Category Archives: Uncategorized

Are you a physical therapist interested in small group mentoring? Help me out by taking a short survey!

It’s almost here! I have been working on developing a small group mentoring program over the past few months, and it is almost ready to be rolled out!

As an instructor for Herman & Wallace Pelvic Rehabilitation Institute, I have been fortunate to work with hundreds of excellent clinicians who are at various stages of their journeys into the exciting world of pelvic health. While some clinicians enter into the field with a vast network of seasoned pelvic floor experts to support them, others have the additional challenge of being an “island”–basically, being the sole practitioner in their practice, city, and for some, within a 100+ mi radius.

My goal with small group mentoring is to be a facilitator for those journeying into this incredible specialty–to help not only with building the skill, knowledge and clinical reasoning necessary to create outstanding clinicians, but also to help connect clinicians together so no one has to go at it alone.

If this resonates with you, and you’re interested in learning with me, I would love to hear from you! I created this survey to better assess the needs of those interested in small group mentoring. Please take a few minutes to complete this survey, and look out for future announcements when the program is ready for rolling out!

All the best,

Jessica

CLICK HERE TO ACCESS THE SURVEY ON SMALL GROUP MENTORING 

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What’s it like to learn to treat pelvic floor dysfunction? A Video Interview

I just got back from a fantastic weekend in Wichita, KS teaching (and really learning with!!) an excellent group of participants from across the country. Heather Radar, PT, DPT, BCIA-PMD, PRPC and I worked with these clinicians across 3 days, helping them learn about evaluating and treating constipation, fecal incontinence and other bowel disorders; coccyx pain; and introduced them to the exciting world of male pelvic floor dysfunction.

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Enjoying some Kansas BBQ after our first full day of teaching. This t-shirt was very fitting for a class teaching anorectal examinations. ūüėȬ†

Several of my students agreed to be in a short video interview to share about their experiences at the course and some of their big take-aways. I hope you all enjoy this short video! I plan to continue these at future courses both to demystify pelvic floor courses for clinicians out there, and give patients an insight into the training pelvic PTs pursue to become skilled in this specialty.

From left to right, these are the incredible clinicians who volunteered for our interview! If you are needing treatment in any of these areas, please seek these ladies out!

  • Morgan Clark, DPT: www. summitrehabkc.com
  • Hannah Overfelt, DPT: SERC Physical Therapy, Independence MO
  • Nicole DeBrie, PT, DPT: Foundational Concepts, http://www.foundational concepts.net, nicole@foundationalconcepts.net
  • Jennifer Dickinson, PT, DPT: Fitzgibbon Hospital, http://www.fitzgibbon.org
  • Ashley Vollmar, PT, DPT: St. Luke’s of Kansas City, Plaza location
  • Tarryn Andrews, PT, DPT: Accelacare Physical Therapy, http://www.accelacarept.com
  • Marla J. Jacquinot, PT, FAAOMPT: Marla@coreptkc.com
  • Bethany Wellin, PT, DPT: Via Christi Therapy Center, Manhattan KS, http://www.viachristi.org
  • Anne Clark: Wesley Healthcare Outpatient Therapy, Wichita KS, 316-962-9835
  • Caitlyn Tivy, PT, DPT, OCS: Caitlyntivy.wixsite.com/pelvichealthpt

FAQ: Specializing in Pelvic Health as a New Grad

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By Kit from Pittsburgh, USA (Grads Absorb the News) [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)%5D, via Wikimedia Commons

I just received this question via e-mail from a participant at my most recent Level 1 Pelvic Floor course in Little Rock, Arkansas. (See upcoming course schedule!) As knowledge and exposure about pelvic floor disorders and pelvic PT grows, we see more and more doctoral students attending level 1 courses. And honestly, it makes me so excited about our future! These students are passionate, hungry for knowledge, and can’t wait to enter into the field and help people get better! I have mentored many students and new grads over the past several years, and this particular question frequently arises. I hope this post can be helpful for many new grads and DPT students in the future!

