Depression and Anxiety are Real

The Missing Link for SLPs Podcast Full Transcript Mattie Murrey 00:04 Hi, everyone, and welcome to the Missing Link for SLPs podcast. I’m Mattie, your host, speaker, and very passionate speech language pathology advocate. You are listening to The Speechless SLP series with Vanessa Abraham, and you get a unique perspective in each one of these episodes on her journey being the speechless SLP in the ICU bed, unable to talk. So, welcome to this series of the Missing Link for SLPs podcast. Glad you are here. Sit back, take a listen. Welcome to the Missing Link for SLPs podcast. We are wrapping up on our final two episodes in the Speechless SLP series and, again, I welcome Vanessa. And I only welcome Vanessa, because it's kind of a breath of fresh air just to have her back again for her and I to finish off these last two episodes. Welcome, Vanessa. Vanessa Abraham 01:01 Thank you. I'm excited to be back. Mattie Murrey 01:04 I've loved having your colleagues and your friends on, and I'm excited to get back to just conversations between you and I. So, in this episode, and in the next episode, we're going to be talking about more personal things from you as the Speechless lying in the bed. So, are you ready to jump in? Vanessa Abraham 01:25 Absolutely. Mattie Murrey 01:28 All right. You have mentioned several times in conversations that I've had, either in these episodes or when we've talked together outside of the episodes, that having a sudden onset illness, or an illness of this depth, and/or chronic illness really takes a toll on the mental wellness. Can you talk a little bit about depression and anxiety and PICS? Vanessa Abraham 01:52 Absolutely. I was never a person with depression, anxiety. I was always a very “half glass full” kind of person, and that got flipped upside down and I turned into that “glass half empty” kind of person. I think I said in some previous podcasts too, PICS was a whole new topic for me. I never even knew pics existed, and fortunately, I was told about it. I was taught and educated about it when I was in ICU, or when I got out of ICU. But patients go through critical illness, and their worlds are turned upside down. It's very easy for them to become profoundly depressed. Mattie Murrey 02:36 Mhm. Vanessa Abraham 02:37 When you're going about your life, and you wake up and everything's changed, and you're wondering what your future is going to be like it's – I never imagined it. Again, it’s one of the things you don't learn in grad school. You're never taught that these patients that we're working on, they're going through major life changes. Some of them have kids, some of them don't. Some of them are teenagers. Some of them are 30 in their childbearing years. Some of them are 60. Everybody's so different, but their lives definitely are flipped upside down, regardless of what age they are. Mattie Murrey 03:13 So, this might be a very obvious question. Why do you think that the depression, and the anxiety, developed once you became a patient? Vanessa Abraham 03:24 Because I was scared, just terrified. Unsure of what the future was going to hold for me. Unknown diagnosis. So, with an undiagnosed diagnosis, nobody knows what your prognosis is going to be. It's just that pure fear of the unknown. Am I ever going to be myself again? Am I ever going to turn around? I certainly didn't know, and my team really didn't know either. I was tested for dozens of different viruses. And that, I think, was probably the underlying foundation of just the unknown, of what’'s recovery going to look like? Is it going to be years? It's going to be months? Is it going to consist of pain? Is it going to consist of lifelong medications? Is this going to be a lifelong illness that I’m going to struggle with the rest of my life? It's, again, just the unknown, the uncertainty of it all. Mattie Murrey 04:23 So, a lot of mental trauma with the medical journey that you went through. What can the SLP who is listening to this podcast understand about your journey? What would you like him or her to know? Vanessa Abraham 04:43 I think the important thing with treating patients is to be aware of that. Mattie Murrey 04:50 Mhm. Vanessa Abraham 04:51 To be aware of the psychological ramifications of a communication disorder.I keep going back to the things that we don't learn in grad school because this is definitely one of them. For me, there wasn't a class on the mental side of it all. I can't remember ever being taught, or somebody teaching me about the depression, and just the counseling that the patients need. So, I think that's going to be the biggest one, is just trying to understand where they're coming from. Looking at the whole picture of the patient. Looking at the whole, who they are and their goals. I think one of the – I forget who it was in one of the interviews, but thinking about their goals, and where they were and where they want to get to is going to be an important one as well. Mattie Murrey 05:39 I think those who were your