Ep. 5: Rewarding Rehab - Programs and Services and Lee Health

Brian (00:08):

Welcome to the Living the Healthy Life Podcast, where we bring you the latest on health and wellness from the experts here at Lee Health. Discover what's happening at Lee Health and take away tips and inspiration to reach your ideal state of health.

Brian (00:25):

Hello, and welcome once again, my name is Brian Hubbard. I am the manager for marketing and brand management at Lee Health. With me as my co-host, Carrie Bloemers. Carrie is a registered dietician as well as the Director of Education and Navigation at The Healthy Life Center at Lee Health, Coconut Point. It's a long title, but well worth it. Hello, Carrie.

Carrie (00:44):

Hey Brian.

Brian (00:46):

How are you?

Carrie (00:46):

I'm doing great.

Brian (00:47):

Good to have you, and I want to say thank you to everyone else out there who's joining us today. Today's episode is all about something that's very important to the Southwest Florida community, and that is rehabilitation. We are overjoyed and excited to welcome Diana Rippl, she is the Manager for Rehabilitation Services at Lee Health, and she's here to tell us a little bit more about Lee Health's rehabilitation services, special programs, and really anything else that we can think of to talk about. Welcome to the show, Diana.

Diana (01:14):

Thank you. Thank you for having me.

Brian (01:16):

How are you?

Diana (01:17):

I'm doing great.

Brian (01:18):

Good to have you. I want to just jump right in so we can get right to it. If you could, in your own words obviously, can you give our audience a general rundown of Lee Health's rehabilitation services? What are the benefits, what are the programs, a primer on what you do and why?

Diana (01:37):

Great. We have adult rehabilitation services and pediatric services, so we have two branches of it. We have physical therapy, occupational therapy and speech therapy. We don't have them at every location, but we do have them at the majority of locations. And within each of those departments, we have lots of specialty programs. We have specialists trained in certain diagnoses, certain treatment techniques and with about 11 outpatient centers for adults and growing, soon to be maybe 13, we have a lot of things to offer for our community when it comes to rehab.

Brian (02:15):

Excellent. And so one of the things we always like to ask, we like to get our listeners to know a little bit more about our guests. Can you tell me where this passion of yours comes from for rehabilitation? How did you get started in that? How did you get to this point, what led you on this journey so to speak?

Diana (02:34):

Okay. I'm a physical therapist by trade and by licensure and was always an athlete and believe it or not, I was in middle school and someone came to a career day and she was a physical therapist and had explained all about physical therapy. And I said, I want to be as passionate as her about the body and about what she does. And so I changed my direction because everyone had always been leaning me to be a nurse or a doctor-

Brian (03:02):

Got you.

Diana (03:04):

... and so I really never looked back from there and kept pursuing the career.

Brian (03:10):

Carrie, how about you? I meant to ask you this earlier. As you know, as I said Carrie's a registered dietician. How did your personal journey come about?

Carrie (03:18):

Well, man, if I wasn't a dietician I would've been a physical therapist.

Brian (03:21):

There you go.

Diana (03:21):

Good choice.

Carrie (03:23):

Because it is, it's the two things, it's how the body works for movement, which is really important for our lifestyle, and then the way we fuel it with food and nutrition. I do 100% believe the two things go hand in hand.

Brian (03:34):

Very good.

Carrie (03:37):

And as well, I would say it was back in high school where it's those career days and what you're interested in and they're matching you up with, oh, something in the healthcare field. And it was just recognizing how food helps fuel you and make how you feel. And high school, I did sports like basketball and cross country.

Brian (03:57):

Okay.

Carrie (03:57):

And cross country especially, what you ate-

Brian (04:00):

Oh my goodness.

Carrie (04:01):

... before a race-

Brian (04:01):

I know.

Carrie (04:01):

... mattered when you're running your heart out and giving it all. But these lifestyle things, it's great that we can use our passion to help people in our careers.

