If they woke up and just wanted to walk, we wouldn't just say, yeah, go ahead, try it.
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And you know what?
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I think you should actually look at this influencer on TikTok about the best way that you could walk.
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No, we would definitely say, okay, let's start you from zero.
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What is the first step?
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Probably moving your legs around in the bed or like dangling your legs over the edge of the bed, right?
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These would be the ways that we would incrementally progress a person who was needing rehabilitation.
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So we need to think kind of apply that same concept when we're thinking about our own incremental improvement.
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So the discordance and the real problem with high-achieving, very intelligent women is that we kind of refuse to admit which one we're in.
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So the first form of discordance is I'm in crisis, but I won't admit it.
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This is the woman who is trying the meal plan, trying the exercise regimen, trying a better calendar system.
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Every single one is some version of a rehab protocol, but it's not correct for where she is because we're still in crisis.
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The body is still sick.
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This is prescribing physical therapy to somebody who is not yet stable, somebody who's still labile blood pressure, still in ICU on drips and intubated.
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We're not going to put that person in PT and try to get them to walk.
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But this is what we do with ourselves.
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And then when it fails, we take that as a verdict on ourselves and we make a story.
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I can't stick with anything.
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Well, the protocol was fine, but the phase was wrong.
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So the trial wasn't fair.
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So I'd say that that is the profile that shows up for most of the women that I work with.
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Because admitting we're in crisis feels like failure, especially when our identity is built on being the one who copes and is resilient.
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So I just want you to wonder if that might be the discordance that you're in.
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The second form of discordance is when we are stable.
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But because our body, mind, and nervous system is so used to crisis, we manufacture crises.
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Your body has learned that urgency is normal and calm feels strange, which can feel unsafe.
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So you continue to find fires that you need to put out.
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You might move up deadlines or start something new, you know, get a few more plates spinning just to keep the chaos going.
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Find someone to rescue.
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Oh boy, I if I could, if I had a dollar for every mess I have created of trying to find someone to rescue or someone to help when I just couldn't deal with the fact that my life was actually calm and stable.
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Boy, that's gonna have to be another episode.
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But the work is feeling what stable feels like and letting that become your normal.
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So both of those patterns are what your body learned.
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And both can change because neither one are who you are inherently.
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They are just what you have been doing, what you have been practicing.
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And certainly neither one of them calls for shame.
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So how do we come back to basics?
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This is the order that I use with patients.
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Diagnosis, what's actually going on?
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So in this case, is it burnout?
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Is it grief?
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Is it a values mismatch?
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Is it really just that you've been working too many hours?
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What's going on?
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Second step is what assumptions are we making?
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What am I treating as a fact without checking it?
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Third step is removing the cause.
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What is still feeding this problem every single day?
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Where are we still causing the pain?
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Next step is positioning.
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So for that patient, that's finding a body position that is more comfortable.
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For us, that's looking at how's our life set up to make it as easy as possible.
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Schedule, boundaries, what we give energy and focus on first.
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These are foundational changes that can make a huge difference.
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The next step is calm the environment.
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I talked about that as turning down the thermostat or the volume on the entire nervous system.
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This is incredibly helpful when patients are experiencing pain or nausea or other difficult symptoms.
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And it can be the same for us if the symptoms we're experiencing are psychological anxiety, overwhelm, feelings of restlessness, agitation stuck in my life, just calming the nervous system.
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Less input, slow down.
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The next step is scheduled relief.
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In palliative care, when I'm treating a patient, that means scheduling the pain medication, scheduling the nausea medication, because chasing pain is harder than preventing it.
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But most of us are running our self-care and our rest on a PRN basis.
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We have to wait until we get to a nine out of 10 before we're even looking for any relief.
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The foundational principle is to put the rest and the meals and the recovery on the calendar.
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Have them in a repeatable cadence.
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So that when I ask you, how do you sleep?
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Then you can tell me because you do it the same every day.
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Adequate dosing.
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Now, this in the clinic, we titrate up to the effective dose.
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So this may be something that you have to figure out.
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This is part of getting curious, becoming a student of your own life.
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But how much is enough?
00:20:37.310 --> 00:20:41.150
Now, don't be one of those people that tells me my body doesn't need that much sleep.
00:20:41.230 --> 00:20:43.150
I sleep for four hours a night and it's fine.
00:20:43.310 --> 00:20:51.950
Well, that's only true if you also feel energetic and cognitively intact and creative all the time.
00:20:52.430 --> 00:20:59.150
If not, then you're sleep deprived and you're just lying to yourself that the amount that you can get is the right amount.
00:20:59.470 --> 00:21:08.910
So let's be committed, if we're talking about sleep, to figuring out, you know, what is the right amount, not too much, not too little.
00:21:09.470 --> 00:21:15.630
Same thing with food, same thing with water, same thing with meditation, same thing with yoga, same thing with exercise.
00:21:15.870 --> 00:21:17.950
You're gonna figure out the right amount for you.
00:21:18.029 --> 00:21:27.310
And this basic principle of titrating the dose is translatable, but you need to do it.
00:21:27.470 --> 00:21:29.070
And then adjuvants last.
00:21:29.230 --> 00:21:33.550
So we don't skip to the cherry on top, we don't skip to the window dressing.
00:21:33.790 --> 00:21:35.150
They may be helpful.
00:21:35.310 --> 00:21:47.070
Having a specific strategy for a specific goal, having a specific tool like a planner that helps you manage your time can be very helpful, but not if the foundations aren't in place.
00:21:47.470 --> 00:21:49.150
So adjuvants last.
00:21:49.630 --> 00:21:56.910
Once you're stable and we stop treating each flare as a surprise, we start looking for a pattern, right?
00:21:57.230 --> 00:22:03.150
Oh my goodness, every time I'm on service, a predictable set of things happen to me.
00:22:03.390 --> 00:22:04.590
Well, now we have a pattern.
00:22:04.750 --> 00:22:12.670
Now we have something predictable, and we can kind of build a strategy around that so that you get closer to whatever your goal is.
00:22:12.830 --> 00:22:20.430
Just like a physical therapy rebuilds a knee while also asking, why did it get Injured in the first place.
00:22:21.310 --> 00:22:26.509
When we're thinking about back to basics, we want to think about what's driving the recurrences.
