Dr Andrew Greenland: 0:02

Welcome back to Voices in Health and Wellness, where we dive into the real world stories of health practitioners who are building innovative, patient-centred practices and shaping the future of care. I'm your host, Dr. Andrew Greenland, and today I'm speaking with Laura Bunso, a physical therapist and certified manual therapist based in Jacksonville, Florida. Laura is the founder of Smart Body Physical Therapy, a thriving pelvic health clinic that's trans been transforming lives for 20 years or more. So with that, I'd like to welcome you to the show, Laura. Thank you so much for joining me today.

Laura Bunso: 0:31

Thank you for having me. Good morning.

Dr Andrew Greenland: 0:33

Good morning. So can you take us back to the moment you decided to start Smart Body PT? And what was going on in your life at that time, if you're happy to share?

Laura Bunso: 0:42

Okay. Gosh, it was a long time ago. I actually was at Mayo Clinic for several years, and um I had been considering going out on my own. Don't know that I ever would, except that while I was eight months pregnant, um I um uh unfortunately um which ended up being a gift really uh came down with meningitis while I was eight months pregnant. Um and it allowed me to go into preterm labor and discover that my son would be born with no diaphragm. He had a congenital diaphragmatocernia. And so um that uh catapulted my life into a different, very different um trajectory than uh career. Um, thought I would be taking care of a very sick, I hoped I would be taking care of a very sick child at that point because I didn't I think that he was going to make it. I was told that he wouldn't. And um, he's doing great. He's a senior in college, um, but it it did um completely change my life. And um, because I had the the pause and uh space and time and had uh resigned from that position, um I thought I'm I might uh go out on my own and and be able to take care of people in my community um in a way that um I maybe couldn't have before, wouldn't have even had the maybe not even had the courage to do it, but it uh really changes your perspective on things when you have something like that happen.

Dr Andrew Greenland: 2:13

For sure. So from that kind of um central moment, what uh how tell us a little about the evolution of the business from that point when you make that decision.

Laura Bunso: 2:22

So I just really started with um doing orthopedics and uh pelvic health. I had done pelvic health at Mayo Clinic. It was uh really the centerpiece of my um practice and was on the uh labor and delivery task force and things like that in the hospital whenever they had women's health as part of their care. Um so it was uh very close to my heart. I did it in school with one of the residency programs, um, but didn't think that it could be really a main piece or a staple of any sort of business and was really advised against it. Um, but uh just kept growing naturally. Uh, started from one room, one little uh just rented a room from a colleague of mine and um OBGYN, uh, and um kept um really just getting lots of referrals for it until um had this uh shift. Um, my company went the Athena Project, which is a local uh business uh project for our female-owned businesses here, and um had some really great guidance with them to go ahead and make pelvic health their bullseye. Um, and that's men's and women's help. Um, and it was really quite scary to have that as a focus, but there's just it was so underserved and just such a need. Um, and every patient that um that I spoke to, unless they were coming from a a source that had this inside knowledge to be able to um start to access this. But every every patient had a story that was similar. That I, you know, why didn't my doctor tell me about this 20 years ago? How come no one talks about this? Um, whether it was pain with intercourse or uh bowel or bladder control or just so many things that would tuck up under that that you might not be able to just discuss in a public setting to get some guidance like you could for your shoulder hurting. Um and so I knew that the need was there, um, but I wasn't I wasn't quite sure how to to to go about the business part of it, um, but was um brave and with the encouragement of these um wonderful uh people that were on my panel, um went ahead and moved forward into just full fully scaling uh all pelvic health. And um that's and that's all we're doing now.

Dr Andrew Greenland: 4:52

So amazing. So I mean you just mentioned that you were kind of faced early advice that a pelvic health only model probably wasn't viable, and there was obviously something from within that made you think, well, actually, there's something in this. What was it um that the Athena people came up with or managed to convince you to actually take this niche?