PTs. Vanessa Abraham 05:41 Yeah. Mattie Murrey 05:42 On the PT episode, they're like “Our goal is this, to get you out in that square”. So, what was – I'm trying to sink into the mind of someone who's lying in the bed and you're depressed. What were things that brought you down low? And then the next question is, what were things that brought you up high? What little things? [crosstalk] Both. Vanessa Abraham 06:08 Oh, the things that brought me low and high. It’s very emotional. It makes me cry. But I think the lows and the highs all revolved around my child. Mattie Murrey 06:19 Mhm. Vanessa Abraham 06:22 The things that brought me the highs were thinking about reuniting with my child again. But the things that brought me lows were the things of is this my forever? Am I always going to be in this state? And what kind of mom am I going to be for the rest of my life? Will I never work again? Will I ever be the wife I was again? Will I be the daughter I was? So, it’s kind of I think some of the highs and lows were one and the same, at times. Mattie Murrey 06:51 Was it helpful for the SLP working with you to address those issues? Or would you rather have had somebody who's more focused in a counseling career or something? Vanessa Abraham 07:06 Well, I had a Social Worker in the hospital as well, but they were mostly working with my husband. But no, I appreciated my SLP, and my PTs as well, and nursing as well. All of them reminding me of why I was fighting. I think that was important for them to incorporate those highs and lows. And when they saw that I was lonely, they would remind me of that high, of why I needed to keep fighting. Mattie Murrey 07:36 So, you're known as the Speechless SLP. How did you communicate your highs and lows with your caregiver team, with your medical team? And how did they respond back to you? Vanessa Abraham 07:53 At that point, gestures. It was mostly gestures, pointing. And my team did an amazing job of trying, and reading between the lines with my husband's help. He helped them understand what my gestures meant. And once that communication was going between my husband and my team, then they all could understand what I was trying to get out. It wasn't an easy process by any means, but they figured it out. And then they read body language too. There were times that, like right now, there were tears. There were a lot of tears, and they could see what those tears meant. Mattie Murrey 08:34 Mhm. Vanessa Abraham 08:35 My team of professionals at UCSD, a lot of them were mothers and they had families of their own, and they could read between the lines and see the emotion in my body language. Mattie Murrey 08:51 Were there some questions that were easier for you to answer? Like, yes, no, multiple choice, open ended? What did you prefer in the different stages? Was it different? Vanessa Abraham 09:06 No, I don’t think there was one form of communication that was easier for me than another. I just had a lot of questions. Mattie Murrey 09:14 Mhm. Vanessa Abraham 09:14 I had questions that weren't just, yes/no. I wanted details, I wanted explanations, and I had a lot of questions. So, my communication was not easy. Mattie Murrey 09:28 Oh, no. Vanessa Abraham 09:30 Yeah. I wanted lengthy responses, and the communication was slow. It was very slow. They would be in there for a long period of time trying to figure out what it was that I was needing. Mattie Murrey 09:41 What was it like when you asked a question that somebody couldn't give you an answer for? And could you differentiate between what they couldn't give you an answer for, and what they didn't want to give you an answer for? Vanessa Abraham 09:51 No, I couldn't differentiate, but it was a very frustrating process when they didn't understand. I was frustrated. They were patient, but I know they felt bad, just like I felt bad. I felt bad they weren't understanding me. They felt bad they weren't understanding me. It was definitely a hard process on both ends. But I think both parties, myself and my team, or my husband, everybody had the best intentions and everybody genuinely cared, so they were very patient. They would sit there and wait, wait me out. They would wait for me to get those words out, whether it was an alphabet board, or text to speech, or whatever it was. They were very patient with me. And I tried to be patient with them, but there were times that the frustration got the best of me. But overall, like I said, it was just a very slow and hard, frustrating process. Mattie Murrey 10:59 Can you think of a time in particular when one of those discussions was just so frustrating, and you can share that with us? Vanessa Abraham 11:11 No, I don’t remember one specific one. I honestly felt like they all were frustrating. Mattie Murrey 11:16 Mm. Vanessa Abraham 11:17 All of them were. It was – you're dealing with very important questions. Mattie Murrey 11:23 Mhm. Vanessa Abraham 11:24 One important question leads to another important question, and all of the questions were very important and