Speech and Psychiatry with Speech Talk’s Emily and Eva

Preston: [00:00:00] This is maybe my philosophical stance, but all medical care is end of life care. You really want like get down to it and it's just that you're actually now with patients that have confronted and accepted that the end of life is coming and that you can do that. All you can do is optimize the time that you have left patient.

Margaret: Welcome back to How To Be Patient Podcast, where we have a step challenge 

about psychiatry 

Preston: time, to step up and walk it off. That's what we've been doing. Margaret has walkmogged me. 

Margaret: I have walkmogged 

Preston: in front of everyone, all 3,996 of you. I was like, good Lord you have to out me like that. So I'm pulling up the numbers right now.

Margaret: Pull 'em 

Preston: up and so. For everyone who's, who cares? This is, it's a weekly, this is a, we're 

Margaret: doing a speech episode in five minutes. We just wanna tell you this, but we're gonna talk to SOPs. We, yes, it is round like three of our [00:01:00] apologies. Tour. That is coming up in two minutes. So we wanted to talk about this stuff challenge first.

Preston: So, so it, today's Wednesday, I'm at 51,491 steps. Margaret is at 58,884 steps. And we have till Friday. 

Margaret: we've been walking for two and a half, almost three days. 

Preston: Yeah. I just gotta, it's tough because I run and I've been getting annoyed myself. 'cause I'm like, I'm putting all this effort into this like seven mile run that I'm doing, but I'm not getting as many steps.

Margaret: How much is it for mile running versus walking? 

Preston: It's about, 1400 steps per mile. 

Margaret: Okay. 

Preston: running and I, think it's about like almost 2000. Yeah. Or 2,500 steps, walking. So. If I run seven miles or walk seven miles, I'm getting like 700 less steps per mile. 

Margaret: You're getting walk mogged? 

Preston: Yeah.[00:02:00] 

I have to, run like 40% more. 

Margaret: I just wanna say the reason that this is happening to you guys, listeners, which it's on the app pacer, and we are starting a challenge, although Preston made it for like a month and I did see that you made the step limit 69,000 steps. yeah. Yeah. but you made it a month long.

But I feel like, like a week or two weeks is better because if you do a month, then like people like get discouraged if they fall off on like day four and then they're like, oh, I can't do it. 'cause for the rest of the month. Also, maybe people are as intense and want that competition length. 

Preston: Yeah. My thought was to do a month long competition and then every week just like, look at the, how the scoreboard's doing, rather than like resetting it, 

Margaret: but then it doesn't start.

Oh, I see what you're saying. Yeah. Mm-hmm. 

Preston: Yeah. So it's like we have, because otherwise then we have to like start a new competition and then [00:03:00] hopefully everyone signs up again. 

Margaret: That's true. 

Preston: And X, Y, z. So maybe there's a way to break down like week, to week. But I kind of, I, like the idea of rewarding the, people that 

Margaret: show up early, 

you know what, I, 

Preston: actually 

Margaret: agree with you.

Preston: And then, we can just say like, you know, 

Margaret: I can't wait to publicly 

Preston: beat 

Margaret: you. 

Preston: Jason's been, holding the line. Yeah. And honestly, if there's just 10 of us, you know, like all, 15 from the Tron destroyed, it's so close. That's a good, that's a good crew. That's a good crew for the step challenge.

So honestly, a, any company's good company. 

Margaret: And what date did you put it to start at? 

Preston: It is starting next Monday. So 

Margaret: when that 

Preston: will be, when 

Margaret: this comes 

Preston: out 

Margaret: though, 

Preston: this will be this episode. 

Margaret: It, 

Preston: step challenge will already be out by the time this episode does. We'll be letting you guys know on the 

Margaret: Instagram.

Preston: On the Instagram, but it's I think it's like March 13th or something. March 14th. 

Margaret: So this happened 

Preston: Mor K 

Margaret: listeners, and this is gonna be a rare occurrence because I [00:04:00] told Preston if he wanted me to play the, like New York Times whatever game that he had to join my friend Step Challenge it 

Preston: Scrabble.

Yeah. 

Margaret: which you are magging me on that right now. I'm like, I feel so dumb. I'm like, wind. And then Preston will come up with words that are like, I don't even know what they mean. 

Preston: Yeah. Oki 

Margaret: Is that how it's pronounced? 

Preston: Yeah, the line on a dartboard, 

Margaret: I mean I was ing it 

Preston: like your last name mean. I was just kind of guessing on that one.

And then it said okay or Okie. 

Margaret: This is what I'll say about the step challenge though is my friends in the step challenge that Preston got added to are like, what's wrong with him? Like why is this happening to our step challenge? Because like all of us like casually run, like we were like, I think before you entered the step challenge present, the average per day was like, I don't know, like 11,000, like something normal.

And then you joined in, you are running like longer [00:05:00] distances and it activated my extremely competitive spirit in something that doesn't matter, which is the only time it gets activated. and so now I'm like, I cannot, I can't have this happen. You can't beat me at my own game. 

Preston: Margaret's been averaging like 20,000 steps a day.

I 

Margaret: have been 

Preston: lit. This has been a lot. Yeah, 

Margaret: it's been lit. It's 

Preston: incredible. 

Margaret: I'm like, I'm getting up and running in the morning now. And 

Preston: sometimes it's just the extra little bit you need. 

Margaret: I know. 

Preston: You know, to be like, I gotta mug somebody so I'm gonna exercise 

Margaret: and I got, and then this is the last thing I'll say and then we'll transition to the actual episode.

But Preston did text me today and he goes, you better get ready. What did you say? You said you're going to regret. 

Preston: I said You're gonna regret 

Margaret: posting on the Instagram. On 

Preston: Instagram? Yeah. 

Margaret: And I think I said probably not. And he said, I'm like, later I will like running MOG you or something. And then I just sent him a screenshot of the, standings and I go, maybe you need to do that today.

Preston: Yeah, we'll see I'm only, [00:06:00] 6,000 steps behind. 

Margaret: Right. But like can 

Preston: happen. 

Margaret: I'm gonna walk, I mean I'm get another 20,000 tomorrow, so like 

Preston: Yeah. We'll just, 

Margaret: we'll see. We'll love the, anyway, if guys wanna join us. I think it's fun, but I'm in my thirties. Mm-hmm. So it fun. I would think this kind of thing is fun.

Okay. We're going to transition into the episode with our sister Brother Comp Compatriot podcast Cousin, cousin podcast. 

Preston: Mm-hmm. 

Margaret: on the Human Content Network. And again, it is part of our apology tour of this season, I guess. Sorry, 

Preston: Marshall Linehan. 

Sorry, 

Speech Language Pathologists. 

Margaret: We are going to be talking to the two co-hosts of Speech Talk and we are going to be exploring just the overlaps of being, we're talking 

Preston: about speech 

Margaret: and, 

Preston: on speech stuff, 

Margaret: swallowing 

Preston: and, 

chewing and [00:07:00] death and food.

Margaret: And the theme of this season 

Preston: is death. And why do we even eat anyways? Yeah. 

Margaret: Graham crackers. So we are gonna skip and hop after this ad, break into that segment.

