Bladder Chatter

By Riva Preil

The School of Pelvic Health returns tonight, Tuesday October 21, 2014 (7:00 PM) with a fascinating class entitled Running to the Bathroom, Again!  Stephanie Stamas, physical therapist at Beyond Basics Physical Therapy, will discuss the urinary system’s anatomy and physiology.

She will then explain what happens when this system is not functioning properly, and she will elaborate upon urinary urgency (“I have to go and I have to go NOW!”), urinary frequency (constant feeling of needing to urinate, even if one has recently done so), and urinary incontinence (involuntary loss of urine).  Stephanie will explain the differences between the various types on incontinences, particularly stress, urge, and mixed incontinence.

Other topics that will be addressed are urinary tract infections (UTI), what increases the likelihood of developing a UTI, and how to distinguish between pelvic floor dysfunction and a UTI.  Stephanie will also address INTERSTITIAL CYSTITIS (IC), a common diagnosis that patients self-diagnose on WebMD, and the difference between pelvic floor muscle dysfunction, which often presents symptomatically as IC, versus actual IC.

Male pelvic floor issues will be addressed as well!  Stephanie will discuss prostatitis, prostatectomy, and benign prostatic hyperplasia (BPH).  She will explain how physical therapy, including bladder retraining and irritant avoidance, can help address the aforementioned diagnoses.

Men and women alike stand to benefit tremendously from the information Stephanie will share with the class.  The class will conclude with a Q and A session, and many yummy, healthy treats will be available for participants.  Furthermore, a free DVD of “Healing and Abdominal Pain” will be distributed to all first time guests.

We look forward to seeing you on OCTOBER 21 AT 7:00 PM!  Please email any questions or comments to us at desk@beyondbasicspt.com.

 

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Uppity Science Chick

By Riva Preil

Dear readers, I have found SUCH an incredible and informative website that I simply MUST share it with you.  Not only because the quote on the homepage is fantastic, (“Well behaved women rarely make history,” Laurel Thatcher Ulrich), but because the evidence-based material on the website is amazing.

Kudos to Dr. Kathleen Kendall, PhD, for creating Uppity Science Chick, an educational and helpful website that provides an abundant amount of material for women.  Dr. Kendall discusses a wide array of topics including women’s health, breastfeeding, postpartum depression, Omega-3s, and obesity.  She provides articles and research for the material that she shares which enables readers to make informed health-related decisions.

According to Dr. Kendall, “I have had a lot of people ask me about why I started this site. It all started with some conversations with some male colleagues who implied, among other things, that “girls can’t do science.” Au contraire!  Not only can “girls” do science, but they are setting the world on fire with their discoveries. These studies can change your life.  UppityScienceChick.com offers a forum for sharing current and noteworthy research on the mind-body connection and how it relates to cardiovascular disease, diabetes, trauma and PTSD, depression in new mothers, and breastfeeding.  I hope you find these studies to be helpful in your work–and life.”

Thank you, Dr. Kendall, for sparking our curiosity fires and providing us with the ability to learn and grow.  Not only are you a “girl who does science,” but you are an inspiration who is ROCKING THE RESEARCH.  Please keep the material coming!

WE WANT TO HEAR FROM YOU- please share your thoughts!  What is YOUR favorite article on Uppity Science Chick?

Be Cool, Stay in School

By Riva Preil

Get excited for the incredible new FREE seminar series at Beyond Basics Physical Therapy, The School of Pelvic Health!  This educational series, taught by our very own STEPHANIE STAMAS, is designed to inform individuals on pelvic floor muscle function, the connection between the pelvic floor and pain free movement, and to provide tools that will help participants improve bowel, bladder, and sexual function.  In addition, the seminars create a safe environment for patients to interact and build community with one another.

All seminars will be followed by a Q and A session for further discussion with Stephanie.  Also, classes will contain a practical component, during which Stephanie will teach a technique (ex. stretches, mindfulness and relaxation, diaphragmatic breathing) which will give participants a useful take home tool to improve their quality of life.

Speaking of take home tools, a free “Healing Pelvic and Abdominal Pain,” Amy Stein’s new self-care DVD, will be distributed to each first time guest.  In addition, a $20 voucher for products sold at Beyond Basics Physical Therapy, including Amy’s book Heal Pelvic Pain, meditation CDs, and massage stick will be given to individuals who attend five or more seminars.  Plus, snacks and beverages will be provided.  Knowledge, free DVDs and tools, and food…it’s the best of all worlds!