00:22:27.550 --> 00:22:33.150
So when we start what we might consider this rehab phase, I teach something called the spark cycle.
00:22:33.390 --> 00:22:39.790
And I'll have a little PDF of this in the show notes if you want a visual and a little bit more about what the spark cycle is.
00:22:40.029 --> 00:22:41.950
But Spark basically is five steps.
00:22:42.110 --> 00:22:43.630
Number one is spot your phase.
00:22:43.710 --> 00:22:47.230
So are you in crisis rehab or manufactured crisis?
00:22:47.550 --> 00:22:52.750
Where am I out of one to 10 on how I want to be meeting my goals?
00:22:52.990 --> 00:22:58.910
And every cycle starts here because the right, the next right move depends on your answer, right?
00:22:59.070 --> 00:23:01.950
If you're in crisis, you need a crisis plan.
00:23:02.430 --> 00:23:04.750
If you're rehabbing, you need a rehab plan.
00:23:04.910 --> 00:23:10.590
And if you're in manufactured crisis, you need something to help you get out of manufactured crisis.
00:23:10.910 --> 00:23:16.190
Then the P is pick one microwin and make it almost too easy.
00:23:16.430 --> 00:23:19.390
So this, you know, we often start way too much.
00:23:19.550 --> 00:23:21.870
We want this to be the tiniest, tiniest step.
00:23:22.029 --> 00:23:24.509
Rehab starts where the body is today.
00:23:24.750 --> 00:23:28.350
Nobody, the minute they get out of knee surgery, goes out and runs a 5K.
00:23:28.430 --> 00:23:29.470
At least they shouldn't.
00:23:29.710 --> 00:23:34.509
We really need to start with a small thing and build from there.
00:23:34.590 --> 00:23:36.110
So pick one micro win.
00:23:36.509 --> 00:23:38.590
A is for anchor it in identity.
00:23:38.750 --> 00:23:42.750
I am the kind of person who this is what we're looking for at this step.
00:23:42.830 --> 00:23:44.509
You're being it's becoming who you are.
00:23:44.750 --> 00:23:50.190
And every repetition becomes a vote for that identity.
00:23:51.550 --> 00:23:53.470
R is for reframe the meaning.
00:23:53.630 --> 00:23:55.150
We can have everything the same.
00:23:55.310 --> 00:24:00.190
No circumstances need to change, but if we give it a new story, it's gonna feel different.
00:24:00.430 --> 00:24:07.310
A short session that you repeat over time and can build upon itself means the rehab is working.
00:24:07.470 --> 00:24:10.190
It doesn't mean that you're too lazy to do longer, right?
00:24:10.269 --> 00:24:14.430
So like we're just kind of reframing the meaning, changing the story.
00:24:14.670 --> 00:24:16.910
And then K is for keep it going.
00:24:17.310 --> 00:24:19.550
Um, repeat, track, and calibrate.
00:24:19.710 --> 00:24:24.910
When the step is steady, like when you really feel like, okay, I got this stuff, then you add more.
00:24:25.230 --> 00:24:29.790
When the symptoms flare, you notice what changed.
00:24:30.110 --> 00:24:41.710
When something happens, life throws your curveball, you get sick, there's a new complication in life, you take a step back and you have the like the fun the foundation that you have to fall back to.
00:24:42.350 --> 00:24:47.630
When times get tough, we don't rise to the occasion, we fall to the level of our practice.
00:24:47.950 --> 00:24:53.230
So we know through using this cycle, because then we'd come back around to the S again, right?
00:24:53.310 --> 00:24:55.230
And spot our phase.
00:24:55.550 --> 00:24:56.670
Am I now in a crisis?
00:24:56.830 --> 00:24:58.509
Has something happened that put me into crisis?
00:24:58.590 --> 00:25:02.350
And can I design my cycle depending on that?
00:25:02.590 --> 00:25:12.350
And we'll talk more in the future about the spark cycle and how to use it and why I think that's thinking in cycles instead of linearly is so beneficial for us.
00:25:13.870 --> 00:25:20.509
But I really want the spark step to be something that's simple on purpose.
00:25:20.750 --> 00:25:24.350
So you stop trying to rehab while sick.
00:25:24.430 --> 00:25:30.750
But even if you do, the method has a kind of internal check built in.
00:25:30.830 --> 00:25:34.590
So it's a success story of going back to basics.
00:25:34.750 --> 00:25:46.509
Well, for our patient, Molly, we did some really good basics, got her on scheduled pain meds at the right dose, allowed her to feel comfortable in her body.
00:25:46.910 --> 00:25:55.470
We also treated her nausea and her constipation so that her internal systems were working well and she could start eating again.
00:25:55.630 --> 00:26:09.790
And then once we were getting good nutrition in her and had a good foundation of pain management, she could start working with PT and rehabilitating to begin walking and playing basketball again, which really was her goal.
00:26:09.950 --> 00:26:20.190
So even as she continued to go through her cancer treatment, we were able to keep her symptoms at a level that she could participate in the activities that gave her life meaning.
00:26:20.430 --> 00:26:26.509
So that's what we can do when we go back to basics, when we are brave enough to go back to basics.
00:26:26.670 --> 00:26:30.670
I'm sure you can imagine the implications of this for your life.
00:26:30.830 --> 00:26:38.110
And the part that I care about most is that you recognize you will have another crisis.
00:26:38.350 --> 00:26:39.310
We all will.
00:26:40.029 --> 00:26:42.990
Progress is in how quickly you catch it.
00:26:43.790 --> 00:26:52.990
So instead of saying I'm right back where I started every time something kind of knocks you down, can we begin to think I'm having another crisis?
00:26:53.390 --> 00:27:03.070
But this time I recognized it and was able to get myself on a crisis plan within two hours instead of two weeks.
00:27:03.470 --> 00:27:06.190
Those are very different sentences, right?
00:27:07.310 --> 00:27:12.029
The second one describes a real change in terms of how you're seeing yourself.
00:27:12.190 --> 00:27:20.110
And so being able to spot yourself, being able to self-study is why I teach yoga and meditation inside of self-trust school.
00:27:20.350 --> 00:27:26.190
These are the practices that allow you to be able to spot yourself more clearly.