We know that a lot of people who listen to our podcast are also therapists and maybe running their own practices. And as someone who is brand new to the game of opening my own private practice, simple Practice has been a really, important tool for me. 

Preston: Simple Practice is an all-in-one EHR that is HIPAA compliant, high trusts certified and built specifically for therapists.

It brings scheduling, billing, insurance, and client communications into one place so you're not juggling multiple systems to run your practice. 

Margaret: And one of the features that I'm really excited for that can help with the business side of things is automated reminders for your patients to help reduce no-shows as well as other components of billing and insurance to make the business side a little bit less of a heavy lift.

Preston: And if you're [00:08:00] just starting out or growing your practice, there's also credentialing service that can take the headache out of insurance enrollment, which can honestly be a huge lift. So if you're ready to simplify the business side of your practice, now's the perfect time to try Simple practice. 

Margaret: Do it with us.

Preston: Start with a seven day free trial, then get 50% off your first three months. Just go to simple practice.com to claim the offer. Again, that's simple practice.com.

Margaret: Welcome back you guys. We, as part of our apology tour on how to Be Patient, the podcast last week I apologized for falsely saying that Marshall Lenahan, the inventor of DBT was dead. And this week we are apologizing to the field of SLPs and speech language for not mentioning it during the aphasia episode.

Which Preston, I mean, I don't know what I'm as apologizing for. That was a pa Preston led episode. 

Preston: Yeah, that's, why we have Margaret to, apologize for the [00:09:00] things that I'm too embarrassed to bring up. That's fair. It's really about the things you don't say is what we found in podcasting.

And you know, ironically it was the aphasia episode, which we omitted all the things that we should have talked about, the things we couldn't say, but we're, correcting it now. Yeah. 

Margaret: So we are happy to have on to SLPs, Emily and Eva who also run a podcast within our network. And I'm gonna have you guys introduce yourselves because I really never think anyone can introduce to you as well as yourself.

Emily Brady: so true. Yeah. So, hi, I am Emily. I am a speech language pathologist. I've been in the field, about two years. And, I mainly work with geriatric patients in short-term setting all the way to long-term residential. 

Eva Johnson: I'm Eva and I've been practicing for just as long as Emily because we graduated together.

That's how we know each other. [00:10:00] And I do a hospital setting, skilled nursing, and yeah, we've done some other rotations, but that's like our bread and butter, skilled nursing and hospitals. 

Margaret: Amazing. Amazing. Yes. And how long have you guys been doing your podcast for? 

Eva Johnson: Well, that is an interesting question. Okay.

We wrote for about a year, and then we have been recording for about a year, so recording and actually hear people hearing us a year, but we've been working on this project for two years, so this has been, a lot of fun for us and it's a great time for us to mostly hang out, vent about work, discuss the problems with our children, and, we just don't 

Emily Brady: separate people through that 

Eva Johnson: and exactly.

Margaret: That's 

Eva Johnson: clinical research. Yeah. 

Preston: I feel like podcasts are one of those things that you think about starting for a long [00:11:00] time and everyone buys the equipment, it's lays dormant and collects dust, and then eventually you, dig it up and start to use it. Even like when, we started this and I sent Margaret, like some of the, mics I had, I bought those in like 2020 in med school.

When I was like, I'm gonna start a podcast. So I could even say this has been like six years in the making because it's just been sitting in my desk doing nothing. 

Margaret: That was when I think I texted you back and I said, I've got, best I got is a MacBook. And

what's your He was So that's not gonna work. 

Emily Brady: No. If anyone is struggling to get something off the ground, they need a EVA in their life. 'cause I had the original idea to have a podcast 'cause I was looking for something more skilled nursing base because there's not, there's a million podcasts out there for speech therapists, but it's all kids and schools and heavy medical or very serious.

[00:12:00] There was nothing that was just like an easy listen and I'm like, Eva, I need, you. And then she has all of the friends and it just like very quickly took off from there. So. Everyone needs Eva. 

Eva Johnson: Yeah. And everyone frankly needs an Emily. I am very manic. I'm like, do. I had this like clinical question deep into the tabs, like reading all the research and then I would never upload anything.

I would just sit there with all of my thoughts to myself. So Emily's really one who keeps us going. 

Margaret: So obviously we have a blind spot in terms of that. We didn't even talk about SLPs and I don't, I'm jokingly blaming Preston, but I also didn't ask any questions or bring it up myself. And so one of the questions I have just as a nosy person is I'd love to hear like, what is a day in the setting you guys practice in, like for you, like what's your, like I get there at this time and I do, you know, this and I round or I note whatever.

These are all my [00:13:00] tools in my belt. be warned that Preston might make a TikTok video about SLPs if you give him too many good ideas. 

Emily Brady: Can I just like. Whiteboard right here. Can I take away some of this guilt? Because in 90% of my interactions, I'm explaining to my patients and the patient's family what I do.

They're like, I'll walk in with a referral in hand. I'm like, hi, I am here. I'm from speech therapy. And they're like, I took Vine. Like, I, I don't know why you're here. nobody stutters, so you're not alone. I feel like we are just the ugly, redheaded stepchild of the rehab department. Even like, I feel like physical therapists and occupational therapists, they're like, oh yeah, you, probably need speech.

It's like weeks after they've been seeing them, they're like, oh, you kind of sound weird now. Like, you're not saying things chronologically like, what's happening, so you're not alone. Lift the guilt off your shoulders. It's fine. We're used to [00:14:00] it. 

Eva Johnson: No one knows who we're, 

Margaret: you're ending madic in that way, which, you know, maybe it's good.

Sometimes people don't know. Who you are in the hospital. I can't paid you. 

Preston: Yeah. They're the fairies that come in and do a swallow study 

Margaret: and it's like, can they have applesauce? Can they have, 

Preston: yeah. Wake up in the morning and they're like, we're the snack ladies. Visit them. Yeah. 

Eva Johnson: Yeah. But we give it and we take it away.

Like we give applesauce and we take the graham crackers. You've been harboring and the drawer because you're not approved for regular textures. 

Margaret: Okay. So days in your life, tell us, inform us. Let, 

Eva Johnson: let's see. Clock in, print your schedule. Let's do skilled nursing. 'cause that's where Emily and I share a lot of, overlap.

Margaret: Yeah. 

Eva Johnson: And it's a great bridge between the acute setting and going home. We're that really terrible limbo. We hope no one gets stuck in. so you go in, you print your schedule, you get your patients, you go through and you go, how many [00:15:00] evals do I have? How many regular treatment sessions? And then you go to your first room.

Someone is likely getting changed. So you go to your next room and that person says, I just ate breakfast. I don't wanna see you for dysphasia treatment. So you go to another room and you just keep going and going until you try and hit everybody for the required amount of time. Then do all of your documentation.

In the meantime, fix all of the problems with communication with the kitchen. Explain why if somebody changes 5% weight loss in the course of a week, they need to get a eating referral. Be like, this person has a MS, can we please send them out? It's a big concern and know we're not gonna treat them until they've had an evaluation for sepsis.

You know, like let's get 'em on broad spectrum antibiotics if that's needed before we start trying to, you know, do a cognitive evaluation. Hit a 90% productivity level. 

