Pelvic Floor Dysfunction for New Nurse Practitioners
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Show notes:
I’m SO excited to share this interview with you. I’m interviewing two pelvic floor therapists -- a family nurse practitioner who has gotten additional training, and a physical therapist with a specialty in pelvic floor therapy.
This is SO IMPORTANT. It seems like a hidden corner of medicine that we don’t learn about in school, or maybe it’s touched on when it comes to dyspareunia or urinary incontinence, but it’s so much more than that and we have the power to be so helpful for patients.
It relates to widespread chief complaints in primary care: dysuria, constipation, pelvic pain, and urinary incontinence, to name a few.
What You Need to Know About Pelvic Floor Dysfunction
In this video, we cover so, so many gems, including:
What is pelvic floor therapy?
What is pelvic floor dysfunction?
When would someone need that?
What do you wish primary care providers knew?
What resources do you recommend to learn more or to get patients access?
Why should we not give exercise handouts?
Resources mentioned in this episode:
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well hey there it's liz rohr from real world np and you're watching np practice made simple the weekly videos to help
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save you time frustration and help you learn faster so you can take the best care of your patients
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so um this week's video is an interview with two phenomenal people um kathy melissa
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you'll meet them in a second um but this is a recorded interview we did to talk about pelvic floor
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um pelvic floor dysfunction pelvic floor therapy like basically all the things that you
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didn't know in school that like i really wish that i knew a long time ago so i really hope you enjoy
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our conversation there's a couple of resources that we mentioned down in the description below in the blog post we'll
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link down below and um yeah let us know what questions you have and definitely check out all of the resources that we
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talk about inside that video so uh without further ado i'm going to share my interview with you if you haven't grabbed the ultimate resource
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guide for the new np head over to realworldmp.com guide you'll get these videos sent straight to
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your inbox every week patient stories uh insights and other just bonus content that i really just don't share anywhere
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else so welcome and thank you so much for being here today would you like to introduce yourself so
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i'm melissa i'm a pelvic floor physical therapist at welles integrated health in boston
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and i work alongside kathy and i'm kathy i'm a family nurse
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practitioner with a specialty in pelvic floor health and pelvic floor
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therapy and i work with melissa at welles awesome thank you so much for being here
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um so as you and i we've all talked before this call like a lot of nurse practitioners who are
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newer or in school have no real conception or very little conception about like what pelvic floor
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dysfunction is what pelvic floor therapy is um so do you want to just give us like a
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overview of what you think how you would explain it to a new grad nurse practitioner
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sure so go ahead melissa i think first the important thing to talk about is what is
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the pelvic floor um so kathy has some beautiful models sitting right next to her but the pelvic
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floor is essentially a group of muscles that like any other muscle in the body can get tight weak um and cause dysfunction
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however the dysfunction is not necessarily like oh my neck feels sore or my my back feels
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sore it comes in the form of sexual dysfunction bowel dysfunction
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urinary dysfunction and then pain so these are muscles that you're not generally thinking about on a day-to-day
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basis because they have autonomic function so if they're performing like they should
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you're not thinking oh i've got to squeeze my pelvic floor muscles so that i don't leak urine right these
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are muscles that just contract when your bladder's full so that you are not leaking
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when you have pain or when these muscles become weak um that's when they're not functioning
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so then you notice oh gosh i just sneezed and leaked urine
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or oh i'm feeling constipated why why is my stool coming out in you know
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little pebble-like form why can i not have a good bowel movement these are all can be causes of
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the pelvic floor muscles so most of these muscles attach on the pubic bone and they wrap
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they create a nice bowl shape to the coccyx or the tailbone and if kathy flips that yep you can see
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all the red and there is muscle um so you're sitting on your sit bones right now
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you can take a deep breath and you will feel those muscles that create your anal sphincter your perineum
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the space between your in your anus and your vagina and the vaginal opening um so they're
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very dense muscles and they're very supportive because they hold up all your viscera and your organs
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um obviously with pregnancy these muscles do a very good job at supporting your
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growing baby um so i think the most important take away with the pelvic
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floor muscles there's a lot of them you may not even like feel them on a day-to-day basis
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a lot of them there's a lot of nerve endings and blood supply in the area that's what helps you have an orgasm
