Shireen: In this episode, Dr. Eva Norman shares her path to physical therapy. She discusses how one-to-one and at home physical therapy can be beneficial for individuals struggling with chronic illnesses and allow them to make better progress, Tune in to learn about how to maximize physical therapy in chronic illness management.

Podcasting from Dallas, Texas. I am Shireen and this is the Yumlish podcast. Yumlish is working to empower you, to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type two diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week. 

Dr Eva. Norman is a physical therapist who founded Live Your Life in response to her passionate desire to offer to her clients, patients, and the public services, both in-home and the community that could help them experience health, wellness, and a more active lifestyle throughout their lifespans. Welcome Dr. Norman,

Dr.Norman: I appreciate the opportunity to share a little bit about myself and physical therapy.

Shireen: An absolute pleasure having you on. So Dr. Norman, diving right in, what really led you to a career in physical therapy? 

Dr.Norman: Yeah, it's kind of a life altering story and I love to share it. When I was 13, I was involved in a hit and run accident where I was told I would never walk again.

The surgeon wanted to amputate my left, lower extremities. But my parents were adamant that an amputation is not necessary. After four months of rehab in an outpatient clinic at the hospital, we got a letter in the mail saying that we had reached our annual cap for insurance for that year. So my parents were forced to find a physical therapist that could come to the home at the time, you know, 13 years old.

Even today, we all struggle finding home care services for children in their homes, and as sad as this sounds, my parents actually had to put an ad in the paper and, and had to look high and low because they had called every clinic hospital hoping to find someone because no one would take private pay to continue my rehab process.

And I was nowhere near sadly, achieving the goals that I wanted to achieve. Which was walking again. And, so thankfully we were able to find a physical therapist who truly was extraordinary.  I'm trying to protect her privacy, so I not, will not be mentioning her name, but,she, it was truly a life altering experience.

She made me believe that I would walk again because I had doubts. I had gotten very depressed during that time actually tried to commit suicide.  So  I've experienced deep depression and extreme pain in my lifetime, which honestly has helped me in my career. Obviously being able to empathize with many of my patients, but after eight months of intensive rehab, working very hard with her in an in-home gym that her and my father had built in our garage. I walked really for the first time. And,  shortly after, really walk with no deficits. And today I engage in marathons, triathlons and numerous activities that perhaps science would have disproved back then that I would be able to do. But yeah, I have both legs and I'm healthy today. Thanks to this physical therapist.

Shireen: Oh, wow. Powerful story. How do you feel physical therapy and chronic illness management intersect? 

Dr.Norman: Yeah. You know, most Americans, sadly, don't move enough. Despite proven benefits, such as reduced risk of cancer and chronic diseases and improving your bone health, cognitive function we control and just honestly, overall quality of life. And due to that lack of physical activity, many Americans have, or likely sadly to experience, you know, chronic illness. Such as heart disease, diabetes, depression, and obesity. So as physical therapists, we're known as movement experts, specialists, and you know, our goal is to improve the quality of life through prescribed exercises, manual therapy and patient education.

After we make a diagnosis, we create a customized treatment plan that helps our patients improve their mobility, manage their pain and other chronic conditions. As well as recover from injuries and prevent future injury and chronic diseases. So we can play a huge role for individuals with chronic illness and prevention, just through our customized treatment programs and comprehensive evaluations.

Shireen: Interesting. Can you speak to some of the benefits of physical therapy for individuals living with chronic illness? 

Dr.Norman: Absolutely. So there's, honestly it is probably endless, but I'll, I'll, I'll share a few. So regular physical activity can really benefit your physical, mental, and social health. It also helps to prevent or improve many chronic conditions such as, as I mentioned earlier, like heart disease, diabetes, and depression, but even some cancers and physical therapists help people overcome those barriers to physical activity. I mean, we kind of, what we do is really amazing about what we do is when we evaluate that person, we really have a very holistic approach so that we see them far beyond their physical capabilities.

We take into consideration, perhaps their occupations, perhaps their finances. How they socially interact in the communities or even just their emotional state, but keeping all of that in mind, we can truly come up with a very personalized program that meets their specific needs and their challenges perhaps in life too, in order to meet their specific goals. And we help strategize, of course, with them utilizing oftentimes motivational interviewing to help them achieve those goals. And we treat actually individuals of all ages and disabilities. So it's not even just a unique group of people. All individuals actually have the same approach. 

Shireen: Can you speak to some of the challenges that might arise for individuals with chronic illnesses, especially as it relates to physical therapy?