Margaret: [00:16:00] Of course, we're, this podcast is brought to you by rvu. All of us are getting a 0.1 RVU right now. 

Preston: So what, does an eval look like? I'm sure there's like a lot of different things that you get called for.

What are some of the classic ones? 

Emily Brady: it's very patient specific. So like, like all the things that we can get into and treat in speech therapy is dysphagia or swelling disorder speech, a k, a dysarthria, so like your motoric movements for talking language. Talked about that for aphasia and then cognition.

So first we have to tease apart what is the concern? What are we looking at? Is it one of those, is it multiple of those? once we have like their initial diagnoses, maybe we can start to, you know, figure what we're gonna be looking at. If they had a stroke, maybe we're [00:17:00] doing cognition or, and, or dysphagia, maybe, dysarthria, if it's a Parkinson's patient where maybe we're looking at voice.

so it all depends on first, what is that etiology? What is their sighted concern? kind of going through their notes, what do, they say? And then picking out our dysphagia task or our evaluation tasks. 

Eva Johnson: And within that, I think to, to the point of nobody really seems to have a good handle on speech.

Your speech department is somewhat what you make it. A lot of times you'll get an eval, Hey, someone came in, recent stroke. Go see 'em. That's it. That's all really the information you have. I'm like 

Margaret: a consult. They're mad. 

Eva Johnson: They're mad. you go in and you're starting with, orienting towards language.

Then you notice, oh, they're eating the blanket. [00:18:00] Turns out they have underlying dementia. Now this is a cognitive issue, so you have to be integrating very quickly as many evaluations, and sometimes multiple at once. Mm-hmm. As possible so that you can. Develop that plan of care more holistically. Some places will give you diagnostic treatment time, some of them won't.

So a lot of times if you don't, you're just going in there and you are just seeing what you can pick up. You're like, oh, they're not oriented. Oh, they're not talking. They don't seem to understand what I'm saying. That, is that a cognitive issue? Is that a receptive language impairment? Here, eat this cracker.

Did you swallow it? No. All right. Try a sip of water. By the way, my name is Eva. I'm from speech therapy. I'll see you later. 

Emily Brady: Yeah. 

Preston: So what's, what would be a more appropriate way for them to ask? They say like, Hey, eating. What's eating blanket question. They're eating the blanket. Can you come see them? Speech like, are you're like, oh yeah, just, you know, I got a, pillow, police and someone else, can 

Margaret: you please come in 

Preston: this earlier?

But I'll get to him. [00:19:00] 

Emily Brady: I don't, think there's like a bad way to ask for speech. I think it's just sometimes people are more funny about it. Like if you're telling me they're eating their blanket, like take away the blanket, then like, let's go from there. 

Eva Johnson: I also wanna know if that's their baseline.

Like is this a new eating of blanket or an old eating of blanket? Mm-hmm. Right. 'cause if it's an old eating of blanket, we can talk about errorless learning dementia strategies for behavioral management. But if it's new, then we wanna be looking for an acute change. 

Margaret: What's errorless learning? 

yeah.

You say error. 

Eva Johnson: That's errorless Error. Error. Yeah. So in people with severe cognitive impairments, we're typically thinking about a demen, a dementia population. If I tell you something, for example, my name is Eva. Then I say, what's my name? Normally you would just [00:20:00] wait for the person to respond, but for errorless learning, you go, what's my name?

Hey, my name is Eva. You give them the answer. 

your snacks are in the drawer. Okay, where are your snacks? They're in the drawer right here. I'm gonna open up for you. And you do that over and over again. And then you try to extend the timeframe during what you're asking. You try and see independent actions.

They may never tell you, but you start noticing they're going into the drawer by themselves to get their snacks. so for people who, when they are attempting to fill in the blank for a question, are likely to make up something random, just give you something from their memory that has nothing to do with.

Contextually where they are. We don't want them to be cementing the wrong answer. We want them to be cementing the right answer. So it's this excessive overlearning strategy that relies on the speaking partner or the caregiver to be essentially training rather than like a, real, a true ask, if you will.

Preston: So, so [00:21:00] you're not necessarily testing them, you're just, you're like a physical therapist forcing someone to do reps with their arm or their leg. You're just doing that, but with the learning portion of it, you know? Yeah. I think that's a pretty fair comparison. Gimme five. My name is Eva. My name is Eva. My name is Eva.

What? What's my name? You know? 

Eva Johnson: Yeah. 

Margaret: Instead of coming with a harmonica, like 

Eva Johnson: actually another one. Yeah. Say my name. Say my name. 

Preston: Yeah. Do you ever use music? 

Eva Johnson: I only knows, I'm pretty sparse with the pop. Oh, for therapy? 

Preston: Yeah. 

Emily Brady: Oh, I do. 

Preston: How do you, apply it? I, because I feel like memory and music are, they hold a different pathway than just like, regular memorization.

Emily Brady: Yeah. it does like, especially for people with aphasia, If just generating language is really hard sometimes that automatic speech is really easy. And automatic speech comes from those nursery rhyme type songs. We've [00:22:00] sung again and again, so we'll sing our ABCs. we'll put on some old music, like whatever genre they like and see if we can sing along.

We'll do karaoke. They're fun sessions. They're fun. You're laughing, but it's so fun. Fun and we'll see. 

Margaret: Thank you. I'm 

laughing, 

Margaret: to it. 

Preston: I'm laughing because I'm picturing when I'm old and have dementia. What songs will be the ones that's gonna be the worst? 

Margaret: My chick bad. Who? My chick. What's your chick?

Bad. Bad.

There you 

Eva Johnson: go. Yeah, exactly. No, or just TikTok. 

Preston: Not over and over. Like lizard, lizard, lizard, 

Eva Johnson: It's gonna be weird. It's, they're gonna have to, it'll be tough. They're gonna have to install subwoofers everywhere. 

Preston: but 

Eva Johnson: it gets the 

Preston: people 

Eva Johnson: going to that point of like, you may, it does, [00:23:00] and when the old people get going, they get down.

I mean, as far as the mobility will permit them, but they get down. 

Mm-hmm. 

Margaret: and Okay, another question I have for you, you mentioned like the cognition part, and so some of that, I presume a big portion of that is within the sort of memory issues, dementia, but like I'm wondering more like what are the elements of cognition?

Because we think about cognition and psychiatry one way neuro thinks about another way. You guys think about another way. All of those overlap, obviously a lot, but I'm just wondering, like if I was. Like a baby, SLP, like starting to practice. What would be the basic way you would teach me? Like how you evaluate cognition in the settings you guys are in?

Emily Brady: Yeah. We use the same test you do. We still use the moca. Yeah. 

Margaret: Sick. 

Emily Brady: We use the moca and just talk about how that applies to different populations. I mean, we use a lot of other tests too. Like I've done the Ripa and ados and [00:24:00] I can't think of all the other ones. Slums. Slums. 

Eva Johnson: We, love 

Emily Brady: a good short form.

Especially, we're just judging if they maybe have a dementia or not. 

Preston: Boston naming. 

Emily Brady: Boston naming. I also used the Boston naming so often. No, I don't. She doesn't. It's at some of my prn. They do have it, but we have like, we're often like the CLQT, I can't think of it there, but I'm not a Boston naming 

Preston: team.