When students ask the questions listed above, they often are hit with well-intended, but often somewhat discouraging advice:

“You should really do orthopedics for a few years first, and then go into pelvic health.”¬†

“I really don’t think new grads should go straight into the pelvic health specialty”¬†

“It’s really important that you use all of your other skills first so you don’t lose them.”¬†

While this advice often means very well–aiming to create well-rounded practitioners, I find that this can feel very disheartening to that passionate-about-pelvic-health new grad. So, in that light, my advice is often a little bit different. I find we are all biased by our own experience, and in reality, many excellent clinicians spent multiple years in different specialties like orthopedics, neuro, acute care etc. prior to specializing in Pelvic PT, so I think there is a tendency to see this as the “best path” to becoming the most skilled clinician. Of course, I am biased the opposite way– I jumped into pelvic PT immediately upon completing my doctorate, and never looked back. Of course, this has meant that I had to do some work to build upon other skill sets that were needed over the years, but this path worked well for me.

So, why am I telling you all of this, excited-soon-to-be-new-grad? Because, honestly, you can do whatever you are passionate about doing! If you want to take some time to practice in another specialty, do it! If you are just too excited and want to jump right in to pelvic health, welcome aboard! Your experience alone is not going to make you an incredible clinician. Rather, it will be your passion, your hunger for learning, and your dedication to your patients that will fuel your path.  So, on that note, here are a few of my top tips for new grads entering into pelvic health!

  1. Choose an employer who will support your learning journey. In many ways, it has become very popular for clinics to build pelvic health programs. This is wonderful for patients (if they are committed to building good programs!) and a great opportunity for those entering the field. So, when you interview with an employer who is excited about your pelvic floor interest, ask questions to find out how much support they will give you along the way. Will they pay $$$ for your continuing education courses? Will the provide you time to work with a mentor? Will they support you by providing adequate time in your schedule for your patients (meaning, 45-60 dedicated minutes, not overlapping patients)?
  2. Negotiate for what you want.¬†This is very very important. When I was first hired as a new grad, I negotiated with my employer for them to pay for me to attend 4 continuing education courses within my first year of employment. This allowed me to complete a full pelvic health curriculum within the year. Now, I realize that may seem a bit ambitious to some, but I considered this my personal “Residency” program and I felt like it gave me the jump start I wanted! So, this can mean negotiating for courses, mentoring time (get it in writing!), or even participation in an online mentoring program (like the one I plan to set up soon!).
  3. Find a good mentor. Of course, my perfect scenario for you involves finding a good job with a good mentor attached to it, but I realize that is not always easy to find. Reach out to local pelvic PTs in your area and connect with someone who is willing and able to be a resource to you! Of course, this can involve meeting periodically for coffee, or could be a more formal mentoring program. If the latter is the case, see point #2.
  4. Don’t be afraid to jump ship. If you start working somewhere and you don’t find that you are supported in the way you need to be, or you just don’t like the place you are working, it is totally ok for you to find a new job. Seriously. Life is too short to be unhappy where we spend our time.
  5. Be hungry for learning. I would encourage you to make a plan for attending coursework to help build your knowledge within the specialty. There are many excellent course series out there– Herman & Wallace Pelvic Rehabilitation Institute, the Section on Women’s Health, Evidence in Motion, among many others. Of course, I teach with H&W, so would love to have you at one of my classes! ūüôā Also, there are so many wonderful opportunities for learning today, outside of traditional continuing education. Read blogs (like this one!). Research conditions and diagnoses that you are not familiar with. Join social media pelvic health groups like Women’s Health Physiotherapy and Global Pelvic Physio (both facebook groups!).¬† Attend conferences like the Combined Sections Meeting through the APTA, the International Pelvic Pain Society’s Annual Meeting or the International Society for the Study of Women’s Sexual Health’s Annual Meeting. And don’t be afraid to ask for help when you need it!

I hope that is helpful! We are so fortunate to have so many excited and passionate clinicians joining our field! What other tips do you have for those joining this wonderful specialty? What other question do you have my dear PT students?

~ Jessica

 

Happy New Year!

Can you believe it is 2018?! I find that as the years go by, time seems to pass so much more quickly. 2017 was a year full of so many changes for me–both personally and professionally. I successfully kept a small (and super precious) human alive. I joined the faculty of Herman & Wallace Pelvic Rehabilitation Institute and taught 4, 3-day continuing education courses for physical therapists. I cut back on my clinical hours in order to spend more time with the aforementioned small human ūüėČ and focus on my other professional endeavors. And, I started video content on the blog (although not quite as much as I would have liked).