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if they are dysfunctional they will compress the nerves they'll compress the blood vessels
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in that area and that's what can cause burning pain burning with urination
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uti-like symptoms what people think are yeast infections but maybe that's the
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pelvic floor muscles um so all these things can be pelvic floor dysfunction if
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you're ruling out all the other things um think of like the shadows
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oh go kathy sorry go ahead i was just going to say like think about all the times that your patient comes in
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and they have like burning and itching and you do the cultures or you look under the
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even if you're doing wet mount microscopy and you don't see anything and you're like okay i'll send for culture
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and you don't see anything it comes back right nothing comes back and then your patients in your office
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another the next week later and they're like i have burning i have itching i have pain
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and i totally didn't mean to interrupt people if i'm sorry but these are the kind of things that i
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think nurse practitioners can totally have on their radar
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i think we just don't learn about it in school so we don't think about it like we're all
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really comfortable you know when you're doing your head to toe assessment you're comfortable with your range of motion right and
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we're like okay like we're gonna do this and we're gonna do this and all that kind of stuff right so we're that's about our comfort level
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with the musculoskeletal system yeah and then we like totally ignore all of
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this in here and then when people come in i think we're very overwhelmed
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you're like i don't know it's a uti oh it's yeast it's bv yeah and a lot of the times it's not
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well that's like one of the things that when you and i were talking kathy about like this blows my mind like how often do we
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see stuff like that and i think that we're just like never thinking about muscular dysfunction as being a
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contributing factor to presumably vaginitis or dysuria you know and i think to melissa's point you
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absolutely have to rule out yeah that it's not a uti
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it's not db it's not yeast it's not gonorrhea it's not chlamydia the host of things that it might be you have to rule
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that out but but we have to like with a
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like recurrent like yeaster uti a lot of times that can create
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pelvic floor dysfunction because these these people are
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constantly having these infections which is creating inflammation in those muscles and in that tissue so
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then trigger points and tightness occurs because you're just stuck in this inflammatory
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response so by getting pelvic floor therapy you can go in
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and you can release those muscles and those trigger points and provide blood flow in a good um
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you know environment for all of that tissue so that it's not stuck in
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this inflammatory response because it's getting oxygenated blood flowing um
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so also important to think of those people that are constantly coming in with infections as well yeah
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so so i guess like on that on that note like when because there's like there's it's it
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feels like endless amount of information you guys are just such like a vast resource like so much depth of knowledge right
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but like if you were to kind of like think about like when when would you what are the kind of scenarios where you would
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um so i guess just to clarify for for people are not aware of public floor therapy um like what is that and when would you
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want people to when would you recommend primary care providers referring to pelvic floor therapy
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so pelvic floor therapy at wellest we we're lucky we have 55 minutes
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per patient um and just to clarify you're talking about your own business right your own private pelvic floor practice
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which is beautiful love it um so we so we have a good amount of time
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you know anywhere between like 40 minutes to 55 we take a very thorough medical history
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in the beginning we do a postural assessment pelvic alignment really look at any external
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imbalances that could be causing pelvic floor dysfunction um so you know even though we're
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treating the pelvic floor we're looking at the whole body and alignment then
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we do a lot of external release so we specifically kathy and i do a lot of
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myofascial release visceral manipulation which is organ specific um craniosacral just pretty much all
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hands-on manual therapy and then some alignment therapeutic
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exercise kathy specializes in yoga i do gyrotonic which is similar to yoga
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so in the treatment we would probably depending on the issue but
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maybe spend you know half the time externally working on uh areas of tightness and weakness
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and then about half the time working internally you're fully draped one finger with lubricant go intravaginally