Brian (04:12):

Deanna, we've seen healthcare organizations like Lee Health Specialists, we've been really focused on prevention for a while now. It's something that I've mentioned in other podcasts is that it used to be, you thought of healthcare as it was a hospital. When you got sick, you went to the hospital. But we know that healthcare now is so much more than that, preventive and everything else. Many people in our community out there, they're snowbirds, they're retirees, they're coming down here to enjoy the sunshine, the good life, all that good stuff. What techniques or exercises would you recommend for someone focusing on staying active and warding off potential problems?

Diana (04:46):

Good question. And I think the key would be what approaches to take, and that would be movement. Movement is key. In therapy, we joke about it and say, motion is lotion. If you move your joints, you move your body, you move your muscles, it helps to lubricate, it helps to stir up all the great healing processes that are going on-

Brian (05:10):

Interesting.

Diana (05:10):

... and basically helps you to remain and keep active. When people do come down here from up north as snowbirds, a lot of them are already very active, which is great. But those that aren't, those are the things that we encourage for preventative maintenance is to get up and move and to walk and to use your muscles.

Carrie (05:30):

And I would say that's a excellent point. I had a couple surgeries this year, as you both know, but sharing with that, one came with three weeks of bedrest and then having to get back into moving and being active. And that was where working with a physical therapist who prescribed those exercises that were appropriate, but also just getting you motivated to move again, to get that, like you said, that lotion so that your whole body is functioning and feeling a little better, helping that healing process.

Diana (06:02):

Right. And then when you move, what it does to your mental wellbeing is incredible.

Carrie (06:07):

Absolutely.

Diana (06:07):

You can either be in a socialized group, if you're socializing and you're moving together, but also the state of mind, nobody wants to be isolated and with these times now a lot of our patients did knock it out and did not socialize, but also didn't get a chance to exercise and move their bodies. We're seeing the repercussions of that and really motivating individuals to make it more ingrained in their lifestyle.

Brian (06:34):

You've seen with COVID, like with everything else, the trend being COVID has kept people more inside. Are you seeing that trend, obviously has increased, is it starting to level off a little bit, like you said, are people starting to get back into it a little bit?

Diana (06:46):

I think once some of the restrictions were lifted and people were vaccinated, the tennis courts and golf courses exploded.

Brian (06:56):

There you go.

Diana (06:57):

People flock to the things that they loved and wanted to be a part of, so we are seeing people getting out there. We just got to get it to the people that maybe weren't as active prior to, that have continued to be isolated and not move as much, so those de conditioned individuals. Or after hospital stay, a lot of people were just hospitalized in general, coming out of a hospital stay, what it takes in order to get that exercise tolerance back.

Carrie (07:24):

That whole other cliche of move it or lose it. That same thing when you're staying home during COVID or like you said, had a hospitalization, then you're susceptible maybe to more injuries and weaknesses and imbalances where that's where rehab can come in and help get people back to their baseline, would you say?

Diana (07:43):

Yes. And it's all about practice, you have to practice things. That goes with anything, that goes with athletic skill. I think one of the books published by Malcolm Gladwell, I think was Outliers said that you have to have 100,000 hours in order to be an expert in something with practice.

Brian (07:57):

Right.

Diana (07:58):

Think about it, if you want to be an expert in moving and walking, you got to get back and put those practice hours in no matter what the activity is that you want to get back to.

Brian (08:09):

And you mentioned walking, obviously that's the first thing I think of when you talk about somebody just starting out or somebody who's been in the hospital for a while, would you say that's true? Walking, obviously the easiest thing to do, but if someone's looking for an entry point, is there a specific type of exercise other than walking that you would recommend something that people do from home? Is there weights involved? I'm just curious.

Diana (08:36):

For the geriatric population, research has now shown that there's three general concepts of important things, to put it in simple terms, that helps to gain strength and function. We call it, reach up, sit up and get up.

Brian (08:48):

Nice.

