89 | Know What You Don't Know

Annie - Well. Hey there. Leah.

Leah - Hey, Annie. How are you?

Annie - I'm good. How are you?

Leah - Doing very well. Enjoying spring time. You know, before it's going to be blistering hot in about a week.

Annie - Yeah, we just got some spring weather, but it's very still at the suspicious level of, like, is it going to keep going or is it going to turn back. And I know we're going to get one more cold snap. Who knows.

Leah - Yeah. This time of year is so weird because it's like, oh, I love this. And I want to move somewhere that's like this all the time, you know, because it's only a few weeks here in Houston that we get like spring ish. But it's fun to have all the flowers blooming. We've been gardening and all the birds, so just enjoying this time of year is fun.

Annie - Well, we are looking forward to our deeper dive, which is happening next week. If you're listening to this podcast, the day that it came out, our guest for next week's Deeper Dive is Cathy Watson Genna. We're meeting with her on Monday the 15th. And as always, you know, you can register and you get the recording. Everybody who registers gets the recording. This is going to be a good one because we're talking about reflex. And Cathy has been doing a deep research dive into reflux over the last. I don't even know how long. I mean, she's such a research like a maven.

Leah - Oh, amazing. Yeah. Every time I hear her talk, I'm like, how do you fit all this information in your brain? And then regurgitated? I'm like, marveled at the level of retention she has and like, these amazing deep dives that she can, like, then put together for us and then explain it to us where we don't have to spend two years researching and doing the deeper dive. I so appreciate that about her.

Annie - She says she enjoys it, and I'm glad she does, because our deeper dive is also kicking off registration for a course on reflux that Cathy's doing. So it's going to be very long, very involved. It's going to involve feedback from Cathy on your assignments. We're really going to try to learn everything we can about reflux because again, like the topic that we came up with for today is know What you Don't know, because this is an area where I feel like you just start going down one little path and then you're like, okay, I get it, I get it, I get it, and then you hit this research wall where it's like, I am not trained enough, like in science, to be able to keep going, like I need a teacher. Thankfully, there are people like Cathy out there. I know you're better with the science stuff than I am. You have more of that brain than I do.

Leah - Yeah, I would say I am a lot like Cathy and that I like to research. I like to like, really thoroughly understand something because I think it just builds my confidence that I could like, talk about it confidently with parents or feel like the recommendations that I'm giving have, like good science based background, you know? But I totally feel you when you're saying, like, you hit this wall.

Leah - And I think what it is, is like sometimes you need some lower foundational understanding of maybe some physiology or some kind of pathway or, you know, something that, you know, was way, way back. Maybe we didn't even take those classes, but it's like way back in like biochem or anatomy and physiology and, and maybe like a deeper part of that that you first have to get before then you could build something on top of that to understand like this, you know, pathway or this physiology being, you know, interrupted by something or not working properly. You have to know how does it work in the first place. And, you know, if it's stuff that we're not dealing with day to day, I mean, we could probably talk a lot about, you know, some things that we're seeing every single day. But then we get to these topics that, you know, although sometimes I feel like I do see, like reflux every single day or often at least. But we get to these other things that require us to step back, say, okay, like, let me get the foundational pieces of understanding. And I think that's what Cathy is so good at, is like, I'm headed down the the end of the journeys over here, but I've got to take you on this whole entire path so that you can get to that end point, which is so helpful, because then I really do feel like you have such a strong grasp of the concepts and the, you know, being able to turn around and explain it to somebody else, which I think is the gift of having those foundational pieces versus like, well, you know, reflex is, you know, maybe somehow linked to da da da da da. Well, if you can't understand, like, how is it linked, why is it linked? What is that pathophysiology that leads to that. You know it's okay. It's hard to feel confident about talking about it. So I love the way that Cathy explains these things. And it also always reminds me that the topic that we're talking about today is like, know what you don't know? Because I feel like, we all don't know everything and we're never going to. And when we have people that can guide us along that path of understanding all the things that we don't know. It's so helpful. And it's also great to be with others that are also recognizing that, like, I don't know everything and I need to learn more.