Laura Bunso: 5:09

Well, it's funny when you ask a question like that, it makes it makes you kind of look back at a really uh pivotal like what was the pivotal moment or pivotal conversation? So um, so the first part of that question, um I remember sitting at lunch with um a wonderful uh business uh advisor that I had who helped me a lot um for more of a traditional outpatient physical therapy type of a model, um, and thought that this was a great thing um to um have as a specialty. And we were sitting at lunch in this rest full restaurant and we looked around and he said, see, everyone in here, or half of he says, half of the people in here have back pain through their at some point in their lifetime and would need care. You know, there's just not enough people that that need the pelvic help. And um, I looked at him and I said, everyone in here at some point in their lifetime is going to need pelvic help, whether it's uh teenager struggling with uh sometimes in leakage during running or something like that, as a female athlete, uh uh a woman postpartum, of course, males with pelvic pain. We treat helicopter pilots all the time here with pelvic pain, um uh post-prostatectomy, um, cancer treatments later on, and just you know, the whole spectrum. And uh so that that was he that sort of shifted his uh mindset. And then later on, of course, after the whole Athena experience and us switching to public health, he was like, You are right, you can definitely do a whole business of this. Um, but with the the Athena project, um, that panel of experts, and then specifically uh Jennifer Holland, who's a branding expert, and she is uh fantastic with helping you get dialed in on exactly what makes you special, what makes your company special, um, and what's so special about the people that are working with you. And um really just we actually closed the company for the day and had uh one of my my um dear friends who was working with me at the time, um her daughter is a musician, came in, played music. We very kumbaya whole day about you, you know, who are we, what are we, what are we trying to do here, and um what makes us different, and um, you know, what can we offer to the to the to our community that is uh really of the most value and service. And um and the the thing that we came around um that that and I didn't really talk much, so which was which was uh unusual for me for some of what we're doing. Um, but um it what really was uh this our staff. Um and uh you know, she went around um talking to each of them. And um this was really turned out to be the heart of everything that we're doing. Everyone was crying by the end of the day, um, because some of it is um, you know, really life-changing. You know, some people aren't going to have their life completely changed because they're having a little, a little leakage, they're a little damp after they go for a run or they do some jumping jacks, but uh, you know, some of the other things that we're doing are really um really, you know, really change people's lives, keep them out of the emergency room or keep them from having some life-changing surgeries like an ostomy uh um, you know, um uh surgery or something like this. So um there, so that's so that's really where where it came from. And then they gave me really the the push and the courage on the business side to to help kind of develop out the the plan to be able to move forward with it.

Dr Andrew Greenland: 8:54

Brilliant. So I guess pelvic health is finally gathering gaining more attention, if not already, from your work, but I guess it's probably still under discussed. What's changed in your patient population or the referrals you've had over the last few years from your perspective?

Laura Bunso: 9:08

Um so I think that um there's honestly TikTok has probably changed a lot of what we're doing, um, which is seems a little goofy to say. Um, but um it's really um lifted the veil for a lot of people as far as what uh the potentials are, what the possibilities are for them to be able to have help with some of these things, um in in all age groups too, um, as we know. It is not, you know, that probably the creators are uh tend to be younger, but the consumers of social media are are all ages. And I I think that that has um, you know, they're they're good, they're they're good and bad about everything. And um I think uh one of the beautiful things is um in all areas of health that a lot of us are gaining that knowledge of uh some of these things that we're suffering with are maybe not as acceptable as we thought that they were, or that we had been taught by um generations, even if it wasn't a conversation, but it was by um, you know, watching your grandparents were diapers, you know. Um that's uh something that we are um learning as we are walking through life that that's just a part of life. Um, whenever they're really, you know, it's not something it just because it's common doesn't mean it's normal, is one of the things that we say on a regular basis. Thank you.

Dr Andrew Greenland: 10:39

So would you mind just talking through like a typical patient journey? Now I appreciate you treat a diverse range of conditions, but what does a typical patient journey look like from the moment they come to you to the kind of work that you do with them and what the outcomes might be for them?

