Hi and welcome to another episode of Celebrating small family businesses. Today we are celebrating Terri and Dr. Carl Page, the medical transformation center in Louisville, Kentucky.

Yay.

Hi, Carl. Hi, Terri. Hi, how are you doing?

Nice to see you.

It's.

We're glad to have you here. You've got quite an interesting story, so I, I'd love to just jump right in. So, Carl, you've been a. I want, I don't want to say traditional allopathic medicine, I guess, is the right term for 30 plus years.

Probably the right way to, to phrase it. Yeah. I was traditionally trained as an internist and a pediatrician and practiced that way exclusively for 25 years and kind of transitioned over five years and have been in the space I'm in now for a decade.

Awesome. Awesome. And what is that space?

And we have a cellular medicine, anti aging and regenerative medicine practice, and it combines that with functional medicine approach for complex problems. So we help people that are sick, you know, with a really exotic issues, try to find out the root cause of what their problem is and address it that way with the cellular medicine tools that we have now in the 21st century. And we work with people just to optimize health and achieve, you know, weight goals or body composition goals or just energy, you know, get them functioning as.

Best they can and just really optimal aging. Some people just want to head things off at the past, you know, especially too, with people now looking at their genetics and their predispositions and maybe watching their parents age not so gracefully, and they want to know what they could do today to head that off, get the best outcome.

I like that you said optimal aging because anti aging is some, someone thinking, you know, it's possible to reverse aging or stop aging it. No, not really. But we can slow down the, the, the amount of damage.

Definitely. Slow down the drain for sure.

Yes, yes. Oxidative stress and that kind of stuff.

Right, right, right.

Yeah. I always tell people, you know, we're all gonna pass on, we're all gonna die. And so, you know, you're right. We don't say that we have the fountain of youth, but really the point is, is to have the best health that we can for the time that we're here.

Yes. I, I've heard it said, you know, extending the health span instead of the lifespan. Would you tell us how you came to shift gears like that and, and move into this area? What, what triggered that?

She likes to tell the story. She's good at it.

Well, I, I tell it a lot, actually, because I I tell it in a class that I teach four times a week, so maybe I've had a lot of practice on this one. But really, Carl was very traditionally trained and really very, you know, very good at it. I mean, people came from all over with tough cases and things like that. So we had many years in the TR traditional, as you said, allopathic medicine arena, which is sometimes the absolute right answer, especially for acute care and that type of thing. But I actually had some health issues that hit the wall in about 2008, 2009, just from an accumulation of years and a lot of other factors in that. And really the regular answers of take this medication for this symptom that kind. Kind of old. And I was the squeaky wheel in the house. And so at one point, there was a challenge to his abilities that I might have. Might have put out there, really just.

To happy wife, happy life.

Well, just. Just to, you know, to go back to his roots because he's so good at figuring out what's wrong with things, like whether it's a. Something broken in the house or an electronic or anything. He's really, really good at troubleshooting and finding what's wrong and fixing it. I just had to remind him one day that he could do that with people too, instead of just covering it up with a medicine. And that led us down a path at home of looking at health differently. And what we found was that there were a lot of other tools that we could add to the toolbox to really help people thrive and be well. So once I started to feel better and our family started to make a shift, there were a lot of things happening in the healthcare arena during those years post healthcare reform and 2008 recession. And it made us really want to bring these principles into our. Our. Our traditional clinic that we had at the time to see how we could help folks that were looking for that type of thing. You want to kind of take that evolution from there?