I was just trolling. I don't know how effective it is at the bedside, but, Margaret's in Boston, 

Emily Brady: it's, it exists. People use, it 

Preston: exists. Yes, it sure does. what about, Hopkins Verbal Learning test? How do you guys feel about that? HVLT? Never 

Emily Brady: heard of it. 

Eva Johnson: Never heard of it. 

Preston: So pretty low.

Okay. Yeah, 

Margaret: send 

Preston: it. Sorry, guys. Susan Hopkins, 

Margaret: Preston, you know, Boston naming neuro psych, and I'm, like, okay, 

Preston: I'll stop, 

Margaret: learning has all sorts of tricks. No, [00:25:00] this is your, this, is an episode where this is good for your tricks to come out. Preston, 

Eva Johnson: answer your question more like in the clinical space, in terms of what different people do with the moca, it seemed that is common ground here, is that if we're doing digit spanning, like say these numbers after me, and people are like, well, what's the point?

I'm like, can you say your phone number? Could you say your kid's phone number? I don't need to know the clock. I have a clock on my phone. Okay. Well, if you can't draw the numbers all the way around, how am I gonna make sure that you are seeing your whole plate? 

Margaret: Mm-hmm. 

Eva Johnson: How am I gonna make sure that you are filling out all of your forms if you're ignoring things?

Mm-hmm. Also, when people trash on the clock draw, I'm like, well, you should see some of the clocks I've seen. They're wild. We're not catching like small number differentiations. We're catching people scribbling and writing hearts on it. Like it's very different. 

Preston: Yeah. The, 

clock 

Emily Brady: is very telling. If I say clock draw too, and they're like, the numbers are all skewed.

I'm thinking like, okay, like they're not planning [00:26:00] this. Like, what else might they need help planning? Like how big does that transition? Are we planning our medications? Are we planning for their, our schedule appropriately? Are we planning for, how much time is left to cook this meal or to get my laundry done?

yada, yada. How is that fitting in their scope of their day? 

Eva Johnson: And for the int interdisciplinary aspect, if we're seeing issues with the clock draw that don't seem directly cognitive or more visual. If there's a Diplo diplopia or a Hemi, an obia, we wanna be referring to ot. Can we get a vision eval done because this person's gonna be hitting the road driving.

We wanna make sure they can see, all right? 

Preston: Mm-hmm. 

Eva Johnson: Totally. 

Preston: So, one thing that I've had trouble with administering the moca, and maybe you guys, you probably run into this, but I'm wondering if you had any tricks. So someone who, let's say had, they have like a comprehensive speech aphasia, they have issues, with their, fluency, but [00:27:00] otherwise their executive function should be intact.

So the issue may be like understanding the instructions to then draw the clock appropriately, even, though they in theory could draw the clock. So there's a lot of times where all of a patient just like totally bombed the moca, but it's literally just because. I can't communicate with them to deliver it appropriately where they should really only have deficits in like some of the language areas.

So I'm just curious if you guys have any tricks or tips of ways, around that. 

Eva Johnson: Emily, do you wanna talk about the 

Emily Brady: click 

Eva Johnson: it? 

Emily Brady: No. No, because I don't, give it a lot. Just one that we have, like we have access to it and like people at work use it. I don't use it. Yeah. 

Eva Johnson: Okay. Quick reason I brought it up is because it's actually, I would say if significant expressive, receptive language of pyramids are present that the mocha iss not appropriate because of the implications drawn from the scoring.

So the click, it is supposed to be a cognitive [00:28:00] test that, is targeted for people with aphasia. Like it's much less verbally based, much more visually based. It probably has some limitations for receptive language issues, but I would, in some cases, I've told my department like, I will not administer a cognitive test unless you can get me an aphasia friendly one because.

I know that if this person scores like below a 10, you're gonna start telling the family they should get a different POA and that's not fair to the patient. 

Margaret: Mm-hmm. Yeah. Yeah. So it's like also like the limitation of the tools. And I, wonder, I guess, what kind of frustrations you guys run into at that?

'cause it seems like similar to psychiatry or psychology, like the departments and settings that you're working in have a lot of need and like, so even things like, will they provide the funding so that you can do the screenings or get the licensure to do the screenings, whatever. so I just, I guess I'm asking like, what are common frustrations [00:29:00] in working in your field that like we wouldn't know necessarily about as people not working in your field?

Eva Johnson: Oof. 

Margaret: This is your time to vent professionally. 

Preston: Yeah. Besides telling people that you exist 

Margaret: so bad, 

Preston: like once, once they find out you exist. 

Eva Johnson: Oh my god. Instrumentals. Oh, weak. Fetch about instrumentals. 

All 

the, time. Yes. Bring 

Emily Brady: out that New York 

Eva Johnson: accent. 

Emily Brady: It's so bad. A, PT asks for an x-ray. No problem.

Somebody wants an x-ray of the chest to see if there's pneumonia. Cool. Getting a swallow study to see if someone's aspirating and actively causing problems. No. Just downgrade. No. 

Eva Johnson: Oh my God. Really? Just know. Can't you just know what their swallow is? Or if there's silent aspiration? Can't you just know if the upper esophageal cylinder is opening or not?

Like just use your x-ray vision? No. 

Margaret: Why is that? 

Eva Johnson: It's really annoying. 

Margaret: Like why is there less access? 

Preston: [00:30:00] So, so when you ask for a swallow study, you get pushback. 

Eva Johnson: Oh, we have to like. The amount of advocacy you have to do to get a patient one, like if you are not the, you know how I said earlier in the episode, like, oh, and then fit in all your tasks.

Mm-hmm. Mm-hmm. One of those could be every day showing up to like nursing department showing up to your DOR, like bugging whoever you can get ahold of and being like, mm-hmm. This needs to happen. This needs to happen. This needs to happen, and I'm not gonna stop talking to you until something is on the books.

Preston: Do you ever go straight to the MD work room? I guess you, you work mostly in a, I'm not sure how many 

Margaret: imd that walks around sometimes. 

Preston: Yeah.

Yeah. I guess just when I've been on internal medicine, if, a speech like language pathologist came to our work room and was like, Hey, this patient needs a small inpatient study, we'd be inpatient. Yeah. We'd be like, yes ma'am. Right away. But 

Emily Brady: yeah. Inpatient. Can we ask what setting? Inpatient. 

Margaret: Inpatient?

Preston: Yeah. That'd be inpatient hospital. 

Emily Brady: Yeah. I think. There's so, much pushback when it comes to [00:31:00] literally anything financially in the sniff world. I'm gonna speak on specifically because it is at heart a business, right? Like they do not want to pay anything extra. Mm-hmm. Because they are a business, they want to make sure that they have the least amount of overhead possible.

And each time we send someone out for a swallowing study or bring swallowing people in, it's like a $500 bill. And they're just, they just. Feel like downgrading could be a cheaper option overall, which is not true. Like it costs hundreds of dollars monthly to maintain a nectar thick liquid diet. It can cause more disruptions in like the flow of your kitchen staff having to downgrade certain diets and making sure that they're staying up to code.