Annie - It's so true. And you, you brought up, you know, back in that class you took on physiology. So here's where my poor training comes into play, which is that I was one of the last cohort of exam eligibility. So when I took the exam in 2011, I qualified, got all of my requirements. And before they made the background health sciences classes mandatory. So you have a science background. You studied science in school? I studied drama and American studies. I took Intro to Psychology for one class and Earth, Environment and Humanity for the other one, which was actually a really cool class.

Leah - I'm sure that sounds really cool.

Annie - I didn't learn anything about how anybody's body works. And so, you know, watching these, you know, because, you know, like, I'm a continuing education, very passionate about it. I love it and.

Leah - I love that.

Annie - You know, sometimes it gets to a point in a training where I feel like I'm being asked to take a step of faith with the instructor, that now they're at a point where what they're saying to me is beyond my ability to understand. I am a student and you're teaching me. I don't know how to evaluate what you're teaching me, because I'm just taking it on faith that you are using the correct terminology or you are interpreting the study the way it's meant to be studied. And I remember having that same feeling when I started in graduate school. So right after college, I went to graduate school for cinema studies, which is really academic. It's discourse analysis, it's semiotics. It's like cultural study. I mean, there's like so much that I had not been trained in, and I started in my first class and they were like, okay, read this assignment and I'm reading it and I'm like, okay, I'm reading this, but I don't know how to read this.

Leah - I'm like, I don't know what my brain is supposed to be doing, right?

Annie - Yeah. So that's something where I'm always, like, aware of that. If nobody has taught you how something works. Yeah. Then when you get to the point where you have to decide what to do with that, you don't know, you're just guessing. And, you know, and I did get the training that I needed, and I got to the point where I'm like, okay, I know what I'm supposed to do with these articles that I'm reading and I know how to write about it, but I had to be trained on that. And so the same thing with like these biological processes in these, you know, physiological systems and just how the body works. And there's still so much that I feel like I'm jumping in, you know, the middle instead of at the beginning.

Leah ( - Well and I think you have seen and know because of this passion that you have about helping other people get the training, I mean, you put out these amazing conferences and different learning courses all the time. I think because you recognize that as we go through this profession, not only are there always going to be gaps in our understanding because we don't have, like some very standardized process to become an IB, CLC. So people come from all different angles and all, you know, what you choose to take your coursework in could vary. People have all kinds of backgrounds that can either help or hinder their understanding of things, you know, and I think it's so evident that you have this passion of learning and then, you know, you and I together, we're also always like recognizing like there's so much more we could learn. And I think the other thing is, like, we're still in a baby profession and we're constantly understanding, I mean, the whole world of understanding the body and and the whole medical world, you know, it's constantly changing. I mean, we see that all the time, like the pendulum is constantly swinging, like, everybody should be low fat, everybody should be keto, everybody, you know, it's like even just thinking about that one tiny piece of what we understand about the human body. And it's like all over the place, I think the same thing, but even in a different way, because we don't even know where the pendulum starts with a lot of things in lactation. It's just like wobbling all over the place. As we're learning, a new studies are coming out. I think it just really forces us as iPSCs to recognize that, like, you have to be on a constant learning pathway. Like, this is not like I became an IB, CLC, and then I knew everything about lactation and humans that are lactating and babies that are feeding babies. And, you know, I mean, there's like there's just like this infinite amount of information that we just don't even know. It hasn't even popped into somebody's brain yet, that we still have to be, like, willing to hear and be ready to take it in once somebody figures something out.

Leah - So I love all the people that we always get to bring on the show for the deeper dives, because I feel like they're doing just that. But like they put a connection together, they figured something out and we're like, okay, tell us. And with your courses, you know, saying you're like, okay, you figure something out, tell us all about it.

Annie - I know if I could, like, maybe put a wish out into the universe. If anybody's listening, I would love a training on hypertension, pre-eclampsia, like blood pressure and vascular issues in parents because I don't know. You tell me if you're seeing anything like this. I am seeing that the majority of my clients, for the last, I don't know, year or more have had either hypertension or like I've seen so much pre-eclampsia. Where it was something where I used to not see it before.