00:27:26.430 --> 00:27:31.310
Yoga teaches you to read your body while the signals are still small.
00:27:32.029 --> 00:27:37.630
Meditation teaches you to notice a thought as a thought and not part of who you are.
00:27:37.790 --> 00:27:50.110
And these verdict loops where we've already decided the verdict before we've even seen the evidence, we can recognize them and snap out at them as we train the mind through yoga and meditation.
00:27:50.430 --> 00:27:54.269
So over time, we can broaden our categories.
00:27:54.430 --> 00:27:57.150
We are not either just fine or falling apart.
00:27:57.390 --> 00:28:09.710
We start to recommend uh recognize more specific states, running on fumes but stable, early crisis, manufactured urgency, genuinely recovering, genuinely thriving, right?
00:28:09.870 --> 00:28:12.910
You can put nuance and texture to how you're feeling.
00:28:13.150 --> 00:28:16.910
Whether you have vocabulary for it or not doesn't so much matter.
00:28:17.070 --> 00:28:19.550
Whether you can describe it to other people doesn't so much matter.
00:28:19.710 --> 00:28:20.590
But do you know?
00:28:20.830 --> 00:28:22.509
Can you perceive the difference?
00:28:22.670 --> 00:28:25.870
And this is what we train through yoga and meditation.
00:28:26.590 --> 00:28:34.830
So I want you to track one thing this month, which is how long does it take to notice?
00:28:35.150 --> 00:28:45.470
Can we go from hours or days from the first signal to picking up on things within minutes, perhaps?
00:28:45.790 --> 00:28:49.310
So if you take one thing, I want you to get back to basics.
00:28:49.550 --> 00:28:55.950
And one of the basics can be simply checking in with yourself and saying, am I in crisis or am I in rehab?
00:28:56.430 --> 00:29:01.470
Answer it honestly and then make your plan from there.
00:29:01.630 --> 00:29:14.509
Remember that if anything in your life feels acutely unstable, please utilize crisis management resources, crisis line, your medical provider, 911-988.
00:29:15.070 --> 00:29:18.029
Nothing here is medical advice, of course.
00:29:18.350 --> 00:29:33.790
But recognizing when we are in a crisis that is not of that magnitude, but is still requiring a lot of care and pause in our lives can be a really important back-to-basics type of skill.
00:29:50.509 --> 00:29:51.470
Take care.
00:00:19.070 --> 00:00:22.750
All right, welcome to today's episode of She Changed Her Mind.
00:00:22.990 --> 00:00:26.190
On this episode, we're going to talk about back to basics.
00:00:26.350 --> 00:00:28.829
And I want to start with a clinical story.
00:00:29.070 --> 00:00:40.989
Let me tell you about a patient named Molly who was a seven-year-old girl who had osteosarcoma that had relapsed and progressed and was metastatic through much of her body.
00:00:41.149 --> 00:00:53.230
And I got called as a palliative care consultant to come and help Molly because her oncology team was really sad and frustrated that they couldn't seem to relieve any of her symptoms.
00:00:53.469 --> 00:01:01.390
They were working as hard as they possibly could to treat her cancer and attain a cure that would allow her to live for a long time.
00:01:01.629 --> 00:01:14.430
But along the way, she was getting significant pain, nausea, constipation, and mood dysregulation that the team just couldn't seem to handle or couldn't seem to resolve.
00:01:14.510 --> 00:01:19.950
And so they called in a palliative care consultant, which is the specialty of medicine that I practice.
00:01:20.269 --> 00:01:25.709
And our team got to solve the puzzle of this intractable symptom.
00:01:26.269 --> 00:01:40.670
And that can be very frustrating when we know that we have a patient who's suffering and we have a team who has been doing their very best and believes that nothing better can be done because they believe that they have done everything.
00:01:40.909 --> 00:01:46.269
So what I will most often do in those cases is do what I call back to basics.
00:01:46.590 --> 00:01:51.149
Have we done everything we could possibly do from a foundational standpoint?
00:01:51.629 --> 00:01:54.989
Have we addressed the pain as well as we possibly can?
00:01:55.310 --> 00:01:57.950
Meaning, have we addressed the diagnosis?
00:01:58.189 --> 00:02:00.030
Have we scheduled pain medication?
00:02:00.269 --> 00:02:05.149
Have we really thought about what non-medication interventions can be done?
00:02:05.310 --> 00:02:17.550
And then we'll do that for each symptom, making sure that we're addressing each step along the way and not just skipping to one intervention that we hoped would work and then when it didn't, calling it failure.
00:02:17.710 --> 00:02:22.990
So I think of this sometimes as a complicated problem wearing a basic problems costume.
00:02:23.629 --> 00:02:27.229
So, or a basic problem wearing a complicated problems costume.
00:02:27.389 --> 00:02:30.909
You know, sometimes we can get confused and these things masquerade.
00:02:31.549 --> 00:02:35.310
And the reason why I'm talking about this here, because this isn't a clinical podcast.
00:02:35.469 --> 00:02:40.829
This isn't about me teaching you how to do symptom management in children with cancer.
00:02:41.069 --> 00:02:43.870
This is about you managing your own life.
00:02:44.030 --> 00:02:55.310
And the thing that I want to change your mind on is when we feel like something is intractable or when we feel like a problem cannot be solved, can we go back to basics?
00:02:55.549 --> 00:02:57.710
What steps have we possibly skipped?
00:02:57.870 --> 00:03:03.389
Can we be courageous enough to go back and examine the foundations?
00:03:03.710 --> 00:03:14.909
So I want to talk about why boring foundations often matter more than we would like to admit, why so many smart and capable women skip them.
00:03:15.150 --> 00:03:23.069
And then the question that is often underneath it that we skip is am I really in crisis or am I in a rehab situation?
00:03:24.109 --> 00:03:29.389
Because I believe that most of us are still in crisis, but we really haven't said so yet.
00:03:29.629 --> 00:03:37.789
So making the correct diagnosis is the first basic, and identifying, correctly identifying where you are is going to be important.
00:03:37.949 --> 00:03:39.549
So let's get into it.
00:03:40.030 --> 00:03:42.030
Why do basics matter?