Having any citations from state, not following specific diet orders can be a large citation. So I don't why they don't want to [00:32:00] listen to us. The only thing I can think of is that dollar sign, but I wish it wasn't a thing. I wish there was more doctors within that setting to advocate with us because I think everybody in the therapy department, and I'm sure the nurses and everybody who's working the floors all understand the need, but it's a, business at the end of the day and they want to make sure that they supporters or their investors are happy.

Funds. 

Preston: Mm-hmm. The, shareholders. So just to, clarify for our, less medically inclined audience, and if I'm understanding this right, when you suspect that someone may have a swallowing difficulty, you clarify that with a swallow study. So, so for anyone who's not familiar, it's where essentially you swallow barium, is it still barium or is just some kind of like fluoro contrast, and then you watch them in real time through an x-ray swallow, and then you can use that to evaluate their sphincters.

The 

Emily Brady: one, there's 

Preston: only one, [00:33:00] 

Emily Brady: there's just, 

Preston: I'm probably 

Margaret: this just 

Preston: on 

Margaret: the basement yard with Dr. Mike, 

Preston: this, sorry, the upper esophageal sphincter, not the lower esophageal sphincter. You're less concerned about that one. 

Eva Johnson: yeah. There's also one further down than that. So def Oh yeah. 

Preston: The camera goes 

Eva Johnson: in a different way for 

Preston: that.

Yeah, sure. Def other screeners are, not our territory, but, anyways, so Okay. We're 

Margaret: still learning about the 

Preston: pelvic 

Margaret: floor. Don't worry. 

Preston: Yeah, it's, on my to-do list. These, are all associated with certain, like, diets that patients can have, right? So you have like a all liquid diet. You have an all solid diet, and then there's like a, about seven levels in between there.

And so the business is essentially saying C 

Eva Johnson: scale. 

Preston: Yeah. And, S And SSIB or something? No, that's non-suicidal Self Andre behavior. It's And S. S something. 

Emily Brady: SDI. It's C-I-I-I-S-S-D-I. Dsi. [00:34:00] I ddsi. Dsi. 

Eva Johnson: What does that stand for? 

Emily Brady: The international dysphasia. 

Eva Johnson: International Dysphasia Diet. something fair.

Emily Brady: Dang it. I didn't think there'd be a quiz. 

Preston: If you suspect that there's a problem, instead of actually like letting you evaluate and confirm what I-D-D-S-I level they're at, they're just making them go to a, software or liquid. A diet allegedly. 

Emily Brady: So allegedly, 

Preston: yeah. Allegedly. Because of the money. 

Eva Johnson: Yeah. So what basically what happens is if somebody comes in and they have a suspected swallowing issue, we go see them.

We conduct a bedside swallow where we give them a couple different snacks of a few different textures. We make our recommendations. If there are overt signs and symptoms of penetration aspiration, you're coughing, you're gagging silent. Aspiration cues can be like watering of eyes, facial grimacing.

That's where it's getting into the airway without an overt cough. 

Preston: Mm-hmm. 

Eva Johnson: Then as clinicians we say, Hey, this is what we think is the best [00:35:00] matched texture we take into account, you know, patient preferences. Then if there's. Something as like significant as overt symptoms. A lot of the field is generally trying to push towards like you should just get that evaluation.

Like you should just, you should actually see what's happening because otherwise we're guessing. The additional benefit of getting visualization of the pharynx is that there are compensatory strategies for swallowing. You don't just have to modify textures. You can do a chin, took a head tilt, an effortful swallow, a super subglottic swallow.

So now are the opportunities to try those on video and say, Hey, is this effective? The person may be coughing and gagging when they eat regular textures, but if they chew 30 times and then swallow while holding their breath, maybe it's fine. 

Margaret: Yeah, 

Emily Brady: But we don't know that unless we can 

Margaret: see you. No, this is, so interesting to hear.

'cause this is constant top My, my dad had [00:36:00] glioblastoma. 10 years ago and then five years ago, and the resection plus a stroke alongside of it made it so that he has some dysphagia and he's had it for years. I will say he was a primary care doctor, and so I think he's a little bit like, I will eat my food and if I die, love you guy. Yeah. 

Eva Johnson: He's not the only one. 

Margaret: Yeah, exactly. But there are a lot of strategies definitely that he like uses now. 'cause it's like obviously unpleasant to like be coughing or choke on food ever. and I wonder, I feel like on the, maybe on the opposite spectrum, when we are inpatient and it's like we are doing the test, at least in the hospital settings, I've been in like Preston right away in the hospital.

It's like if someone starts doing that even a little bit, it becomes very like, okay, well now they're going to have to eat like the, we get like very rigid in the opposite direction of like. Now they can only ever have applesauce and like they can only ever have whatever. 

Preston: Yeah. 

Margaret: And they will not eat anything else in the hospital.

And it's illegal. And we need to call [00:37:00] speech to come get the grand cracker 

Preston: and smack, smack it outta their hands. I've been consulted for like suicidal ideation after like a speech pathologist has seen a patient and then like basically sentenced them to no graham crackers and they're like, 

Emily Brady: no, 

Preston: I live anymore.

And that is, there's no point 

Emily Brady: that's terrible calling. 

Preston: And then we see him. I'm 

Emily Brady: calling it, I'm it like, personally I feel like I'm a very lenient speech therapist like I am. I am on the way opposite spectrum when it comes to aspiration. When we think about like something all the time. Reference back to these three pillars of aspiration, pneumonia, and like if these three pillars align, then we're more likely to have aspiration pneumonia.

So are they're actively aspirating, contents. They have a really bad oral hygiene, a lot of active oral bacteria. And I think the third one is like just, like the mobility of their structures or maybe their general [00:38:00] mobility. I, forget the third one. 'cause of course I'm talking about it.

Preston: Mm-hmm. If, like their, head isn't 

Emily Brady: tilted up or something down, their movement isn't ty like their, it's not timing. Right. or like physical movement. if you're laying in bed all day and you're not moving around, you're not getting your lungs moving, you're gonna be more likely to get pneumonia 'cause you're not exercising and using your lungs.

if someone is aspirating and they're very mobile and they're like. I don't know, maybe they're wheeling down the hallways all the time or they're constantly in physical therapy and they are super rigid about their oral hygiene. Their chances of getting pneumonia are super, super low. So to tell that person who is comfortably aspirating just a little bit that they can't have whatever they want is terrible.

And I am like super big about shared decision making. Like if I am talking to you about all these compensations and you don't care that you are aspirating or it's like [00:39:00] very uncomfortable to cough and you are still able to maintain weight just fine, then who am I to tell you? You can't have something.

Any person is able to completely refuse any kind of medical care, any kind of medical intervention that is their right. As a patient. I cannot come into their room and say, you can only eat applesauce or get out. Like that is not their only choice. They have rights as a person, as a patient, as a. A human being and I, can't do that.

And for someone to come to you suicidal, that's horrible. That's heartbreaking. Like, get the guy a graham cracker. What the heck? Mm-hmm. I hope you gave him a graham cracker after that. I give him graham crackers. 

Preston: That's, so helpful to, to hear, because I think we see the, speech therapist prescription or assessment as draconian almost.