Well, it was. I'd always been curious in the traditional medicine arena about some alternatives to diagnose or manage problems that patients had. And when Terri had her issues after all of the kids and her primarily ended up with systemic inflammatory, autoimmune GI health issues. And it just started to put some of the pieces of that together and found where I could find to train in things that they just didn't teach us in medical school. The traditional training was very focused on there's a problem and then here's your solution. And almost all of the solutions either ended up with some Sort of medical device implanted in you or surgery or a pharmacy, pharmaceutical agent. So we didn't get any training in how do you find root cause of things and address root cause. So I spent several months and evenings studying after I finished my traditional training, getting formally educated in that space so that I could use those tools in my traditional practice, which is how we started initially trying to integrate that form of managing patients and diagnosing problems into the traditional medical practice. And we did that for a few years. But really hybriding the two was difficult. Primarily just from a financial or business standpoint. It was you spent so much time with these patients that a traditional insurance model for a copay and whatever they gave you after the copay, seven minute visit, even sometimes. And in many of the diagnostic tools we use were not reimbursed by the insurance model. So they were very well, they used technology and diagnostic technology that's from the 60s a lot of times it's almost designed that way. It's like don't, don't look in detail or don't go into too deep of a dive. It might cost too much, you know.

So we, we were trying to use more advanced diagnostics and tools for our patients in that insurance based care model. But ultimately we decided it was a square peg in a round hole. So in 2014 we actually started Medical Transformation center and ran it in tandem with our insurance based primary care for about a year or so. And then we just decided there was more joy and we were helping more people in Medical Transformation Center. So we sold our primary care practice and then went through that transition period. But ultimately we became full time in Medical transformation center in 2017.

Wow, that's wonderful. I applaud that so much. It would seem that the insurance companies would realize it costs less to keep people healthy than it does to try to just continually treat sick people. But it.

Well, what I always say, patience. Now your logic would tell you that, right? But all they really care about is that you make your premium payment on time. And, and when you think about it, they have no incentive to make you healthy after that plan year.

Oh, well, that makes a lot of sense. Yeah. So it's a conflict between short term and long term planning. Kind of.

There you go.

Wow.

Well, it sounds like you two have been working together now for, for many, many years, right? Even before you start Medical Transformations, Correct.

Yeah, we've been together a very, very long time. We actually grew up together and we were in junior high, high school and college together. I mean, Carl went to medical school I, I, my original training is I'm an accountant. So that was my, my bachelor's degree was in accounting. And so we had a plan. We knew that I would work as an accountant and while he was still in school and in residency and that was really good training for me in, you know, in corporate accounting and in the business world. So that some, you know, someday, right when we finished, when he finished all of his training, that we could open up a small business by ourselves. And so that's what we did. In 1992, when he finished his residency, he did a double residency in internal medicine and in pediatrics and did the board certifications and all that good stuff. And we went out to a bedroom community of Louisville, Kentucky and hung a shingle and painted the walls. And back then we were hanging borders, if you remember those, the borders up around the wallpaper borders and you know, decorating. And we started with no patients, which was, was fun, you know, I mean, it was an adventure. But we ended up ultimately growing and when we sold our primary care practice, it was a 10,000 patient practice. So.

Wow.

It was a big one. Wow.

Yeah. In a bedroom community. That's community of Louisville.

Yeah, yeah, well, it was, it served like the tri county area because we were that our county was that first stop in from the rural counties in between Cincinnati and Louisville. And so we were just really blessed to have, you know, and because it was pediatrics and internal medicine, I mean we had families that we had seen for many years, newborns and grandma and grandpa and everything in between. So there was a lot of joy in those years.

Oh, that sounds wonderful. So you didn't have to go through that transition of working in a big clinic and practice management overseeing everything. You were able to start on your own.

Well, most people don't do that nowadays. We were starting to see a lot of physicians just go work straight for the hospitals right out of residency. And I was one of the few people that, you know, just started out on their own.

And well, this was 1992 too. And it was very different back then. I mean, you know, there had been a wave of hospital owned practices, but people were coming back out of those back then in 1992. But no, we just started out as a small private practice and started from zero. We did the billing at night and insurance forms were so easy back then, relatively speaking on a little dot matrix printer. And you know, all of that, I mean, you know, I go in and do payroll. I did, well, that lasted about a year. I did payroll one year and I Have not done it since. That's way too complicated. You don't want to get into any trouble with payroll taxes there. So I've outsourced that for, for years now.

