Learning Summary: Becoming the Best Event- Interview with Jessica Drummond

As you may know, part of my goal in writing this blog was to have a forum to process things I learn, and of course, to allow you to benefit from my nerdiness in learning. This week, many of my physical therapy colleagues from across the nation are traveling to Indianapolis for the American Physical Therapy Association’s Combined Section Meetings—basically a week of excellent presenters, networking, and seeing old friends. Of course, my heart is SO sad that I won’t be there this year—so I just had to find a way to learn on my own!

Thankfully, Jessica Drummond clued me in on Twitter to the Becoming the Best Event– a week long summit of (FREE) interviews with top holistic health professionals in the country! I read the bios, and I was in. I have been following Jessica for years (Didn’t know you had a stalker, did you Jess?:) ) and I have truly enjoyed learning from her. Jessica is a physical therapist and the CEO and founder of the Integrative Pelvic Health Institute. She has created a unique model of treating the whole person—managing the hormonal and dietary aspects as well as the physical—and she is pretty awesome at doing it! I was fortunate to collaborate with her this past year in caring for a wonderful woman who was experiencing sexual pain, and I can say from my experience that Jessica really did make a difference in her life!

Jessica Drummond

So, here is a summary of what I took from Jessica’s Interview:

  • In treating women, Health Care Providers (HCPs) must work to normalize women’s health issues. We should all ask about a woman’s menstrual cycle and reproductive history the same way we ask about diet, bowel movements and sleep habits. For some reason, women are taught from an early age that our normal cycle is something to hide and be embarrassed about. However, it is so important and can be one of the only clues to us that something is off! Did you know that an abnormal menstrual cycle could even be an indicator of Celiac’s Disease? I didn’t, until today.
  • Just like we individualize nutrition based on the person, exercise and fitness recommendations should be individualized based on the person. Jessica said this awesome statement during our interview, and I absolutely agree: “I actually don’t think there is any specific form of exercise that is bad—it’s the way, the intensity and your body’s readiness for it.” 
  • What about high impact activities (running, jumping, gymnastics)? Not “bad” either but can put women at risk for problems if they do not understand how to adequately use their pelvic floor muscles.  Increasing pressure on the pelvic floor without adequate timed recruitment can lead to problems like incontinence/prolapse. Jessica recommends that all athletic women should be mindful of their pelvic floors (not always Kegels!) and all HCPs working in wellness should ask questions and encourage seeking help when needed.
  • Women often ignore the benefits of our hormonal cycles—we are always encouraged to hide it from the time we are 12 years old! Estrogen and testosterone are at its highest right before ovulation (2nd week in the cycle). Women actually have more energy at this time, and will burn more fat when exercising these days! We can capitalize on that by eating a higher fat meal a few hours before we exercise to encourage our bodies to burn more fat. So, at mid-cycle- we should eat less sugar, healthy protein and good fats to encourage our body to utilize the natural hormonal environment. In the second half of the cycle, the body actually prefers using protein as energy! If a woman has a big fitness event at the end of the cycle- she may need to eat more often and will probably need more support since hormone levels are at their lowest. And what about running with gels and gus? Jessica actually says that doing this does not encourage our body to use the right fuels but rather pushes a simple sugar energy.
  • Women exercising intensely daily without modulating for hormonal cycle can end up being a negative thing—this does not necessarily allow for adrenal recovery and can negatively impact the system. Estrogen can become lower and this will put someone at risk for cardiovascular dysfunction (and poor bone health too!- JR add)
  • What about for pregnant women? There are some specific things that can be done to tweek a fitness program and get maximum benefits. First, it is important to recognize that the uterine environment is a very important environment to build. That environment can pre- program the genetic expression of the fetal genes. Weight issues, DM, PCOS, Metabolic issues can impact the environment. Clean eating (low sugar) with regular, healthy eating. Insulin sensitivity decreasing as pregnancy progresses can lead to big blood sugar swings which are also not ideal for womb environment. Eating healthy foods at regular intervals can help- focusing on eating nutrient dense foods, healthy fats and minimal sugars. Exercising (even just walking 30 minutes per day) can also help to control blood sugar and promote healthy blood sugar for the baby. Of note, pregnant women should be careful of actively detoxing during pregnancy and while nursing. Stored toxins are “hidden” from the baby and trying to “release” them can actually transmit those things to baby. That being said, a more intense detox before pregnancy can actually be a good thing.
  •  Hormones are of course significantly impacted during menopause. Did you know we can help prepare for menopause? Jessica recommends women focusing on building strong adrenal function during their 30s and 40s, emphasizing addressing stress, nutrient density, and controlling blood sugar. Doing this can impact the entire hormonal environment and create better health for women as they age. During menopause, women lose the estrogen support from ovaries–but having healthy adrenal glands can help a woman make enough estrogen to minimize menopause symptoms (including hot flashes, discomfort and brain fog!)
  • And lastly, what about us health care professionals? How do we avoid adrenal burn-out? It is essential for us to create a fairly strict list of priorities focusing on our vision for our life: What do you want life and work to be like? What must your health be to support this life? Jessica encourages prioritizing self-care and in an oh so inspiration way, encouraged us to “Be an inspiration for patients rather than being the person resposible for ‘fixing them.'” She also encouraged eliminating the guilt we often feel from being unable to cure everyone. She said, “You are not everyone’s healer.” We cannot heal everyone, but there are specific people out there who need our specific skill sets. Our goal should be to provide the knowledge, wisdom and skills patients need to allow themselves to heal. When they see us as an inspiration, they will take the responsibility to own their healing, wellness and healthcare. And this is a total mindset shift! We don’t have to feel guilty when we cannot help someone! And this frees us to really be what we need to be for the people who need us.