Stephanie will be teaching the first class on October 14 at 7:00 PM, entitled Something’s Wrong With my What?  It will be a review of pelvic floor muscle anatomy and its relationship to bowel, bladder, and sexual function.  Mark your calendars and be sure to join the launch of this fantastic new program!  The inaugural event is sure to be a hit, and we look forward to seeing you there!

 

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Next on The Pelvic Messenger: Dr. Khalid Khan

By Riva Preil

Get excited for International Pelvic Pain Society (IPPS) Conference in Chicago, October 23-26, 2014!  Some of the interesting topics at this year’s conference include updates on chronic pelvic pain, yoga for pelvic pain, and a fascinating Post-Conference Course, New Perspectives from The Integrated Systems Model for Women’s Health, from our blog talk radio superstar herself, Diane Lee.

Speaking of radio superstars, one of the other keynote speakers at IPPS will be Dr. Khalid Khan. Dr. Khan graduated from Medical School in 1989. Currently, he is a Professor of Women’s Health and Clinical Epidemiology at Barts and the London School of Medicine. His academic expertise is in patient-oriented health research and medical education. He has published over 200 peer reviewed journal articles making contributions in systematic reviews (meta-analyses), trials of treatments and tests, health technology assessments, and evaluation of educational methods. His book on Evidence-based Medicine has won the BMA medical book competition. He is Editor-in-Chief of British Journal of Obstetrics and Gynaecology.

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In order to whet your appetites for the amazing topics he will cover at IPPS, I will be interviewing Dr. Khan on our blogtalk radio show The Pelvic Messenger on October 14 at 10:45 AM.  The topic of the show is Translating Translational Research: Let’s Get Practical with Dr. Khalid Khan.  Dr. Khan will explain translational research, the CROWN Initiative, the impetus behind it, and how to make the most from the vast sea of research being performed.  We will also address certain pre-natal and post-partum topics and myths, including whether or not inducing labor increases the likelihood of requiring C-section delivery.

To learn more about these and other fascinating topics, tune into the show on October 14!  I encourage and invite you to email questions in advance to riva@beyondbasicsphysicaltherapy.com.  Looking forward to hearing from you!

(More) Kegels for Men?!

By Riva Preil

Women have long been familiar with the benefits of pelvic floor strengthening exercises, colloquially referred to as “Kegels,” in honor of Dr. Arnold Kegel, the individual who first described them in 1948.  Almost any woman who has ever been pregnant has been told by her doctor, sister, or friend to engage in Kegel exercises to help strengthen the muscles that get stretched and weakened during the nine months of pregnancy and during labor and delivery. However, recent conversation in the International New York Times (Pelvic Exercises for Men, Too, July 14, 2014) has turned to the benefits of Kegel exercises for MEN.  Author Roni Caryn Rabin describes how pelvic floor strengthening benefits men with urinary incontinence and possibly even sexual dysfunction.  Research has shown that Kegels are helpful for men who experience premature ejaculation, and they may possibly help men with erectile dysfunction. Rabin interviews urologist Dr. Andrew L. Siegel, creator of a pelvic floor muscle strengthening system for men called Private Gym.  The system utilizes light weights attached to a silicone band that is placed on the penis to provide resistance training to the pelvic floor muscles. Dr. Patricia Goode, medical director of the incontinence clinic at University of Alabama, participated in research in 2006 which proved that Kegels help restore continence in men after radical prostatectomy.  In fact, the results are startling- the group who participated in Kegels post-surgery were ALL, on average, fully continent within 3.5 months compared to the control group (no Kegels performed), HALF of whom were not continent after SIX months. So, men, I challenge you to join your lady friends and join the Kegel club!  If you have no idea how to perform a pelvic floor muscle contraction or have any questions about pelvic floor health, we here at Beyond Basics are happy to assist! Please let us know if there is anything we can do to help.

Know Your Nodes, Part IV

By Riva Preil

So, how does physical therapy help treat lymphedema?  Great question, I am glad you asked.  The gold standard of care to treat lymphedema is COMPLETE DECONGESTIVE THERAPY (CDT).  CDT consists of four components:

  1. Manual Lymphatic Drainage (MLD)
  2. Compression
  3. Exercises
  4. Skin Care

MLD was pioneered by Dr. Emil Vodder in the early 1900s, and it is series of various manual techniques (including “pump,” “rotaries,” “scoop,” “and pump-push,” to name several) which promote moving the excess lymph fluid from the distal extremities towards proximal, healthy open lymph channels.  Another way to think about lymphedema due to lymph node removal is that there is congestion on one “road”.  Therefore, the certified lymphedema therapist (CLT) seeks to open up and create new channels on uncongested “roads,” thereby creating detours for the lymph to return to the venous system through alternate routes.  MLD allows the CLT to direct the lymph along healthy, open lymphatic pathways.