Well, in that too, when we, when we. The longer we stayed in business, the administrative burden of practicing just kept going up and up and up. And then you had the introduction of electronic health records, which were mandated, essentially, and the cost burden of that on small business was huge. It literally drove many small practices to out of business or to be able to be absorbed by the large corporate entities that. That could have the capital to. To fund that, you know, farce essentially that, you know, it was. Still doesn't work.

Well, I mean, ultimately what happened too, for so many. And that really about that time, you know, again, after 2008, after the recession, after people's insurance situations changed and, you know, all health care reform, all the things that happened there that, you know, after 2008 and kind of into then 20 and on, that really changed the landscape of private practice, which is why you saw all those private practices close during those years. I mean, what was happening was reimbursements were going down and overhead was going up. So it was really hard to maintain any semblance of margins because you had. There were so much. There was so much more red tape to take care of. Like Carl said, just to see a patient. I mean, you know, if you kind of think about it, there was the referral and there was the authorization and there was, you know, all those little pieces.

So at the same time that was happening, I was transitioning the way that I was practicing medicine. So I didn't really think of it as this is going to be a, you know, a new business venture or we're going to be doing something totally different than traditional healthcare. But it ended up that way that we ended up at the forefront sort of frustration with patients with the business of medicine. And, you know, providers that are currently still stuck in the traditional way of practicing, many of them are frustrated with that, but they don't have any alternatives. You know, it's just basically that's the way you have to practice now. So, so we've developed a new business model just sort of organically and, and really when we tried to go to talk to the accountants or the, or the lawyers, they're like, what are you doing? You know, what type of stuff are you practicing there? Because, you know, there was no benchmark for them to look at. So, so, and, and even now, you know, when I teach how to practice like this, Terri's teaching some of the interested providers how to do a business like this, you know, so that's, it's.

Kind of interesting, you know, how you just, like Carl just said, you know, you're, you're going along and you're just doing the next right thing, you know, Right. You're just doing the next right thing and growing and morphing and changing. And now we kind of, as we look backwards, realize, oh, wow, we've been doing this for, I don't know, what, 2013, so 11 years now in this business model. And I guess we are some of the original. So now what? You know, people ask us, oh, tell us how to do this, you know, train us on this, can we come and watch your practice? And it just seems kind of funny to me because it's thing I always think to myself, I can tell you what not to do. There you go.

Well, that's important to know.

This didn't work, but this works.

Thomas Edison figured out a lot, a.

Lot of ways not to make it forward.

Right. You just fail forward.

Exactly, exactly. So.

And fast and.

Yeah, iterate. Iterate fast and often. Wow. It seems like you figured out your roles real fast. Like some family members, one of the early struggles they have is everybody, you know, finding their lane and figuring out their strengths and, and all that. But you kind of had that figured out in college. So I mean, you guys just hit the ground running when you started the business. Sounds like.

Yeah. Although I will tell you, I'm having an awful lot of fun learning the science now. That's fun. I'll go here, why don't we do this, Carl? And he'll go, oh, that's a bad idea. No, no, where'd you get your medical degree? Or sometimes he'll go, oh yeah, that's a really good idea. So I keep learning the science piece, which I love, I love that. I just don't like actual hands on blood and guts. But I love the science part.

Well, early on in our original practice, I came home one day, it was the first couple of weeks, and Terri would take the receipts, you know, for the day and look at them and for the week. And then she said, where's the $20 missing from Thursday collections? And I said, well, I had to eat lunch. And she goes, you can't do that. It's like, you know, so, so basically after that they just took all of the, the money out of my hands and I'd do the medical side. Don't mess with any of that. So.

So Terri, you Mentioned teaching the class four nights a week, and I wanted to come back to that. What is that?