I am so excited to see what 2018 brings and have so many exciting plans on the horizon, both personally and professionally. I am continuing to work with the Institute teaching continuing education, and would love to see some of you at a future class! I am also actively working on developing new content for this website! This year, I hope to continue diversifying the content you see via written and video blogs and interviews. I am also working to develop both an online mentoring program for clinicians as well as some online program options for those struggling with pelvic floor problems. Keep on the look-out for more information about these programs! If you are interested in either, please be in touch! I would love to hear your thoughts and interests to better develop something you would find worthwhile!

Looking forward to continuing to learn with you and from you in the new year! Thank you as always for your continued support of this endeavor!

Cheers!

Jessica

Biofeedback for Vulvodynia: An Update 

“Do you do Glazer’s protocol?”

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I have been asked this question several times over the past few years, by searching, hopeful women, looking for help after suffering from vulvar pain for far too long. I generally respond with, “I’m familiar with Glazer’s protocol, and would be happy to discuss it with you. Why don’t you come in for an evaluation and we can discuss treatment options specific to you?” This, in place of the, “I know it, but it’s more than likely not appropriate for you.”

Glazer’s protocol was a popular treatment approach, utilizing SEMG biofeedback to teach patients a method of contracting their pelvic floor muscles, to ultimately “fatigue” the muscles, and with the hope that doing so would relieve pain. Dr. Glazer was one of the first to publish research about treating the pelvic floor muscles in helping women with Vulvodynia, and all of us working with men and women with pelvic pain are grateful for his contributions.

However, as time goes on, we learn more and more. Which is awesome. And as we learn more, we hopefully change how we practice to provide the best treatment we can to our patients. Recently, my colleagues Sara Sauder and Amy Stein (2 fantastic clinicians and educators in pelvic pain) wrote an excellent commentary summarizing the evolution of biofeedback in helping women with vulvar pain. I was thrilled to see their commentary, and I thought many of you would benefit from it as well!

Sara and Amy very eloquently explain how the understanding of treatment to the pelvic floor muscles have changed over the years. Glazer’s protocol was based off the idea that frequent contractions of the pelvic floor muscles (both holding contractions and quick ones) would fatigue the muscles and thus lead to relaxation and pain relief. However, our current understanding of the pelvic floor musculature is quite different.

Shortened, Tender Pelvic Floor Muscles 

Amy and Sara go on to explain that as we have learned about the pelvic floor and seen the presentations of women experiencing vulvar pain, we have found that most women actually present with shortened, tender pelvic floor muscles. Typically, when this is found on examination, the optimal treatment includes a combination of relaxation strategies as well as manual treatment vaginally to encourage lengthening of the pelvic floor muscles. And what about fatiguing them by doing lots of kegels? Well, we have found that when shortened muscles do lots of contractions, they can actually get irritated and more shortened!

So, what’s the place for biofeedback?¬†

First, it is important to realize that the term “biofeedback” is not exclusive to EMG. Really, biofeedback can be any cueing to encourage a patient to perform an exercise accurately. Sara and Amy give a few great examples: a finger in the vagina to encourage and cue the patient to relax and lengthen their muscles. A clinician teaching a patient the optimal way to harness the diaphragm with breathing. All biofeedback. And what about SEMG? It can offer some help for some patients to learn to relax and let go of their muscles. However, it can also be a little tricky because women with shortened muscles may appear “normal” on SEMG. Why? It’s complicated, but in summary, SEMG reads electrical activity… so, when a muscle is held at a shortened position for a long period of time, the body will adjust to this position as the new normal. Thus, this can “trick” a patient or clinician (especially if SEMG is done to replace an internal examination) into thinking the muscles are relaxed and functioning well, when they are actually shortened.

In summary, Glazer was a pioneer who really helped us in the process of better understanding Vulvodynia. But as all treatments and understandings do, we have evolved and changed to better understand what the most effective treatment techniques are for women experiencing Vulvodynia. Biofeedback should be a part of any treatment program… but SEMG biofeedback will have some utility for specific populations and limited utility for others.

I would encourage you to read Sara and Amy’s commentary yourself! You can find it here. If you are a physical therapist treating this population, you have the opportunity to learn from Sara in person! She teaches via Alcove Education, and has an excellent course: Vestibulodynia: An Orthopedic and Pelvic Floor Approach. My clinic is fortunate to host this course in just a few weeks! (Our course is sold out… but you can find upcoming courses here).

