Pelvic Health & Orthopedic Physical Therapy
Addressing your questions about pelvic, women's, and musculoskeletal health. Health is a journey. Movement is healing!
So we are in the final countdown leading up to my second scheduled excision surgery. New town, new surgeon, new plan. I have so many emotions leading up to this procedure. My first surgery was November 2019 where I was diagnosed with stage III endometriosis impacting my right ovary, ligaments, nerves, and ureter. The surgeon indicated postoperatively she had to "fillet" my ovary to remove the endometriosis and that she could not remove all of the disease. The recovery from the first surgery was tough. I ended up in the ER twice and had to go to do a second MRI postoperatively. I had a few months of relief, but then my initial symptoms of pain came back with a vengeance. Cue the second act. I am scheduled with an endometriosis excision specialist in St Louis in the next few weeks.
I am now in this wild emotional ride of fear, hesitancy, anxiety, and hope. I hope that this is the procedure my body needs to remove all of the endometriosis tissue. I hope this is the last surgical intervention I need to start my healing journey. But even with these hopes I also feel a sense of dread and fear. I very much remember how difficult my first recovery was. It is not something I am looking forward to reliving in the next few weeks. What if they don't find anything in my surgery? What then is causing my pain? What if the surgery does not help, but worsens my pain? I have been reading a lot of success stories from other patients who had a second surgery with my physician. That helps to ease my anxiety a little bit. I've been trying to get myself physically and emotionally ready. These past few weeks I have been organizing my house, almost nesting if you will. My endo box of resources is ready. List of these items below! I have been strategically buying comfy clothes throughout the past year for my recovery. I am filling my space with items that comfort me and bring me joy. Treating myself with Trader Joe flowers, a new candle, soft blanket. Mentally, I have been talking with my counselor. I am doing preoperative and chronic pain meditations. I am filling a journal with my thoughts and feelings. After surgery I plan on going for walks, working through my Netflix list, embroidering, and reading a few books I just ordered from the library. Also starting to play with the idea of creating my own wellness and health coaching business, so stay tuned for that! If you have any other suggestions for things I should do after surgery to support my healing please let me know! I would appreciate any prayers, good vibes, or healing energy you can send my way this month. As promised my endo go box: -Heating pad for shoulders -Ice Pack -High waisted underwear (1 size bigger) -Cotton Pads -OTC stool softners and gas meds -Biofreeze -Pillow for protecting incision site in car -Abdominal binder -Toiletries Other endo items: -Pregnancy Pillow -Loose fitting dresses, sweats, shorts -Peppermint Tea -Ginger Turmeric Tea -Squatty Potty -Compression socks I've had pain since I was a teen. I have seen more women's health provider's than I can count.... in the past two years alone I saw 6 different physicians. Each one had a similar treatment planned, which failed over and over again--birth control, pain medication, heat, topical creams. As a pelvic health provider this has been incredibly frustrating. Those things patients tell you that make you cringe, I've heard them as a patient too. "Drink more wine", "maybe the tampon is too big", "periods are supposed to be painful take some naproxen", "your symptoms will only improve with birth control", "maybe you should seriously consider whether you want to have kids", "you are just too complicated, what a mess". That last one was my favorite, let's just say that was the first and last visit with that provider. So many ultrasounds, CT scans, and MRIs all normal.
