 All right, so this is super exciting for me to be here. I went to the very first AHS and I thought that it would be really neat to be one of the presenters at some point. So this is a little bit of a dream come true for me. In terms of disclosures today, I'm horrible at math. I love PD Scotch and I binge watch Netflix when my hubby's on night shifts, he's a firefighter. Sometimes drinking Scotch in the tub too. But those are probably not the kind of disclosures that you're looking for, so I don't have any funding or grants to disclose today. In terms of objectives, I'm going to describe the ABCs and Ds for triaging your client's most important health issues, help you understand how to apply the ABCs and Ds in acute care family medicine and in a primary care setting, going through some case studies to illustrate that, and then I'll help identify a step-by-step plan that you can follow with every client to ensure consistency in your practice. So in ancestral circles, it's pretty common knowledge that things like sleep, nutrition, exercise, and mental health are important, but they're not necessarily as commonly accepted within medical communities, within the medical circles. It's starting to shift, but we're not quite there yet. After working for 10 years in the fitness industry with a Bachelor of Kinesiology, I wanted to make a bigger difference and affect greater change. So I went back to university to get my Bachelor of Nursing and I've spent the last six years working in different settings as a registered nurse, often in overlapping settings. So I've spent five years working as an acute neurology nurse, working with patients with brain tumors, strokes, head injuries, things like that. Very acute setting where patients are very sick, requiring assessments from every five minutes, up to every hour, sometimes even more detailed than that. It's sort of like a step-down ICU unit. I've spent three years working as a chronic disease management nurse, giving lots of recommendations on sleep, nutrition, exercise for patients, and I've also worked in some family medicine settings in public and private clinics. So I've got a good variety of experience. Now, just like many of you, I've had more than my fair share of health challenges along the way, and it was the ancestral approach, the ancestral style of looking at things, that multifaceted approach that really transformed my health and got me back on track. So I wanted to share this fountain of youth with the world and I thought that it would be the greatest idea to share it with my nursing class. In fact, I thought that I should just ram this information down their throats and throw it at them. And what I learned is that that is absolutely not the way to get people to listen. In fact, it has the opposite effect and turns people against you. Over the past six years, I've learned how to navigate through the healthcare system and I found ways to get traditional medical practitioners on your side and at the same time, pull from the triage process that they use regularly to simplify your practice. To do this, I'll take you through some case studies and show you how to systematically prioritize your client's health, regardless of what type of a practitioner you are. So for my case studies, these are fictitious characters. However, they're built from many years of experience working with clients, seeing the same types of things come up over and over and over again. So although this could be a generic person, I've dealt with 50 Trinas, I've dealt with 100 Trinas. These are very common examples that I think many of you will be able to relate to. So Trina is in a primary care setting. She's working with a chronic disease nurse at her primary care network. She is a 56-year-old female with a primary concern of weight gain, super common at that age, although we know weight gain at that age is common, not necessarily normal. She weighs five foot seven, sorry, is five foot seven, weighs 220 pounds and most of her adult life was around 160 pounds. Majority of her weight gain has been over the past five years, specifically over the last year. So we know that this really could be any person that many of us deal with. So some more information for Trina. She works full-time as a teacher's assistant to high-need students in a high school with some behavior issues. She eats an average, standard American diet, eats pretty good, not so great in our viewpoint, but from the standard view, people think that she eats pretty average. Her alcohol consumption is beyond the safe drinking guidelines of 10 drinks per week. She does exercise occasionally, doing a little bit of running once in a while and in terms of sleep, because of her job, because of her busy lifestyle, she stays up late during the week, trying to get things done. She's up early in the morning to get to work and as a result, she sleeps in on weekends. Now we're getting a better picture of what's going on. Again, this could describe any of the hundred of Trinas that I've worked with. So let's give a little more psychosocial perspective to that to make her a bit more unique. So Trina is a chronic people pleaser. She has an adult son with a developmental disability that requires some time for her to help him out and support him, and she also has an adult son with a mental health issue that lives in another city. So between these two, Trina's got a lot on her hands between her job and her family situation, and as if that wasn't enough for her already, her husband was diagnosed with terminal cancer a year ago. So it's no surprise that Trina has minor depressive symptoms. Now when we look at this in a