Laura Bunso: 10:54

So um they may come just directly from hearing about a pa another patient. Excuse me. They may hear from a friend or something like that. So there are all kinds of avenues for them literally landing on our doorstep or on our uh a phone call. Um and uh typically one of the we found this seems a little silly to to say, but we found to make sure that the patient knows that they will be undressing whenever they come to have a consultation with us, typically, if they're coming for anything related to sexual function, bowel, or bladder function. Um, and so the evaluation would involve uh history taking and um really just making sure that um the thing that they're coming in for is related to the thing that we are uh uh specializing in and treating. And um oftentimes they're coming from a specialist physician that's already screened out anything more sinister than something musculoskeletal. And then we will do a lumbopelvic girdle screen where we do some range of motion and strength testing, uh maybe a little uh sensation testing depending on what their complaints are. And then uh we'll walk them through the anatomy and exactly what we will be assessing and what the pelvic floor muscles look like because most people have no idea. And then um do the exam, which would be uh for female, be a vaginal and rectal exam, which is really quite quick, no metal objects, no speculum, no um stirrups or anything like that, just a gloved hand. Um, and then for the males, um just a rectal exam to be able to have uh an assessment of the pelvic floor contracting, relaxing, and getting the quality of the musculature with that. And then uh we come up with a plan based on what the integrity is of the muscle, just like if we were evaluating or assessing their shoulder, their hip, or their low back. And then carry carry on from there.

Dr Andrew Greenland: 12:58

Thank you. And with such a um vast array of different conditions that can be helped, what surprises people most about what pelvic PT can do for them?

Laura Bunso: 13:08

Um, well, I I think it's just surprising at all that there's any kind of pelvic PT to most people still. Um, it's just uh maybe uh fewer people are are surprised about it now. But um, but um I think um I don't know, I'd I'd say probably um one of the things it's is uh really quite simple um with uh late lately. I feel like I've had uh quite a few male patients that are um having frequent um emergency room admissions for uh what is being diagnosed as prostatitis, um and having um really um uh uh public floor tension um and poor uh habits as far as behavioral habits or voiding habits um that are um you know drinking diet coke or drinking uh uh diet sodas or or coffee all day and then um uh having a lot of tension in the pelvic floor for the some high stress jobs, um the some high-level executives that are just you know maybe clenching and then when they go to to uh actually urinate that they're pressing and pushing hard. And so doing some retraining of the pelvic floor. Um actually I just did a um I did an episode about it called for men only on on the on my uh podcast. That's my most recent episode. Um, because it um they're three visits and their um life is completely changed. They're not going to the restroom every 30 minutes. Um, they aren't having to plan their uh flights around uh how long it will last or if they could get up or um those those kinds of things. So so those that's on the the simpler end of what we might treat, but I think for um for a man in that kind of a role, it can be um just really uh shocking and um overlooked that that uh can be a component of of that care. Um and don't and to be clear, um oftentimes these are middle-aged men who maybe do have a little enlargement of the prostate, but it's not aware um maybe 80% of their symptoms were actually coming from uh this dysfunction of the pelvic floor that wasn't even considered as um a contributor, um, you know, but which is it's not unusual for, you know, anything in this area we call, you know, the the pelvis in our world we call it the center of the universe. Um it's scary to have anything in this area of your body have something wrong with it, whether it's hurting, not working correctly, um, difficulty getting your stream started, difficulty holding your urine or your bowels are um alarming and shocking as they should be because it can be an indicator of something quite sinister happening. But because I think that there's such a long list of sinister things that could be the cause of that, we our healthcare system starts there. Um, but that's how we address most things. So um, and just and and and the um musculoskeletal component is is quite overlooked. Um and um, you know, really even with uh bowel dysfunction, you know, the number of um emergency room visits over abdominal pain and constipation, um, and it which can be quite severe. Um, as you know, you know, someone can have uh a uh constipation that is literally, we call it outlet dysfunction or outlet constipation, um, which is, you know, most people a lot of people don't like to discuss it, but it's it's a very real thing, but it can be so severe that they do end up needing an ostomy or um even vomiting stool is really kind of the worst end of things that can happen. You can get so backed up. But um the way that I describe it to patients is sort of like trying to get the furniture out of the room with the door closed. Um, you know, they they they often can with all kinds of medications that essentially uh the mechanism is really to liquefy their stool so that they're, you know, and I and I'll I'll tell patients that, you know, if we if our life depended on it, we'd get this furniture out of this room, we'd splinter it into a thousand pieces and you know, slide it under the door. And that's essentially what what we're doing with um uh a lot of these medications that are designed to to help with uh you know, whatever the claim is, motility, all of these things, but um oftentimes with with that sort of uh dysfunction, and thankfully we have a lot of gastrointestinal physicians in town in town, excuse me, that will um that will screen for this and actually refer them for it rather than doing an exploratory surgery. So that that's really been actually a very big evolution in probably the last five years, is um patients were coming to us for that kind of uh the bowel dysfunction without being cut on. Um oftentimes in the past uh they were they were having had some resection, some exploratory uh, you know, laparoscopy prior to having uh just having a pelvic floor evaluation done or you know, some sort of anal uh you know defecography study or anal manometry study. Um so now that's a little more of a a part of the regular uh screening, I think. Um but um it I wish it was a little sooner. I wish it was earlier on the list. Um but yeah, that's that's I think those those are probably two pretty shocking things for for people once they finally land um in front of us.