Oh, well, we have learned over the years that there are just some very foundational principles that our patients need to grasp in order to get the full benefit out of working together. And, you know, we used to just always tell people, you know, this is a partnership. You have your part, we have ours, but it only works if we work together. And, you know, there were a lot of different things we would talk about and we would give suggestions and recommendations and chart notes and that type of thing. But what we realized, and we, we built a full. A large facility in 2021. And that was one of our goals was, was to have areas where we could do in person classes. But I also. We've also learned too, that people like Zoom, so we do a combo. I do four classes a month in Zoom and four classes a month in person on these topics, but basically just foundational principles about the impact that nutrition and gut health and environmental toxins and factors and so forth have on overall health. And, you know, we can help with some really cutting edge tools to repair damage, but actually the patient does the work of being mindful of purchasing preservatives, processed foods, all the toxins and artificial sweeteners, all those other things. And so in the class that I teach in, we, I do a 101 and a 102. In 101, I do tell that story, like the more full story of my health journey. Because whenever you tell a story, people hear elements of themselves in that and then, then they get it and they realize, oh, well, while I didn't think my Diet Cokes had anything to do with my problem, I realize now what impact that's had on my gut and permeability and microbiome and brain health, you know, blah, blah, blah, all the different things that. That impacts. So that's really what I try to do, is connect those dots for people. And what better way than a story, right?

Yeah, an impactful story. You know, I mean, we, we interviewed somebody not long ago that she had a health crisis. She was, she was working so hard just trying to, you know, climb the ladder and that she neglected her health and, and she got shingles and lost the sight in one of her eyes and, and that, you know, caused her to really shift her focus and change her lifestyle.

But, you know, that's interesting you say that, because shingles is part of my story.

Ah, me too, just a little bit. So what is a challenge that you've overcome together? That you think other family business owners could learn from something about how the family working in the business. Is there something that comes to mind.

Is that, well, to me, stay in your lane would be, you know, one of them. But really that kind of translates too, to draw some boundaries between we're at work now and. And now we're at home. And, you know, not to take the work towards 247 because, you know, you really just disrupts normal family dynamics. And you can never relax if you're working 247 and on weekends and holidays, reviewing, you know, contracts or records or the books. I mean, at some point you've got to draw a boundary there. No, nobody else would take their work home like that. You've got to learn what to leave and when to leave it at the office.

Yeah. You know, kind of as a little bit of an offshoot to that, I would say when you're at the office, very much a boundary around that in terms of the way you speak to each other. I mean, you might be really mad at each other when you're at the office, but, you know, you have to remember that you are in a professional sett and that's not how you would speak to a co worker. Right. You know, not the same thing that maybe you might have been thinking five minutes before when you were at home. So, you know, trying your best to keep that boundary of just overall professionalism and also not being too familiar or flirty as spouses in the workspace. Too many public displays of affection, things like that, because again, that's uncomfortable for. For people. So either way, you're, you know, you don't. You want to just have that level professional interaction as opposed to one way or the other. Too much.

Perfect. Cool. Really well said. We could go on that for a little bit there.

Again, we've seen that in small family businesses. I worked in a small one, and they were always at each other's threats. Yeah, it's hard when you're standing there trying to sell something and then, you know, they're back there bickering, and then your customer goes, can't take it. I'm out.

So, yeah, so we can. We've seen how that impacts. But yeah, those. That family familiarity. I guess it's a different type of boundary. Right. We don't have that dispassionate or it comes in handy.

I mean, I know if Terri's embezzling from me, she's taking it home, you know, so it's like.

Wow. Hey.

That'S cute.

Oh, goodness.

So what.

What have you learned about yourself working together?

What have I learned working about myself working together?

I've learned. I don't like spreadsheets, but anyway. Yeah, yeah, I just want to see the last number. Right.

