Episode 299

Jun 5, 2020

Got a pathology question? Here's how to ask a better question to get the answers you need.

Listen to "E299: Asking Better Pathology Questions" on Spreaker.
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Michael Reynolds Hey, everyone. Welcome to the Massage Business Blueprint podcast, where we are still looking for the reboot button for 2020. I'm Michael Reynolds.

Allissa Haines I'm Allissa Haines.

MR We're your hosts. How are you today?

AH I'm good. I am also looking for the reboot button. I would like to send this year back and perhaps try another meal because this one is not to my taste.

MR Yeah. Yeah. I'd like an exchange or a refund.

AH Right?

MR [indiscernible]

AH Yeah. So there's that. Michael, what are you reading this week?

MR What am I reading? So you guessed it. More PPP updates to review.

AH Yay.

MR I know. You cannot wait. You are so excited because you're like -- every week, you're thinking, okay, what new, exciting PPP updates is Michael going to share this week? So I will not disappoint. I have new updates. As of the recording of this, which is Thursday, this may be updated by tomorrow, which is Friday, which is today for you, and now I'm all confused anyway.

The Senate has passed a bill to give more flexibility for the PPP terms. Just to review for those who may be -- aren't totally in the loop on all this, PPP stands for Paycheck Protection Program. It is the loan program for small business that helps continuity of funding for operations, primarily for things like paying yourself and your team members. But for our audience, it really equates to paying yourself.

So the PPP program has been out for a little while. We've had various levels of success from our members working with it. There is a bill that is passed the Senate to update some of the terms, which were a little restrictive. So there's a link in the show notes. I encourage you to go check it out. I think this article is from The Hill specifically.

But the highlights of the updates are this. One, it extends the covered period to the end of 2020 -- December 31st, 2020 -- which basically is extending the time that businesses have to apply for PPPs. So it extends it beyond -- I think it was like -- end of July was the original or July 1st or some time in July, but it extends to the rest of the year now. So in theory, that means you will have longer to apply for the loan, which is intended to be a forgivable loan. Another option or another feature is the forgiveness period -- or I'm sorry, the loan amount is from two years up to five years. So if there's an unforgivable portion of your loan, it was a two-year payback period -- is now being extended to a five-year payback period. The 8-week period of using it for compensation or payroll is being extended to 24 weeks. So again, going from 8 weeks to 24 weeks. This is a really -- to me, this is the most significant and useful change because you no longer have to kind of compress everything into eight weeks. You can take a little bit longer to divvy out the funding for compensation. So that may or may not apply to everybody, but especially for those who -- I think a lot of the -- like restaurants in particular were the ones that benefited from this because they can kind of extend that payroll out as things ramp up slowly. In a massage practice, it may or may not be helpful, but I think having more time is always helpful.

Also, this is not going to apply to most of our listeners, but it's there. This feature is you don't lose your forgiveness if you can't rehire people due to a downturn in business. So if you're having trouble rehiring people either because they just don't want to come back to work, or maybe the unemployment's paying more than they used to make -- there's all sorts of weird glitches that are happening. If you're just having trouble rehiring people, then your forgiveness won't be jeopardized. This is also a big one. It used to be that you had to use at least 75% of it for payroll or compensation. That is being reduced to 60%. So I think for most of us, it's not very difficult to use it for payroll or compensation because that's the bulk of what people need it for. But there is that caveat if you have other expenses that fall into the rent or utilities category, you only need to use 60% for compensation to be forgiven. And then the last thing that's kind of the highlight is you have ten months now to apply for forgiveness. So that has been extended quite a bit. It used to be, I think, the eight-week period after the loan was dispersed. And now it's up to ten months.

So those are some highlights. Makes it a little bit more flexible. I encourage you to check out the article for more in depth. Those are kind of the highlights on the updates. Now, again, when this podcast releases, the president may have signed the bill, maybe not. But it passed with an overwhelming, almost unanimous majority in both sides of Congress, so it looks like it's fairly a sure thing. That's what I got.

AH Sweet. So there are still PPP funds available? If I haven't applied for one yet, I could apply for one tomorrow?

MR Yes. I know of a business that just got funded two days ago.

AH Yay.

MR So yeah, there's still funds out there. And who knows? There may be another stimulus package as well. We don't know.

AH Thank you. Thanks for the update. Thanks for all of the updates, Michael, because this is so tedious to me. There's just no way I could wade through it, so thank you for doing that work for me.

MR Yeah. Yeah.

AH I've been reading a couple of our reviews on Apple Podcasts and list at iTunes.

MR Yay.