Dr Andrew Greenland: 19:12

I can definitely speak to the constipation thing from the point of view I'm my day job as an emergency physician, and I think people will be very surprised to even know that people actually turn up to the emergency room with constipation to the level that you've mentioned. It becomes such a severe problem. People think it's all blood and guts and trauma and car crashes, it's not. We see so much constipation. So I'm really interested in your approach, your much more holistic approach, and I love your analogy about the furniture and the closed doors. I think that's a really interesting take. I I couldn't help but catching earlier on that you mentioned that you have been aware of helicopter pilots, and I'm really curious to know what is it about helicopter pilots that make them land on your doorstep and what kind of problems do they have that you can help them with.

Laura Bunso: 19:51

So, well, I think it's anyone who is stuck inside of any particular container with high stress, high stakes um happening. We have a lot of military uh around us here, and that's uh got got a lot to do with it. Um I'd say uh helicopter pilots, executives of large companies that cannot leave a boardroom or have a very intense. Um we have um Jacksonville, Florida is where we're where we're based, and um we have a lot of large corporations here. Um and it's um it's it's it's it's a lot of them. It's really uh surprising. Um, and sometimes I'll even have the conversation with at least on the executive end, I'm like, you're you're in charge of the meeting. Pause the meeting, tell everyone to go get a drink of water and go to the restroom, you know, like make it make a shift and you know, have everyone walk around a lap or something like this so they can uh take a little better care of themselves. But um, and I think in terms of the the pilots or um, you know, they can't they can't uh pause, you know, they may be on some sort of mission um and uh have the uh intense uh physicality of their role, of course, um, in addition to um the stress and the um inability to to be able to um access facilities, obviously. So um they're yeah, so that it's it's uh it's interesting um because it it's a lot of them. Yeah.

Dr Andrew Greenland: 21:23

And do you have any uh funky tools you use in your work? I think you mentioned on a previous call about surface EMG. Is there anything else that helps you with your work that's quite advanced?