Oh, I've got a good one too there then. This is really. Oh, now we're going personal on this one. But remember earlier when I said he's so, so good at finding the problem and being that critical thinker and you know, I mean that it's a strong suit that. And that's why he's such a good diagnostician. But I will tell you that that's a tough one in the personal world.

Yeah.

So, so recognizing that that's actually one of the qualities that I really love about him. But maybe just not so much when he's noticed the spot here on me or the whatever balance that of. Oh yeah, but that's actually can be. It's a really good quality too.

Yeah. I can find something wrong with anybody except usually myself.

Well, it, it, it's a focus, a trained focus. Right. And getting, you know, getting to that root cause is that's. Do you find that with these newer kind kinds of medicine and the new technology that you, that you approach diagnostics from from a different angle? I mean like a, maybe a non linear or non logical. When something you know, isn't obvious, do you, you know, like really go outside the box or how does that work?

Well, I mean, you know, just from my job is to. There's a lot of times when I'll see patients and fairly quickly have a gut or a gestalt of here's what's going on. But you have to throw that out so that you don't. Sometimes you stare at the obvious and you miss some things in the weeds that are very important. So you know, I'll take that initial impression and you know, make a mark on it and so that I remember it. But then I spend the rest of the time digging through the weeds to make sure there's not something else or something less obvious. That's really the problem now as far as, you know, the cellular medicine is really working just at the basic physiology of the cell and trying to optimize energy metabolism. You know, how do you take fat, protein and carbs and turn it into ATP, you know, and energy. It's going to be also, you know, ph balance. It's, it's going to be redox balance or reduct reduction, oxidation balance. So the things that make a cell run efficiently are the things that impair it from Running efficiently are also. If you can fix those then and you fix the cell. And if you fix a single cell, then you're on your way to fixing a multicellular organism, which is what we are. So it's very in depth and detailed actually. Now there may be some. Seems tangential, but you just have to understand the language of how that cell functions. And it's really very, very structured and organized way that it functions to be in its homeostasis or everything's happy and everything's running efficiently. So we just try to help it achieve that. Now there may be the group of problems that may create pathology or maybe different, but ultimately at the cellular level, they, they cause almost the same dysfunction. So it's like a lot of times I'll tell a patient that the scar is a scar. I can't tell you what, what cut it or what caused it. It's just a scar. But you know, so many things lead to that damage, but they all sort of lead to the same space.

Oh, that's so cool. I mean, yes, I would love to just geek out about all this. You mentioned redox. That was, that's something I Learned about about 12 years ago and yeah, transformative, really transformative. I'm not a doctor, okay, layman, but I started looking into what causes this and what causes that and I found my own, you know, again researching on the Internet. But you know, well, we don't really know what causes that disease but you know, it's associated with, you know, these lifestyle factors and oxidative stress. And oxidative stress just seemed to be this, you know, baseline thing that, you know, the body, we got to clean up the garbage, right? The body, the cells have to have a mechanism for recycling and cleaning up. And if there's too much trash piling up, they can't clean up. And so then it builds up and we get sick. I mean that's my.

Well, and it's a balance too. You can have reductive stress too, where you have too many reducing agents. And a lot of times now we'll have, you know, the just like ph, you know, acid base metabolism where a cell is designed to function in a very narrow range and be healthy. There's a narrow range of redox balance where the cells happiest and functions most efficiently so you can over antioxidize. And that's actually, you know, happens nowadays. People think that taking too many anti, you know, they take too many antioxidants, therefore they have now reductive stress. So the cell is not efficient in that space. Just like it would be if it doesn't have enough antioxidants.

Now that's a brand new. I hadn't heard of that. Very cool.

Sure you don't want to come to Florida to practice?

I don't know. We.

We.

I think I'm a Florida native, so I was born in Homestead, so we.

Are kind of interested in that whole Sarasota area. So if you've got an idea.

Well, that's only an hour, so we're good.