I wanted answers to all of them. So, I really don't think one was more difficult than the other. Mattie Murrey 11:40 All important. Vanessa Abraham 11:42 Yeah. Yeah, all very important. And, like I said, I wanted to know what was going on. I wanted to be involved. Mattie Murrey 11:50 It reminds me of that children's book, If You Give a Mouse a Cookie. Vanessa Abraham 11:53 Yeah. Mattie Murrey 11:55 So, if you ask a patient in a bed a question it can go here, then here, then here, then here. And I'm sure you're lying in bed, you just – your mind just whirling. Vanessa Abraham 12:05 Yes, and especially when you're cognitively intact. Mattie Murrey 12:08 Mhm. Vanessa Abraham 12:09 The anxiety starts going. You start thinking, what if? What if that goes wrong, then what are you going to do? Well, if that goes wrong, what are you going to do and how are you going to… ? You just – the facts just keep coming at you like a wave. And you're so right when you say that book. Mattie Murrey 12:25 So, there was a point in time when they put the Passy Muir valve on you, and you said, “I can't even think”. Tell us about that. Vanessa Abraham 12:35 I was in a state of shock and disbelief. All I could think about is, this is going to sound really weird, but as a school-based SLP, we don't use Passy Muir valves. Mattie Murrey 12:46 Mhm. Vanessa Abraham 12:46 And the only time I've been really exposed to them – we talked about them in grad school, but that was years ago for me – and the only other times since then that I've ever been exposed to them is when I go to a convention, when I go to my state convention or an ASHA convention every year and I would see the Passy Muir valve booth there. And I would always just kind of breeze right by it, look at it and kind of think, “Oh, interesting”, but I would pass right by it. As a school-based SLP, it's just not something that we do. Mattie Murrey 13:14 Mhm. Vanessa Abraham 13:13 So, when they brought that in, it was more of a state of shock and disbelief, and thinking like “You’re not in the right room. You’ve to be in the wrong room. This is not – you've got the wrong patient. This can't be me”. And yeah, lots of tears involved in that. Mattie Murrey 13:32 What was that when that little button went on? What were your thoughts, concerns, worries, hopes? Vanessa Abraham 13:41 Oh, thoughts and concerns – this is the hardest thing I've ever done in my life, by far. It’s the hardest and scariest moment of my life. Mattie Murrey 13:52 The Passy Muir valve was? Vanessa Abraham 13:55 Mhm. Mattie Murrey 13:56 Why? Vanessa Abraham 13:57 It was so hard. And I don't know if it was the nature of my diagnosis, and the way my illness was, and the things that were damaged, like the cranial nerves that were involved, I don't know. That would probably be more of a question for my SLPs. But it was absolutely terrifying. Hard. The act of producing voice again is – it brings me nightmares, still to this day. It's just so much work. Mattie Murrey 14:31 So, the words of encouragement from the SLP putting the valve on were important. Explaining step by step – Vanessa Abraham 14:39 Yes. Mattie Murrey 14:40 – education? Vanessa Abraham 14:41 Patient education. Here I was an SLP, and you’d think I would have some clue as to what was going on with me. But, again, I think I've said in previous podcasts, when you're in that state of fear – Mattie Murrey 14:53 Mhm. Vanessa Abraham 14:53 – you're not able to think clearly. You don't know your right foot from your left foot. Being so patient with the patients, and explaining to them. Bring in visuals. Some people are visual learners, some people are auditory learners, there's all sorts of different learners. And I think at that point in the game, for me, I needed all sorts of different modalities to help me learn. Just explaining to them, this is what is going to happen. My SLP did a good job of kind of explaining to me what it was going to feel like, just to prepare me beforehand, “This is what you’re going to experience”. Mattie Murrey 15:34 What did it feel like? Vanessa Abraham 15:38 It was just really hard. Hard to breathe hard. Hard. Mattie Murrey 15:43 Yeah. Vanessa Abraham 15:43 And, again, I don't know if it was just the way my body was, and the areas that were affected, because I know that plays into – everybody, whether you’ve had a stroke, or whatever you had going on, everybody's body responds differently, and you’ve a different experience to different events whether it's a PMV or learning to walk again. But, for me, it was just the most exhausting, scary part of the entire experience for me. Mattie Murrey 16:23 Do you remember what your first words were? Vanessa Abraham 16:31 I totally forgot about that! That is so funny, but – oh my gosh, wish my SLP was here. But I do, now that you say that, I remember, and it was something to the effect of how awful the secretions tasted. Mattie Murrey 16:55 Ew! Vanessa Abraham 16:56 Yes, because it was just disgusting. I had so many that – yeah, it was something – I