medical setting, we're trained to respond to clients using the A, B, Cs and Ds of triage. So our airway breathing circulation and then deadly bleed in that order. You would never see an emergency room physician dealing with a paper cut when their patient isn't breathing. Yet sometimes we use this approach in the ancestral health world. We can get tied up by our client wanting to know whether her macro should be 50, 20, 30 or 50, 25, 25. When we haven't even made sure that Trina is dealing with the acute stressors in her life, like her husband having terminal cancer or that she's actually getting a good night's sleep or that she's doing some exercise, it's super easy to get caught up chasing one aspect of health that we forget to take a step back and look at that big picture. In trying to create some consistency in my own practice, I took a look at what other healthcare practitioners are doing in all different styles of health, what they have in common with the medical system and created a similar way to follow the ABC assessment model to simplify the process and to prevent myself from chasing things down the proverbial rabbit hole. And sometimes that rabbit hole is very, very large. Now, this is something that we probably intuitively do in our practice. I've just put it into more of a formalized process. So starting with your apex, that is what's most important right now, the crux of the issue. So Trina is in for a weight loss but if her fasting blood sugar is 320 or for those of you like me from Canada, that's 20, we need to address her high blood sugar first. We can't just start dealing with what she wants to if we've got some critical numbers there. So at this stage it's really important that you validate your client's concerns. What's most important to Trina, her weight loss right now or finding out her macros may not actually be most important. So we wanna build some trust with Trina and explain why we're doing certain things. We're going to sort out her macronutrients later on. We're gonna make sure she's eating better quality food that she's sleeping, she's doing some exercise and stress management before those macros will actually make a difference to her healthcare. For our A's, what's most important right now, this is what is the single biggest factor contributing to her health. So some of you might say that Trina's biggest issue is her stress. Most of her weight gain's been over the past year so we could easily tie that to her husband's diagnosis. Perhaps seeking some counseling might help her out. Some of you might say that she needs to eat better nutrition, that's gonna be what makes the biggest difference. And some of you might say it's exercise or some other component. It's not necessarily what's right, it's more about being able to explain or justify your answer and coming up with something that will yield the greatest return for Trina. Now when we look at what is the litmus test for what's most important, there's lots of different theories within ancestral circles of how do we triage things. So I've come up with what I feel are the seven pillars, the most important factors for health. That's your sleep, nutrition, mental health, medical conditions, lifestyle factors, exercise and digestion. So for healthcare practitioners, I explain this as the center, that union is where optimal health can occur. When the circles start pulling back from that center, we lose the ability to achieve optimal health. For patients I explain this in a slightly different concept. I use the analogy of a tabletop. So you've got your four table legs, your sleep, your nutrition, your exercise and your mental health. Those are your four core pillars. We can get away without one of them. We think of a pregnant or a new mom. She's kind of lost her pillar of sleep. She's down to three legs. But we've all seen tables with three legs. They still stand up. Your digestion is the top that ties those legs together. It's interconnected with all of those components. And then your medical conditions and your lifestyle factors are what pile up on top of your table. If we've got this imbalance, our pillar of sleep is missing and we have a little bit of poor nutrition happening, that table can easily fall over and we lose the ability of health. So we've addressed the most important issue of our health, our apex. We move on to the base. That is all the other factors that influence those seven pillars of health that affect your patient's health. So focusing on those seven pillars, which of those elements are most out of balance? So we know that Trina came in for weight loss, but how's her sleep or her stress level? Most of her weight gain has been over the past year. So again, it's likely connected to her husband's terminal diagnosis. She's so overwhelmed, so she rarely exercises. And so she doesn't have time to prepare healthy meals and her sleep isn't great. So we've got lots of areas that we can work with and what we wanna do is start chipping away, giving her one or two areas to work on with each of those. So for example, we can get Trina to start with a 10 minute walk every day where she just focuses on breathing and relaxing or introducing one extra serving of vegetables a day or having a hard cut off bedtime of midnight instead of the 1 a.m. or 2 a.m. where she's currently going to sleep. Now while these recommendations are far from optimal, we want to create some success for our patient. We want them to be able to feel accomplished in what they're doing and so we can easily prevent overwhelm by doing that. We've done our A's, our B's, moving on to our C's, our complimentary issues. These are the