Diana (08:50):

And I believe that we had a talk at The Healthy Life Center, one of our cohorts who's a geriatric specialty certified physical therapist, and he mentioned these three things. It's basically reaching up, getting your arms up overhead for exercise, getting up out of your chair, or sit up, sitting up, sit to stands, and then get up and go, which is get up out of your chair and walk.

Brian (09:11):

Right.

Diana (09:12):

Three basic principles of anyone who needs mobility. Great tips working on power, speed, and strength.

Brian (09:21):

It's funny as soon as you said, sit up, both Carrie and I both unconsciously just did it, because-

Carrie (09:27):

Kicked in a little posture.

Brian (09:29):

... I was slumping a little bit. But you're right, to the point, you need someone, it's a collaborative process. I'm assuming, you need someone to-

Carrie (09:38):

Cue you.

Brian (09:38):

... give you the reminders and cue you and all that kind of thing. And that's what your group does.

Diana (09:42):

As therapists, we're there to encourage, we're there to provide the best evidence based practices and principles and try to listen to the patient of what it is they can't do and go alongside them and help them to accomplish the things that they maybe were used to being able to do. But it's definitely going alongside of the patient. We're encouraging, we're giving exercise protocols, not just for that time that they're in therapy, but to sustain a lifestyle, a different lifestyle of mobility, or to get back to that lifestyle. Again, that feeds into feeling good about yourself, being able to go out and do things. There's so much fear sometimes in if you don't have the right balance or the strength. And we want to try to alleviate that and not have fear be something that limits people from doing activities and engaging in activities.

Brian (10:43):

And you said, it's like everything else in healthcare, at least the way we hope everything is, it's an individualized process. There's no one size fits all. There's general things that we know people can benefit from, but if someone comes to you, what you're going to do for them is different than what someone else would do.

Diana (10:59):

Correct, that's what provides us as being skilled therapy. And that's when you come to us for therapy, we do a full evaluation, whether that's speech, OT or PT, we do a full individualized evaluation, and then we actually write up a plan of care. We send that plan of care, outlines everything, and send it to your physician, and then we become a part of your care team with us, the patient and their physician.

Carrie (11:28):

And sometimes you see the physical therapist more frequently than anyone else on your care team. And you mentioned, how that partnership, that collaboration, how motivating, and I think personally, I've experienced that in that the therapist also have a level of understanding maybe your condition or what you're going through even more so than family members and friends, because they get the science and the medical part behind it. They really become a personal motivating, empathetic person as part of your journey when you partner with rehab.

Brian (12:02):

That's good.

Diana (12:02):

Absolutely, and I think a patient said it to me, "You're the most caring person that tells me what to do," so there's caring spirit because that's who we are at Lee Health and not patient rehab, but we also have a job to do for you and we're going to hold you accountable to the goals that you have set forth for yourself. It's a matter of being a little bit stir, stir-

Carrie (12:27):

[inaudible 00:12:27].

Diana (12:26):

... is not the word, but we want to push you to the limits that your mind or your body may have already set for yourself.

Brian (12:34):

It's the empowerment.

Carrie (12:35):

Really...

Brian (12:35):

It's empowerment.

Diana (12:35):

100%.

Carrie (12:37):

And it increases that quality of life, that way you can function in your life and that you can do more.

Diana (12:42):

And I encourage people to find the therapist that you connect with in that way.

Carrie (12:46):

That's a great point.

Diana (12:47):

That's very important. It's a very important piece.

Brian (12:51):

Diana, how does someone, say I need rehab, how does that work? Is it a referral, do I call you guys up, how would that normally work?

Diana (12:59):

We encourage people to have some discussions with their physician pending what concerns that they may have. And although our state requirements allow for direct access as a healthcare organization, we require you to speak with your physician and have the physician send a referral.

Brian (13:22):

Got you.