You know what isn't "normal"? Constant sharp pain in your abdoment and back that keeps you from sleeping and drains your energy during the work day. Constant fatigue. Period cramps so painful that you're tied to a heating pad. Pain with feminine hygeine products. Pain with sex. Bloating which increases your pants size by two sizes. It took me 11 years and LOTS of self research to find one physician who took my symptoms seriously and affirmed that my symtpoms were not "normal". Four weeks later I was scheduled for an endometriosis excision surgery. While I have worked with patients recovering from similar procedures, I really didn't understand the depths of recovery. November 2019 I had an extensive endometriosis excision surgery where I was diagnosed with Stage 3 endometriosis on many aspects of my pelvis and abdomen. My right ovary was filleted to remove the a majority of an endometrioma. Nerves were adhered in my abdomen and had to be freed. I knew the recovery was going to be painful, but I had no idea just how long it would take. Initially as a PT I was really angered that when discharging from the hospital NO ONE spoke with me about bed transfers after having an abdominal surgery. COME ON NOW. You are weak, your nerves have been disrupted, and there is a higher chance of developing hernias if you rely on a vaslava to get up and move. A few weeks later my chest pain was still very persistent, I was having a difficult time sleeping, and shortness of breath. I was advised to immediately go to the ER to be assessed for a pulmonary embolism. It wasn't thank GOD! Six weeks later I was feeling pretty good, I passed my follow up with flying colors and advised to start pelvic PT and resume sex. So I started some gentle abdominal tissue work to address scar tissue. Not a great idea. I started to have searing, constant belly button pain. I couldn't wear pants because any contact in that area burned. I was sent again to the ER and for further diagnostic testing, nada. I suspect I flared a nerve. It was pretty angry for a few weeks. I felt so disconnected from my body. I was having a difficult time connecting with my abdomen and pelvis, it just didn't feel like it was mine. Emotionally and mentally it was difficult to recover. Not just because my body wasn't my own, but the compounded trauma from years of living with chronic pain and the toll it takes. It changes your relationship with other people as well as your relationship with yourself. It is so disheartening to see so many proclaimed experts who try to diminish the validity of your symptoms and offer solutions you have tried for years. Six months out and I am better, but still not painfree or symptom free. I still have flares of pain which limit my ability to participate in life and disrupt my sleep. But, I am constantly building my treatment team and plan. Professionally here is who I have seen in the past 6 months:
I still struggle with connecting with my body. I am just starting to feel strength in my body again, it is definitely weak. I think this will be an ongoing journey to recover and thrive. Most days I am hopeful, some days I am not. But I plan to continue to share my journey with you all. Be well! What a crazy year. I apologize for my hiatus, it was unintended. Let's catch up on the cliff notes.
I have struggled with debilitating back and abdominal pain this year. Which drained me at work, at home, in my relationships leaving me constantly exhausted and a shell of myself. It was a daily struggle to make it through the work day and try to come home and make dinner. While surgery definitely helped to alleviate my physical pain, some still remains. It also left me feeling disconnected from my body--the mental and emotional impacts were completely unexpected. I became physically weak. (Six months later and I am FINALLY starting to feel my strength returning.) When you are constantly in survival mode, you neglect other aspects of life. The silver lining, I have so much more empathy for my own patients. I also get to experiment with different treatment modalities firsthand and figure out what resources I can pass on. So now with all my down time during my transition I have the opportunity to reflect on what I value, how I want to live my life, and what kind of relationships I hope to cultivate. Let's not kid ourselves, these stents of introspection are fleeting during quarantine. I'm doing some serious work on my Netflix list too. Be healthy. Stay well. Your first year out of school can be daunting. You passed all of your classes. You studied and passed the boards, which at the time seemed like the most difficult task of a Physical Therapist's career. Now for the fun part, practicing! You are a trailblazer entering the specialty field of pelvic health! You may have started some course work as a student. You felt invigorated! But where do you go from here?
1. Develop short term and long term professional and personal goals. This will help to design a path for your first few years out of the gate. Where do you see yourself going? Do you want to get involved in the Section on Women's Health? Do you want to get certifications? Do you want to set yourself up for independent practice? Start with a few things you know are attainable. Maybe it's setting up mentorship. Maybe it's marketing to or shadowing with a physician. Maybe it's just stepping up your social media game. Whatever your personal goals may be, write them down. 2. Find resources. This was one of my biggest influences as a brand new graduate. I maintained my membership to the SOWH and APTA. In doing so that allowed me access to the SOWH journal. My Medbridge subscription was also well worth the $. You can find all sorts of discount codes, but for the price you get access to con ed (and if you choose HEP programs). Social media has also been a HUGE resource! You would not believe the information I get from Facebook groups, Twitter, and free summits hosted by medical professionals. They are also a great place to network. Continuing education is fantastic, but expensive and can be time consuming! So check out other avenues for information as well! Also related to resources---when you find a great resource save it or print it and start to build your library. I have a accordion file folder full of journal articles and patient resources which has come in really handy! 