Sara and Amy are excellent clinicians, educators and advocates for men and women with pelvic pain. Sara runs a wonderful blog, Blog About Pelvic Pain, and Amy has created fantastic self-help tools, including her book Heal Pelvic Pain and her instructional DVD, Healing Pelvic and Abdominal Pain. I hope you enjoy these resources! 

Have a wonderful week!

Jessica

ÔĽŅI’m back! And I have a really really cute baby!

Ok, I know you must be totally shocked to hear from me! But, I am back! For real!

My beautiful daughter, Emma Caroline, was born on October 26th at 1:32 pm, weighing 7 lbs 14 oz and 23 inches long. In case you are super observant, yes, the little girl who threatened to come early actually ended up coming a week late! We delivered her via c-section after 37 hours of labor. Yes, 37. I’m hoping her dramatic streak ends here. I’ll spare you the details now, but I’m sure some will come out along the way as they fit with future posts!

I was so fortunate to spend 12 weeks at home with my little girl, but I am back in the clinic seeing patients now, and back to writing! In fact, I promise you’ll get another post (a real, hopefully educational one!) before the week is through!

2017 is going to be a great year! I have some exciting things planned for the blog (hoping to finally start some fun video posts, more book reviews, and some interviews with colleagues who are super smart!), and I am SO excited to start teaching for Herman and Wallace Pelvic Rehabilitation Institute and continue teaching online webinars! See my “for professionals” section for current course listings! I would love to meet you in-person!

Wishing you and your family a happy and healthy 2017!

Jessica

My sweet little Emma, visiting her mama on my first day back at work!

An Update

Hello my friends, colleagues and blog readers! I know what you’re thinking… a post from Jessica? We haven’t heard from you in ages. And you’re right, you haven’t. And I’m sorry. There have been quite a few things going on, and I¬†wanted to fill you in so you would understand why I’ve been a little MIA.

As most of you know, I am currently pregnant, expecting an adorable, sweet baby girl in October! My pregnancy has been wonderful overall, and it has been incredible to be on the “other side” of learning about pregnancy. Unfortunately, a few weeks ago, I began experiencing regular contractions, which ultimately resulted in a short hospital stay, and being placed on modified bedrest. (Now I know what you’re thinking… isn’t bedrest really bad and no longer recommended? It’s modified…meaning, I can move around, etc…but they don’t really want me working as high levels of activity are causing me to contract more, and my little girl needs to cook for a bit longer). This all happened the same exact day I was supposed to give my live webinar on pregnancy (Ha!). Thankfully, Andrew and Karl with Therapy Network Seminars were very understanding, and we canceled the webinar, ultimately rescheduling for next Wednesday, September 14th! So, if you missed it the first time, there is still time to sign up! And I would love to have you on the webinar!

So, back to my current situation… the initial plan was to keep me at home for a few weeks, allow the contractions to slow down, then return to work. Well, unfortunately, my little daughter has other plans for us. So, long story short, I will be out of the clinic until after my daughter is born to give her the best opportunity to grow and develop safely. I do plan to write a few more blogs for you between now and her arrival, but honestly, haven’t been too motivated to do so over the previous few weeks (I think my little mommy nesting brain was so focused on making sure everything was ready for her, should she arrive earlier than we expected!).

My husband and I truly appreciate all of the love, support, meals and prayers that we have received over this time! We are grateful that our sweet daughter is staying put for now, and seems to be healthy, happy and content (I like to think she is completely oblivious to what is happening in the uterus around her!). For those current and prospective patients, I will be scheduling patients again in early January. I plan to keep this information updated on my contact page.

Thank you for your understanding and support! I look forward to continuing this learning and growing journey with you in the future!

~ Jessica

Upcoming Webinar (RESCHEDULED): Management of Musculoskeletal Pain During Pregnancy

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“Management of Musculoskeletal Pain During Pregnancy”¬†

LIVE Webinar, Wednesday September 14th, 8-9:30 p.m. EST 

I am thrilled to be partnering again with Therapy Network Seminars to present this live webinar providing participants with an introduction to the management of musculoskeletal pain during pregnancy!