Diana (13:23):

Once you have that referral or they send it over, then we can get you scheduled and do a full evaluation. But I hesitate to not wait for the physician to say something to them, but to have that dialogue with somebody and say, "Hey, you know what, I think I might be a good candidate for it." You can advocate for yourself that, "These are the things I used to be able to do, these are the things I can't do now," and that is not just age or it's just not...

Brian (13:48):

Don't just accept it as normal.

Diana (13:50):

Don't accept it as the new norm, no. We know so many active people that are in their 80s and 90s and our hope and our intent is that everyone can achieve that mobility.

Brian (14:01):

That's a good point. One of the other things I wanted to ask you, there are some special programs that are going on. We all know the rehabilitation, people have in their mind what that might look and feel like and sound like. Well, there's another special program though, that I know you wanted to talk about. Can you tell us a little bit about that?

Diana (14:17):

We do have a ton of specialty programs, and not to take away from all those wonderful things that we're already providing, but one of our fresh new programs is we have an adult and pediatric scoliosis program that we started. And this really came to fruition thanks to a child life specialist, her name is Anna at Golisano Children's, who as a child underwent scoliosis surgery and as an adult started experiencing some back pain with the demands of a physical job. She inspired and encouraged me to find therapy solutions to help scoliosis patients, because as a child she never had therapy, nobody offered it to her.

Diana (14:57):

I researched a treatment technique called Schroth physical therapy. I took some courses, I became familiar with it. I'm not fully trained, but I have just enough passion and interest that I nudged the administration to invest in this program to offer a non-surgical solution for patients. We hired a fully certified... Did a search out there to find a fully certified and experienced Schroth physical therapist, and I'm so excited that she is with us in outpatient rehab here in your community at Lee Health. There's very few people in our entire state that are certified in doing this program, and she's here at our City Center outpatient rehabilitation at City Center location.

Brian (15:41):

And which one is the City Center?

Diana (15:43):

City Center location is on 41 Cleveland Avenue-

Brian (15:46):

Okay, [inaudible 00:15:47].

Diana (15:46):

... and it's just south of our Lee Memorial Hospital location. And she is there seeing both pediatrics and adults. And what makes this technique so unique is that it's a three dimensional approach to therapy. If you've had traditional therapy before we still use those concepts of traditional physical therapy, but we use a three dimensional approach. And I was trying to explain this to Carrie-

Carrie (16:15):

Yeah, just before the show.

Diana (16:16):

... and she said it was a good example so I'm going to use it if that's possible? But if you think about a soda can or a pop can, depending upon what part of the country you're from, soda or pop, and it's dented on one side and it's crushed a little bit down. You can do lots of things on the outside of the can, you can pull it, you can try to twist it and move it to try to get all of the dents out, but it's not until you go into the can and push the can out that you can maybe really correct a part of the dented can. And that would be a person with scoliosis who has lots of curves and dents, per se. And what the Schroth techniques uses as the inside portion, because I know you're probably thinking, well, how do you get inside my body and-

Carrie (17:00):

Exactly.

Diana (17:00):

... push my spine out or push my ribs out? We use it with breath. We use it with your lungs being filled with air and your diaphragm. If right now you take a large inhale and you three dimensionally expand your chest, hold the chest open and try to exhale. Try it again. You inhale, you expand three dimensionally in all dimensions your spot, hold it all out there and exhale as you do that. You're using your lung. Now, if you take a big inhale in and try to breathe in just your left lung, push all the air into the left side of your body and then exhale.

Carrie (17:41):

Is that even possible?

Diana (17:42):

It doesn't seem like it's possible, but that's how we retrain that unidirectional breathing to get that dented can in order to open up.

Brian (17:51):

That's awesome.

Diana (17:51):

That's just one of the techniques.

Brian (17:53):

We're trying it right here on [inaudible 00:17:54] everybody, and it works.

Carrie (17:53):

Can I tell you know, they're grunting, and it's mind blowing, it's next level.

Diana (18:00):

It is. And I can automatically see you guys lifting in your seats and elongating when you were doing that, which is one of the principles is to get elongation in your spine from the top and from the bottom down. That was just a teaser.