AH But I remembered Apple Podcast. And I want to say thanks to kate.lmt for a lovely review that said, "I’ve been listening to this podcast for a couple of years now. I’m always blown away by the content and tips given by both Michael and Allissa. They are very generous with what they share, and their banter is mostly hilarious." Mostly? Not completely? All right.

MR Mostly? [Laughing]

AH Baby steps. "No matter if you’re a newbie or a seasoned massage therapist, you will learn a lot from the podcast." Thank you. Thanks, Kate. We really appreciate that.

MR Yeah.

AH I gather these up and pin them to my walls for the cold, dark nights where I sit huddled in my office trying to write stuff, so thank you. And we did get another review that was asking about the cover art--

MR [Laughing] With a quill pen and a candle.

AH Pretty much. That's me, wrapped up in a quilt. We did get another review that was asking about the image of our "podcast app thingamabob" art that changes. Sorry. It was -- sometimes they just change. Sometimes they revert to our old art. Our new one is back, and we hope that you like it. But thank you for everyone who leaves a review. And if you like our podcast, please leave us a review and/or tell a friend about us. We would appreciate that.

Michael, who's our first sponsor?

MR Jojoba!

AH Hey, Jojoba.

Sponsor message As you know, I recommend HobaCare jojoba for use in your massage practice since it never goes rancid, and it's safe for all clients, and it won't stain your natural fiber sheets. But with all the extra handwashing we're doing recently and in the foreseeable future, it is time to grab a bottle for your house and use a little bit of self-care. Jojoba is the closest thing in nature to the sebum that your skin produces. Our skin cannot keep up with this repeated handwashing and sanitizing, so one or two drops on your hands will keep them soft and healthy. And you, my friends, can get 10% off the price of the product orders of $35 or more when you shop through our link, which is massagebusinessblueprint.com/jojoba.

MR I'm just still picturing you in my head wrapped up with this candle burning and a few scraps of breadcrumbs on your plate and the reviews taped to the wall, like your only solace in the darkness.

AH Trying to write.

MR [Laughing] For some reason that's just hilarious in my head.

AH It's not that far off. I'm glad you take humor from my pain, but that's fine.

MR Yeah. I'm over it now.

AH And I've had a really hard time writing lately. I've just had a hard time concentrating, which is a thing that happens to me in phases, but also direct results of the low level, day-to-day anxiety of being in a global pandemic and race war. And it's just a tough -- I haven't been able to concentrate, so I really do -- I have to remind myself every time I sit down to write something that the process of writing is tedious, and I don't really like writing. I like having written something, which is something my friend -- our friend -- Ruth Werner said that has stuck with me deeply. I have to remind myself, you hate this part, but you really like the feeling of having written something. So yeah, when I'm huddled in my quilt tap, tap, tapping away at my -- face glowing from the light of my MacBook, that's what I'm thinking of.

Anyhow, speaking of Ruth Werner, we've got a little bit of a different topic today. Normally, we try to stick to things that are very business and marketing related. And this is a little bit, but it veers more into the actual hands-on practice and critical thinking of a massage business. And it is inspired by a chat that a whole bunch of us premium members at Massage Business Blueprint had with Ruth Werner, a pathology expert and educator. And many of us have been turning to her for lots of questions related to COVID-19 and how we're going to screen clients and what about these clotting issues. We did a wonderful office hour with her that we actually recorded. It's in our premium member portal, so if you're a premium member, and you haven't seen it yet, check it out. And if you're not a premium member, this is worth the price of an admission times ten.

So we had this great pathology discussion with Ruth, and it -- working through how to screen people and the questions we need to ask and the things we need to think about to decide if it's safe to work on anyone, not just people in a COVID world, it made me think of a topic that's been brewing for a while, which is how to ask better pathology questions. And many of us -- I would say all of us -- have seen in online discussions and larger groups where someone will say something like, one of my clients was just diagnosed with cancer. Is it safe to work on them? It's a valid question, but it's not a question that anyone online can answer without more information. So it's always like, is it safe to work on X, Y, Z? And that might be my client who has cancer, a pregnant woman with calf pain or a client who's four to six weeks out of a heart attack, or nowadays, a client recovered from COVID-19.

And it's frustrating because often these questions -- we need more info to actually answer them properly, and the answers that end up being in that thread are a variety of thoughtful or semi-informed or entirely uninformed opinions. And we have no context regarding that answerer's education or experience. So someone might pop in and say, it's totally fine to work -- to do deep tissue -- on a pregnant woman who has calf pain. I don't know if the person answering that is someone who is skilled in pregnancy massage or someone who has never worked on a pregnant woman but thinks they know everything that needs to be known about deep tissue or whatever. So these are tricky situations. And I would love -- I've been thinking a lot about how to ask better pathology questions when you need to crowdsource some answers because none of us have all of the answers. And sometimes our power is in our community and being able to tap other people for guidance and more resources so we can make better decisions as a practitioner.