things that come all over the place. So they're not necessarily critical, but they do contribute to her health. So for Trina, things like the fact that she keeps a candy bowl at her desk at work and it's constantly staring at her and asking her to just take one little piece. The fact that she has poor self-esteem and puts other people's needs first, these are other factors that come into play. We do want to address at some point, but these are like the paper cut when your patient isn't breathing. We still want to be able to deal with the big critical issues before we start tackling these. And then instead of deadly bleed, we want to do it again. We want to repeat that process over and over and over, whether it be every week with our patient, whether it be every month. We want to repeat that process because things are going to constantly change. Is it still the same? What's most important now, that issue is going to shift over time? And we want to make sure we're doing this at least every month or two with our patients or clients to make sure that they're getting appropriate progress. They're doing what they say they're going to do because that accountability piece is key for patients. We also want to have a level of uniqueness, of customization, because all of our practices are different. We've got physicians, we've got massage therapists, we've got chiropractors, trainers, all different types of practitioners here and I expect you to work within your scope of practice. This isn't about saying, well, all of you need to address all of these pillars of health in your specific practice. You may not have the training to do that, but it's making sure that if you don't have the training to do that, that you're referring to other people because those factors still need to be addressed. Applying the concept of the ABCs to a family medicine practice. We've got Luke, who's a 65 year old male with a primary concern of type two diabetes and hypertension. Two issues that are pretty popular right now. He's got a blood sugar of 120 to 270 and in Canada we're ranging from 6.7 to 15 with an average blood glucose of 8.2 and a blood pressure of 185 on 94. He's five foot nine weighing 185 pounds and is sedentary. So Luke is also not a great sleeper. He doesn't have a great track record of sleeping. It's varied from night to night, pretty much his whole life, but now that he's getting older and starting to change even more and there is a little bit of concern with Luke for possible cognitive decline, mostly because he retired a couple of years ago and he just doesn't have a lot of stuff going on in his life. His goal was to sit at home and watch TV when he retired and I've worked with lots of Luke's as well. So in terms of his ACE, his Apex, at this point we would want to focus on treating that diabetes and hypertension, tracking those and bringing those into good control within roughly three months is obviously an ideal. We can use a combination of medications or lifestyle approaches. Some practitioners focus on one end, some on the other end, some a combined approach. If we're talking traditional medicine, we're typically talking medication only. In our circles, we're likely leaning more to the lifestyle end. Ultimately it depends on the motivation of your client and how willing they are to make changes. And then his B's, looking at those other, those base factors for things like nutrition, we can have him focus on reducing refined carbohydrates in his diet and replacing that with some nutrient dense vegetables. For his digestion, if he started on a medication like Metformin, we know that there's going to be some digestive changes with that. The side effects of diarrhea are quite common with that medication. So are they tolerable for him? Can he handle that medication? And then for exercise, similar to Trina, adding in just a little bit of activity, five to 10 minutes every day to start creating some patterns for him, having some success so that we can eventually get two or above the target of 150 minutes of exercise each week. For his sleep, he does use sleeping pills occasionally, but he hasn't had a focus on sleep hygiene before. He doesn't even really know what that term means. So teaching basic sleep principles, teaching the focus on good quality sleep versus quantity being in bed and being restless for long periods of time and possibly entertaining the idea of cognitive behavior therapy at that point as well. And then for his seas, looking at that possible cognitive decline, we're not really sure, is it not? Looking at his personality as an introverted guy, we could consider things like cognitive testing might be important, but what about other things as we age? How is his hearing? How is his vision and doing the testing to rule those out? Or we know that he's just recently retired in the past couple of years, so finding things that give him purpose and give him some pleasure that adds some stimulation into his day are very common things that we can do that I've seen have made incredible improvements in patients like this. When we apply that ABC process to acute care, we've got Thomas, who is a 25-year-old male. He's got a primary concern of a brain tumor for which he's having surgery, and so this case study is after he's had the surgery in the hospital setting, he was also born with a frontal lobe tumor and hydrocephalus, so this is a long-standing history for him having tumors, and then he's developmentally delayed. So apart from this, he's a pretty healthy guy. The brain tumor he has right now has been causing severe headaches, some vision changes, and so it was time to go in and to