don't remember verbatim what it was, but. Mattie Murrey 17:06 Yeah, but it was something like that. That's pretty important. Vanessa Abraham 17:09 Aha. And I don’t think the words I chose were very pleasant or very appropriate for a podcast, but …! Mattie Murrey 17:16 But you got them out there with your Passy Muir valve on, and you got your voice back. Vanessa Abraham 17:23 Yeah. Yep, and I was just angry at the time, and all sorts of emotions and rage were running through my body, and I just spewed out these words that – yep. But I got them out! Mattie Murrey 17:38 Good, good. So, you’ve mentioned before that you're now able to relate to a lot of your other students that you work with. And so, I'm moving you now from being in the bed and getting the Passy Muir valve on, now to understanding the perspective of those you work with. So, what perspective – before we move on to the next part, the next set of questions in this episode – any final perspective that you want SLPs to know about you laying there in that bed voiceless? Anything to do with being voiceless, or mental wellness issues? Vanessa Abraham 18:13 It all comes back to me, about the mental wellness. That's just who I am now as an SLP. That's kind of where all of this has taken me. I'm just overly concerned with patients’ mental wellness and how they're doing, keeping positive and keeping the hope up. For me, everybody was always saying, “Remember where you were. Remember where you were.” And at the time, you just – you're frustrated and angry, and you're thinking, “Yeah, I know. But where I was, I want to be back where I was pre…” Mattie Murrey 18:50 Mhm. Vanessa Abraham 18:50 But they would say, “No, think about where you were a week ago”. We could go, “You were … “ and just the progression of healing. In a week's time, you can make gains to being completely sedated and unable to move, to maybe a week later you're able to at least sit up in bed and eat a meal. So, just remembering where you were. And I think that's just so important to write these things down. Write them down in a book so patients can maybe reflect on them. That yesterday or last week you weren't eating, but today you had your first bite of applesauce, or whatever it was, just so they can see, “Okay, yes. I am making gains”. Even though they're tiny and small and sometimes we feel like it's not enough, at least it’s a gain. Mattie Murrey 19:42 Mhm. So, you're three years post? Vanessa Abraham 19:45 Yes. Mattie Murrey 19:46 And you've healed a bit, and you’ve returned to work as a school-based SLP. You're back to being a mom, and a wife, and a daughter, and a mother. A lot of times when people recover from something, they have these invisible disabilities, and people will say, “Wow, you look so good”. What kind of a response? How do you handle that question or comment? Vanessa Abraham 20:15 Okay. I'm so glad you brought that up, because I have this conversation with so many people so often, and it just frustrates me. But you know what, I was just actually having a conversation with a friend just yesterday about this, and although that comment frustrates me because you don't know what's going on with people mentally, you don't know how they're feeling by looking at somebody – so they can cross the street, so they can eat a meal. Do you really know how they're feeling? And something that I've had to tell myself, and remind myself, because sometimes they get pretty down thinking, “Wow. Everybody else can live it up, and get up and run around, and they're doing their thing, and they’re a soccer mom, and they’re going to the gym and lifting this weight and that weight”. But I have to remind myself that so many people are struggling with invisible disabilities that we just don't know. We just cannot see the PTSD that they experience. You can't visibly see depression. You can't visibly see the anxiety that they're having. I have some close friends right now that are dealing with some medical issues, and they just don't feel good. They go to work every day and they put their best foot forward, but they are dealing with some medical issues that you just can't see. And they – I hate using the term, but they “fake it until they make it”, and I've been one of those too. That I go about my day, and I put on my work clothes, and just fake until you make it. But I've been one of those too, that people look at and say, “Wow, you look amazing”. And I think, “Yeah, if you only knew”. Mattie Murrey 21:56 Mhm. So, opening up some of those conversations, not presuming. Vanessa Abraham 22:00 Yeah. I look at people in a whole different light now. I see people that are very active, and I think, “Wow, they look – they appear to have a good life”. But what was their childhood like? Maybe they're dealing with some emotional issues from childhood. We just don't know. We don't know what anybody's feeling or what they've gone through. So, that saying of being kind to everyone, you just don't know what they're dealing with, that's so true. Mattie Murrey 22:26 Mhm. Vanessa