And so sometimes like people in the hospital follow it to the t like we talked about, without doing that proper [00:40:00] risk assessment. And the irony is the, all these same medical teams will turn for like, I don't know, something like capacity or for, like being cleared for surgery and say like, we don't clear people for surgery.

We do a risk assessment. You know, we don't clear someone for capacity. we, well, we kind of do, but we do a risk assessment essentially with the patient. and so you're saying that's exactly what you're doing too. You're doing a risk assessment. Whether or not you're aspirating and you know, you know who, else comfortably aspirates this guy?

Like, half the time. What? Because I'm not good at eating, I food down way too fast and I'm always like, or like, like my cats, I'm not, gonna deprive them of their rocks just 'cause they, they aspirate a little bit, you know, 

Margaret: they're a little bit suicidal. 

Preston: I'm gonna put them on liquid night. They, love their rocks.

Okay, this is good. I'm, gonna apply those three pillars in my home. 

Eva Johnson: I feel like when we were looking through the things you guys wanted to ask us about, we just [00:41:00] inadvertently hit on something super, I think, interesting about the field, which is that everybody, I think comes to speech therapy for language and, you know, speech and you end up staying for the food.

Margaret: Yeah. 

Eva Johnson: It's, you know, it's just something that is integral to everyday life. it's so. I mean, so heavily regimented and can have such severe effects. And also coughing does not mean you're aspirating. I've watched fees, which is not the barium, but like they put the camera up your nose and down into your throat and watch you swallow.

and you'll watch people with like a sitting chunk of like fruit, just like on top of their vocal folds and they're coughing. You're just like watching it like come up over and over again, me this morning in blueberry, and then they swallow away. And 

Margaret: you're like, like those videos that kids watch that like, like dancing peas, like the blueberry.

Preston: You're like, dang, he did that. 

Margaret: No, I think I've jokingly said this on the podcast before, but the like, health, [00:42:00] morality, police is like, I don't know, I feel like also doctors at, as a doctor, I feel like doctors can be the most guilty of this as like the putative top of the hierarchy or whatever. But this kind of like paternalism that's like, okay, I know all the information and I'm gonna tell you and you're gonna stick to, while you're in my house, in the house of God in the hospital, you're gonna stick to my rules.

And it's like we all choose our carcinogens. Mm-hmm. Like, like 

Eva Johnson: Yeah. But to that point, I think that medicine, I'm gonna co-opt a phrase somewhat uncomfortably here, is like very pro-life. 

Margaret: Mm-hmm. Mm-hmm. 

Eva Johnson: You know? Yeah. Andre Antide amount of people who I know, I'm like, this, we're anti-death. We life anti-death.

Yeah. 

Preston: Yeah. 

Eva Johnson: Is, and you can see that reflected by the fact that there is very poor palliative and hospice integration into overall plans of care. If somebody has a progressive degenerative like diagnosis that needs to be from day one from the jump, they need [00:43:00] to be in there. Somebody even with a, car crash, you know, motor vehicle accident, like why isn't palliative in here talking about comfort?

They may physically never return to their baseline. Someone should talk to them about how they're going to be physically comfortable and enjoy their lives from here on out. 

Margaret: I find that psychiatry ends up being the role that's called in for where palliative sometimes should be like. 

Eva Johnson: Mm-hmm. 

Margaret: Some accident happens or something else.

Someone gets a diagnosis and it's not terminal, but it's going to, or it's not terminal as in it's like going to kill you quickly, but it's going to be a new way of life for you to live with. And even when it's like they just found out they had that diagnosis and it's like normal to be upset, that is sometimes the, like our version of, we don't know can speech come see them, they're chewing a blanket, something's happening, and then they're chewing a blanket.

And for us it's like they're three days out from a bad car accident where like someone they love got seriously injured or died and they broke two of their legs and are gonna [00:44:00] have to do PT for the next year. Like that's like actually a minor case of this. Right. Can psychiatry come and help them cope and yeah, I, don't know if that's like the right role for psychiatry.

I don't know if we like expanded palliative and pediatrics. Palliative does do that. More of that work like palliative is larger for most pediatrics hospitals in terms of like the span of life they will cover versus adult. It's just like you're on the path to death in a more imminent way. Mm-hmm. 

Eva Johnson: Yeah, and I think some of the other biggest barriers to those discussions are family.

You're like, look, dude, Nana's got empty in the tank. Like, why are we pushing for a PEG tube? This is something Emily and I have talked about in a previous episode, in intervention is physically invasive. It can be physically traumatic, and for some. I don't have a lot of time left. Can [00:45:00] I just go sit in the courtyard and like have a smoothie?

Margaret: Can I have my graham cracker? So Graham 

Eva Johnson: cracker. 

Emily Brady: Quickly I looked up the last three, three third of the pillars and it's immunocompromised thing, so it's not exercise, it's oral hygiene. This presence of dysphagia and how immunocompromised they are. Three pillars. So I don't have to come back on your podcast and apologize later.

Margaret: Say hello, new apology. Well you can do an apology. I'm so afraid. So apology to her.

Okay, we're back after a camera failing, off into the night, but we're back and we have a chart to talk about. 

Emily Brady: Oh, I love a good chart,

Eva Johnson: Emily. Loves charts. And she has seen this chart. This is [00:46:00] not a chart she loves. 

Emily Brady: Oh, I don't love this one. 

Eva Johnson: so when we were getting ready to come talk with you guys, Preston asked a question about PPAs or primary progressive APHAs and I think PPAs or other neurodegenerative co cognitive like processes get at this heart of what are we doing?

And kind of jumping back to what we were saying before of what, is the end goal here? If we know somebody is potentially on a terminal track or a track where they're going to end up not being able to speak, not really understand the people around them and be disoriented, like what is the point of speech therapy?

It's an existential question I think all therapists should ask themselves. And so I'm going to get around my mic, come up to the camera and show you my chart that I. Painstaking all through together. 

Margaret: It's show and tell time. Love it. Oh wow. This is why you should be watching on YouTube. You guys. 

Preston: Okay, full screen.

I'm making 

Margaret: this visual for Spotify. [00:47:00] 

Preston: Oh, this, looks like the dil chart. 

Eva Johnson: Well, that's a fancy name. for those of you who are listening, we have on the x and Y accesses language and time. If you don't do any intervention and you have a primary progressive condition, it's just gonna tank. It's just gonna go straight down.

But through various interventions, whether it's speech therapy or just community stimulation, engaging, having people sit and actually talk to you, face to face, not talk around you, you begin to delay it by just having these sort of maintenance periods, these tiny increases and the drop offs. Tiny increases in drop offs.

And so we're just shifting out the timeline. 'cause at this point, all we're fighting is time, right? We know the progression is gonna happen. We're just extending functionality for as long as we can. And I think some clinicians really have a hard time with that. They're like. This person's got dementia or like, this [00:48:00] person has Huntington's, like there's nothing we can do.

And it's like, no, there's a lot you can do. There's management, there's quality of life, there's caregiver participation and training and making sure that is an active portion of care, I think is what makes end of life care kind of fun. You're like, we're in this together. Come on, let's all like pile in the car and talk about where we're going.

Yeah. 