00:03:42.270 --> 00:03:49.870
Well, basics are kind of like the load-bearing pillars of our lives, right?
00:03:50.349 --> 00:04:00.109
If you could picture a building and there's a crack in the ceiling on the third floor, you could plaster and repaint it for years.
00:04:00.909 --> 00:04:06.270
But if the cause is that the foundation is cracking and the house is sinking, it's just going to keep coming back.
00:04:06.590 --> 00:04:10.109
The problem often shows up far from the source.
00:04:10.270 --> 00:04:22.750
And so that's kind of the first mental shift for us to make when we're looking at something in our lives that we want to be different, instead of going right to where that problem is and saying, How can I?
00:04:22.910 --> 00:04:28.829
I just need better time management, I just need a different meal plan, adjust, adjust, adjust, right?
00:04:28.990 --> 00:04:30.990
Or lots of things outside of ourselves.
00:04:31.150 --> 00:04:38.750
We love to say, I just need my kids to be older, I just need my boss to be different, I just need my husband to be different.
00:04:38.990 --> 00:04:42.189
But what if we go back to the foundations?
00:04:42.350 --> 00:04:45.950
So we can think of some examples from the clinical realm.
00:04:46.110 --> 00:04:49.310
You know, think about really basic things in not too distant history.
00:04:49.390 --> 00:04:53.310
We could go back really far, like the pump handle on the cholera outbreak.
00:04:53.630 --> 00:05:05.230
But, you know, thinking back to even to the 2000s and looking at central line infections in the ICU, which are often serious and deadly, um, can we just do a checklist?
00:05:05.390 --> 00:05:16.750
Write a simple checklist, wash our hands, use sterile barriers, clean the skin, chlorhexidine, wash, avoid ephemeral sites when possible, and remove lines that are no longer needed.
00:05:17.070 --> 00:05:27.630
Can we just have this simple process and reduce central line infections, thereby improving survival rates and outcomes from the ICU?
00:05:29.390 --> 00:05:39.550
Every physician already knew these steps, but just being willing to do a foundational principle of making a checklist, which now sounds so simple, now sounds so intuitive.
00:05:39.630 --> 00:05:43.470
But at that time it was quite revolutionary to even suggest that.
00:05:44.830 --> 00:05:46.590
Because the knowledge wasn't missing, right?
00:05:46.670 --> 00:05:47.870
It was kind of the implementation.
00:05:47.950 --> 00:05:54.430
So a foundational principle of like, what's a really simple thing that I can implement in that kind of way?
00:05:54.590 --> 00:06:01.230
Because the trap is sometimes we have competency, we have insight, we have knowledge, but we're not really implementing.
00:06:01.790 --> 00:06:08.030
And the more we know, sometimes the easier it is to assume that knowing counts as doing.
00:06:08.270 --> 00:06:10.670
I see this constantly in high-achieving women.
00:06:10.750 --> 00:06:31.230
They can tell me all the things that they know are consistent with healthy lifestyle, sleep, rest, proper nutrition, proper hydration, creative outlets, hobbies, connecting with others, you know, all of the things that they can say, meditation, yoga, they can cite the evidence on these things, but they don't do it.
00:06:31.390 --> 00:06:38.030
They could teach a class on it, but then when we actually look at what they're doing, they're not living that.
00:06:38.189 --> 00:06:39.710
So where's the disconnect?
00:06:39.870 --> 00:06:41.950
That's because we're skipping the basics.
00:06:42.270 --> 00:06:44.670
So what are the real basics when we talk about our bodies?
00:06:44.830 --> 00:06:45.310
Sleep.
00:06:45.470 --> 00:06:50.990
I know I need it, but then we're doing five hours a night for months.
00:06:51.470 --> 00:07:01.230
Or we're looking for the right, just the right brand of magnesium that helps us sleep instead of doing something foundational and simple, like giving ourselves up bedtime.
00:07:02.110 --> 00:07:03.310
That's what I'm talking about.
00:07:04.030 --> 00:07:15.710
Food, granola bar as breakfast, coffee as lunch, and then whatever the world comes out by the time we get to dinner.
00:07:16.030 --> 00:07:25.150
That is not sound nutrition that helps our minds and bodies run its best and perform in the way that we want it to, right?
00:07:25.230 --> 00:07:28.270
It's not going to help us feel the way that we want to feel.
00:07:28.990 --> 00:07:35.950
But instead of saying I need to eat breakfast, lunch, and dinner every day, what are meals that I actually like to consume?
00:07:36.110 --> 00:07:40.750
And can I make sure I'm actually just getting food, actual food?
00:07:40.990 --> 00:07:49.070
We are spending all our time looking for the perfect adaptogen or the is keto better than Mediterranean diet?
00:07:49.310 --> 00:07:53.630
We're really focusing on the window dressing and not on the foundations.
00:07:53.870 --> 00:07:55.230
Important conversations.
00:07:56.350 --> 00:08:05.630
One direct conversation avoided can lead to numerous workarounds and numerous like rethinkings.
00:08:06.189 --> 00:08:22.030
So, what can we do from a communication standpoint that is foundational to make sure that we are keeping open lines of communication with the people that matter most and not avoiding conversations that lead to then all of this other stuff?
00:08:22.350 --> 00:08:24.350
Great place to look for foundations.
00:08:24.670 --> 00:08:25.950
Our calendars.
00:08:26.270 --> 00:08:43.870
If your calendar is just back to back to back to back to back, or your to-do list every day is like 40 things, but then like 37 of them are left undone at the end of the day, we are having some kind of problem here.
00:08:44.029 --> 00:08:48.029
We have a foundational problem of expectation.
00:08:48.350 --> 00:08:51.549
And so we really don't need a new time management system.
00:08:51.709 --> 00:08:59.309
It's really not whether you're using system A versus system B or this brand a planner or that brand a planner.
00:08:59.549 --> 00:09:04.750
It's really that we have too many things on there and we have unrealistic expectations for ourselves.
00:09:04.909 --> 00:09:06.110
That is the foundation.
00:09:06.269 --> 00:09:07.870
And then how about support?
00:09:08.029 --> 00:09:13.629
Are you diving into something that's not supportive enough?
00:09:13.789 --> 00:09:20.350
Are you trying to do personal development when you don't really have a firm foundation of self?