operate and help relieve some of those symptoms for him. For his A's, at this point, the apex is going to look very different than it would in that family medicine setting or in that primary care setting. We're gonna focus on his pillar of medical conditions. At this point, we're in the hospital, there's a lot of involvement from our neurosurgeon, from our nursing team, from our physiotherapists or occupational therapists, possibly even speech-language pathologists at that point. The biggest things for him are to focus on recovery from the surgery, focusing on pain management, the sleep, the rest, recovery part of that process. Things that we could do, not necessarily being done at least not in my setting where I work, is grouping assessments, and I know this is something that could be done easier, just a little bit more coordination of care. Rather than the resident or the physician going in and they do their assessment, I go in a little while later, I do my assessment, an hour or two later, the physio goes in, does their assessment. We can find ways to group those assessments together so we can all be on the same page rather than repeating that information with our patients. They've already been through that, they've already said their name and the date and where they are six times. Yes, it's important, we wanna make sure our patients are oriented, but making sure that we're giving our patient rest, which is the most important thing. And when we're constantly going in there at different intervals, they're not getting the rest. Shared rooms are also very common in hospital settings. So making sure that if we have patients with shared rooms that the nurse with the A bed and the nurse with the B bed are coordinating to try to have those assessments happen at the same time so that room can have a little bit more quiet time in between. When we're creating new hospitals, doing things in line with sleep hygiene, making sure there's a way for a roll shutter or a blackout blind to come down to make that room pitch black. That doesn't happen at least in my setting. And then doing things like having our IV monitors and the heart rate monitors where we can dim them to a certain point, but they never turn off completely. We still wanna obviously know those numbers. They often ring off at the desk, but things like putting a towel on top of it so that room gets a little bit darker, creating good sleep hygiene for our patients. For our Bs, at this point, we wanna focus on nutrition. Hospital nutrition is obviously not at its most optimal level. There's a lot of work we can do there. So focusing on more vegetables, more antioxidant rich foods. I don't think I've ever seen berries on a meal tray for patients in the hospital. Giving us good quality food because these are our sickest people. They need the highest quality nutrition and that's not happening. And then eliminating the high sugary snacks that are brought in. The nursing desk is a huge pile for where all of that ends up, but our patient rooms as well, the chips and the cookies and the sugary snacks that get piled up in there, making sure families understand the implications of what that's doing for that patient's recovery and healing. For mental health, we can look at things like having social supports. Social workers are a big part of the hospital system, but making sure beyond that, that your patient has visitors and that there's also scheduled nap time. Sometimes that doesn't happen where the entire room is quiet and we can just allow our patients to actually rest. So it's this delicate balance of social and rest. And then for digestion, we know that narcotics are super bad for causing constipation. We can do more teaching with our families around preventing constipation, making sure that we've got hydration, that we're adding lots of extra fiber. We're using other medications for bowel protocol to make sure they don't get constipated. And ambulation is a huge step at this point. And then exercise is going to look very different at this part of the recovery process. We're focusing more on independent ambulation, independent movement, because a lot of times when we do things like brain surgeries, balance gets thrown off. So making sure that they're able to regain that. And then Cs are complementary issues at this point. Looking for the need for supports when he goes home, would he need increased supervision for the first couple of weeks, doing cooking, laundry, those basic ADLs? Looking at a gradual return to activity, not necessarily exercise at this point, but just getting back into daily life. And then we want to do it again. So now he's been discharged from the hospital. He's at home after that initial recovery process. What do the ABCs look like at that point? So there's going to be more involvement with the family doctor at this point. A follow-up with the neurosurgeon, but less hospital involvement. So for our A's, we're still working on focusing on stabilizing that medical conditions pillar. We then want to move on to our B's, things like the rest and sleep will continue to be important, good nutrition at home, and then increasing his activity level as tolerated, with the balance of those social activities without getting overwhelmed from it, to ensure that he's getting some rest. And then regular bowel movements without straining, increasing the pressure in his head. For complimentary issues, we can look at things like not too much TV time or cell time. Those are really common after brain surgeries. We need to be able to decrease stimulation for the brain for that healing to occur. And most of us are glued to our cell phones