So when a tricky situation presents itself, I want to encourage us to think through all the factors to consider that will get us to our own answers and help other people give us better answers. And more often than not, I found when I go through these questions myself, I tend to not need to ask the world for answers. But often times, I still do because I really value the experience and the expertise of my colleagues. So some of these questions that I ask myself -- one, what -- say a complicated client presents themselves or an ongoing client now has a complicated health condition that's new. What does the doctor say? Now, this is not an entire metric because we cannot count on MDs or GPs or even NPs or PAs to know exactly what massage does to a body or when massage is or isn't safe. But oftentimes, these medical professionals and primary care practitioners can help us find the information we need to determine if it's safe.

So is this person's illness contagious? What are the restrictions or suggestions that the doctor has given the client? And many of these answers we can get from the client. We don't have to talk to the doctor specifically. There are cases in which we might choose to, but we don't always have to. We can ask, did the doctor say that you're contagious? Have they given any restrictions as far as who you can be around? Have they given you any restrictions as far as activities that you should stop or start at this point? Are you taking any new medications?

So those are some questions that can help guide us. If the doctor has said they need to stop running, then that tells us the doctor doesn't want them stimulating their cardiovascular system that way or doing cardiovascular exercise right away. Or if they're coming to us for a hip problem, we know that the doctor thinks that rest for the hip is better. If they've told the person who normally runs five miles a day to stop running for a while, that tells us that the doctor thinks that the injury could be aggravated by more movement and continued movement. And medication's the same thing that tells us what else we need to consider. If they put a patient on blood pressure medication, that tells us we need to adjust our work accordingly. Okay. So what do doctors say? Okay.

What does the physical therapist say? If someone's in PT, what's the physical therapist telling them and also doing to them? If you've got somebody coming out of a shoulder surgery and they're four weeks out, but you're uncomfortable about doing deep work around the shoulder -- you're not sure if it's okay, if that's safe yet -- what is the PT doing? Ask them specifically. Are you uncomfortable? Are they using so much pressure that it hurts? Are they moving your arm to the maximum range of motion? And we know that if a PT is doing super deep work and tons of range of motion and all kinds of weight stuff on that shoulder, that it's probably pretty safe for us to be doing regular massage, even with a little deep tissue work and some friction stuff. If the PT's working on the scar, we can work on the scar.

So getting input from -- via the client -- what's going on with the other medical professionals in their life? What is the client's daily life like? What is their daily movement like? Are they doing things that challenge their cardio and respiratory systems, or are they fragile and limited? If a client is experiencing such weakness and exhaustion that the maximum of their activity is getting out of bed to a chair, getting from a living room chair to a dining room table twice a day, and then going back to bed, we know that their activity's really limited and we don’t want to do anything to their body that will be more challenging than their regular activity. But if we know that that client is walking briskly for a couple miles a day, if they're carrying laundry up and down the stairs without getting winded, then that tells us a little bit more. Are they bruising easily? So what is the client's daily life and movement like? These are good markers for us to determine and also to know if we need to ask other colleagues these questions. So when you do ask these questions and you've got answers from the client, now you can formulate a better question for the masses if you do need to crowdsource some information or ask our colleagues for more resources and guidance.

So here is an example of a lousy question and then a better one that kind of covers all of these factors I've talked about. The lousy version would be, is it safe to work on a client who had a heart attack six weeks ago? That's a lousy question -- right? -- because nobody -- the answers you get are irrelevant because there's no context. So a better question would be, a regular monthly client had a heart attack six weeks ago, and here are the factors related: she did not have surgery, she's now on a statin for cholesterol and an ACE inhibitor to lower her blood pressure. Okay. The MD said it's okay for her to return to work -- it's a desk job -- and to her regular activity. So now we're going to get into her regular activity. She can carry a light load of laundry across the house, one level -- she doesn't have stairs -- and she can unload the dishwasher at what she considers her normal, pre-heart attack pace. She's in cardio rehab at the hospital twice a week. She walks her dog slowly, she says, once a day. She used to get medium pressure massage from me, occasionally with deeper work on her shoulders.

So if you consider all of these factors, the people who you're asking for guidance can give better, more educated answers. But also, if you think through all these questions, you can come up with your own answer. You don't need to crowdsource this. You can trust your own judgement. And that's kind of the point that I wanted to make. Ask better pathology questions. Get the context. Consider it yourself. Come to your own conclusion. And if you feel you are lacking knowledge in a particular area, then absolutely seek guidance from colleagues that you know and trust. I don't know that I would put it out there to the masses in the world. And when someone gives you advice, I might say, hey, do you have a lot of experience working with heart attack clients and people who have had cardiovascular distress and are in recovery from that? I would ask. You don't want advice from someone who's never worked on anyone with any kind of cardiac issue history and doesn't understand medications.