Leah - It is so weird. And like even the postpartum pre-eclampsia, like people getting readmitted after they get home, like, so often. I mean, it just goes to show that's so tied into our metabolic health, which we know is been kind of coming up as such a huge problem and affecting so many different things. And I think with blood pressure, like how many people you go around not even knowing they have high blood pressure to start or, or through their pregnancy and luckily they get checked, you know, but I think it's something that I'm seeing too. And then because now we're seeing it so much more often. Okay. What is the impact on the lactating person when they have these issues? Now that we have a bigger group of people that are dealing with it versus before, it was like so isolated to a smaller portion of the population. And, you know, I just don't think we had as big of a sample size, I guess, to like research and understand it and understand the impacts and even the impacts of, like, all the different ways people are being treated for it. You know, it's just and.

Annie- It's definitely having an impact on lactation. I'm seeing so much just delay of milk coming in, not having full supply, pumping and getting nothing.

Leah - I know it's crazy.

Annie - How can we better support these families? I mean, I teach in prenatal. I always teach about, you know, prenatal colostrum expression, you know, as a way to just get familiar with your body and, you know, in case you need to supplement. But it's that, you know, they can do that. And I've seen people that were like, I got colostrum and now I'm getting nothing. And it's not just edema from the fluids and maybe it's the magnesium, but it's also like it's persisting. And they feel like they're taking a lot longer for their levels to return to normal. Somebody needs to be studying this. I'm sure somebody is.

Leah - I can't imagine there's a world in which nobody is studying this, but I'm the only.

Annie - Person that thought of like, maybe we should study this. It's also like, we need to study this because we need better ways to support these families, to support lactation, because it's falling apart for them.

Leah - So yeah, I totally agree with you. It's so funny because we work in a birth center, I guess not funny, but just interesting that we work in a birth center. And I think maybe like a month ago, I was sitting with some of the midwives and talking about this very thing, like asking them like, do you guys feel like this is higher? Because I am feeling like I'm seeing this so often and I don't, you know, I just know that there's a bigger impact. We know there's an impact. But I'm like, I feel like there's even more to this story. And like you said, I'm sure people are out there thinking about it. But there's a lot of times I think. We're like boots on the ground. We're in the thick of it. We're seeing the outcomes, we're connecting the dots. And then sometimes I think, I think this higher up. I'm like, is anybody else seeing this? Because they're seeing that the milk never comes in. They're not. They're like I do wonder about that, you know? So it's important for us to all keep talking about it like that. We put this out in the universe today is important because sometimes we might be this missing link to connect some dots to, to help somebody else have a different perspective that could take that information and be like, yeah, this needs to be looked at. Or let's look from this angle because of what you're seeing, boots on the ground. You know, I think getting that information up the chain of, because I'm certainly not going to be the one to do any research. I do not have the brain for putting a whole research project together. It's not going to be me. But I do feel like sometimes our perspective could be so, so valuable and informative because we have this, like such a unique vantage point for the experiences and understanding like what actually is happening, the sequela of it all, when they're just kind of discharged and, and put on medication and check your, check your blood pressure and then is anybody really looking at what's happening. You know. So I think there's so like that's just one of probably like 100 topics you and I could come up with that. I'm like, I wish somebody knew about this. So all that to say, there's so much we don't know. And if you're listening to this podcast, I hope you're on a journey with us to keep learning and to keep recognizing that there's so much we don't know and there's so much out there to be learned and also to be discovered.

Annie - One of my favorite books is a book called Every Patient Tells a Story, and we'll put a link in the show notes. It's what a physician talking about. She's talking about the art of diagnosis, like it's about differential diagnosis, but it's also about how to really listen to the people that are sitting in front of you and how to stop yourself from going down the track. I know that we know not to do this. You're like, okay, you have to like, get all the information.

Leah - Exactly.

Annie - You know, and you form a couple of different hypotheses and then you start moving. But I also think what happens, what can happen? As you're like, okay, I have a plan. I have an idea of what's going on. We've got a plan is that you're like, as a provider, this is how I handle these types of situations. So kind of always doing that. And at a certain point, you know, with doing this for so long, there are things that are habitual. But there are also, you know, some trainings where you feel like, well, that must be the definitive training because it was so involved and it was so intense and it was so hard and even and there were things I couldn't understand. So it must be good. So I'm going to do it this way, the way you know, this one, you know, maybe training or, you know, maybe it was a, maybe it was a book that you read or, you know, whatever it is sends you down that path. And then it can be hard to even say something where it's like, I really know a lot about this particular topic. And there are definitely topics you and I both could say, like, we know a lot about these clinically, like we're good at this, but even in that we have to say, what do we still not know about this thing that I feel like I'm really good at? Yeah. Helping families with. Yeah.