00:09:20.909 --> 00:09:30.189
Are you trying to take on something that's going to help you teach other people when you don't really have the foundation of practice of skills within yourself?
00:09:30.429 --> 00:09:33.389
And I have been guilty of all of these things myself.
00:09:33.549 --> 00:09:37.870
The reason why I can speak with them so competently is because I have lived them.
00:09:38.110 --> 00:09:40.350
So absolutely no shame.
00:09:40.750 --> 00:09:47.149
I am inviting you to courageously come back to basics, to courageously come back to the foundations.
00:09:47.949 --> 00:09:50.750
Because let's notice what all of these have in common.
00:09:50.990 --> 00:09:54.269
Fixing a basic would mean confronting something, right?
00:09:54.350 --> 00:09:58.110
It would mean changing something about ourselves or within our lives.
00:09:58.350 --> 00:10:10.029
To fix my sleep, I have to admit that I'm wasting time doing things that are unimportant, like scrolling or watching TV or whatever.
00:10:10.589 --> 00:10:14.829
And I would have to admit that my schedule load may be too heavy.
00:10:15.149 --> 00:10:16.990
Maybe I'm working too many shifts.
00:10:17.230 --> 00:10:18.909
Maybe I'm staying too late at work.
00:10:18.990 --> 00:10:22.909
So my whole evening is messed up, whatever it must be.
00:10:24.350 --> 00:10:31.949
I have to have a conversation, maybe just with myself, maybe with other people about what I'm going to stop doing.
00:10:32.509 --> 00:10:35.230
I have to take the risk of that conversation.
00:10:35.789 --> 00:10:47.870
A new system or a new supplement that just lets me keep everything the same and avoid every challenging thing and gives me the illusion that I'm doing something.
00:10:49.069 --> 00:10:50.669
But let's do a quick test.
00:10:51.069 --> 00:10:56.350
Could you describe your last week of sleep, meals, and movement without guessing?
00:10:56.509 --> 00:10:58.429
Like could you tell me what you did?
00:11:00.110 --> 00:11:03.149
If not, your foundations are not in place.
00:11:03.469 --> 00:11:07.629
Because one of the elements of foundation is predictability and repeatability.
00:11:07.789 --> 00:11:16.029
And so if you can't tell me what your bedtime is because it's not the same every night, or you're embarrassed about it, then we have a we need better foundations.
00:11:16.189 --> 00:11:29.389
If you can't tell me what you eat, and I don't mean every single food, but like the kinds of food that you typically tend to eat, the style of eating that you tend to do, what times you tend to eat, we have a foundations problem.
00:11:29.629 --> 00:11:30.429
And movement.
00:11:30.589 --> 00:11:32.589
What style of activities do you tend to do?
00:11:32.750 --> 00:11:34.990
Do you work out in the morning, work out in the evening?
00:11:35.230 --> 00:11:36.029
Do you like walking?
00:11:36.189 --> 00:11:37.149
Do you like to work out outside?
00:11:37.309 --> 00:11:38.429
Do you like to work out inside?
00:11:38.589 --> 00:11:43.870
Like those types of things should be able to kind of come off the tongue very easily.
00:11:44.110 --> 00:11:46.509
I walk almost every day for at least 10 minutes.
00:11:46.669 --> 00:11:49.870
I practice yoga twice a week and I lift weights twice a week.
00:11:50.750 --> 00:11:55.629
Like we know these things, unless we have a foundations issue.
00:11:55.789 --> 00:11:57.629
So those are a little bit of quick checks.
00:11:57.789 --> 00:12:00.429
Again, no shame, no shade.
00:12:01.629 --> 00:12:03.230
You're starting where you're starting.
00:12:03.389 --> 00:12:16.110
And then the question that I want to invite is that sometimes why even going back to basics feels hard when we're thinking about lifestyle change is that we're actually in a crisis.
00:12:16.750 --> 00:12:19.309
So if you're in a crisis, that's an acute phase.
00:12:20.029 --> 00:12:22.750
The system is beyond capacity already.
00:12:22.909 --> 00:12:31.149
Your system, your internal system, your family system, your work system, like every system is kind of overloaded.
00:12:31.949 --> 00:12:36.350
And in crisis, we can't think about optimizing.
00:12:36.509 --> 00:12:38.589
We can barely even think about starting small.
00:12:38.750 --> 00:12:40.669
What we need to think about is stability.
00:12:41.149 --> 00:12:45.629
We need to remove what's causing it, just like we do in the pain patient.
00:12:45.870 --> 00:12:47.789
We need to bring in support.
00:12:48.909 --> 00:12:50.750
What do we need to stabilize?
00:12:50.909 --> 00:12:52.429
What do we need to treat?
00:12:52.669 --> 00:12:53.949
In what order?
00:12:54.589 --> 00:13:02.509
We need to relieve the load on the schedule instead of just waiting for it to like to pass, because it's never going to.
00:13:02.669 --> 00:13:09.309
How many times have you said, when I just get through this season, only for another busy season to come?
00:13:09.629 --> 00:13:17.469
So crisis gets handled differently than the way we would approach incremental lifestyle change when we're in a more stable place.
00:13:18.269 --> 00:13:23.389
Rehab phase begins once we're stable enough to rebuild.
00:13:23.629 --> 00:13:40.429
So for that patient that I mentioned at the beginning, once we have done our good foundational crisis management basics, we've made the proper diagnosis, we've removed anything that's causing pain, we've positioned the patient so that we're no longer exacerbating the pain.
00:13:40.589 --> 00:13:46.669
We've turned down the temperature on the entire nervous system by calming the environment.
00:13:46.829 --> 00:13:56.589
We've scheduled pain medications so that the body can finally experience comfort and doesn't have to re-experience pain every three to four hours.
00:13:56.829 --> 00:14:00.350
The pain medicine is just there already.
00:14:00.750 --> 00:14:06.509
And then we're considering adjuvants if and only if all of that doesn't work.
00:14:06.669 --> 00:14:08.750
We titrate incrementally.
00:14:09.069 --> 00:14:13.069
So once we have comfort, then we can start to rehabilitate.
00:14:13.389 --> 00:14:15.069
Now we can try to walk.