In addition, appropriate compression must be applied to promote the return of lymphatic fluid and to prevent it from improperly pooling in affected areas.  Therefore, compression is an appropriate component of CDT.  During the acute first phase of treatment, bandaging should ideally be worn 23 hours during the day and removed only for showering or bathing.  CLT therapists bandage patients with short stretch bandages and they teach patients how to perform self-wrapping.  During the chronic second phase of treatment, compression garments can be substituted for bandages during the day, either custom made or over the counter.  Bandaging is continued for nighttime usage in most cases.

No physical therapy experience would be complete without some exercise, right?  Exercises are important in treatment of lymphedema because the musculoskeletal system helps with venous return and promoting fluid movement by acting as a pump mechanism.  That’s why ankle pumps (ankle dorsiflexion and plantarflexion) are recommended after ankle surgeries, in treatment of postsurgical edema (swelling).  So too, similar upper extremity and lower extremity “pump-like” exercises help return lymphatic fluid to the venous system.  Depending on the type of lymphedema (upper vs. lower extremity) several examples of lymphedema appropriate exercises include ankle pumps, knee and hip flexion and extension, shoulder flexion and abduction, elbow flexion and extension, and wrist flexion and extension.

Finally, skin care is a huge component of CDT.  The reason for this is that increased swelling of any extremity increases the DIAMETER of the extremity.  This increases the distance that gases (ex. oxygen) and nutrients must travel to reach the surface of the skin.  This is referred to as increased diffusion distance.  Oxygen is a necessary component in skin healing after any injury, even simply a paper cut!  It is harder for oxygen to travel long distances compared to short distances, therefore increased diffusion distance (as in the case of lymphedema) SLOWS the healing process.  Slower healing rate increases the likelihood of developing an infection through the open wound.  Therefore, it is crucial for all patients with lymphedema to be vigilant about skin care and inspection.  Their wounds heal slower than those of other individuals, and it is important to minimize the chance of developing infection by keeping wounds clean and covered.

So there you have it!  That was a brief overview of “How I Spent My Summer Vacation.” I could not think of a better way to spend my time this summer.  Don’t get me wrong, a week in Italy or an Alaskan cruise are trips that I look forward to hopefully taking one day, but I am grateful that I had the opportunity to take this incredible course his past summer.  This course is rarely offered in New York, so I had to jump on my chance when I saw it advertised. Thank you to Amy for supporting my continuing education and to my co-workers for helping to treat my patients while I was at the course. Italy and Alaska can wait for me, because my patients are more important!

Know Your Nodes, Part III

By Riva Preil

Background complete- you have made it through the anatomy, good job!  Time to discuss the PATHOPHYSIOLOGY.  Unfortunately, things don’t always run as smoothly and perfectly as we just described, and dysfunction of the lymphatic system can result in LYMPHEDEMA.  Lymphedema (LE) is swelling of the upper or lower extremities due to impairment in the lymphatic system.  It can also develop in the trunk, head, neck, or genitals.  It is a chronic disease and treatment involves lifetime management of the condition.

There are two types of lymphedema, primary and secondary.  Certain individuals are born with a congenital malformation of the lymphatic system, (ex. the vessels are too large or too small).  This is known as PRIMARY LYMPHEDEMA.

Furthermore, an initially healthy lymphatic system can develop problems through infection, obstruction, or damage.  This is known as SECONDARY LYMPHEDEMA.  Globally, the most common cause of lymphedema is filariasis, a parasitic disease that is caused by thread-like roundworms which occupy the lymphatic system, including the lymph nodes.  The worms enter the lymphatic system through blood feeding mosquitos and black flies in certain tropical countries.

In the United States, the most common cause of lymphedema is breast cancer-related surgeries that involve removal of affected axillary lymph nodes.  Removal of lymph nodes results in impairment in the lymphatic system, and it disrupts the normal return of fluid to the venous angles.  This can result in swelling of the involved upper extremity.  Similarly, lower extremity lymphedema can develop after removal of pelvic and or inguinal lymph nodes (ex. due to prostate or gynecological cancer surgeries).

Lymphedema can develop days, weeks, months, or even years after surgical node removal.  Therefore, individuals who have undergone these types of surgeries should be aware of their predisposition towards developing the disease. Any abnormal swelling or changes should be reported to one’s physician immediately, because the prognosis is better if the disease is detected and treated earlier.

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