So that's it. That's what I got. Use your brain to ask better questions and come to better conclusions in regard to client care and decision making.

MR Nice.

AH Thank you.

MR Good stuff. Yeah. Ruth was -- it was a huge office hours. It was one of our biggest, best attended office hours ever.

AH 60 people.

MR Yeah.

AH Three screens of people. It was amazing.

MR Yeah. I got a lot of good feedback that people loved it, so good stuff. Thank you for sharing that. All right. Before a quick tip time, let's give a shout out to our sponsors at Yomassage.

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MR Yay.

AH Uh-huh.

MR All right. Quick tip. Yeah.

AH Do you have one?

MR No.

AH No? Okay.

MR I'm going to not have one because yours is the most important.

AH Okay. Well, that's very thoughtful. So my quick tip as of Thursday, June 4th, in the context of what's been happening in our world and specifically our country, is -- my quick tip is to don't be a racist. And I say that not really lightheartedly. I say that with the acknowledgement that I am a super privileged, middle-class, suburban white woman, as I have been my whole life, and it's time for all of us to acknowledge our internalized racism issues and sometimes externalized racism issues. Recognize that saying, "I don't see color," or "I think everyone is equal and that's how I treat people," is probably a naive statement, and that we all have a little bit of work to do to understand people of different races, the history of how we have treated people with different colored skin in this country, why we do that, and how we can be part of that change. Not everybody needs to be marching on a street in a city this week or in the future, but if you're not going to do that, let's maybe think about other things we can do.

A thing that I'm doing is I have -- I've donated to a couple of bail funds pre some of the protests in bigger cities. And then I hear that bail funds were pretty much over-funded because everyone was doing that, so I have donated a little bit to some legal mutual aid organizations in different cities near me and throughout the country. And I am starting -- I'm starting it tomorrow -- a 30-day course called Do the Work from a woman named Rachel Cargle. And the course is designed to be an eye-opener and a call to action for those who seek to be allies, specifically, to black women. I will put the link to the signup in the show notes. You can also get it through Rachel Cargle's Instagram account. And I'm really excited about it. It's super easy. You sign up, you get a confirmation email, and you get a link to the first ten days of training -- sorry. I'm just looking at it now. And each day is a prompt to think about or do a small activity to do the work recognizing your own racism and how to be a better ally to black women, which is something that's obviously very important to me. And that is my quick tip. Don't be a racist, and take some action to be anti-racist. That's what I got.

MR Yeah, a note on that. I signed up for it. It's a little confusing, so just to be aware -- I clicked the link, and it basically went to something that just said, hey, sign up, but there was no description. So I put in my email address in there, and then it straight to her Instagram page with no confirmation, so I had to wait to get the mail a few minutes later -- say, okay. I'm actually enrolled, and here's how it's going to work. It's a little confusing to me, so be sure you're aware of that when you sign up. You are signing up for the thing.

AH Yeah, totally. Just -- I think it was probably a program she started a while back that is no longer focused with a big landing page because -- this woman is really amazing. She set up, among many other things -- she runs a bookstore, I think, in Akron, Ohio. And there's an organization that she is the founder of where she's the speaker and an educator in all things race relations. And also, she created a foundation that funds mental health therapy for black women and girls. So it's really -- she's really got a lot going on, so it didn't surprise me too much when I saw that there wasn't an official landing page. And it looks like part of her website's under construction, and I'm guessing she's a little busy nowadays. And yeah. So you don't see a full course description or anything, but just sign up with your email. You'll get the response email, and you can click and access through there. So yeah. But I'm really excited about it. I kind of skimmed through it, and I set an alarm on my phone to start the process every -- I want to try to do it at night, but I don't know if that'll work. I might have to switch to mornings. But I feel good about taking a step forward with the acknowledgement that it is not the biggest step that could be taken and I still have other work to do.

MR Thank you for that.

AH Yeah.

MR All right. Good place to wrap it up then. All right. Well, thanks, everybody, for joining us today. We appreciate you being a listener. As always, you can visit our shiny new website at massagebusinessblueprint.com. And I know we've mentioned it over and over, but now's a really good time to join our community. You get a month free. And it's really inexpensive after that, and there's a ton of good stuff in there that we've referenced already, so consider that. And if you have any questions or comments for us or topics you want us to cover, you can email us through the website, or you can send it to podcast@massagebusinessblueprint.com. So thanks for joining us today. We will see you next time.

AH Bye.

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