00:14:15.230 --> 00:14:25.870
Now we can try to challenge the system to see what we're capable of from a functional perspective once the crisis has been stabilized.
00:14:26.669 --> 00:14:30.669
That's a rehab phase in a clinical context.
00:14:31.230 --> 00:14:34.829
At that point, we're starting from zero and we're trying to get to 10.
00:14:34.990 --> 00:14:37.469
When we're in crisis, we're in a negative.
00:14:37.709 --> 00:14:44.110
And if we're trying to walk while we're still in a negative, the most logical result is that we're going to fall.
00:14:44.350 --> 00:14:50.189
Just think about a patient who's lying in a bed in an ICU for the past seven days.
00:14:50.509 --> 00:14:55.709
If they woke up and just wanted to walk, we wouldn't just say, yeah, go ahead, try it.
00:14:55.870 --> 00:14:56.669
And you know what?
00:14:56.829 --> 00:15:01.789
I think you should actually look at this influencer on TikTok about the best way that you could walk.
00:15:02.029 --> 00:15:05.949
No, we would definitely say, okay, let's start you from zero.
00:15:06.029 --> 00:15:07.309
What is the first step?
00:15:07.949 --> 00:15:13.069
Probably moving your legs around in the bed or like dangling your legs over the edge of the bed, right?
00:15:13.230 --> 00:15:18.509
These would be the ways that we would incrementally progress a person who was needing rehabilitation.
00:15:18.589 --> 00:15:24.829
So we need to think kind of apply that same concept when we're thinking about our own incremental improvement.
00:15:24.990 --> 00:15:35.469
So the discordance and the real problem with high-achieving, very intelligent women is that we kind of refuse to admit which one we're in.
00:15:35.629 --> 00:15:39.949
So the first form of discordance is I'm in crisis, but I won't admit it.
00:15:40.429 --> 00:15:47.870
This is the woman who is trying the meal plan, trying the exercise regimen, trying a better calendar system.
00:15:48.350 --> 00:15:57.309
Every single one is some version of a rehab protocol, but it's not correct for where she is because we're still in crisis.
00:15:57.389 --> 00:15:58.909
The body is still sick.
00:15:59.309 --> 00:16:07.949
This is prescribing physical therapy to somebody who is not yet stable, somebody who's still labile blood pressure, still in ICU on drips and intubated.
00:16:08.029 --> 00:16:12.589
We're not going to put that person in PT and try to get them to walk.
00:16:12.990 --> 00:16:14.509
But this is what we do with ourselves.
00:16:14.669 --> 00:16:20.509
And then when it fails, we take that as a verdict on ourselves and we make a story.
00:16:20.669 --> 00:16:22.269
I can't stick with anything.
00:16:23.149 --> 00:16:25.629
Well, the protocol was fine, but the phase was wrong.
00:16:25.870 --> 00:16:27.389
So the trial wasn't fair.
00:16:27.549 --> 00:16:32.509
So I'd say that that is the profile that shows up for most of the women that I work with.
00:16:33.389 --> 00:16:42.029
Because admitting we're in crisis feels like failure, especially when our identity is built on being the one who copes and is resilient.
00:16:42.750 --> 00:16:47.709
So I just want you to wonder if that might be the discordance that you're in.
00:16:47.949 --> 00:16:52.029
The second form of discordance is when we are stable.
00:16:52.350 --> 00:16:59.629
But because our body, mind, and nervous system is so used to crisis, we manufacture crises.
00:17:00.829 --> 00:17:08.750
Your body has learned that urgency is normal and calm feels strange, which can feel unsafe.
00:17:08.990 --> 00:17:12.350
So you continue to find fires that you need to put out.
00:17:12.509 --> 00:17:19.789
You might move up deadlines or start something new, you know, get a few more plates spinning just to keep the chaos going.
00:17:20.589 --> 00:17:22.509
Find someone to rescue.
00:17:22.910 --> 00:17:36.430
Oh boy, I if I could, if I had a dollar for every mess I have created of trying to find someone to rescue or someone to help when I just couldn't deal with the fact that my life was actually calm and stable.
00:17:37.390 --> 00:17:40.430
Boy, that's gonna have to be another episode.
00:17:41.390 --> 00:17:47.550
But the work is feeling what stable feels like and letting that become your normal.
00:17:47.710 --> 00:17:50.750
So both of those patterns are what your body learned.
00:17:50.830 --> 00:17:55.310
And both can change because neither one are who you are inherently.
00:17:55.390 --> 00:17:58.990
They are just what you have been doing, what you have been practicing.
00:17:59.390 --> 00:18:02.029
And certainly neither one of them calls for shame.
00:18:02.190 --> 00:18:04.029
So how do we come back to basics?
00:18:04.190 --> 00:18:06.350
This is the order that I use with patients.
00:18:06.590 --> 00:18:08.750
Diagnosis, what's actually going on?
00:18:08.990 --> 00:18:10.750
So in this case, is it burnout?
00:18:10.830 --> 00:18:11.630
Is it grief?
00:18:11.870 --> 00:18:13.630
Is it a values mismatch?
00:18:13.870 --> 00:18:16.590
Is it really just that you've been working too many hours?
00:18:16.830 --> 00:18:18.110
What's going on?
00:18:18.830 --> 00:18:21.230
Second step is what assumptions are we making?
00:18:21.390 --> 00:18:24.430
What am I treating as a fact without checking it?
00:18:24.670 --> 00:18:27.070
Third step is removing the cause.
00:18:28.830 --> 00:18:32.750
What is still feeding this problem every single day?
00:18:33.310 --> 00:18:35.470
Where are we still causing the pain?
00:18:36.590 --> 00:18:38.269
Next step is positioning.
00:18:38.430 --> 00:18:45.070
So for that patient, that's finding a body position that is more comfortable.
00:18:45.390 --> 00:18:50.029
For us, that's looking at how's our life set up to make it as easy as possible.
00:18:50.910 --> 00:18:55.870
Schedule, boundaries, what we give energy and focus on first.
00:18:56.590 --> 00:19:00.830
These are foundational changes that can make a huge difference.
00:19:01.710 --> 00:19:04.029
The next step is calm the environment.
00:19:04.190 --> 00:19:12.430
I talked about that as turning down the thermostat or the volume on the entire nervous system.