We'll keep our eyes open. What's next for you guys? Like, where do you see your. Your practice in five years or so?

So what we're trying. What we've been doing for the last few years is, you know, as we grew, whenever you grow and there's just a few of you and it's all hands on deck and everybody can pinch hit and that type of thing, and then you start to grow your team, you need standard operating procedures, different structure, that type of thing. And so we've been. Our practice has been really growing quite a bit in the past, I'd say, four or five years. So as we've done that, we've tried to really create systems and processes so that we are able to duplicate in a number of different ways. One of them is that we actually just recently hired our first physician into the practice, and Carl is working with her and training her on how to think like this, which has been wonderful because ultimately we do want this to be standard of care, which is why Carl mentioned earlier that we go about a lot different. You know, I think we've been out of town several weekends in the past two months. We go out and we. And we work with other practices and practitioners that want to apply these principles in their practices, but also for our own, we do want to make it to where Carl is not the only physician here, therefore the only one that can see patients, but he has trained a team that can apply these principles. You know, this MTC method, if you will. And then, I don't know, we're kind of looking at, like you just said, expanding that.

That's wonderful.

We have to get the prototype just right.

Just right.

Right. Scaling's hard in this type of business because there's a lot of intellectual knowledge and experience that you can't just plug anybody into it and create that over again. So. But we're trying to work with ways to develop algorithms and management strategies that will allow that to be duplicatable or scalable, whether that's with other people or with technology to allow that.

That and using that lens, like Carl talked about earlier, of thinking at that very base level, how is the cell malfunctioning? What does it need? And, you know, people applying that cell cellular biology right at that level to start to think through problems ultimately is what will make this duplicatable. But it's going back to your original training, isn't it?

It's back to that stuff where you took the class and you, like, forgot about it and then went on and.

Oh, I'll never need that.

Yeah, yeah. But we, you know, all of that stuff I had to relearn, you know, cell physiology.

Okay. Yeah. Because you. You learned it, but it wasn't really something you. You had direct interaction with. So it was just.

There's no application.

No application, Slight geometry.

I don't know if that's coming back.

Now. We use algebra when we cook. That's what I always tell my kids. You use algebra when you confront. Convert recipes.

There you go.

We've got a friend that loves to send us memes about, you know, another. Another week went by and I didn't use algebra. Oh, goodness. This has been wonderful. Thank you so much.

We appreciate you sharing everything in your wisdom with us. This is great. Is there anything that you would tell a small family business, you know, that are out there just kind of struggling, you know, any words that could help?

I think it. And this. I think we've experienced this a number of times. Sometimes when it's darkest is when you are getting ready to. To turn around whatever situation that you're working on. When it just seems like, oh, my goodness, what were we thinking? What were we doing? If you've been thoughtful as you've gone along, I'm not, you know, I'm not saying, oh, just go capriciously, do whatever you want and let it, you know, go wherever it will. But if you've been thoughtful and you're moving through the steps, but it just seems like, oh, my goodness, how are we ever going to get through this? Or what's going to happen? I have noticed, and I don't know if you have or not too, but over the. Over the many years we've been doing this, that sometimes when it just seems the very darkest and you're thinking, what was I thinking? That's when it shifts and you.

It's like, no pain, no gain for me. That's the way I look at it.

There we go. Fabulous.

It's gonna hurt a little bit to get to the other side, but it's.

Worth the effort, but it's always worth the effort. Oh, that's a great place to.

And growth without a little bit of hurt. Doesn't happen, does it?

No, not at all. If it was easy, anybody would have done it and. Yeah, that's right.

Remember growing pains when you were. When we were growing and things hurt and it was just kind of like. Well, it's all part of the process.

Stretchy.

Yeah, that's right. That's right. Yeah.

All right, well, we'll wrap it up.

Here and so people can find you@medicaltransformationcenter.com okay.

Those will be in the show notes.