or our computers or our televisions, and so getting away from that a little bit. Or protecting his head using helmets if he's going to play in sports, because now he's got this tender spot on his head, or perhaps there's a bone flap missing. Then we would do it again. And so at a six month mark, his health is going to look very different than it did in the hospital or at home. And we're going to continue to go through this triage process over and over and over again, what are our A's, what are our B's, what are our C's, as those continue to change over time. So how to systematize the process? So using this diagram, on the one side we've got our patients, when they typically start out, they're unhealthy, they're not well, that's why they're coming to see us. Our goal is to bring them up to a state of optimal health. Along that health continuum, there's different stages of what that health looks like. On the opposite side is our stages of change model. What is their readiness and willingness to change? At the bottom again, they're typically not ready to change, moving up to the idea of actively changing and actively participating in their health recovery. At the bottom is our base, those are our key pillars, focusing on those different components. Our nutrition, our exercise, our sleep, our medical conditions. So within each of these, there's lots of different things that we can do to make sure that all of those are balanced. As we start to address them, there's going to be barriers to success that come up. Patients always have excuses. I don't have time, I don't have money, I don't have knowledge. There's always barriers that come into play. And it's pulling away from those barriers, giving our patients the ability to overcome them so that we can create patient satisfaction. Happy patients are good patients. They will refer, they will increase your business. We want to improve their biometrics that helps us prevent the health crisis that's going on and help to get it under control. And then having some successful patient outcomes. And then with eventual goal, having optimal health. And what that looks like for each of your patients will be different. Optimal health for someone who is a quadriplegic is going to look different than optimal health for an ultramarathon. These spectrums are still going to be different. And even for you on a daily basis, optimal health today might look different than optimal health next week or next year, depending on all those other factors coming into play. Now with those base pillars, there's lots of different things that we can do within those. So with our medical conditions, some of us come in and we don't have a lot of medical conditions. We come in and we are generally pretty healthy. So then we would look at your genetics. Does everyone in your family have heart disease? Does everyone in your family have cancer or diabetes? Or are they overweight? It's looking at those tendencies. We may not have the medical condition yet, but we might one day. And so it's being aware of what our predisposition is. Turning that light switch on and off. For mental health, I focus on key pillars like what I call the five P's. So people, pleasure, pauses, purpose, and positive self-talk. Having those within balance tends to help with a lot of depression, anxiety, mental health issues. Nutrition, I'm talking to the converted here. You guys are very aware of the nutrition spectrum. Good quality, healthy nutrition. Seven to nine hours of sleep a night, some form of exercise, making sure that we're keeping our bones strong, our muscles, that we're stretching, we're maintaining our balance, because those are all things that we lose over time. How you want to accomplish those? Completely up to you, but those are key fundamental areas that we need to focus on. Digestion is a huge growing area. We could put out an article today and in a week it's going to be completely outdated already. This area is growing so fast, but we know that digestion has a huge influence on our health. And then your lifestyle factors, that is literally all the other stuff that comes into play, all the other things that come on your plate. So I've been working with this model for many years. I put it together in this type of a picture over the last couple years, and then applying that ABC process to really focus on triaging my patients and going through them to have more of a systematic process. So I've pulled all of those concepts together in my book, Healthy by Choice. Really proud of this book. It's something that I talked about for 10 years, so finally made it to print here. It's coming out September 19th. So looking for anyone who might be interested in helping with a launch group, I definitely believe that by empowering our patients to patients and clients, to take charge of their health, that we can influence a bigger impact on the healthcare system, rather than just trying to tackle policy change. We're not getting anywhere with trying to change policy. So let's deal with this from a grassroots level. Let's take charge of our health, let's get our patients to take charge of their health and make a bigger difference. If you want a copy of the PowerPoint after or you're interested in being part of my launch group or you want to know more about my programs or services, definitely just write your info on your card, what you're looking for. I'm happy to connect with this, many of you as I can after the conference, and thank you so much for having me here today. Before we jump into questions, I just want to give a quick plug to the banquet tonight. I told Gil that I would. So for anyone who