Preston: Mm-hmm. Well, I mean all this is maybe my philosophical stance, but all medical care is end of life care If you really wanna like get down to it. And it's just that you're actually now with patients that have confronted and accepted that the end of life is coming and that you can do that. All you can do is, optimize the time that you have left.

You know, like that's not a conversation you have with a 30-year-old, but, or you could try obviously, but people aren't, knocking on desk doorstep in the same way. So I've actually like, I usually use that as a way to even like. Introduce that topic to people that whether you're [00:49:00] 20 or 80, like all doctors can do, is try to get you as close to your baseline as possible and make the time you have left as good.

As good as it can be. 

Eva Johnson: Yeah. Snaps 

Emily Brady: to that. Yeah. They don't accept nothing. We just laughing because the 

Margaret: acceptance 

Emily Brady: portion, 

Preston: nothing's the hardest one. I'm going 

Eva Johnson: into the light. 

Emily Brady: I recently had a completely bed bedbound person. Tell me how they were starting physical therapy so that they can walk again.

Sweetie, it's been a few years, like it's time that boat has sailed, but we don't, we just encourage, like, you know, you can, go do it, you know, like get in physical therapy, but it's like 

Eva Johnson: mm-hmm. 

Margaret: Mm-hmm. 

Eva Johnson: Let's 

Emily Brady: that start with that morning bed mobility exercise. It's so very hard. Even if it's not like just death acceptance, but like accepting that they do have a dementia, like maybe it's mild, maybe they're not remembering, but accepting that this disease is present and progressive.

I have eval people and their family has, and I've showed them a [00:50:00] tent on amca and I showed this to the family and they're like, 

Margaret: shh. Mm-hmm. Which for our non-cognitive folks in healthcare, 10, 

Emily Brady: bad, 

Margaret: Less than 23. Less than 22 bad. Right? 

Emily Brady: They're like, so do you think she's had a stroke? No, I don't. Like, there's no other stroke symptom, like, no.

So it's just, it, that accepted piece is just, it's hard all around for all of it. 

Margaret: Mm-hmm. I mean, I think one of the things, and this sort of has come up in our existential like episodes a little bit, but one of my mentors back in med school ha, had this book he would always recommend that was about like, examining the corpse.

And it's basically the idea of what you guys were mentioning, that all of modern medicine, especially in the last 20 or 30 years, with the idea that we can just like get rid of pain and kind of have this fantasy of living forever and biohacking our way into [00:51:00] eternity. I think it's, so confronting for clinicians to recognize that illness is real.

Which sound, I mean, not just patients like I, I mean clinicians. And I think that's one of the hard parts for some people of like psychiatry. Although it's true in, every part of medicine, but like that you're not gonna fix this and it's actually gonna be here. And for some patients you see it might get worse.

Some patients you might get rid of it and everything's great. But similar for the patients that you guys are seeing, I'm gonna guess in your setting, it's very rare that you do an intervention and that intervention makes them go back to who they were when they were 25 years old without any mortality.

And it, it's this like marginal wins and how do we find that meaningful and accept that mortality is really, present and that like we just, we have a year to make the most of in the body that we currently body and brain that we currently have. 

Eva Johnson: Yeah. [00:52:00] Emily, I dunno if you've had this experience, but I know definitely other SLPs you have where you're working with somebody who has poor expressive communication.

Receptive is fine. You are maybe using a C or you are just finally getting to a point where you can kind of understand one another and the person's like, I wanna die, help me die. And you're like, oh man, put that on my shoulders, bro. Like, talk to your family. But no, I mean, the thing is that sometimes it's not just that we're recognizing that, hey, this is something that is going to happen as people are actually telling us in session, I am ready, help me leave the box of pills by the table.

And we're like, I can't do 

Margaret: that. You consult us and you say, psychiatry, get in here. 

Preston: Hey 

Eva Johnson: neuropsych. 

Preston: There's a difference between being suicidal and just wanting a good death. and I think it's hard for us to differentiate that on the clinician side. Like [00:53:00] it people, have come to terms of their death and they're ready for it.

And they're like, you know, release me from this pain. And we're like, oh. Let's safety plan. Yeah, that's, how we're gonna respond to that 

Eva Johnson: a hundred percent. I had an a LS patient who asked me about like, pathways to dying. And she very cheekily. Very good. Remember talking about her very cheekly was like, she was like, what's 

Preston: a, CE 

Eva Johnson: Oh, a c, augmentative alternative, communication device.

So it can be anything from as low tech to like a piece of paper that says yes and no on it. To an icon board with a variety of ADLs to an iPad that uses eye gaze. Like it's the full range of anything that is kind of external that we use for communication. Good question. And she could eye gaze type pretty quickly and she was like, I wanna die.

And I was like, oh. Okay. [00:54:00] You know, hard to have like a good response in the moment. I'm still working on that. And she was like, I get an enema four times a day. You know, it's just, today I'm kind of ready to like move on. Yeah. Yeah. And then after she passed, I found this book that she had written via Eye Gaze about her life.

And it was like, she was this total red hippie chick concert going, like, festival, like Burning Man, like you name it. And it was just so different from the person that I had met and realizing like, if that's who you see yourself as, and this is your life now, accepting that like, this is no longer who I am, no longer comfortable.

Like someone help me out. You know? 

Margaret: Yeah. And it's, like, I mean, in psychiatry and the most psychiatry that we do, and because we, like you said, medicine is so kind of like. Literally pro-life or lean, [00:55:00] trying to maintain life as much as possible. Yeah. 

Preston: Preserve and extend life. 

Margaret: Yeah. Mm-hmm. Preserve a pulse.

We see people and it's like, I don't know, there's this like kind of contradiction within psychiatry, at least that it's like implicitly we are saying like, no, you have enough things or there's enough about your life that you should want to stay alive and so you have a pathology. And, but then we also have these conversations about like, when is a life, when should we let people choose to let their life end, which is palliative care and more it's like medical assistance and dying.

And I don't think there's a clear cut answer, but I'm just hearing your story. Like I could, you could also hear like, there are also times when I don't know if you, if someone, if she also had clinical depression episodes. Like was actually depressed during that, which she probably wasn't, but like, let's say that they were, and then we like are [00:56:00] like, let's do medical assistance in dying without treating depression.

Like I, it's just, it's so tricky when it gets to this tricky is like an understatement, but this question of like, how much suffering does someone have to be in and how do we observe it and let them know if they get the autonomy to choose to live or die and when is it pathological? 

Preston: It's honestly just, it feels arbitrary and it's like whether or not we agree with them.

You know, if a patient wants to die and we're like, I think you should wanna live, that's pathology. And if a, patient wants to live and we're like, I think you should want to die. That's palliative care Consult. Yeah. Also pathology. 

Eva Johnson: It's funny because I feel like that is the definition I was trying to give my daughter about what a weed is.

I was like, we're weeding. And she was like, which ones are weeds? Like what is a weed? And I was like, the ones I don't want like, 

Preston: yeah, like, like the, nicest girl, you know, going through her animal crossing island. 

Emily Brady: No, that's not, doesn't relate. 

Eva Johnson: These are all wings. I too, [00:57:00] 

Preston: that's too much of a jazzy joke.

Nevermind. Nevermind. 