Leah - And I think so often it's, it's the humbling experience of working with families and doing what you do, and then it doesn't go the way that it has with other people. And you recognize that, like, okay, there's another piece to this, or needing to have more customization or needing to stay open to like, like you said, like the story in front of you. And they're also unique. I mean, I think that's also the wonderful and then also not wonderful thing about our job is like, yeah, you can go to the class and learn all the things and have a plan. And then when the baby doesn't respond to the way the course trains you, they would or the, you know, person's body doesn't respond to X, Y and Z the way the course trained that you would. It's like you have to be constantly willing to be humble and that like, okay, I don't know every human's body on the planet, right? And also willing to like let some of that be your teaching to like and then really trying to understand, okay, why was this different? How can I expand my understanding of this particular situation so that I could maybe put some pieces together and, and understand like different ways I could customize techniques and plans and things like that, or just understand more about some part of that, you know, so that you can be able to apply it in a different way or customized way. It's basically just like the longest college you'll ever go to.

Annie - We also might be more aware that we have to know what we don't know because of dealing with other members of the health care team.

Leah - Yeah.

Annie - Who says very confident things.

Leah - I know.

Annie - Had somebody told me something the other day, like a client was like, ask me a question. And she's like, I heard or I read or somebody told me. And then she said what it was. And I sat with it for a minute, and I was just like, it's not how it works. And I was like, I'm like, I can't even find the true seed. I'm like, it just literally doesn't work like that. It was, oh, I know what it was about to. And I think it must have been something on some influencer's account, but it was that. Your milk changes from months 1 to 3, and then it changes again at three months. And she was like. And so the milk you pump between 1 and 3 months, you have to use it during that time because then it's just different.

Leah - Way to stress the family out.

Annie - Okay. I was like, there's I can't even find it with that. I'm like, it's like I can like the daytime, nighttime milk. I can kind of be like, well, there's a lot of cool things about breast milk, but doesn't really mean that it's got to affect your daily life, but that when I was like, I mean.

Leah = - It's just always changing. I mean, that's the thing. Yeah, at some moment and be like, we are switching to switching.

Annie - Like, is there something like little gears in your body are like, okay, hold on pause or we're changing over to the three month milk. Now it's like, do you have to take a nap while that happens? Like, I don't know, I didn't ask what account this was on or where she saw it. I can only imagine it was just I mean, it is awful out there on social media for families. Talk about so much.

Leah - Much and so much are so much like it. Sometimes it doesn't even feel like misinformation. It's just like they turn a tiny bit of information that's like, hey, fun fact or cool thing and make it like this, like such a stressful situation. You know what I'm like. That's just a fun fact that didn't need to turn into, like, a whole thing or processed or like, you've got to do stuff or, I don't know, it just I feel like that happens all the time where I have so many people that are like, stressed about all these things and I'm like, that's just fun. Facts like, leave it at that. Like, you don't have to do anything. Like just be like cool, fun facts. Like fun facts. Moving on. You know, I.

Annie - I saw something,, I follow on Instagram. I follow Maggie Patterson, who was our deeper dive guest, and we talked about pricing. And her business is coaching for service providers. And she doesn't mean like it's not really like health care people like us, but it fits for what we're doing. But she's more like, you know, if you build websites for people or, you know, do that kind of like B2B stuff. And she had a post the other day that said, you are a service provider, not a content creator. That really hit me. I think also she really got me feel good about not doing social media when she said a couple of years ago on one of her podcasts, you don't have to dance for your business. I think it was like the early days of TikTok. And I'm like, that is like one of the best pieces of advice anyone has ever given. You do not have to dance for your business and you're not a content creator, you're a service provider. And I think, you know, social media, I think encourages you to like. Let's just put stuff out there and there are so many fun facts, like you said. But it starts to become less marketing and more like content creation, feeding the algorithm. You know what gets hits and really kind of thinking about like there are I mean, there listen, and there are people that are using social media and they're doing an outstanding job with that, like Rachel O'Brien, Shelly Taft, those are two people that their social media content is informative, it's educational, it's it's accurate, it's helpful, and it's also serving their marketing goals, from what I understand. But if it's not serving your marketing goals, and if you're feeling pressure to just come up with stuff, you know, because you feel like you have to have a social media presence. And I don't know that that's really true. The way we all felt like it was four years ago, where it did feel really urgent to have a social media presence, you know.