Thanks so much Jess for all of this great information! Please check out Jessica’s website for more information about her and the awesome work she is doing! If you would like more information on the Becoming the Best Event, please feel free to check it out here! You can access all of the interviews for free for 24 hours after they air, or you can pay $97 to access them whenever you would like!

Hope you enjoyed this summary! Please let me know any thoughts/comments you have below! ~ Jessica

Throw-back Thursday: When “Kegels” are not appropriate for Urinary Incontinence

For the next few weeks, I plan to re-blog/update every Thursday a previous post originally written by me when working in Greenville, SC for the Proaxis Pelvic PT blog (http://proaxispelvicpt.wordpress.com), in hopes of building a comprehensive library of posts at jessicarealept.com. Selfishly- I like having them all in one place since I often refer patients who come to see me in Atlanta for pelvic PT to my old posts to read as “homework.” 

That being said, today’s post is one published a while back here, originally titled, “Yes, you have incontinence. No, I do not necessarily want you to do Kegel exercises.” It has been modified/updated for you today 🙂 Enjoy! 

~ Jessica 

Recently, I was fortunate to evaluate a nice middle-aged woman referred to me by her urogynecologist for urinary incontinence. When we first sat down, she looked at me and said, “I’m not sure why I am here. My doctor specifically told me that I have a strong pelvic floor. I really don’t think you can help me.” I smiled. I hear this same thought process on a weekly basis (See my previous article on common misconceptions of pelvic physical therapy) You see, at some point the world became convinced that from a musculoskeletal perspective, stress urinary leakage is always due to a weak muscle. And the best way to fix a failed muscle is to strengthen, strengthen, strengthen. But, if that’s the case, then why do I have so many patients walking into my office telling me that they have done “Kegel” exercises and still leak? Why would a patient like the one above have a “strong” pelvic floor that cannot hold back urine? Why is urinary leakage associated with low back pain and pelvic pain- disorders that we know can often include tight and irritated pelvic floor muscles?

Now, as a caveat to this article, let me say now that it is sometimes totally appropriate for a person to start a pelvic floor strengthening program. In fact, the person with a truly weak, overstretched, poorly-timing pelvic floor will likely be prescribed a strengthening program. With that being said, the truth is that the majority of patients referred to my clinic for evaluation of urinary incontinence are not issued a traditional kegel exercise program. My colleagues and I actually tend to be surprised when we evaluate a new patient who truly needs to start a true “strengthening” program for their pelvic floor at the first visit. The reason behind this is that Stress incontinence is not simply a failed muscle, but a failed system.

The urethra is supported within the continence system by fascia, ligaments, as well as muscular structures. When a downward force is applied to this system as occurs with coughing, sneezing, lifting, bending, etc, these structures function in a coordinated way to compress the urethra and prevent urine from leaking. In fact, Hodges et. al. in 2007 examined musculoskeletal activation occurring when a person performed an arm movement and found that the pelvic floor muscles pre-activated to prepare the body for movement. This helps to demonstrate that our pelvic floor muscles function as a member of the anticipatory core team. This team requires optimal and coordinated function of the diaphragm, the deep abdominal muscles, the deep low back muscles as well as the pelvic floor muscles. My awesome colleague, Julie Wiebe demonstrates that relationship very well in the video below (Note: Julie has an AWESOME blog/website- read more of her stuff here):

When any of these structures are not functioning well, leakage can occur. Now, the tricky part here is that optimal functioning requires both strength, flexibility and proper timing. A tight irritated muscle then becomes equally as dysfunctional as a weak over-stretched muscle. And, a strong, flexible muscle that doesn’t have the right timing contributes to a very dysfunctional system.

So, treatment for incontinence then must include retraining and reconditioning the system to ensure its proper functioning—which for me includes a bit of detective work to truly identify the faulty components. And, when it comes down to it, typically does not include doing 100 kegel exercises a day. More often, it includes learning to relax the pelvic floor and teach the pelvic floor to be a working team member– learning to coordinate the pelvic floor with the diaphragm, eliminating trigger points and restrictions which may be inhibiting this function, and then retraining the motor control of the lumbopelvic girdle as a system.

So, for now, take a deep breath and relax. We’ll save Kegels for another day.

For more information, check out the following:

I hope you enjoyed this throw-back- please feel free to share any thoughts or questions below!