3. Build your support network. As pelvic health physical therapists we practice so independently it is important to have a network of support. That may look different for different people. I've worked in hospitals with multiple pelvic health PTs where we all discuss challenging cases and treatment techniques openly and as an independent practitioner in an ortho heavy clinic. Regardless, have people you can talk to. It may be the people you meet at continuing education. It may be individuals you network with online. It could even be people you meet at conferences. 4. Prioritize self care. Make sure you take time for yourself. It is a fine balance between your professional and home life. Your professional life will be there. Make sure to take care of yourself and cultivate your relationships outside of work. I didn't realize how poorly I was caring for myself until I actually started making time for myself. That also comes with setting boundaries and saying no. Now don't get me wrong it's great to take on new and exciting opportunities, but this is where your goals come into play! Examine your personal and professional goals to ensure if new opportunities align with the vision you have for yourself. If they don't, don't feel guilty about saying no! 5. Stay curious and be kind to yourself. Healthcare is a team sport. Many of the individuals we see in the pelvic health realm have complex diagnoses! Start from one angle and continuously treat and reassess. Don't be afraid to refer back to the physician though. Sometimes there are barriers to musculoskeletal healing or other adjunct treatments need to be in place for success. Some people just aren't ready for the PT aspect of their health journey. One of my mentors told me as a very new graduate if you can give someone one thing that is helpful to them you are successful because you are still making an impact! I think that is completely true! It is all about perspective! Health is a journey. Best of luck in your journey as a pelvic health practitioner and welcome to the field! If you have more specific questions drop a comment or a message. So pretty neat, more studies are being performed looking at pelvic floor training for overactive bladder. One study I came across this morning was recently published in the American Journal of Physical Medicine & Rehabilitation. I'll post the link I found below, but to summarize the findings they looked at pelvic floor training for Overactive Bladder (OAB) and urinary incontinence in two groups of women. One with idiopathic cause of symptoms. One group who had been diagnosed with Multiple Sclerosis. The researchers were monitoring the activity of the detrusor, the muscular layer inside the bladder. With their standardized exercise protocol almost half the women with idiopathic cause and about a fourth of the women with MS showed elimination of detrusor overactivity. So what does all that mean?
The bladder is a muscle. It has muscle on the outside, muscle on the inside. These muscles give and get information from the nervous system. The muscles of the bladder are also impacted by tissues around it like the pelvic floor muscles. There are certainly a lot of factors that can contribute to overactive bladder and incontinence. The link between the muscles of the bladder, the pelvic floor muscles (which are further south), and the nervous system play a large role. Proper use and implementation of urge suppression techniques suggested in this study can be helpful in hitting a reset to the system. A pelvic health physical therapist can help to assess and instruct individuals in proper urge suppression, as they were also part of this study. Essentially utilizing your pelvic floor muscles (which you can control), sends a message to the muscles of the bladder, which relays through the nervous system and brain to decrease the overwhelming urinary urge. Pretty awesome use of our voluntary nervous system! Study summary can be found here: https://www.sciencedaily.com/releases/2018/10/181019120736.htm Full journal: https://journals.lww.com/ajpmr/Abstract/publishahead/The_effect_of_pelvic_floor_muscle_contraction_on.98382.aspx Osteoporosis is common in older women after menopause. The cells in the bones that make cells don't work as quickly as the cells breaking the bones down. Exercise can help keep bones strong and prevent fractures with osteoporosis. You want to focus on weight-bearing exercises as well as exercises that help increase muscle mass.
Weight-bearing exercises include activities where you have to work against gravity. This type of exercise can be squats, balancing, lunges, step-ups, walking, jogging, etc. They can vary in intensity. Strengthening exercises build the muscle bulk. Most exercises can be converted into a strengthening exercise. It is not limited to utilizing weights or bands. You can still use your body weight to strengthen the muscle (it isn't exclusive!). If you have been diagnosed with osteoporosis or osteopenia and have concerns of fractures consult a local physician and physical therapist for proper exercise. One of my biggest pet peeves as a pelvic health PT is when runners or weight lifters think they need to leak urine to prove a good work out. Ugh! First of all it's gross. Second of all we don't see a problem with having an accident? If you are peeing unintentionally during any activity which does not include you sitting on a toilet you should see a pelvic and women's health physical therapist. Let me explain why.