Brian (18:14):

Something so relatively simple as breathing.

Carrie (18:16):

I'm sure they all tried that in their seats at home as well.

Brian (18:20):

Yeah. It's amazing what something like that can do.

Carrie (18:20):

Hopefully nobody passed out and hold their breath.

Brian (18:24):

People might think of rehabilitation as, I don't know, maybe they think of it as rigorous exercise or machinery or all these things, but really you're just talking about... I know there's more to it than that, but you're talking about simple breathing techniques that people can really just naturally do.

Diana (18:42):

Yes. And in conjunction with the other exercises that we do, so we teach people to do other exercises, do a lat pull down, or maybe do some other shoulder over the head, maybe the get up, sit up, reach up exercises with the breathing in order to create those principles, elongation. Really if you know anyone that as a child has it right now or an adult, because adult scoliosis progression is real, you could say, oh, I had it when I was younger, but it absolutely can progress as an adult, and pretty significantly. I encourage you to speak with your physicians about getting a script, or getting a referral for physical therapy and going and seeing this therapist over at our City Center location.

Brian (19:25):

That sounds good. That's awesome.

Carrie (19:27):

Amazing.

Brian (19:29):

Carrie, I know that, like I said in the intro, Carrie is Director of Education Navigation at The Healthy Life Center at Lee Health, Coconut Point. Can you tell me, I know rehabilitation is a big deal there. Well, it's a big deal everywhere, but at Coconut Point, dedicated spot, and can you tell me a little bit about some of the rehab events-

Carrie (19:50):

Sure.

Brian (19:51):

... whether they're virtual, in person, all that stuff.

Carrie (19:53):

Absolutely. At this time, we are continuing virtual education classes. We've found that many people in our community like the convenience and it also opens access to more people who can maybe jump on through work throughout the day, but wouldn't necessarily be able to drive in their car and come to see a speaker. Our rehab series is going to continue virtually into 2022. We have a monthly dedicated spot for a rehab expert, and Diana here actually helps us fill those spots with different, exciting topics like the scoliosis program or others that are lifestyle based, very maybe orthopedic related. That's part of what we do to educate the community, help them be aware of the services out there and then empower them to make these changes so that we can maintain our health or even improve it as we age, we have a high quality, a high vitality as we age.

Brian (20:51):

That's true. Diana, when you're doing a virtual session or a virtual class, can you tell us a little bit about how that works? Now, are you talking about speaking, are you talking about actual movements? All those kinds of things.

Diana (21:03):

Okay, great question. We do a PowerPoint presentation so if you log on you can see the PowerPoint. Some of us include pictures of people in the PowerPoint. I know I did a series on posture and as everybody sits up... Get that can up.

Brian (21:20):

It's a good one for our society, we're all sitting in chairs all day.

Diana (21:26):

I showed pictures of those exercises and did a little screening assessment that you could do on yourself. We can include pictures, some have videos that they put up in there, we try to make it interactive to some degree. And there are topics that the public has and the community has told us that they want to hear. We try to really focus intently on things that you want to hear, like tips on golf injury prevention, tennis. I'm doing another one on posture, posture is always usually really big. I'm doing one in January on the three blocks and dividing your body up into three blocks and how you can impact your posture and your positioning in those three blocks. We have all sorts of shoulder, overhead. I think we do a series on geriatric and aging. We do try to do the best that we can to touch all subjects. But one of the nice things is that the virtuality, is that a word?

Brian (22:30):

It is now.

Diana (22:31):

Virtualness?

Carrie (22:31):

Virtual setting.

Diana (22:31):

It allows our therapists to be more involved-

Brian (22:33):

Absolutely.

Diana (22:34):

... in these community talks because they don't have to drive somewhere, take out the time from the treating patients, they can set up shop right there. It allows us to have more of a variety of individuals to be able speak.