00:19:12.910 --> 00:19:19.390
This is incredibly helpful when patients are experiencing pain or nausea or other difficult symptoms.
00:19:19.470 --> 00:19:33.150
And it can be the same for us if the symptoms we're experiencing are psychological anxiety, overwhelm, feelings of restlessness, agitation stuck in my life, just calming the nervous system.
00:19:33.950 --> 00:19:36.590
Less input, slow down.
00:19:36.830 --> 00:19:39.070
The next step is scheduled relief.
00:19:39.710 --> 00:19:50.350
In palliative care, when I'm treating a patient, that means scheduling the pain medication, scheduling the nausea medication, because chasing pain is harder than preventing it.
00:19:51.230 --> 00:19:57.070
But most of us are running our self-care and our rest on a PRN basis.
00:19:57.470 --> 00:20:03.150
We have to wait until we get to a nine out of 10 before we're even looking for any relief.
00:20:03.470 --> 00:20:10.430
The foundational principle is to put the rest and the meals and the recovery on the calendar.
00:20:10.750 --> 00:20:13.550
Have them in a repeatable cadence.
00:20:13.950 --> 00:20:17.950
So that when I ask you, how do you sleep?
00:20:18.190 --> 00:20:20.269
Then you can tell me because you do it the same every day.
00:20:20.430 --> 00:20:21.710
Adequate dosing.
00:20:22.190 --> 00:20:26.590
Now, this in the clinic, we titrate up to the effective dose.
00:20:26.830 --> 00:20:29.230
So this may be something that you have to figure out.
00:20:29.390 --> 00:20:34.269
This is part of getting curious, becoming a student of your own life.
00:20:34.990 --> 00:20:36.990
But how much is enough?
00:20:37.310 --> 00:20:41.150
Now, don't be one of those people that tells me my body doesn't need that much sleep.
00:20:41.230 --> 00:20:43.150
I sleep for four hours a night and it's fine.
00:20:43.310 --> 00:20:51.950
Well, that's only true if you also feel energetic and cognitively intact and creative all the time.
00:20:52.430 --> 00:20:59.150
If not, then you're sleep deprived and you're just lying to yourself that the amount that you can get is the right amount.
00:20:59.470 --> 00:21:08.910
So let's be committed, if we're talking about sleep, to figuring out, you know, what is the right amount, not too much, not too little.
00:21:09.470 --> 00:21:15.630
Same thing with food, same thing with water, same thing with meditation, same thing with yoga, same thing with exercise.
00:21:15.870 --> 00:21:17.950
You're gonna figure out the right amount for you.
00:21:18.029 --> 00:21:27.310
And this basic principle of titrating the dose is translatable, but you need to do it.
00:21:27.470 --> 00:21:29.070
And then adjuvants last.
00:21:29.230 --> 00:21:33.550
So we don't skip to the cherry on top, we don't skip to the window dressing.
00:21:33.790 --> 00:21:35.150
They may be helpful.
00:21:35.310 --> 00:21:47.070
Having a specific strategy for a specific goal, having a specific tool like a planner that helps you manage your time can be very helpful, but not if the foundations aren't in place.
00:21:47.470 --> 00:21:49.150
So adjuvants last.
00:21:49.630 --> 00:21:56.910
Once you're stable and we stop treating each flare as a surprise, we start looking for a pattern, right?
00:21:57.230 --> 00:22:03.150
Oh my goodness, every time I'm on service, a predictable set of things happen to me.
00:22:03.390 --> 00:22:04.590
Well, now we have a pattern.
00:22:04.750 --> 00:22:12.670
Now we have something predictable, and we can kind of build a strategy around that so that you get closer to whatever your goal is.
00:22:12.830 --> 00:22:20.430
Just like a physical therapy rebuilds a knee while also asking, why did it get Injured in the first place.
00:22:21.310 --> 00:22:26.509
When we're thinking about back to basics, we want to think about what's driving the recurrences.
00:22:27.550 --> 00:22:33.150
So when we start what we might consider this rehab phase, I teach something called the spark cycle.
00:22:33.390 --> 00:22:39.790
And I'll have a little PDF of this in the show notes if you want a visual and a little bit more about what the spark cycle is.
00:22:40.029 --> 00:22:41.950
But Spark basically is five steps.
00:22:42.110 --> 00:22:43.630
Number one is spot your phase.
00:22:43.710 --> 00:22:47.230
So are you in crisis rehab or manufactured crisis?
00:22:47.550 --> 00:22:52.750
Where am I out of one to 10 on how I want to be meeting my goals?
00:22:52.990 --> 00:22:58.910
And every cycle starts here because the right, the next right move depends on your answer, right?
00:22:59.070 --> 00:23:01.950
If you're in crisis, you need a crisis plan.
00:23:02.430 --> 00:23:04.750
If you're rehabbing, you need a rehab plan.
00:23:04.910 --> 00:23:10.590
And if you're in manufactured crisis, you need something to help you get out of manufactured crisis.
00:23:10.910 --> 00:23:16.190
Then the P is pick one microwin and make it almost too easy.
00:23:16.430 --> 00:23:19.390
So this, you know, we often start way too much.
00:23:19.550 --> 00:23:21.870
We want this to be the tiniest, tiniest step.
00:23:22.029 --> 00:23:24.509
Rehab starts where the body is today.
00:23:24.750 --> 00:23:28.350
Nobody, the minute they get out of knee surgery, goes out and runs a 5K.
00:23:28.430 --> 00:23:29.470
At least they shouldn't.
00:23:29.710 --> 00:23:34.509
We really need to start with a small thing and build from there.
00:23:34.590 --> 00:23:36.110
So pick one micro win.
00:23:36.509 --> 00:23:38.590
A is for anchor it in identity.
00:23:38.750 --> 00:23:42.750
I am the kind of person who this is what we're looking for at this step.
00:23:42.830 --> 00:23:44.509
You're being it's becoming who you are.
00:23:44.750 --> 00:23:50.190
And every repetition becomes a vote for that identity.
00:23:51.550 --> 00:23:53.470
R is for reframe the meaning.
00:23:53.630 --> 00:23:55.150
We can have everything the same.
00:23:55.310 --> 00:24:00.190
No circumstances need to change, but if we give it a new story, it's gonna feel different.