Dr.Norman: Yeah. There's, you know, there's, sadly there's, there's quite a few. And so I kind of go into these and a little specifically, so first just thought is lack of transportation, you know, depending on the age group, I mean, I've had, you know, of course my young kids that perhaps parents are working, you know, right now, especially in a pandemic, you know, parents are, you know, having to work either from home or perhaps they're working long hours now.

So it makes it very difficult sometimes to transport their children. Our elderly folks also struggle because they may not even be able to drive, you know, they may not be able to have a vehicle or perhaps, um, a sibling or a child that can transport them. So that becomes, certainly can be a barrier. And of course, just the, you know, I would think of middle aged individuals. You know their work. So, you know, either you can possibly fit it in the beginning of your day or the end of the day, but you know, a lot, a lot of us have children, which makes it really difficult. So that can be obviously a huge, huge barrier. 

And then also think about rural America here. I'm actually from the state of Minnesota and here 80% of our counties are underserved. And if you look at the map across the country, of course, You know, a large percentage of well as well, that are underserved. And so access to care can be very limiting. Just to give you an example, there are areas in our Northern part of our state, where the closest clinic is anywhere from 30 to 50 miles, and that is true in many other states across the country.

So of course that can certainly delay care, access to care and sadly. You know, unfortunately turn, you know, an acute injury into something extremely chronic and, or unfortunately never really treat the chronic illness, which then of course leads to other comorbidities unfortunately. And then as far as, for the elderly, 

And also for the elederly, I just want to highlight the mobility that is sometimes required, you know, to go to a clinic can be like to, and from, can be extremely challenging because it can be considerably taxing and very stressful. Also sessions can take a long time. Sometimes they're, you know, you're waiting and in the waiting room and so forth, and that can be very limiting for them because their stamina might be limited.

And so overall the experience just becomes a huge challenge for that population. And then of course, sadly, of course, in this country, we certainly have those individuals that just lack adequate insurance or income to be able to cover expenses. You know, many insurance plans have high copays and deductibles for our type of services.

It's unfortunate that, I mean, as sad as it sounds, but there are plans that literally are paying $75 a session just for your copay. It's ridiculous. I mean, who could afford that session after session? If you think about my story, that would have bankrupted my family. So hence why, which essentially we had to do private pay.

Thank goodness. My therapist volunteered some of her time because most people cannot afford those types of services, but my parents, you know, obviously sacrificed a lot to make it possible for me. And, but, you know, I was very fortunate, but there's so many that don't have those resources. And then of course, as I mentioned earlier, I mentioned delays in care.

Delays in care can come in many different forms. I mean, I just look at it right now. I live in the twin cities, Minnesota Metro, and you know, we're, we're flooded with healthcare. I mean, there's just many different healthcare systems. We have numerous clinics, but despite that we run into sometimes waiting a week, if not longer, for orders, to be able to see our patients under insurance.

Which is ridiculous. What happens is because of the pandemic physicians are now being furloughed certain weeks, and I understand talking to colleagues across the country that this is happening across the country as well. So they may be on one week off a week. So covering physicians don't necessarily, or providers, whether it's a nurse practitioner, physician assistant, may not be comfortable, you know, covering for that clinician because they obviously have their full load as well because they're so limited in help in the clinic. So then we're looking at a week to two weeks perhaps to get an order, to see an individual. And most insurance requires prescriptions in order to be able to see our clients, So unfortunate delays in care, and that could be anyone for that matter.

And then of course, then there's a long waiting list as well. Or of course, in rural America, if there's only one clinic for individuals within a 30 to 50 mile radius, there probably is a long waiting list. Right? But also in the cities, you'd be amazed. I actually looked into this in preparation of this podcast just yesterday. I called my local clinic, which is walking distance from my home. There was a six week wait today to see the physical therapist on site. Who was going to wait six weeks as I just had my rotator cuff repaired, you know, to have that care?  And I'm actually in the twin cities, like I said, Minnesota, Metro. So I can't even imagine. Actually, my gosh, it's painful to even think about what rural America is experiencing today. So all challenges of course, that people can be experiencing.

Shireen:  I do want to dive a little deeper on one of the ones that you mentioned  with health insurance. So you, you know, you mentioned essentially there's a cap on the amount of care you can receive and from there, it's “figure it out on your own,” right? In my mind, I think that it is much easier for the insurance company to bring in that physical therapist, to work with the person, to make them better. Right? Essentially. Rather than have prolonged long-term associated costs with unmanaged, whichever condition. Right? Why is that? Why aren't we looking at, why are we thinking long-term here? 