The abdominal cavity has four sides to it. The top is the diaphragm. The front is the abdominal wall. The back is the spine and back musculature. The bottom is the pelvic floor. When you leak urine with exercise it indicates to me that something in this system is not operating to its best ability. In fact there may be more than one thing. Urine leakage generally indicates pelvic floor weakness. Weakness in this area means that one key aspect to the "core" is not optimally functioning. When we take a closer look what a pelvic and women's health physical therapist may find is that other aspects of the abdominal cavity are working less efficiently or compensating due to lack of coordination with pelvic floor musculature. Okay, okay you don't leak all the time. Just after the 10th mile on the pavement. Or just when you hit your rep max with dead lifts. This is still something we can work on. Yes it could still be a deficiency in pelvic muscle strength or endurance. It could be that the force of running on pavement or your form as you start to tire change your ability to activate pelvic floor muscles. It could be you don't even realize you are holding your breath with lifting which creates increased pressure on the bladder. So the moral of the story remains the same. You still should not accept urine leakage with exercise. A pelvic health physical therapist can help assess and treat this type of urine leakage and improve your work outs. Breastfeeding has irrefutable developmental benefits for infants. Oftentimes mothers are shamed for breastfeeding in public or trying to pump at work. Nourishing a baby is not shameful. August is breastfeeding awareness month.
Some women who elect to breastfeed may experience clogged milk ducts. These clogged ducts can cause pain. Physical therapists can be part of the treatment team for this diagnosis. They can help women to learn and perform tissue mobilization techniques. Physical therapists can also utilize therapeutic ultrasound to treat clogged milk ducts. The therapeutic ultrasound uses sound waves to heat underlying tissues.
From the little flutters to the ninja kicks, it is crucial for developing babies to move in the womb. These movements aid in development of the musculoskeletal system helping to strengthen the muscles. Even after birth movement is important as the infant learns how to explore their environment and develops more complex movement patterns.
I saw this amazing video again today of a baby moving in the womb, brought to us by MRI technology.
You see the floor the baby is pushing off of to tap dance and flip? That's the bottom part of the uterus and it has a close proximity to the ever important pelvic floor muscles. Every individual who has been pregnant and given birth should be assessed for changes to the pelvic floor muscles and rehabilitated appropriately! Need to keep those muscles functioning after serving as a dance floor.
This post brought to you by my recent trip to the Grand Canyon, it got me reflecting...
Chronic pain is a bit of a beast. It bears its ugly teeth and its bark is as bad as its bite. As time continues this chronic pain can feel like it is worsening. Pain is a nervous system response to something the body perceives as dangerous. Acute pain is a natural protective response of the body. If you step on a Lego your body recognizes the threat (you know exactly what I am talking about) to the foot and responds by having you pull your foot away from the Lego. The pain goes away and you continue to function. Wallah! That is what we want our bodies to do. It gets tricky when we have an experience or injury that causes longer lasting pain. Let's say you are a working mother of a few young children. You have a desk job and commute into work. You also have young kids at home which requires lifting kids, taking kids in and out of carseats not to mention the housework you do with standing, lifting, and bending. Your youngest still has a difficult time sleeping throughout the night so rarely do you get a full night of sleep. Since the birth of your youngest you really have had time to return to exercise. Sound familiar? Maybe you can identify with aspects of this hypothetical case. You start to notice some back pain throughout the day. It really isn't that bad, you pop a few ibuprofen and get back to life. Your pain gets progressively worse over then next year. You now have this pain constantly that is altering your ability to do the things that you need to do or enjoy doing. Movement is healing. Movements can help to regulate the nervous system to decrease the intensity of pain in the body. They key is finding movements that feel good and possibly making some changes to the movements you do throughout the day. This is where physical therapy can be really helpful. Physical Therapists are movement experts, especially in the rehabilitative process. The key to healing from chronic pain is to remember that is a journey. There will be good days and bad days, but the number of good days will increase with persistence. Persistence and patience are crucial! Just like the Colorado River in forming the Grand Canyon. If the waters of a river can persist to form a canyon 277 miles long, 18 miles wide, and a mile deep you can persist against your rock barrier, pain. |
AuthorHello! I am Caitlyn, Doctor of Physical Therapy and Board Certified Women's Health Physical Therapist working in St Louis, Missouri. Faculty in developing residency program. Endowarrior Categories
All
Archives
July 2021
|