Laura Bunso: 21:32

So yes, it is um in the literature shows that especially actually, especially for bowel dysfunction, that um it it can be quite crucial. It's a little uh it's a little bit more expensive of a tool as far as physical therapy goes. Usually um physical therapy is quite an expensive. So when I say it's more expensive, I mean relative to physical therapy. As far as medicine goes, it's still um, you know, a A little uh you know straw hut compared to the uh you know the uh huge uh skyscrapers of uh healthcare. Um but uh surface EMG gives you um a visual and an auditory representation of what your muscles are doing. The muscles are hidden, they're tucked up inside uh your your vaginal and rectal muscles. And for the men, the the pelvic floor muscles are the not just the the back half, the rectal, but the front half, which would be in charge of uh making the penis nod or clamping down to cut off the the flow of urine on the urethra. Um but we will put these little stickers about uh maybe a not even an inch wide right at the perineal space, which is uh for for women between the vagina and the anus. And uh uh some women here in the US at least think about where you might have an epesiotomy. That's the space where these would go. And for males, they go in the same space, but it's behind their testicles and in front of the anus. Um, or they can have a vaginal sensor or a rectal sensor. Um, but usually we just use the little surface electrodes that go on the outside. Um, and then there's a little wire, and um, we have a Bluetooth actually to our uh tablet that people can see and they can see the line move. So when they're relaxing, it's here, and when they contract, it moves up and it may stay up or it may come down, depending on how well they're able to contract or relax. And so we can use it really, even with urinary leakage, um, to help with coordination training. And so the the beautiful thing about our bodies, um, and it's true for the pelvic floor, is it it to feel good or for it to function well, it's not required for it to be a perfect system. Uh, it just usually needs to be pretty good. Um, you know, we for us to to have a good, healthy life and feel good in general, we don't, you know, we don't have to eat perfectly, we don't have to do everything perfectly, we just need it to be, you know, most of the time pretty good. So the same thing is true, I think, for our pelvic floors, where um you you just need it to be coordinated. You don't have to be at normal strength, perfect strength to be dry, but you do need to be doing what what it is that you think you're doing. And what I mean by that is oftentimes, for example, with bowel dysfunction, people are doing what's called a paradoxical contraction. They're sitting down to evacuate, they're pushing their straining, they're working so hard, and they're accidentally contracting the pelvic floor and pulling it up and in rather than letting it lower and open. And uh really the harder that they try, the harder that they push against it. And using the same door analogy, you know, you if you took all that furniture and you just pushed it and shoved it up against the door, you're not, you're definitely not getting the door open to be able to uh let the furniture get out. Um, so that biofeedback lets them see, and we will do functional biofeedback too, where we'll have them sit on the Kamo with the electrodes and practice. And I'll say, do all the things, and they get a little privacy in the restroom, you know, with the electrodes, and we can see what's happening on the uh the tablet. Um, do all the things that you're doing at home to try to evacuate, to try to have a bow movement. And so they'll um, you know, they'll do all this thing, and they'll and what they'll see happening is that the line's going up equal with a contraction, which they would be doing if they were trying not to pass gas at a dinner party. And so once they have that revelation, um, that alone is helpful, uh, so that they'll quit straining and quit working so hard and at least bring the tone down. Um, but then we usually got to go a step beyond that because oftentimes they've just developed so much uh tension and clenching, and oftentimes it's habit to be able to just relax the pelvic floor. And so they get that visual feedback to be able to see how they're doing on it. Um, and um they get to practice, and uh just like anything else, it uh often takes a little bit of practice to be able to get that to where you're because they they get a little panic, especially if they've gone to see you in the emergency room a couple of times, and they've had this whole, you know, anytime we go to the ER, it just wrecks our world, you know. Everyone's world stops. That's important. Uh, you know, if you're important in their life, everyone's world stops for you if you're going to the emergency room. And then whatever things cascaded from that. So there's just this whole almost a trauma response around it. Um, if they start to get uh backed up again, um, even if things are working a little bit better. Um, so they do have to do some some training and have some guidance and and uh coaching really on um working on this and having this be an effective uh uh thing for them. Um and one of the other things that can be tied into this is actually orthopedics, the musculoskeletal, um, a little more on the traditional physical therapy side, but sometimes uh it's not just as simple as them learning how to relax the pelvic floor, sometimes they can't if they have something else going on, and that's part of what the the lumbopelvic girdle screen is for. Um if someone has a labral tear of their hip, uh, which it's it's common. If you have a thin Caucasian female, you it's it's likely she may have a little labral tear of the hip, but it may not be uh symptomatic. But for people, uh, male and female who maybe have a labral tear of the hip, um, and we work closely with a couple of orthopedic surgeons here in town to help us with caring for them and screening that out a little more to be sure that that's uh not part of the reason why they're having this tension in the pelvic floor. Your pelvic floor is actually part, the obturate internus is one of your hip muscles. It does the rotation of your muscle of your hip. Uh, it helps provide the stability of your hip when you're standing on your leg, it it's supporting it and it's part of that pelvic girdle. So if you've lost some integrity of your hip joint, your pelvic floor may be just holding on for dear life and be the only thing really giving you support whenever you're doing um anything physical. Um, and so there, so sometimes we have to dive a little deeper onto uh the orthopedic side of things to to see if we can get to the the the reason why. So um that that can be really challenging too for the for the patient, uh, you know, going from GI landing and pelvic floor rehab, and then ending up in orthopedics are usually very open to it though. They're like, there's something wrong, you know, what's I don't know why, but I can't relax my pelvic floor. And so um we can uh move into those um you know problem solving all of those things to figure out what what the actual source is of it.