00:24:00.430 --> 00:24:07.310
A short session that you repeat over time and can build upon itself means the rehab is working.
00:24:07.470 --> 00:24:10.190
It doesn't mean that you're too lazy to do longer, right?
00:24:10.269 --> 00:24:14.430
So like we're just kind of reframing the meaning, changing the story.
00:24:14.670 --> 00:24:16.910
And then K is for keep it going.
00:24:17.310 --> 00:24:19.550
Um, repeat, track, and calibrate.
00:24:19.710 --> 00:24:24.910
When the step is steady, like when you really feel like, okay, I got this stuff, then you add more.
00:24:25.230 --> 00:24:29.790
When the symptoms flare, you notice what changed.
00:24:30.110 --> 00:24:41.710
When something happens, life throws your curveball, you get sick, there's a new complication in life, you take a step back and you have the like the fun the foundation that you have to fall back to.
00:24:42.350 --> 00:24:47.630
When times get tough, we don't rise to the occasion, we fall to the level of our practice.
00:24:47.950 --> 00:24:53.230
So we know through using this cycle, because then we'd come back around to the S again, right?
00:24:53.310 --> 00:24:55.230
And spot our phase.
00:24:55.550 --> 00:24:56.670
Am I now in a crisis?
00:24:56.830 --> 00:24:58.509
Has something happened that put me into crisis?
00:24:58.590 --> 00:25:02.350
And can I design my cycle depending on that?
00:25:02.590 --> 00:25:12.350
And we'll talk more in the future about the spark cycle and how to use it and why I think that's thinking in cycles instead of linearly is so beneficial for us.
00:25:13.870 --> 00:25:20.509
But I really want the spark step to be something that's simple on purpose.
00:25:20.750 --> 00:25:24.350
So you stop trying to rehab while sick.
00:25:24.430 --> 00:25:30.750
But even if you do, the method has a kind of internal check built in.
00:25:30.830 --> 00:25:34.590
So it's a success story of going back to basics.
00:25:34.750 --> 00:25:46.509
Well, for our patient, Molly, we did some really good basics, got her on scheduled pain meds at the right dose, allowed her to feel comfortable in her body.
00:25:46.910 --> 00:25:55.470
We also treated her nausea and her constipation so that her internal systems were working well and she could start eating again.
00:25:55.630 --> 00:26:09.790
And then once we were getting good nutrition in her and had a good foundation of pain management, she could start working with PT and rehabilitating to begin walking and playing basketball again, which really was her goal.
00:26:09.950 --> 00:26:20.190
So even as she continued to go through her cancer treatment, we were able to keep her symptoms at a level that she could participate in the activities that gave her life meaning.
00:26:20.430 --> 00:26:26.509
So that's what we can do when we go back to basics, when we are brave enough to go back to basics.
00:26:26.670 --> 00:26:30.670
I'm sure you can imagine the implications of this for your life.
00:26:30.830 --> 00:26:38.110
And the part that I care about most is that you recognize you will have another crisis.
00:26:38.350 --> 00:26:39.310
We all will.
00:26:40.029 --> 00:26:42.990
Progress is in how quickly you catch it.
00:26:43.790 --> 00:26:52.990
So instead of saying I'm right back where I started every time something kind of knocks you down, can we begin to think I'm having another crisis?
00:26:53.390 --> 00:27:03.070
But this time I recognized it and was able to get myself on a crisis plan within two hours instead of two weeks.
00:27:03.470 --> 00:27:06.190
Those are very different sentences, right?
00:27:07.310 --> 00:27:12.029
The second one describes a real change in terms of how you're seeing yourself.
00:27:12.190 --> 00:27:20.110
And so being able to spot yourself, being able to self-study is why I teach yoga and meditation inside of self-trust school.
00:27:20.350 --> 00:27:26.190
These are the practices that allow you to be able to spot yourself more clearly.
00:27:26.430 --> 00:27:31.310
Yoga teaches you to read your body while the signals are still small.
00:27:32.029 --> 00:27:37.630
Meditation teaches you to notice a thought as a thought and not part of who you are.
00:27:37.790 --> 00:27:50.110
And these verdict loops where we've already decided the verdict before we've even seen the evidence, we can recognize them and snap out at them as we train the mind through yoga and meditation.
00:27:50.430 --> 00:27:54.269
So over time, we can broaden our categories.
00:27:54.430 --> 00:27:57.150
We are not either just fine or falling apart.
00:27:57.390 --> 00:28:09.710
We start to recommend uh recognize more specific states, running on fumes but stable, early crisis, manufactured urgency, genuinely recovering, genuinely thriving, right?
00:28:09.870 --> 00:28:12.910
You can put nuance and texture to how you're feeling.
00:28:13.150 --> 00:28:16.910
Whether you have vocabulary for it or not doesn't so much matter.
00:28:17.070 --> 00:28:19.550
Whether you can describe it to other people doesn't so much matter.
00:28:19.710 --> 00:28:20.590
But do you know?
00:28:20.830 --> 00:28:22.509
Can you perceive the difference?
00:28:22.670 --> 00:28:25.870
And this is what we train through yoga and meditation.
00:28:26.590 --> 00:28:34.830
So I want you to track one thing this month, which is how long does it take to notice?
00:28:35.150 --> 00:28:45.470
Can we go from hours or days from the first signal to picking up on things within minutes, perhaps?
00:28:45.790 --> 00:28:49.310
So if you take one thing, I want you to get back to basics.
00:28:49.550 --> 00:28:55.950
And one of the basics can be simply checking in with yourself and saying, am I in crisis or am I in rehab?
00:28:56.430 --> 00:29:01.470
Answer it honestly and then make your plan from there.
00:29:01.630 --> 00:29:14.509
Remember that if anything in your life feels acutely unstable, please utilize crisis management resources, crisis line, your medical provider, 911-988.
00:29:15.070 --> 00:29:18.029
Nothing here is medical advice, of course.
00:29:18.350 --> 00:29:33.790
But recognizing when we are in a crisis that is not of that magnitude, but is still requiring a lot of care and pause in our lives can be a really important back-to-basics type of skill.
00:29:50.509 --> 00:29:51.470
Take care.