Dr.Norman:  So, this is your question. You, what you're asking for is my understanding of why aren't we having more one-on-one care when it is needed most versus, you know, just sort of capping the person and then saying, well figure it out on your own. And a lot of people are not able to figure it out on their own. So then they go, you know, and then of course you're looking at more costs down the road associated with heavier costs down the larger bills down the road as a result. 

And what's happening today is that we're incredibly shortsighted and saying, oh, It's done.

Let's wrap it up for months to whatever that time period is. And you're capped at that again, not having sort of that long-term, you know, So you're really talking about the insurance company, insurances are dictating these policies, right? That we're having to abide by. So I, I mean, I can't stress enough that's where we need to be advocating. That's who we need to be talking about. Sitting down with insurance companies and being able to have these conversations. I mean, from a loving perspective, I actually lobby for the Minnesota physical therapy association. I'm actually headed to Washington DC next week to lobby Congress. We're trying to change things legislatively  on a federal level. But, you know, we’re hoping that it can translate down to them on a private scale level. Cause it's a lot of these private insurances we're running into issues, but even on a federal level. 

And so, and what we hear the message year after year, is there are no dollars to do that. You know, they have to put caps on services or they have to limit, you know, so much because there isn't this endless bucket of money. And so even though I feel like some of these programs are well-funded. Unfortunately, you know, and what they've also shared too, that there's sometimes abuse of the system in certain parts of the country. And sadly, everybody suffers as a result. So, I mean, there's just, there's a lot of layers to this, right?

There's many different variables that we have to consider, but I think the greatest thing in what we have done at my company is urge every single one of our patients to communicate with their member of Congress and really stress the importance of getting adequate access to care and avoiding these delays of care.

And also helping with the administrative burdens is sometimes also part of this that can certainly delay care. And as far as providing the quality of care that we want to. So, for all those that are listening, contact your member of Congress, because it really has made a difference because we've been able to do so much, especially for children and the elderly over the years, by just giving our patients a strong voice on Capitol.

Shireen: And so coming back to why they should contact a member of Congress. How do you feel that one-on-one experience with patients really allows them to make better progress and have a better experience overall? 

Dr.Norman: Yeah, so I mean, it's invaluable, right? And so that individualized approach provides high quality of care because of being patient-centered, but, you know, I mentioned earlier that holistic approach, right? To their injury, their disease, their disorder. We have time to listen, listen, and really engage and get to know them holistically. And as far as what's important, what's meaningful so that we can generate goals that are valuable to them. That hopefully we can achieve.

And it also makes it easy as I've already kind of alluded to, that relationship building when you're one-on-one, especially when you have a consistent therapist with you. It's so easy to develop that relationship. I have to tell you. And I think because our sessions are also longer, you know, we tend to see people a lot longer. I say the average physician, you know, isn't a nurse practitioner, physician assistant, we're seeing a lot longer. So we're able to build those relationships and to, I think what's been helpful too is it also provides them the privacy to ask those questions, perhaps that sometimes they may not feel as comfortable elsewhere in other, perhaps other settings or with other individuals, because we are spending time because they, now we have that trusting relationship.

They can, they can share more, which. To help them more. Cause we're able, again, to have those conversations to understand them more holistically, right.? Looking at perhaps their social, their emotional or financial, their occupational, their spiritual and intellectual wellbeing. And then, I think also too, just having that one-on-one connection allows us to provide the adequate education to, for them to be able to understand perhaps what's necessary in order to achieve the goals that they want to,

As far as the consistency goes to another benefit to that of having say the same clinician in that one-on-one interaction is we're able to monitor progress so much easier, especially having the same clinician that's obviously can be a challenge, but, you know, I know there's obviously a lot of my colleagues across the country that really work hard to ensure that. Because it's invaluable, you know, especially today, especially in a pandemic, you know, certainly someone could be out of the office for one week. And so then you're being shuffled to another clinician. So,  thankfully I have to tell you it has been really great to see so many of my colleagues across the country, you know, Having very safe practices to be able to stay engaged and so fortunately not, you know, being able to be that consistent therapist because they're having all those safeguards to protect themselves and being can during a pandemic, which has been great. I've had numerous, conference calls over the past year and I think. Instilling those best practices to make sure that, you know, you're wearing your mask, your shield, your gloves.

I mean, seriously, some of those of us are required by our states, but some of us are really going on the extreme side, just to ensure that everybody feels healthy and that we can continue to provide the care that we want to for our patients. 