Dr Andrew Greenland: 29:17

Thank you. So look, running running a clinic is never simple, and you talked about the early days when you're kind of going against the grain and wanting to niche down against some early advice. But right now, what's working really well for you in the work that you do?

Laura Bunso: 29:29

What's going really well for us in the work that you do?

Dr Andrew Greenland: 29:31

From a clinic business perspective in terms of what you're doing at the moment.

Laura Bunso: 29:35

Oh, business perspective? Um so um, well, for for us um here in the United States, we're are we're really challenged with um reimbursement. So um what works well for us is um as a patient who um is really a just we're not uh not managed by um a health insurance saying, you know, you can only you for example, some of them won't cover um and or because there's such strong literature for it now, um, and there wasn't uh 20 years ago, um, not as much, um they will cover it, but they may not include it in a patient's plan. So whenever we have a patient who's either just paying out of pocket, um, which is really relatively inexpensive, if they just uh pay for it, um, or if the health insurance will cover it and include it in their plan, that's the catch, is it's they'll say that they cover it, but it won't be included in that particular patient's plan so that they won't have it uh paid for. So um because that that piece of things can be uh so crucial, um, and it's not crucial for all of the things that we treat. There are some things that we treat that manual therapy, like with the pelvic pain, a lot of times manual therapy and teaching maybe a woman how to use uh dilators and walking her through all of that at home. Uh it wouldn't be as crucial for someone like that. Um, but you know, financially can be really a bit a big barrier for people if they need it. They're having, you know, all these hospital admissions. Um and they're you know, they're you know, one of the this they there's there was something I heard early on in business of healthcare and said that um, you know, the bit the easiest way to to go bankrupt in the US is to get really sick. Um and um that you know I I don't know if that's completely true, but it, but it does make it really challenging for people whenever it's not covered. So um so having um being able to do all of the things and it not uh be a financial burden to the patient, just being able to take care of them and walk them through these things um is really uh it's really important. Um and it it uh it's really stressful for people to have to worry about that and and manage that.

Dr Andrew Greenland: 32:02

Thank you. I think the reimbursement thing seems to be universal. Been having lots of conversations with North American clinics, and that always seems to come up, and it's not something we have to quite negotiate here in the UK, so it's always interesting to hear how you kind of manage and work through it. Are there anything is there anything else from a kind of a business challenging point of view or any bottlenecks that you're facing at the moment as you kind of think about what you do, or perhaps even think about growth for the future?