has not signed up for the dinner banquet tonight, there are about 30 spots remaining. I thought there were only 20, but there's about 30. So make sure that you sign up for your tickets. Can you pay at the door? That is a really good question and I don't know the answer. I would say sign up ahead of time, probably not. Okay. All right, if we have any questions, we have a little bit of time. So if you're on this side of the room, you can go to the microphone over by the stairs. And if you're on this side, just raise your hand and I'll bring the microphone to you. Oh, thank you for a very good talk. You mentioned a lot of behavior change and lifestyle modification and I wondered what's your take on motivation interviewing. I found it very helpful in terms of giving patients choices of what they would like to tackle next rather than basically being directive. And I think, just wanted to see if you use it in your practice. Yeah, so I love the idea of motivational interviewing. I think it's really great to say, okay, thanks for coming in today. Here's your information. This is what you need to do, bam, bam, bam, bam, bam. That approach doesn't work. A lot of times your clients are gonna walk out and they've got the deer in the headlight's look of, I don't know what just happened. So it's absolutely motivational interviewing is getting your clients involved, getting them engaged in the process rather than me being the right person, that pyramid there, that's the foundation. That's not the right way. That's not to say for nutrition we must do this, for exercise we must do this. There's fundamental components to each of those. We know that for nutrition we need to focus on quality, we need to focus on nutrients. If you wanna eat paleo, you wanna eat ketogenic, you wanna eat atkins, you wanna eat zone, it doesn't matter, but it's more about those fundamentals in terms of how that works for you, how you get your results. So the motivational interviewing technique is great because then it involves your patient, it gets them engaged, it gets them participating in that. So absolutely, I fully support that. Thank you, we have a question over here. The amateur doctor, if I had a patient who was stressed, didn't exercise and couldn't sleep, I would get them exercising, probably something vigorous to get rid of the stress, make them tired so they can sleep. What do you think of that? Yeah, and everyone's going to have a different approach. I'm guessing you're a physician? No. Oh, but you're right, is that everyone's going to have a different process in terms of how they go about doing that. So I've had really good success with starting patients slower to build the confidence, but some patients absolutely, they kinda need that, kick in the pants, let's go, this is what you need to do. They need to burn off some of that energy, they need to make themselves tired, they need to be able to have that endorphins released so they're able to be physically exhausted at the end of the day, able to sleep, and so absolutely, it's looking at what is your scenario, and obviously running this ABC scenario, it's absolutely impossible to come up with, this will work in every single, we have to modify it, and so that's where that customization comes in, is that in your practice with what you are doing is looking at that, okay, so in this one setting, perhaps taking the bull by the horns, jumping in and saying, this is what we're doing, then that might be a more appropriate approach for that situation, for other situations, we might say, ah, this patient just, they need it to be a little more delicate, if I do that and I come in, it's kinda like the personal trainer approach, if I have this personal trainer that's yelling in your face and they're like, push harder, let's do more, not everyone responds to that, so it's sort of reading your client and knowing what type of an approach they need, sometimes they just need a little gentle, they're there, sometimes they need the bull by the horns and let's do this. Thank you, do we have any other questions? We'll let you go again. Ha ha ha. A question for the audience, if I may? Sure. I wondered, are there any medical doctors, residents or students in the audience? Okay, I'm just the president of the Physicians for Ancestral Health and so I wanted to connect with people who might be interested to learn more about the organization, thank you. I was just curious how you keep patients motivated, I can imagine when they first get a diagnosis or are struggling with something very intense that they're ready to go gung-ho, but people that for whom changing their diet and their lifestyle and their sleep patterns and starting to exercise doesn't come naturally, how do you keep them motivated in the long run and especially if they potentially are with families or living in communities that have the lifestyle that got to them to where they are in the first place, how do you also work with families and yeah, how do you keep them motivated? So I don't do a lot of work with families per se, I typically do a lot more one-on-ones, I'm shifting more to a group approach, but motivation is always a hard thing and anyone who works in this industry knows that, is that yes, people come in, they're keen, they're ready to, sometimes they wanna make the change, sometimes somebody sent them, so as a chronic disease nurse, I often saw that and so the lack of motivation, like I'm here because my doctor made me come and I don't really wanna be here and there's no engagement on their end, so what I found to be very effective in terms of engaging patients is finding what's been successful for change