~ Jessica

Partners in Health: Building a Strong Patient-Provider Relationship

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In my mind, one of the most important aspects of patient care is building a strong patient-provider relationship. I find that treatment outcomes truly depend on the patient being able to trust the provider and the provider truly listening to the patient. For many patients, seeking treatment can be intimidating and produce fear—of the unknown, of what the diagnosis could be, etc! This fear can lead to patients feeling a need to hold back thoughts or beliefs and can ultimately create barriers in treatment which leads to frustration by both the provider and the patient. Providers, on the other hand, can often contribute to fear or stall progress without intending to by not individualizing treatment and partnering with patients.

So—this post is for all of us! These are a few of my thoughts—both advice for the patient and for the provider on how to better build a partnership in healthcare. But more importantly, I want to hear from you. So, read on, and comment at the end so we can all learn to work together better and improve the way we deliver and receive healthcare.

For the patient:

  1. Remember that you have control: I have had several instances where a patient will say “yes” to a prescribed medication or will feel pressured into having a surgery that he or she really did not feel comfortable in having. If a physician, PT or other healthcare provider recommends a treatment that you are uncomfortable with, don’t be afraid to speak up and say so! Remember that we as providers want to help you get better as quickly as we can. If you are unhappy with the treatment plan, that won’t happen!
  2. Don’t be afraid to speak up: Many times, we as providers forget that not everyone has the same background knowledge we do when it comes to the human body. If you are being told something you don’t fully understand, speak up! I always thank my patients when they ask me questions because helping you understand and feel understood is such a key piece of my practice. Often times, those questions help me personalize treatment approaches and often I find we end up in a better place by those conversations we have. Along with that, don’t be afraid to question the treatment approach your PT/provider is recommending. Did you read a blog or article which recommended something different? Did your friend hear of a new treatment approach? Share those thoughts and ideas! I love to have those conversations with my patients because often times there are specific reasons why I recommended what I did and having that conversation helps both of us to be on the same TEAM. Occasionally patients may suggest new treatment approaches I am not as familiar with—and that’s great! That gives me an opportunity to learn and work together with my patient to determine how we should proceed.
  3. Make sure your goals are being addressed: If your goal is to be able to walk around the house, make sure your provider knows that! Sometimes there can be a mis-match between what your provider thinks your goal is and what your goal actually So, speak up! Let us know what you hope to get back to so we can work together to help you move!
  4. Be open to new ideas: When it comes down to it, we (the providers) do genuinely care about you and want you to get better as quickly as you can! Sometimes your provider may suggest something that seems “weird” or “unconventional,” but listen to what they have to say! I have had many patients who initially were hesitant about a treatment I recommended then later were SO glad they chose to give it a try!

For the provider:

  1. Listen to your patient!: When I was in PT school, I remember having a professor say to me, “If you listen to the patient, they will tell you what is wrong with them!” Seems so simple, but often our minds jump to immediately categorizing the patient and planning ahead to our next steps. So, let’s all stop, take a breath, and give our patients a chance to tell us what they need to tell us.
  2. There is no “I” in TEAM: To truly help a patient achieve optimal results, we have to partner with our patients and develop a treatment plan that is unique to them and their goals and values. For example, if I think my patient would benefit from doing a yoga/pilates routine but my patient hates that type of exercise, our plan is ultimately not going to be successful. However, that patient may love to swim and lift weights, so we could develop a program that might achieve the same goal in a method the patient will enjoy.
  3. Don’t be afraid of “not knowing”: Sometimes we become anxious if we do not know the answer to a question a patient asks or if we reach a point where we are not really sure how to proceed to help the patient achieve the results that patient is hoping for. I am often shocked how admitting I do not know but will work to learn actually builds a stronger patient relationship! Trust is not only in being able to help, but also in knowing when you need to seek answers from elsewhere. So, be vulnerable. Admit you do not know. Seek additional consultations or refer out if you need to! In the end, the patient is the one who will benefit from your humility.
  4. Watch your language!: No, I do not mean avoid cursing with your patients (that’s a no-brainer!), but be careful with what you say and how you explain things. My sister went to physical therapy and was told, “Your rib on one side is ‘out of place’.” She totally freaked out—not knowing what that meant, she worried something was structurally wrong with her body. She was scared, and guess what? Her pain actually got worse that week. Recent studies have shown that our words do not always mean the same thing to us as they mean to our patients. Check out this awesome blog post by Matthew Low which summarizes several studies on the subject. Pay attention to what you say and make sure your words promote healing and health—not fear!

Let’s partner together and work toward better health! These are just my thoughts…. So, what do you think?

Patients- What would you like your health care providers to know to better help you in your recovery? Have you had any bad experiences with providers you would like us to learn from?

Providers- What would you like patients to know when coming to see you? What can we all do to work together better?

Cheers!

~ Jessica

Interview on PT for Urinary Incontinence in Greenville News

A few months ago, I had the opportunity to be interviewed for a story in the Greenville News on Urinary Incontinence.

Many women (and men too!) don’t realize that there are effective non-surgical options for UI. My hope is that articles like this can help spread awareness and encourage people to be proactive in seeking out help! Women’s Health and Pelvic Floor Physical Therapy can make a huge difference for people struggling with these problems!!

Enjoy the article here! Will be added to our News page for future viewing!

Happy Thursday!