Laura Bunso: 32:27

So, well, um thankfully, our our our biggest bottleneck is being able to um get have providers that are skilled and trained up enough to take care of all of the people that are coming in. Um, you know, we're uh grateful that the word is out. You know, it definitely is much more um uh, you know, um there are more people that understand that they have access to this sort of thing now than there used to be, um, for sure. And so we're um we're trying to do what we can to um be able to take really great care of people, but because it is obviously private and discreet, it's not like a traditional physical therapy where we can have three people at one time. We can, you know, one patient and a private room is uh all we can do at a time. So we really just have to just step, step through our day and take care of each person individually. Um, but with that with that being said, we do have three satellite offices coming, um opening in about a week and a half to expand our scope here and our reach and our community. So that's that's exciting and will hopefully make the access a little easier for patients. And we are um really ramping up our virtual visits because um a lot of this, especially not necessarily on the pain side, but on the bowel and bladder function side, probably 75 or 80 percent of it is behavioral modification. So that can be done virtually, and of course, uh teaching the exercises and things like that can be done virtually, and then uh the other components um, you know, not not necessarily need to to have um, or that they could actually come into the office for um fewer visits and not necessarily have to come into the office for all of those visits. So it'll hopefully give a little more access to people that might not otherwise be able to to physically get in and um you know drive to where we were just with the what the one location previously.

Dr Andrew Greenland: 34:23

Well, congratulations on the expansion and the and the satellite offices. I mean, would that if you had say 50 new referrals coming tomorrow, would that um new structure that you have and the additional office would that be able to mop up a massive surge in demand or would that cause a strain anywhere?

Laura Bunso: 34:39

Um with 50, they would have to wait a few weeks, but we would be able to, we would be able to manage them. Um so that um, but yes, that is um that is the hope that it will be able to expand that. Um but um we what we really try to do is take a new new patient in once we've sort of uh make sure we have space to be able to get them in for follow-ups and things like that. So we'll try to to stagger their starts basically.

Dr Andrew Greenland: 35:07

And for you, I guess you're doing a mixture of things. You're clinical, your admin, you're in charge of marketing and staffing. What's the biggest time drain for you in the business at the moment?

Laura Bunso: 35:17

Um the biggest time drain that doesn't feel productive is um probably the same for every um healthcare clinician, which is charting. So um, so yeah, we you know, we've tried, I recently tried uh an AI um, you know, where it will chart for you and that sort of thing. Um, it did not work well with the public floor space. Um and um, you know, I I think AI eventually will remedy some of those things that are really challenging for us as uh clinicians. Um I don't I don't think it's much different for for any of the clinicians. Some of some of the clinicians are on a different scale than we are. Um, for example, maybe a surgeon can have a scribe, you know, and that's that's something that uh might be covered. And in therapy, that's not uh that's not realistic for us um because we spend so long with with uh one patient. But um, but a AI is trying. So I think that it will eventually get there. Um, but it just really the models are built for more of a traditional physical therapy, and it really just didn't, I think, know what to do with the things that we're saying in a visit. Um, but that was true also with one of our payers that um we had to I had to meet with their uh panel um because they were pulling all of our our charts and uh deeming all of them as uh that they should have been being billed as biofeedback. But I was like, wait, but we didn't do biofeedback. We like why would we bill it as biofeedback? And when we um when we did the review, um it turned out that they're you know, they're they're using this similar technologies for everything. Um anytime you said the word pelvic floor, uh it it it triggered it for being billed as biofeedback, but it and it didn't really have it wasn't clearly uh delineated, and I guess in their their their their format that that was a service code, uh, you know, or a procedure. Um and so we were able to get that remedied, but that was affecting a huge population um for us and um triggering essentially an audit on every single patient that was under that payer, which was a lot of our of our volume. Um and so we were able to, they they fixed it and they I don't think they've done a single one since. Um so just just saying the word pelvic floor is a it it just throws all of all of that off. So hopefully, hopefully that those kinds of things will get sorted out here soon. But um one thing at a time, I guess.

Dr Andrew Greenland: 37:57

Sure. Um I know you've got a podcast which I think is just being launched, Pelvic Light Like It Is. Tell us a little bit about that and where people can find it and what you would hope they would get out of it.