Eva Johnson: I think though, circling back to your initial question of like, Hey, what is, for people who don't really interact with speech therapists, like what is your job? I think you're starting to like get the breadth of it. It's like a little bit of everything. Because what we do is at the intersection of what people do every day.

If you can't communicate about toileting, guess what? Like I'm gonna follow my patient into the bathroom and see if they can sequence the steps to like get on the commode. Are they following their caregiver instructions to roll over if they need to be changed? Are they able to eat? Are they able to like be in a room safely by themselves?

You know, like is everything and somehow it's supposed to, you know. I don't know. Whenever I'm writing up notes, I always, I'm like freaking out. 

Margaret: I'm freaking out. 

Eva Johnson: I'm like, what I did was helpful. I dunno what to tell you. 

Margaret: You're like, what is it? Does it mean to live a life That is a psychiatry note too. 

Preston: Yeah.

Well, [00:58:00] it's not, did they eat a Graham cracker? Cracker is why a graham cracker? Yeah. what is the graham cracker to me, truly, what does it 

Margaret: represent? 

Eva Johnson: Think, not that there is a graham cracker, but, oh. 

Preston: What the graham cracker can do for you. Yeah. 

Eva Johnson: Okay. 

Margaret: We have once again failed our goal of having this podcast not stretch beyond an hour.

But a question I have for you guys as we end is one where can people find you on socials in terms of for the podcast. And then I would like both of you to plug why people outside of people in your field should listen to your podcast. 

Eva Johnson: All right. So our podcast is called Speech Talk. Speech talk pod.com is our website.

I'm hesitant to say our Instagram, which is just speech talk. You 

have 

Emily Brady: send it. You gotta commit, you gotta send it 

Eva Johnson: Instagram. 

Emily Brady: You're a woman in media. Now send it. 

Eva Johnson: I'm not good at Instagram, so I'm always nervous about that one. But we [00:59:00] are speech talk@speechpod.com. Follow us on Instagram, and anywhere else that you like to listen to.

Podcasts. Yeah. Wait, it was socials. And what else? 

Margaret: Why people who are not in your exact field should listen and learn to your podcast. 

Emily Brady: So not just within our field, but we're talking about how our field can scope to other fields. How you as a family member might be able to help someone with a specific disorder.

Maybe you're just looking to learn something. maybe you enjoy listening to. Two friends talk and laugh about something that we feel passionate about. but it's a, fun podcast. It's a light podcast. It's not super long. It's a drive home from work and learn something cool that you didn't know before.

Eva Johnson: We try to really balance the levity and the morbidity, so stay for that balance. But we do, we talk to everybody. It's like [01:00:00] gi, ot, pt, MDs Pharmacy like we're doing. We're at the intersection of it all. So we try to talk about how we really tall the fields. 

Margaret: No, and I think even our just small conversation here showed like, and limiting it to certain populations, age groups and settings as we have for this episode.

Still, there's so much that I think anyone in healthcare or. Who deals with health or deals with family members with health and might age and face mortality, I think can learn a lot from what you guys have to offer even. Yeah, I don't know. I just think it's so core. It's a human experience, what you guys are doing in so many ways.

Emily Brady: Well, thank you guys so much for having us on and we're happy to come back. If, you know, you end up running into a topic and you realize 

Margaret: another apology 

Emily Brady: we could come on and help, 

Margaret: we have another apology. 

Emily Brady: Oh yeah. 

Eva Johnson: We know some people. 

Margaret: Amazing. 

Eva Johnson: It was a true pleasure to be [01:01:00] here today. thank you guys so much for having us.

Margaret: You can catch the next part of this on Patreon. 

Preston: It's patreon.com/happy Patient Pod. 

Margaret: Guys, you missed a lot on the Patreon section. This time you missed fellowship reveal for Preston. You missed us talking about LARPing and, dating stories. The bargy robot. So bar, 

Preston: yeah, 

Margaret: that's what you missed. Okay, Preston.

Okay. Do our, this is our podcast saying goodbye thing. 

Preston: I will, this is our podcast and we are saying goodbye. And I wanted to see what some of the positive comments we got were. Oh, 

Margaret: we'll read on Halloween. We'll read all of our hate comments. 

Preston: Halloween Special, all of hate comments. We only have one. No one ever says anything bad about this podcast.

That's 

Margaret: not a challenge. You guys. 

Preston: Yes, we delete them. Okay, so Jack Fish said, great. Ep. Ep, I think it means episode. Love the [01:02:00] role play. Very informative. Remember, this is non-sexual role play. This is us just being therapists going back and forth with each other. So you wanna see more like that? Go check out hr, the DB K studies with expert Dr.

Kiki feeling. That was last week's episode. Thanks again for listening y'all. How was the show? If you like speech talk, go check them out. If you want to hear us talk more with speech therapists, we'll have 'em on. Again, if you wanna listen to us talk about anything else, literally we'll be on the Patreon or just go check out many of our, other episodes we're, gonna try to like condense 'em and put them on this MedEd platform pretty soon.

So just kind of, we. Keep an eye out for that. I'm not gonna give any names or any specifics, but it's up in the works right now. But that, may be something just we're working towards JT 

Margaret: Cumin. JT Cummin. 

Preston: Yeah. 

Margaret: Okay, fine. Cut that. Whatever. I was doing a 

Preston: creative, 

Margaret: I know. 

Preston: I don't know what JT Cumin means.

You even heard that 

Margaret: means I 

Preston: don't, no, I was just You said jt. 

Margaret: Jt. Oh, what are [01:03:00] they? This is like when you weren't on, I feel like not on, this is the pop culture, like girly pop, TikTok, and I think I just have different memes. 

Preston: I've been too bricked, I'm missing out on, and by brick, I mean I'm like, I'm not using my phone.

Like it's on. Yeah, I use the brick to block myself out of it. I'm not like, 

don't, You know what I mean? 

Margaret: Don't 

Preston: episode end. This episode episodes are available on my YouTube channel at its prerow. You can find us on video on Spotify as well. Margaret's at Bad Art every day. You can see her eating her Shamrock McFlurry there.

I'm Matt PreOn, TikTok, and Instagram as well. And or check out Margaret Substack. Too bad our every day where she's stacking the subs. thanks again for listening. We're your host, Preston Roche and Margaret Duncan. Our executive producers are me, Preston, Roche, Margaret Duncan. Will Flannery, Kristen Flannery, Aron Korney, Rob Goldman and Shanti Brook, our editor at Engineers Jason Portizo.

Our music is Bio Ma Benz v. To learn more about our program, disclaimer and ethics policy, submission verification and licensing terms, and our [01:04:00] HIPAA release terms, go to How to Be patient po.com or reach out to us at How to Be patient@human-content.com with any questions or concerns. How to be patient is a human content production,

how to be patient.

Thank you for watching. If you wanna see more of us or if you wanna see, this is lilac. She's my cat. She's gonna be waving her hand at one of the floating boxes, which will lead to more episodes. Lilac Point to the other episodes. Lilac doesn't know what the internet is, but I swear they're there. They, probably exist for real.

But in the meantime, I'm just gonna pet lilac and then I'm gonna go dance in the [01:05:00] background.