in the past. So even talking about other areas of their life, so perhaps for some people they're very financially motivated. Okay, so what got you motivated about finances? How did you get involved with saving money or paying off your mortgage faster or some people really love their cars? Okay, so what got you excited about the car and using those tidbits from other areas of their life that they're passionate about, that they're excited about and pulling that into health? I find small manageable chunks is a really big key instead of saying like these are the 20 things that you need to do for sleep hygiene and you need to hit all of these along the way, I'm gonna lose them and they're already gone. So having things that every week or every couple of weeks they can come back and say I've accomplished this, I've done this, having those goals in there and then you said the piece with community, sometimes other parts of their family are not supportive and that's a very real reality that we deal with all the time is that the family is not always on board and so unfortunately how do you make somebody change? You can't. We cannot force somebody to change. So if one person wants to change, their partner isn't willing or interested in changing, then we have to say okay, we're gonna respect what their decisions are, we're gonna focus on this person's decisions and then learning for a way for them to be able to kind of coexist and sometimes it means we have the couples come in together and I've had blowouts in my sessions where the couples are arguing and like I want this, I don't want this and you can't make me change, you have to change, like those kind of debates back and forth but it's very much, sometimes then it's shifting it to counseling, okay, this is more a counseling issue than a nutrition issue and then finding the appropriate supports for that. Does that answer? Thank you. Do we have one more question? Okay, we have time for just one more. So I'm a nutritional therapy practitioner so I'm coming at it from a non-license perspective and one of the things that I run into with my clients is that I give them all this great information and then they go to their primary care doctor or their endocrinologist or whatever and they give their doctor this information and the doctor says, yeah, okay, whatever and then my patient or my client comes back to me and says, well, my doctor didn't seem too excited about this and they really start self-doubting that they have made the right decision to start working with me. Is there something that I can do as a non-licensed practitioner to bridge that gap with the medical community and start working with them and get them more motivated to encourage their patients to work with me and see the results that I can give them but they're still a little reticent because they don't have that doctor going, yeah, this is gonna work. Absolutely, so I mean, the most important thing is we all sort of have our scope of practice or what are governing guidelines. Like I'm sure you've got some courses or certificates that you've taken that say from this program that you've taken you can do this. And so the biggest thing is that you wanna make sure you're staying within whatever your scope is. To get the buy-in from the physicians, again, you can't make that practitioner change but what you can do is you can go and meet with the physician and then have that conversation piece and really sit down and say like, I'm happy to coach you for free or I'm happy to coach you and one of your staff members for free and explain the process, get their buy-in that way, build the trust and rapport so that then they're more accepting of your practice. If your client goes to their physician and they say absolutely not, I mean, you're stuck in this difficult position where primary physician saying one thing, it's opposite of what you're saying and that does happen at times. So it's difficult to say, I give you permission to override the physician because we don't wanna do that. So it's more about how do we balance this teeter-totter of who's right, family physicians, especially if they're an older family physician, don't have a lot of the training and the knowledge on the nutrition and the sleep and the digestion and all those things if they haven't been continually working on evolving their knowledge. If they originally just started with things like Canada's food guide, my plate, food pyramid, they're lacking a lot of fundamental information. So it's making sure that the physicians that you're working with are well informed, they've got that background and they're really understanding what it is you're doing and where you're coming from rather than it being like this hokey, fluffy, weird, I don't know who this nutrition person is, really building your credibility with them. Right, and that's the, my plate is what I'm running up against. I've been a type one diabetic for 23 years now. So I did the ADA recommendations and I went to my endocrinologist at one point and he was like, kinda looked at the stuff that I had changed and my blood markers look great and he's like, okay, well, you must have done something else. It's not the nutrition. There's something else that you did and I'm like, there's nothing else. Of course it's not nutrition. I'm like, yeah, so. But yeah, thank you, it's nice to hear that. And you're not alone in that struggle. I'm sure many people in this room can relate, so. Right, thank you. Yes. I've been a practicing NTP in a red state for five years. So it's a line, it's a fine line. I've had my own children's doctors shame me in front of them. So it is a line.