Abraham 22:27 I see people in the community, and I try to always smile at people and be very friendly because you just don't know. You don't really know. You never will know. Mattie Murrey 22:37 Mhm. And makes a difference, sometimes. And if it doesn't make a difference, then that's not your bad, but you were kind and compassionate. Vanessa Abraham 22:51 Absolutely. Mattie Murrey 22:51 I think that's one of our trademarks as SLPs. Many other professions have it, but I think as SLPs we're good at being compassionate and kind, so when there are people who have those invisible scars. What's it been like dealing with the cognitive changes? Vanessa Abraham 23:08 That’s hard. I have to give myself a lot of grace and just sometimes laugh things off, and blow it out, and just think, “Oh, how many other people? How many other moms too. Like moms, and working moms in particular, are experiencing cognitive difficulties. The past two years, on working moms, have been really hard. Mattie Murrey 23:29 Mhm. Vanessa Abraham 23:29 So, I sometimes have to give myself some grace, and think, “Well, you know what, I'm not alone”. Mattie Murrey 23:36 Mhm. Vanessa Abraham 23:35 We’re all dealing with it at some point. People are dealing with juggling grandkids. I look at my mom. She's juggling grandkids and her own life. And I think we all, in some respects, have a cognitive disability at times where we're forgetful and – Mattie Murrey 23:53 Overwhelmed? Vanessa Abraham 23:54 Yes, that’s it. Mattie Murrey 23:56 Stressed, burned out. Yeah. Vanessa Abraham 23:58 Mhm. And multitasking, which we know is not effective anyways. Mattie Murrey 24:01 Mhm. Vanessa Abraham 24:01 So, sometimes, yeah, I just have to kind of blow it off, and think, “Well, I'm not alone”. I'm certainly not alone. We're all really busy and stressed at work. We know they're putting more and more demands on us at work, which really adds to the mental load. So, again, I just have to kind of chalk it up to the fact that we're all dealing with it. COVID didn't help anybody either. Mattie Murrey 24:23 No, no. And just being kind with one another too. Vanessa Abraham 24:26 Yes. Mattie Murrey 24:26 You were looking for a couple of emails – an email from me, and a calendar invite, and I think you twice looped back, and said, “Hey, where is it?” I'm like, “Oh, I'll get it to you!” But it's coming and working with each other instead of the “should have, would have, could have”. It’s the “let’s collaborate”, and see where we can help. And having a positive approach, versus the negative and missing approach. And understanding that people do come from different backgrounds, and bring different challenges, whether we see them or not. The mental wellness scars are the scars we cannot see, and I don't know of anybody who's been through a fairytale life without bumps and bruises and scars. Vanessa Abraham 25:13 No, and I don't think that even exists, honestly. Mattie Murrey 25:18 Mhm. No. You're very resilient. You went into this journey, this medical event, and you're coming out on the other side of it very strong. And you seem to be pivoting away from a helpless, “I'm in the bed, I'm speechless”, into the “I have my voice back. I have my life back, and here's where I'm going to go with it”. How do you develop that sense of resilience, and where do you get your strength from? Vanessa Abraham 25:57 I love this question. Wow. This is a perfect opportunity because something happened to me this weekend, and it's going to answer that question for you. So, I had an appointment this weekend with a woman, and it was actually she was doing blood work on me. And she's looking at my blood work under a microscope, and she says, “Has anybody told you, you have a really strong constitution?” And I said, “What?” And she goes, “Yeah. You have a really strong constitution”. And I said – and she goes, “This is not genetic. This is how you were brought up, how you were raised”. And I said, “Wow”. I said, “Nobody has ever told me that”. But I said, “I recently have told my parents that I figured out that the reason I thought like I did, is because of the way I was raised”. My parents set the example at a young age, not that they knew that back then, but I think that's what got me through it. I think my parents had difficult times, like most people, raising kids, it’s a stressful time. It’s not easy being a parent anyways. And my parents set the example that times get tough. You get out of bed, and you keep going. Mattie Murrey 27:18 Mhm. Vanessa Abraham 27:19 You keep going to work. You provide for your family. And they showed me that example from the minute I was born, and I think that's what got me through it. That foundation. That was my root structure, and I think that's kind of what showed me that this is what you do. Life gives you a lemon, and you make lemonade. Mattie Murrey 27:45 And that expiration date, though, on the carton of milk has expired. So, you've grown up, and you've taken it on your own. Vanessa Abraham 27:55 Mhm. Yep. Taken that, and