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or rectally depending on the issue to check strength
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areas of tightness just like any like just like in your neck if there's tension
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we do like some trigger point release myofascial release to release those muscles so that you can have the
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mask optimize your pelvic function um kathy anything else so lots of education
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tons of education which is another reason why i think mps are perfect
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to get the discussion started and perfect if they know like you would totally trust your np if
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you went like everyone how often often does everyone say like oh my god i love my nurse practitioner i'd like so much rather see my nurse
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practitioner right and so if you as the nurse practitioner knows what pelvic floor therapy is
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you're way more likely to get buy-in from your patient if you're the one
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recommending it um the other thing i just you know i know it can seem very overwhelming when
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you're like oh my god 55 minutes like that's a really long time what a luxury and it is a luxury
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and i just want to say that you can also do so much important education and even just
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like a little bit of postural education and even like very basic helpful hands-on releases
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like literally in the 15 20 or 30 minute office visit because before i joined melissa here at
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wellest i was doing that at a community health center so
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this is and again like mps are the perfect people to start the discussion
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and then be the bridge to get people into specialized pelvic floor therapy if you
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feel like the interventions that you have done aren't really getting your patient to where they need
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to be yeah right like simple examples would okay
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constipation you may be what would you you may recommend like coils or like
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some sort of stool softener right well you could see their breathing mechanics which is like diaphragmatic breathing is a pretty
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easy thing to educate your patient on and then teaching them about like toileting position you know
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it may be in conjunction with the stool softener but just seeing how their motor control is
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and what their breathing is like because a lot of constipation that we see is a pelvic floor issue oh my god that's
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so fascinating you're not able to breathe properly and most people if you if we're assessing internally and we're
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like okay bear down like you're having a bowel movement they contract and do a pelvic floor
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tightening so how are you gonna get stool out if that's how you can you're not so that's why you're gonna have the
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ribbon like stool or like the the little pebble yeah yeah i guess
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just just to jump in for a sec like i think that if people are aware of pelvic floor
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dysfunction they they're usually aware of like urinary incontinence and they're usually thinking
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um uh just do kegels right because i feel like that's like the extent of what we learned in school like kathy i love you like oh but kathy
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you and i were talking and it was like and it and it's just it's just like like i think i love that
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it's it's so it's so i guess two kind of things that i've gleaned from like talking with you guys and also doing my own physical therapy because like i
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think that's one thing that we don't get as nurse practitioners like seeing actually what it looks like you
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know and like yeah so one is kind of that it's complex that is way oversimplified basically any
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well maybe i'm going off here but any sort of physical medicine i feel like that we learn sometimes is oversimplified right so
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it's like a handout about back exercises towards a handout about urinary incontinence and it's actually a lot more complicated
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than that um and i also love too that like kathy like you've really simplified it
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like i'm continuing to learn more and more but it's actually it feels very scary and overwhelming but at the same time it's also not but
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it is complex right so it's kind of i think that's like a major at least takeaway that i would impart on
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new nurse practitioners or nurse practitioners in general is that like just don't give handouts in those
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particular areas you know what i mean like i mean obviously do education but like keeping in mind that it's nuanced would
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you agree with that 100 100 and i think
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you know on all the emrs that we all use when you type in any of those like prolapse incontinence
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any of the painful you know dyspareunia pain with sex any of that stuff that's what comes up yeah it's a handout
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with kegels yeah yeah and i would say go ahead i was gonna say it just depends
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on the physiology i think that's one of the take-homes that i'm taking from physical therapy is that like because i have like a back and a
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back injury and stuff like that so it's it's just it's all customized and it's all based on the individual body and
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kind of what's going on i mean again maybe maybe you have a different view but i think that's what i'm understanding is like oh