It is also, I would say, communition. Is obviously invaluable in any relationship, but having that one-on-one can also be beneficial and communicating also with their loved ones, their caregivers, being there allows us to perhaps be able to engage with those individuals. Oftentimes we will ask loved ones to be a part of sessions so that we can obviously keep them up to date with what the plan is, what the goals are, you know, of course that we've come up with our patient, but then also ways that they can also help support. Right? And I mean, obviously research has shown when you have, you know, this, this try, you know, individuals that can support you. My gosh, you're going to, you're far more likely to have successful outcomes.

So that can be very, very invaluable. And then quality time to be able to demonstrate, to observe and also modify those exercises as well is, is great one-on-one. And then I would say our hands are invaluable. You know, we're movement specialists, but I always call us manual specialists as well, manual therapy specialists, which really allow us to  access and really evaluate tissue quality in any session we're in. And so, I mean, I can't say there's ever a session where I'm not, you know, engaging in some form of touch to help my patients either be relieved from perhaps any symptoms they may have. Or just honestly, just for comfort and to call up and this, you know, during a pandemic, you can imagine the anxiety and the depression that we're seeing, it's overwhelming, never seeing in the communities so that I have to tell you, it has been probably a highlight of every session to be able to hold someone's hand.

And granted I'm wearing gloves these days, but it's still incredibly rewarding to be able to do that. And I can tell they feel comforted by that. And then also I would say that one-on-one allows for fewer distractions too. We're, we're not, you know, the phones are ringing there. Isn't, you know, all these sirens in the hallway or wherever, depending on the city that you're working in, But it can certainly makes a world of difference perhaps with you're just right there with the patient present, listening, engaged. 

Shireen: We're going to round up with the last question here. What, what are some of your recommendations for physical activity for individuals, particularly with chronic illness like diabetes?

Dr.Norman: Yeah, so great question. So there's quite a few things, but we'll start with aerobic exercise. So think about walking, cycling, if you like that bike. Oh my gosh. And these days, you know, with a pandemic, everybody's getting a Peloton or, you know, what, anything like that. And my gosh, they've been wonderful for many of our patients jogging, of course, that your treadmill and swimming, those are all great forms of aerobic exercise.

Resistance or strength training, also known as strength training, can be invaluable with aerobics. You have to do that resistance training as well. And that is, you know, exercises with free weights or even your body weight. My gosh, like even just standing up and sitting down from a chair, crossing your arms can be invaluable for someone, especially the elderly,, or elastic resistance bands. I mean, there's. Medicine balls. I mean, there's so many different things that you can actually purchase easily, and you know, having your home and then as well for injury prevention, I always say flexibility exercises can be very helpful, not only to improve range of motion, but I said like, as I said, injury prevention.

So don't forget about stretching before and after exercise. And then, for those that are having balance issues, which can be the case, especially if you're having perhaps peripheral neuropathy or your sensation is being affected in your feet. You may have some edema, perhaps you may have some issues with your balance.

So you would benefit from definitely incorporating some balance on both static and dynamic into your program. But overall, I would say contact a physical therapist to get that, Remember that personalized program specific to you. And then we would recommend doing daily exercise, at least not allowing more than two days to lapse.

So try to do something at least every day. And I would say those resistance exercises should be done every other day. and what research has shown, is adults with type two diabetes should ideally perform, both aerobic and resistance training or all suboptimal glycaemic and health outcomes.

So I can't stress enough. Those two, as I mentioned, are the two that are most valuable and get 150 minutes a week of physical activity. And of course, looking at your nutrition is very valuable as well. So thank you for the question. 

Shireen: Yeah, no, and I second, the part about nutrition, of course, all bias is included there. Dr. Norman, how can our listeners connect with you and just learn more about you? 

Dr.Norman: Absolutely so well there's many different forms, but I would say the easiest that you can get in touch with in any way is through our website, LiveYourLife.pt.com. You'll actually have access to all of our social media, Follow us like us. You know, we'd love to hear from you seriously, post questions. We always love engaging with the community and you'll also have access to our blogs. And also all of our emails, all of our clinicians bio's with their emails are there. So if you want to send any one of us an email directly, you're more than welcome.

Shireen: Lovely. Well, thank you so much for your time, Dr. Norman, it was a pleasure having you on and to our listeners out there, head over to our social media and tell us what is your favorite physical therapy exercise to do? And how can you modify it at home? We'll see you there after the episode.

Shireen: Thank you for listening to the Yumlish Podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn. For tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspectives. You can also visit our website Yumlish.com for more recipes advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week's show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we'll see you next time. Remember your health always comes first. Stay well.

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