Leah - Better have content that's going to pop up in people's feeds., yeah, I know it's totally changed. So when we're thinking about know what you don't know, the reason we don't just stay on that topic for clinical items. There's a whole bunch of business stuff that I don't know either. So I feel like as if you're a private practice owner, you're like, you have these two sides. Like, I've got to remember that I don't know everything there is to know about being an IB, SCLC, and also, I don't know everything there is to know about being a business owner and why we break it up and make sure we have people that can talk to us about both sides of that. But it's so true about this drive. Like, you have to get just random content out there and people want to make it so catchy. Or like if you make it really dramatic and in your face and like something somebody can do, then you get more hits, you know, which is like not helpful for new parents because they don't need anything else to do other than keeping this tiny human alive.

Annie- The other scary thing too, just on that same note is like, you now don't know if what you're reading was something written by a human, or if it was somebody using AI to generate captions. I mean, there is so much else out there that just the boom of these tools, you can come up with something that maybe sounds like what? You know, this sounds right, but if you don't know what you don't know, right? ChatGPT read everything, including,, books that were submitted without permission of the authors. But that's a tale for another story., ChatGPT is morally bankrupt as an entity, but it's not necessarily. You still have to read what ChatGPT gives you and make sure that you understand it, you know, I know people will use it. It can be helpful for something that you've written maybe to get it, like reworded, but you still have to use your brain like every day, like there's no point. And I think this kind of like sums up both the clinical and the business, and the social media side of it is like, there's no point as a lactation consultant that you get to turn off your brain and just be like,, I'm ready to just coast to the end of my of my days. I've learned it all, learned it all.

Leah (00:27:41) - It's just smooth sailing from here. Oh, it sounds like that's a dream though. But it is not reality. It is a dream. A pipe dream that we'll never have. So I'm glad we get to all be on this ride together., you guys,, thank you for being with Annie and I through this journey of constantly learning, constantly hashing through these topics that are sometimes kind of hard because I would really like to just coast, but I'm recognizing that I can't. But it's always would you though? I mean, that's the thing. I mean. I guess in the end, there are days, let's say, that there are days where I'm like, I am so done learning and I am so frustrated with my brain that is now 47 and doesn't want to learn anything else. I think that's another part of my puzzle, but I'm so glad that I get to do all this with people that I love and that get it. And I don't have to be alone in feeling humbled all the time. And I feel like I can be really, like, honest. Like, yeah, there's so many times where I just feel like I gotta learn more about that. I just gotta learn more about that. Understand it better. Keep an open mind. So thank you, Annie, for being on this journey with me and for always wanting to, like, have all these amazing people on our deeper dives so that we can learn. Because I always say that I'm like, these deeper dives are what Annie and I want to know about, and we hope that everybody else also wants to know about it. But they are what Annie and I are like, okay, we gotta fill in these gaps, fill in this gap, like teach me more.

Annie - Well. We will hopefully see people on live on our deeper dive into reflux. It was so fun last month, joining Hope Lima to talk about allergies and that recording. If you sign up for a deeper dive membership $15 a month, you get instant access to our entire archive of deeper dives going back to January 2020. I'm not kidding. We started this before Covid. We have kept it going. Miraculously. We haven't. We haven't missed a month. No, we have not missed a month. So they're all in there and you can jump right in immediately. Plus you get registered automatically every month in our Live Deeper dive. You don't have to do a thing. It is. It'll be in your account, join live, get the recording. And if you're also like, I'm not ready to make that kind of commitment to you, Annie and Leah, we're fine with that too. We can be casual. We can be. We can be cool.

Leah - You know, you can just come.

Annie - You can one off here and there. It's all good. Just come on Monday if you want to just hear Cathy. Although we've had a couple others with Cathy that are in our archives, so you might I don't know.

Leah - You might want more Cathy.

Annie - We all want more Cathy. We're happy to get her. So until Monday and until next time we're on the podcast. It was great talking to you.

Leah - Great talking to you, Annie. Talk soon. Bye.

Annie - Bye.