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we're going to change this because you're having pain this way or you're going to change this because of you know which i think is a great segue into
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as nurse practitioners who do pelvic exams again like
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we're the we're the ones to do it right and it's like you never learn about that in school right like
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it's like go find the cervix and then you're so happy when you can find the cervix and that cervix is hard to find at the
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beginning right and you're like oh my god where is it and you're like moving the speculum all around and you're like
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um and then and my manual exams too are hard i mean they are they're a little yeah
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like they're a skill to to figure out and i remember we did it they are oh instructors with their titles and they were like oh this is my
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ovaries this is my ovary but it's like every body habitus is different too you know totally and like ovaries are
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really hard to find yes unless the body habitus is a very certain way
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right i mean and even then like yes i've been an np for 10 years and i have
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not palpated a lot of ovaries yeah just thank you for normalizing that no thank you for normalizing because i
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think i really haven't too yeah and you are like you are the women's health mp you know yeah and like i gotta tell you
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not a lot of ovaries you know yeah and i think i also just want to reassure
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people that you know i never learned any of this in school like i learned how to find the cervix
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and how to look for at you know adnexa that was it and then i was running a women's health
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program like doing all sorts of gyn procedures like colposcopies iud insertions endo
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biopsies like and literally for four years i never thought about the pelvic floor
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i mean that that's not i it's embarrassing and i just want to say physical
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i went to physical therapy school all we do is musculoskeletal like that's what we do and i did not
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learn about pelvic floor yeah my physical therapist was like i don't do pelvic floor i was like okay i think like an
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hour long lecture about like okay this is this is pelvic floor therapy if you want
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to explore it go do that on your own we do gross anatomy where we're dissecting we
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didn't even dissect the pelvic floor like you know so this is like what physical therapists
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should we should know about this and we don't even know about it so you guys have to go do like if you want
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to do this you have to do like training after you're finished with school right it's like a specialty
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kind of yeah interesting um yeah i think too like it's important to
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mention because i like you said the key goals and then like a lot of people think pelvic floor oh urinary like
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incontinence yeah or dysphorium yeah yeah right yeah um but i think it's important to note
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like most people that we see are not like your typical like oh i have i have
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leakage or incontinence it's like when you have a 20 year old that has never been able to insert a tampon and has
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pelvic pain and can't sit so um you know there's a wide variety of
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pelvic floor dysfunctions and i think that do not require kegels so
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totally and that's also a time when it would be important to be able to know people that you could refer to like
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you would never be expected totally you know in a primary care office to
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be treating someone with vulvodynia vaginismus like any none of that stuff
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like that's not however if you have someone that comes in with dyspareunia
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you sh and you do your bimanual exam if you just approach it with a different
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lens and you're like what am i actually feeling under my hand yeah that can
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really change and then if you're feeling anything like literally that feels just kind of tight or like bunched up or restricted
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the last thing you want to do is tell that person to squeeze right cosmo right so even yeah totally
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so like going back to melissa's point about the diaphragm right if you like let's say you have just for the
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person has dyspronia you've identified some tightness in the pelvic floor if you work on that patient with
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engaging their diaphragm like i literally will like grab a tissue box and like put it on their low belly and
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say like we're gonna watch this tissue box go up and down if you can start you know if you cut the
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torso in half and you put the box down here and watch the box go up and down then this isn't this is not doing the
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work of breathing as soon as you get somebody to breathe from down here guess what their pelvic
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floor will start to drop a little bit they don't even have to know they're doing it but then you're like
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oh you're in your diaphragm oh look like and then you explain like your pelvic floor is dropping a little bit
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which is a good thing or not a good thing so that means you're relaxing relaxing you're relaxing okay
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if you've identified some tightness and then you're helping that person relax then like