So often, clinicians feel ill-equipped and lacking in knowledge to provide quality treatment to women during this important stage of life. Often, clinicians are fearful of complications or precautions their patients may face, or may not know how to modify examination procedures or exercises to accommodate a woman who is pregnant. I hope that this webinar will help more clinicians feel confident in helping their pregnant clients, and inspire many to help reach a population who so very much needs our help!

I hope you’ll join me on Wednesday September 14th¬†for this live 90-minute webinar! Registration is available via Therapy Network Seminars! Let me know if you have any questions and I hope to see you there!!

NOTE: This webinar was rescheduled from the original date of August 18th. If you can’t make this webinar, or would like to listen to some previous webinars, they are available on-demand! Check out the topics available here!¬†

Exercise during pregnancy

So, I’ll be honest… I’m writing this as much for myself as I am for you. You see, as a women’s health specialist, I have preached the benefits of exercise during pregnancy for years. I’ve taught classes to women in the community on how to exercise safely and encouraged them in all the way exercise would help their babies, their bodies, their overall health. I’ve lectured other health care professionals on how to help pregnant women start exercise programs, how to monitor them for safety, and which specific exercises are better for women during pregnancy.

But the thing is…I’m now pregnant. 26 weeks to be exact. With this darling, sweet little angel GIRL!

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You have to admit, she’s already adorable, isn’t she?

And it has been wonderful, amazing, incredible to experience…and… educational. I thought that I would be the perfect fit pregnant lady. I would follow all of my own advice on everything and stay super active and fit throughout the pregnancy (I mean, I’ve told so many people that pregnant women can keep exercising at the same level they did before pregnancy!). But, then reality hit… First trimester, I was reallllllyyy realllyyyy tired. Like super tired. In fact, I sometimes just fell asleep on the couch after work (and I am really not a napper). My bedtime effectively became 8pm. And, on top of that, I was nauseous. Which creates the perfect combination for not being a super active, fit pregnant lady. But, I tried to do the best I could! Which mostly meant walking¬†sometimes (on the treadmill or outside). Better than nothing though!

Then, second trimester hit, and all of my symptoms got so much better (just as we tell people they should!). I had more energy, could stay up until at least 9pm, and no longer felt nauseous. Buuuttt… I also was in the process of buying a new house, cleaning and updating said house, then moving, unpacking, and trying to organize our home… So, needless to say, I was not the picture perfect fit pregnant lady over that time either.

So now we reach today. 26 weeks, 2 weeks away from starting my third trimester, and walking as well as a little bit of yoga/pilates is still the best I have done for exercise (Not saying anything bad about walking… I have loved it during pregnancy, it has great benefits, and I plan to continue it! But, I also want to add some variety and a little more frequency to my routine!) So, this post serves both to give you some great information, hopefully motivate a few of my fellow pregnant ladies to jump-start their fitness, and also hopefully to motivate me to up my exercise frequency and throw a little variety in the walking routine. ūüôā

So, why exercise during pregnancy?

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For many years now, exercise has been supported as effective and helpful during pregnancy. The benefits of exercise during pregnancy are actually pretty incredible:

  • Cardiovascular benefits (improving blood pressure, heart rate, etc) are passed on from mother to baby… so baby can actually have a healthier little heart when born!
  • Decreased weight gain during pregnancy, which actually can prevent obesity in both mom and baby. Recent studies have suggested that women who gain excessive weight during pregnancy (when starting at normal or overweight BMI) are more likely to have larger babies. The interesting this is that when this occurs both mom AND baby are at risk for developing obesity in the future.
  • Decreased risk of gestational diabetes (and improvements in women with GDM)
  • Decreased likelihood of Caesarean or operative vaginal delivery
  • Improved recovery postpartum
  • Improved psychological functioning during and after pregnancy

How should you exercise during pregnancy?

The great news is, most women can actually continue exercising at the same level they were exercising prior to being pregnant. The American College of Obstetrics and Gynecology just updated their recommendations on exercise during pregnancy this past December. The most recent guidelines recommend that pregnant women exercise 20-30 minutes at moderate intensity most days of the week. The safest types of exercise identified by the committee include:

  • Walking
  • ¬†Swimming
  • Stationary cycling
  • Low-impact aerobics
  • Modified Yoga
  • Modified Pilates
  • Running or jogging
  • Raquet sports (as long as able to do so maintaining good balance)
  • Strength training

The following types of exercise are recommended to be avoided (for mostly obvious reasons):

  • Contact sports (ice hockey, boxing, soccer, basketball)
  • Activities with a high risk of falling (downhill skiing, water skiing, surfing, off-road cycling, gymnastics)
  • Scuba diving
  • Sky diving
  • “Hot” yoga or pilates (due to temperature regulation issues in many pregnant women)

How hard should you exercise?