Laura Bunso: 38:07

So um it is for the lay person, and um it is um typically what is uh I feel like uh there are things that I say 50 times a week that are in there for the patients that are part of the um guidance and education that I give them that are um really simple to implement into your daily life. Um, like I mentioned earlier, the four men only, and um that one is specifically for men who still have their prostate. Um and um it will give you some real life guidance on things that you can make you can do to make adjustments that will give you some relief with um some of the bowel and bladder function or um pain. And it's on Spotify and Apple. Um, and I'm I'm still learning with all of it, um, but I feel like I've got it at least uh to a place where it's uh digestible and uh you can uh get to it. And they're pretty, pretty short clips, uh 30 minutes um or less, um, and and dive into a couple of different topics and uh you know, with being uh with from my perspective, which is of being a single mom for a lot of years with three children and um taking care of all these wonderful patients. And uh I what I really hope comes out of it is that um people's lives will be made easier and they'll have access to some things that um they they'll probably be really surprised about that if they make a couple of little edits, um, we'll just uh be able to think about some other things besides their their pelvic section during their day.

Dr Andrew Greenland: 39:49

Thank you. We'll put we'll put that on the bio page so people can um tune in and talk with them. So you've had a very interesting career and journey. I just wondered if you were going to do it all again tomorrow. Would you do anything differently?

Laura Bunso: 40:03

I would um business-wise, um I would uh probably have started doing pelvic health as the primary um subject matter from this from the get-go. And um I would have not uh taken insurance. As you know, here in the US, the physical therapists were the only practitioners that are not able to opt out of Medicare. Um, so we would have had to have taken that still. But um I uh yeah, I probably would not have even done the insurance part of things and just been able to um, you know, just very simply get paid for what we do. I used to joke all the time if we sold coffee or chocolate, I'd be a billionaire. So just be able to give them the product and get paid for it. Um, be quite simple. Um, but um I love, absolutely love taking care of patients for this and um and I feel called to do it and compelled to do it. I'm not quite sure why, but um, it's uh really amazing to see uh someone's life changed with something that I think is a gift. And the reason I went into physical therapy to begin with, that it can be made without cutting on them or giving them any medication. Not that anyone, you know, sometimes people do also need some of those things, but um, but most of the time we're able to help them without uh those things. And I just think it's such an amazing thing that our bodies are so miraculously designed that they can be healed with uh what we're eating and what we're doing with our bodies.

Dr Andrew Greenland: 41:44

And finally, what's on the cards for SmartBody PT in the next year? Do you have any plans for the next 12 months in terms of where you'd like to be, what you'd like to do?

Laura Bunso: 41:52

Yes, um, I'd I'd love to have more satellite offices for or shifting our model to be able to um hopefully enable other practitioners to be able to have. Um we we've really uh I've had the gift of having some amazing people help us with our marketing and branding. And so we have really um just a robust referral source, um, referral sources, not just one, uh thousands of uh clinicians and then online. But um I would love to be able to have, I mean, eventually I'd I'd love for this to be uh nationwide and for someone to have access to public health physical therapy um just as easily as they have it for um outpatient physical therapy for their shoulder. So um next door to every orthopedic clinic or inside of every orthopedic clinic, I'd love to have a satellite and then be able to enable other clinicians um to support them in offering these services. Um that's one of the things that makes it really challenging to add pelvic health is training the clinician because it is quite specialized. There's not a school for the specialty per se. Um it's postgraduate. Um, so being able to train them and then support them because it can be quite emotionally taxing. There are a lot of stories that we hear that um gets me a little emotional to think about it. But um there are a lot of hard things that you'll hear working in this space. And um I you really have to have support to be able to do that and to carry out that work. Um, and so I feel like we do a really good job of that with our clinicians. Um, that's the feedback that they give us, and we've tried to build that into their to their week um to have that. Um and it's I think it's really important for being able to do this work for an extended period of time.

Dr Andrew Greenland: 43:57

Laura, thank you. This has been such a powerful conversation. Conversation, so educational. I think we're really learning about how pervasive pelvic health issues are and how much can be done using your kind of approach. So thank you so much for joining us today and sharing your knowledge, your journey, and what you're planning to do in the future. I'm very, very grateful.

Laura Bunso: 44:15

Thank you. I really appreciate what you're doing and being able to get the word out for all of the functional medicine and all the health and wellness things that you guys are promoting. I think it's amazing. And I hope you keep it up..