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what a gift you've given to your patient who maybe doesn't need to go the whole route of
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going to a pelvic floor specialist yeah but can start okay and then you
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kind of see where things go from there yeah so i guess to to kind of like sum up and in terms of um
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the reasons why a new nurse practitioner who's not familiar at all with pelvic floor stuff anything if they were like what
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are the takeaways in terms of um reasons to consider consult
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consider pelvic floor intervention well like okay well we'll talk about something
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that kathy and melissa are working on at the end but um in the interim like what are the key things for them to know
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in terms of um uh like the type of um conditions i guess to like raise red flags about
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in terms of like oh this is this may be a pelvic floor dysfunction like and we've covered a lot of them right so disu like some recurrent vaginitis
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dysuria constipation dyspareunia vulvadynia um
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pelvic general pelvic pain it sounds like do you have like lower abdominal pain as well i feel like i've had some people
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where it's like left lower quadrant pain and i've ended up referring them to a pelvic floor because it all the workup we did was
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not conclusive so i felt like it was muscular pain endometriosis oh interesting um
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yeah any like again the constipation um tailbone pain coccydynia
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oh interesting any like s i joint pain joining low back pain low back yeah
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um [Music] yeah any of the like i mean if you're
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finding doing an exam that someone is super
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like guarded in their adductors or their inner thighs tremoring at all they tend to
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like everyone is vibrating
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just knowing like like yeah for these conditions when to refer out so that we're not
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seeing these poor people like three years down the road they've had this issue
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yeah because no one's ever told them well why don't you go get in this like all they need is an evaluation like
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you will say no this isn't a pelvic floor issue yeah or yes this totally is so it's better to
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err on the side of like why don't you go get evaluated and see if this is a pelvic floor condition um
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because we will not we won't say to you oh yeah keep coming when we don't yeah see you
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um the same as we would you know send people sorry the same as we would like you do
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the work up you get the pelvic ultrasound you might get the abdominal ultrasound you do the appropriate lab you know it's the same exact thing i'm
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sorry i didn't mean to interrupt you but it's the same thing pelvic floor therapy can just
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and should be a part of that global workup that you're yeah because the big
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the big issue is just we see people and it's been so long that they've had these
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poor conditions and they come to us and they're like oh my god i'm finally getting relief but of course it's gonna take a while
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because it's a chronic condition now where they've had it for three plus years yeah and it takes a lot of
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time so if you just referred right away when you're suspecting a pelvic floor
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issue it would be so much quicker and better for the patient
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so yeah and it sounds like um in terms of um when to refer them like
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yeah i think i think that's definitely like a huge general physical therapy thing too right it's like the sooner on like the longer it's been
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the longer it will take to kind of continue and i think one of the things you you we all had talked about is like
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um letting the patient know what to expect so i've actually never participated in physical therapy i've never administered pelvic floor therapy of any
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kind um but like i understand that it's an internal like you said like it's an in it's
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external the whole body right it's not just a pelvic floor but it's also then internal exam too so
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i think that's been like the main thing that i have because i've a community i communicate that with patients is like
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what this whole thing is but um yeah i think that's you've said that that was like the major surprise that patients will get sometimes is that they get
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referred and they don't realize that it's like a 55 or 45 minutes potentially internal exam which is
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ultimately beneficial right but it's like a lot for some people you know it's not we never spend
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a full like treatment internally no no no no no never more than probably
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30 minutes okay these are max and like yeah 55 minutes would be way too much yeah
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and we'd probably flare the patient up um but no more like 20 minutes to 30 max
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um and it's really like often patients will say to us oh god i
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was so afraid of this and this is really not bad at all like oh that's not like jamming our
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finger there and no fishing around it's very super gentle
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very gentle it should not be scary at all but we're not scary totally
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i hope not totally no and i think that i mean if it's it does