You may be familiar with the standard method of determining intensity of exercise by monitoring heart rate. This method is not reliable during pregnancy as cardiovascular function changes with pregnancy, thus, the numbers won’t provide accurate guidelines. Instead, women are encouraged to utilize a scale such as the Borg Rate of Perceived Exertion Scale. Basically, this scale goes from 6 (sedentary) to 20(maximal exertion). Pregnant women are encouraged to aim for moderate intensity (13-14 somewhat hard) during exercise. Another option for monitoring intensity of exercise is the familiar “talk test.” Basically, as long as you can continue a conversation the intensity is likely not getting overly difficult and should be safe.

When shouldn’t you exercise?

There are several times when it would not be indicated for a pregnant woman to start or continue an exercise program. Absolute contraindications for exercise are shown in the following table (taken from the recent committee opinion listed above):

An absolute contraindication means that if this is occurring, the person should not engage in an exercise program for any reason. A relative contraindication means that a person should take caution and consult with her physician prior to engaging in exercise. The relative contraindications are listed below:

When should you STOP exercising?

There are instances during pregnancy when it may become unsafe to continue an exercise session. If these situations occur, it is important to immediately stop exercising and contact your physician, as continuing to exercise in these scenarios may be harmful to the mother or the baby:

  • Vaginal bleeding
  • ¬†Regular painful contractions
  • Amniotic fluid leakage
  • Dyspnea (shortness of breath) before exertion
  • Dizziness
  • Headache
  • Chest pain
  • Muscle weakness impacting balance
  • Calf pain or swelling

Getting started

If you are pregnant and have not started exercising, it’s really not too late! There are a few things to keep in mind as you get started!

  1. Talk to your Obstetrician. If exercise is not routine for you, talk to your doctor first before you start a program to make sure it will be safe for you to exercise during your pregnancy.
  2. Start gentle and slow. It generally is better to slowly ease into exercise. Remember, the guidelines encourage 20-30 minutes of moderate intensity exercise most days of the week. But, when you first start, it may be wise to start with smaller increments and make 20-30 minutes your goal. Walking, gentle prenatal yoga or water aerobics may be a good, safe place to start.
  3. Something is a lot better than nothing. It really is. And I feel ya, some days you’re exhausted or nauseous and just can’t get to the gym. So, when that happens, do what you can. Go for a short walk. Try some home prenatal exercise videos. Or, just take the day off and rest. Then try again tomorrow.
  4. Listen to your body. And I really mean it. If something isn’t feeling right, pay attention to it! Talk with your doctor if you notice anything unusual or if something isn’t feeling well when you are exercising. Take breaks as you need to, and don’t push yourself too hard.
  5. Get some help! Reach out to your local Women’s Health physical therapist to come in for a session and get some help developing a program that will work for you! Also, talk with your physician, midwife or doula about resources in the area. If you live in the Atlanta area, like me, there are great programs like OhBaby! Fitness offering exercise classes for new or expectant moms. Remember, you don’t have to do this alone!

What motivated (or is currently motivating!) you to stay active during your pregnancy? What are your favorite exercises? As always, I’d love to hear from you!

Have a great week!

~Jessica

What do you want in 2016? I want to hear from YOU!

Ok, first, I promise a real, educational post is coming this week. So, don’t fret.

In planning for 2016, I really want to help this blog be more informative and helpful to YOU my dear reader. So, I have a little favor to ask… will you pretty pretty please fill out this quick survey to let me know who you are and what you want to learn about? I promise it will take less than 2 minutes (maybe even 1 minute, if you’re fast!). It will help all of us— me, to write posts more of you are excited about… and you, to have better posts that actually meet your learning needs.

Thank you, thank you, thank you!!!! (Survey results are anonymous, FYI!)

Click here to be the most awesome blog reader ever and help me make 2016 our best year yet!