Carrie (22:45):

We have more engaged now than we did prior to COVID with the rehab and it's wonderful.

Brian (22:52):

And even if COVID, whatever the case may be, even that's still going to continue no matter what, because like you're saying, people seem to like, it's more convenient for the virtual.

Diana (22:59):

It's nice, you can even put it on your phone and have your AirPods in or your headphones. It's nice to be able to offer that in the virtual format.

Carrie (23:10):

We use WebEx events for The Healthy Life Center classes where this rehab series is hosted, and like Diana mentioned, you can download the WebEx app on your smartphone or device or through your desktop and that's a easy, portable way to take it along with you or to have it up at lunch, whatever it may be. And our events are all hosted on health.org/events, there's a health and wellness tab. You can use the categories to sort, and there's a category just for rehabilitation so it'll take you to all of these lectures that Diana's mentioning and helping to plan and program with us as we go into the next year.

Brian (23:48):

That sounds good. This has been great. Diana, we want to thank you for being here. Is there anything that we've missed? Is there any point about rehabilitation and exercises, any general tips or advice that you want to give? Can you do it real quick in the next two minutes? Sorry, that's a lot, but what can you leave us with? What would be your takeaway message?

Diana (24:08):

Some pearls is to really get moving. Think about your day, if you sit 50% of your day, if you sit 90% of your day, you want to decrease some of those percentage, just get up and move. Especially if you're older, you want to just move, find things that you can ingrain into your lifestyle for that mobility. If you have an issue, don't be afraid to talk about it with your doctor. It can be as simple as getting a physical therapy referral and a couple of sessions to learn and to get the right exercises and to address it.

Carrie (24:39):

Quick question on that, what is your opinion on the standup desks? For all of us who are in that working population who sit from eight to four, eight to five, what's the physical therapist take on utilizing those as part of your day?

Diana (24:53):

There is a very good balance for that. I personally have one. I may set goals for myself of maybe how long I should use it per day, but I do take into consideration that if you're not used to standing and you go to stand, you want to make sure that your circulation in your legs is fine. You don't want to create any other issues or problems with standing. And most of those standing desks, they really do need a mat, a squishier mat that they use in different work areas, because that will help to absorb the shock. But get up and move as much as you can, stand as much as possible. We probably should have done this podcast standing.

Brian (25:33):

Who says we haven't?

Diana (25:34):

Wait, we're standing.

Brian (25:34):

No one out there knows we haven't.

Carrie (25:34):

There's no video.

Brian (25:38):

When we get the video working, you'll be able to see. That's a good point.

Carrie (25:41):

Well, thank you for taking that question.

Diana (25:41):

No problem.

Brian (25:43):

That's good. Well, thank you so much, Diana and Carrie, as always. Thank you both for being here. A reminder, if you'd like to know more about our rehabilitation programs, resources, and other info, you can reach out to the rehab team directly. I think I'm going to get this number right, Diana 239-343-4760.

Diana (26:01):

Yes, and that is the number to our City Center location where our scoliosis program is at, but they can answer any other rehabilitation question you have and navigate you to the right person.

Brian (26:12):

And remember too, as we said, the primary care physician, please have that talk with your doctor, they can also give a referral over to rehab. You can also find more information on rehabilitation at leehealth.org, search for rehabilitation, you'll get specifics on locations, services, all the members of the team that will be part of your rehab journey. Not to leave Coconut Point out, Carrie, you gave some good places, resources for them to find stuff. The number for Coconut Point is 239-468-0000. Is that correct?

Carrie (26:44):

Yes.

Brian (26:44):

Four zero's, there you go.

Carrie (26:45):

That's one of the numbers, we have so many.

Brian (26:47):

That's right, you'll get to somebody if you call that one. Thank you again for being here. We hope you'll tune back in for upcoming episodes. We'll be interviewing experts around Lee Health so you can learn more about what we do and how we strive every day to fulfill our mission to the community to provide the best care close to home. Thanks for listening and have a great day.