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flare my like blood like makes my blood boil a little bit that it is not talked about enough and that it is
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an extra specialty and it's not incorporated because it's women's health it's it's it's it's a thing i think it was i was i
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would wish that it would be more equitable right but it's the other thing is that like the people who go into pelvic floor therapy have
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specifically chosen that so if there's a silver lining to that um hopefully they're more they're
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specifically passionate about making this a welcoming and and holistically helpful experience i think
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one of the things that um so inspires me kathy about the way that you've talked about uh is just like it's not it's it's
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involved but i also like want to stress like what you've inspired for me is that it's it's actually not that it's like there
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are things that you can do that are not hard right that there are things that like we can learn about as mps to make a really big difference quickly
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right because i think that my conception is like oh this is gonna be hard it's gonna be hard to get them to go there and i could
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never learn that and that would be you know but i think like you've just told me like it's been so great for patients to have like
26:40
real results in a shorter period of time what do you feel like the general trajectory of time is that you typically work with people and i know it's longer
26:46
for more chronic problems but do you have a general sense of what most people do or is it kind of just tailored to the
26:52
individual yeah so we usually say like you'll notice change
26:58
between six to eight visits um we usually see people once a week
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because it's all cumulative so you know we need to get going on it once a week um but
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generally between six to eight again we have some patients that have had issues for like 30 years honestly um
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yeah so they may be coming in for a pretty long time and then other
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patients that are you know postpartum maybe they're coming in for six visits and they're good to go
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right right oh that's beautiful that's really nice to know because i think like in france potentially maybe this is old
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information but i think that their health system supports pelvic floor rehabilitation basically for everybody postpartum as part of their health care
27:44
system i think you get 12 visits i've had some french patients over the years yeah and even in china i haven't i've
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had a few patients from china that have different parts of the country that have shared that they've gotten
27:58
i think three postpartum pelvic floor visits of some sort so we are way behind
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the eight ball on this like it's just it's a travesty yes yeah but we're seeing a lot more um
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like of the perinatal population which is great like even like like pregnant women that are just doing
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preventative yeah here throughout their pregnancy which is awesome yeah um so we'll see them like once a
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month and then as they get to like week 34 35 we'll do weekly um
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and that's to teach like pushing um some perennial massage that's something
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they go into labor and delivery feeling confident that's like the big thing that that women really are so
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thrilled about they're like oh my gosh i know when they say push i know what they're talking about now
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because when you're in labor is not the time to be like wait what what am i supposed to do like it's
28:54
kind of nice if you've had a moment to actually experience that before you
28:59
like are contracting and in full-blown labor yeah and again like you wouldn't believe
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how many women we see that you're like okay like you're you're teaching the pushing mechanics and they
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are doing the opposite key goal you ever ever imagined and you're like how are
29:19
you going to get this baby out there's no way and then you teach them how to relax
29:25
and they like and they're like oh that's awesome how cool that is so cool and see
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i think that's even something that an np could do totally that's a thing yeah like you
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could absolutely do that yeah and like what great access because because kathy
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kathy and i work in a federally qualified health center and um yeah it's it's hard to get people access
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to things so the more that we can know and do in primary care again we're this is mainly for new nurse
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practitioners who are adjusting to clinical practice in general but i think especially as you continue to grow your practice and develop your
30:02
skills like that is definitely something you can can incorporate and the other thing i think
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that will also be so helpful if you are even thinking about some of
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this and referring a little bit sooner i think the frustration level
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for the nurse practitioner think about like you see the same person on your
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schedule like pelvic pain and you're like oh my god yeah right and you've like you've done
30:30
the ultrasound and you've done this and that and you're like oh my god what are we gonna do right
30:36
like we've all had that yeah and you just feel
30:41
it's like the poor patient right like they're so frustrated but then you as the provider you you're like i can't help my pain
30:48
like i don't know what to do and i really think it's just because we get you know like pt's get that one hour
30:54
in pt school and np's get like one or two slides and it's all about like it doesn't talk about
31:03
like the real hands-on like what do the muscles feel like it's just like
31:08
this is the diagnosis and this is maybe the medicine you want to give and yeah i i think this is much broader than that