learned from their example. And I can only hope that I've done the same thing for my child. Mattie Murrey 28:08 Mhm. And your colleagues. Vanessa Abraham 28:08 Yeah. Mattie Murrey 28:08 I know not everybody comes from strong family roots, or strong communities, and they form their own. And you have – one thing, even though I'm happy to have you all by myself today, I have really enjoyed the guests that we've had on, and the admiration that they have for you, and the admiration you have back for them. So, you've had a lot of love and appreciation for your team that's carried you through this. Vanessa Abraham 28:39 Absolutely. Mattie Murrey 28:40 And those tears have been good tears, and bad tears, but you’ve all cried together. Vanessa Abraham 28:44 Absolutely. They've been amazing. They have pushed me through the hard times, for sure. There were many, many moments of I’m ready to throw in the towel, and they scooped me off the floor. Mattie Murrey 28:58 So, moving on to social anxiety? What are social gatherings like for you now? Vanessa Abraham 29:03 They more a trigger of more anxiety? I'd rather just avoid them all together. I’d just rather be home with my family. Mattie Murrey 29:11 And you are, yes? Vanessa Abraham 29:13 Yes. It's harder. It's not as enjoyable as it once was for me, but I’m okay with that. Mattie Murrey 29:19 Final question regarding – now, we've just finished a series, What I Didn't Learn in Graduate School. And so, a final question I have for you, is what do you want SLPs who are in graduate school to know about the mental wellness, the mental trauma of being in an ICU bed and speechless? Vanessa Abraham 29:42 I want them to know that it's real, and that it’s not something to be taken lightly. I don't know what the statistics are, but I would assume that the suicide rates, and the rate of just overall depression with ICU survivors that are in a critical state that may not recover, I would assume that that number would probably be really, really high. It would probably and probably shock all of us, even me being an ICU survivor. Mattie Murrey 30:12 Mhm. Vanessa Abraham 30:12 Because those thoughts are very, very, very dark. I think that's really important. I don't think that area is discussed enough. I don't think it's discussed enough with the family members. Just to prepare the family members of what the transition is going to look like post ICU, just to warn them, like this is what they may experience. Mattie Murrey 30:35 So, as our role, as SLPs, what are the parameters? What's important for us to know, in those discussions? Vanessa Abraham 30:42 I think the most important thing would just be to make sure they're educated. I was very fortunate in the fact that I was identified when I left ICU by the critical care team. They did identify me and red flagged me as being a potential candidate for PICS therapy, for being a patient with severe depression. So, they kind of red flagged me and monitored me, and I was very fortunate for that respect. But not a lot of hospitals do that. They do not – they may not identify. They may just send them off to the next level of care, and just kind of bypass that area, and I think that's important to look at. Mattie Murrey 31:24 So, for SLPs, opening up the vision, and look at comprehensive – in addition to their speech, swallowing and communication needs, look – and even though it's outside of our direct scope, being able to identify it, flag it and include that in our comprehensive care approach. Vanessa Abraham 31:47 Yeah, and I hate to add another thing on the SLPs plate, because I know more than anybody our plates are full enough. But maybe just to even, as an SLP, notifying a social worker on staff. Or just bringing it to their attention during rounds, and just saying, “Hey, has anybody looked into their depression? Has anybody looked into something – looked into PICS?” And just mention that to the team. Just get that conversation going. That could take five minutes, or less. Mattie Murrey 32:17 Yeah. And PICS is Post Intensive Care Syndrome support? Vanessa Abraham 32:21 Yes. Mhm. There's Facebook pages for support groups out there for PICs. There’s ICU survivors Facebook pages. There's a lot of resources out there for people. But I think just having that conversation with the team during rounds, and just planting a seed just so everybody's talking about it. Mattie Murrey 32:42 Excellent. Well, thank you for your time today. One more episode to go. Vanessa Abraham 32:48 Mhm. Thanks! Mattie Murrey 32:53 So, hey, SLPs, that concludes this episode of the Missing Link for SLPs podcast. Please visit my website at fresh slp.com . Follow me on Instagram, or jump on Facebook to connect in our safe and friendly Fresh SLP community where we are empowering new and transitioning SLPs. If you found value in this episode, or in any way had an aha moment, or I gave you a fresh perspective, please show me some SLP love and support me on iTunes or the Apple podcast app or subscribe to me on YouTube. You got this!