31:15
which i think also is why it's so suited for nps who think more holistically yeah 100 mm-hmm
31:23
men can have pelvic floor dysfunction too i know we're talking i was just going to ask about inclusivity um
31:28
just to be inclusive you primarily work with cis female patients but it sounds yeah tell me about that
31:34
and transgender patients yeah like people with neo vaginas and things like that oh great
31:40
that's awesome i was gonna say also for trans men patients or trans male patients like i feel like i've i
31:47
have heard of a lot of um just like anecdotal experiences with patients having a lot of pelvic floor pain
31:54
for trans men so i think that potentially very sensitive topic but important yeah for sure that's
32:00
really cool yeah and i guess it kind of leads into resources like um
32:06
what well i guess if you if you want to tag on this question too i mean i think the question is always about like insurance
32:11
and accessibility so like any thoughts you have about like a nurse practitioner who's in their practice who's seen these
32:17
issues that wants to refer how would you recommend what are the resources that you would recommend for that person to
32:22
refer find a specialist insurance general insurance questions and then learning themselves so i would start off
32:31
find like whatever health system you're a part of know your major hospitals and most major
32:36
hospitals will have a pelvic floor therapy department and i think that's
32:42
you know like liz i'm thinking where we practice right like we have a hospital in boston that we refer to a lot
32:48
that would be the first place that i would go and it depends on your patient population like we serve a very
32:53
particular population yeah but i think for people with more access
32:59
better insurance then you want to start looking beyond the hospital programs because
33:06
unfortunately most of the time they are very overwhelmed and not on waitlist yeah along
33:13
weightless and things so then you could look at herman and wallace
33:18
okay is that a website or a company or so herman and wallace is you will find any like provider that's
33:26
gone through their pelvic floor coursework which is like the main institute for pelvic floor
33:32
so you'll see hospital-based uh clinicians on there you'll see outpatient the big difference is like whether
33:39
you're in network or out of network for insurance right um so you can
33:45
[Music] go on there it doesn't say i think if they're in network or out of
33:51
network but you can then it's very easy to contact these people and ask them if they're in network or
33:57
out of network yeah generally in network you're just getting a shorter treatment time because
34:02
insurance unfortunately is kind of dictating the plan yeah how to network you get a little bit more um
34:09
time yeah and you can find i mean if they have the resources they can find private practices um i don't know if you guys take
34:15
insurance or not but you know private practices i'm sure as well yeah yep um what about foreign go ahead
34:22
oh i was going to say um international pelvic pain society i think also has a provider list that's another resource
34:29
and yeah cool yeah that's awesome and
34:36
what else what about for providers who want to learn more and do it themselves i'm so excited can
34:43
we share totally totally melissa you want to go
34:48
so we're creating um an online course for
34:55
um specifically for women's health and pees and midwives but also for
35:00
any np that is interested and it's really to simplify and
35:05
demystify the pelvic floor so that you have the ability to
35:11
really know when to refer to a pelvic floor therapist but also to do some simple things that
35:17
aren't going to take you very long to really help your patient with their pelvic floor dysfunction um
35:24
so and you can use icd-10 codes it's all good like don't worry about like manual therapy codes or anything
35:31
like that you do don't worry about it you just use your icd-10 display you're all set
35:39
great that's awesome you were saying coffee too like at the health center you will see people
35:44
weekly for a couple of visits as well for sure at family practice like a family
35:50
practice at phc like you're doing it yourself in in regular totally visits so i feel like this totally this is such a
35:56
phenomenal resource i cannot wait for um especially for nurse practitioners who are family
36:01
family providers or um acute like adult gyro like even if they're not in women's health
36:07
like there are so many people that i am in community with that are interested in particularly in women's health like you are a catholic because you
36:12
do you have a women's health degree as well or just family medicine yeah so your family family practice as well so um and also can we can we share about
36:20
the channel mm-hmm
36:30
we'll be releasing weekly videos hopefully in february yes well this will when this
36:36
is live it will be live we will link to down below this video all of the resources your website your
36:44
course so excited great um but yeah for people who just want to
36:50
learn more and want to do more women's health stuff especially with limited access to resources i'm just so excited
36:55
and especially like it's not like it's not it's demystifying i love that because it
37:00
really does feel like complicated overwhelming how could i possibly do that how could i help i don't know enough you know like
37:05
all these things i'm having as a five-year experienced nurse practitioner but it really like and then i had i never
37:12
thought about it four years in yeah never thought about it yeah so and like your test like your feedback from patients sounds
37:19
really beautiful you know in terms of like this is really impactful stuff and like how often do
37:24
people come in with all of these things right so i'm very excited so where can where can we find you
37:30
where can people find you when they want to learn more yeah so so we have a website it's the institute
37:38
institute for pelvichelp.com so you can find us there and you can sign up for our newsletter
37:43
and we have a lovely um four tips to managing that's challenging
37:49
speculum exam guide so to help you right away um yes with with
37:57
your speculum exam and kind of incorporate pelvic floor thank you guys so very much any other
38:03
last things you want to add i think we covered this i think we're good yeah i think we're good yeah
38:08
thank you guys for having us awesome thank you so much for chatting so fun to chat with you yes and i'm sure this is not the last
38:15
time that we will chat so oh i want to say one more thing yeah the other thing i think is so cool about
38:21
what we're doing is that melissa is a pt and i am an np and this is interdisciplinary practice at
38:28
its best and i'm cool yeah there's such
38:34
opportunity there and i think we just think stay in your lane stay in your lane and
38:39
i i just think there's such an opportunity for absolutely all to really grow professionally i know how much i learn
38:47
from you know partnering with melissa and i i everybody can do the same thing yes it's
38:54
a huge opportunity for people i love that yeah well thank you so very much thanks
39:00
thank you for having us liz
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