Thursday, August 28, 2014

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Wednesday, August 6, 2014

Feeding Your Pain

I have been thinking a lot about nutrition lately. My husband and I recently did a juice fast that really made me take a look at my diet and the amount of nutrients that I was getting - or not getting as the case turned out to be. I watched a documentary recently about food and how what you are eating really matters. As a nation, so many are obese, but also malnourished and it is because we are eating too much of the wrong kinds of food. I'm guilty of this myself. According to experts, the Standard American Diet (SAD- the acronym for our diet is SAD! how terrible is that?!) consists of too many fats and carbohydrates and not enough fruits and vegetables. The vegetables that we do eat tend to be over-cooked and have lost their nutritional value. (Can you say fried green beans?!) So many Americans are seriously deficient in many vitamins and minerals. So you may be saying, "that's why I take my Flintstones chewable every day" but the truth is that many vitamin supplements are not well absorbed by the body. Its a start, but your body absorbs these nutrients best when they are gotten from food.

So what does this have to do with pelvic pain? The answer may be a whole lot.
Many people with chronic pain have nutrient deficiencies. For those who are unaware, vitamins are not just a pill that you take every morning. That is a supplement. Vitamins and minerals are nutrients that are essential for basic cell functions in your body.

I recently took a course regarding chronic pain from Dr. David Musnick and what he had to say really opened my eyes to how my patients could be better feeding their pain.

So here is a list of common deficiencies for people with chronic pain:

Vitamin D
It is recommended that anyone with chronic pain have their Vitamin D levels checked. If your levels are low, talk to your doctor about how you can increase them. The sun is a great source of Vitamin D, however with skin cancer risks this can be a challenge. It is typically recommended that one increases their intake through diet and supplements. Fatty fish and fish oils are a good source of Vitamin D, though the major dietary source of vitamin D in the US comes from fortified diary, along with some yogurts and cereals. Mushrooms, eggs, cheese, and beef liver provide small amounts of Vitamin D.


Vitamin C
Vitamin C is necessary for tissue repair after injury or surgery. You can see how this would be important in regards to chronic pain. Okay, this is an easy one. What has lots of Vitamin C? An orange, right? Wrong. Although there is a good amount of Vitamin C in oranges, there are better foods to eat to get your daily amounts. There are 50 mg of Vitamin C in an orange, while Brussels sprouts have 80 mg, broccoli and kiwi have 90 mg and red peppers have 190 mg!

Zinc
Zinc is also necessary for tissue repair after injury or surgery and for normal muscle function. Fortunately, there is a wide variety of zinc food sources available naturally for you to take advantage of.
Zinc is highly associated with protein foods and the highest concentrations are in beef, lamb, pork, crab meat, turkey, chicken, lobster, clams and salmon. If you are a vegetarian, high zinc foods would be found in dairy products such as milk and cheese, peanuts, beans, and wholegrain cereals, brown rice, whole wheat bread, potatoes and yogurt. But of all the vegetarian zinc foods, pumpkin seeds offer one of the most concentrated non-meat food sources of zinc.

Calcium 
Calcium is required for your muscles to function normally. Again, this is an easy one right? Dairy? This time its not a trick - dairy is a great source of Calcium. But its not the only source.
Dairy products, including milk, yogurt and cheese, are good sources of calcium. One cup of milk or buttermilk contains 300 milligrams of calcium. Yogurt contains approximately 450 milligrams of calcium per cup. One ounce of hard cheese, such as cheddar or 1 ounce of mozzarella cheese contains 200 milligrams of calcium. Fish, leafy greens and certain nuts and seeds contain calcium as well. Three ounces of canned sardines or mackerel contains 370 and 250 milligrams of calcium, respectively. One cup of cooked broccoli contains 180 milligrams and 1 cup of raw arugula contains 125 milligrams of calcium. One ounce of sesame seeds contains 280 milligrams of calcium.

Magnesium
Magnesium is also required for your muscles to function normally.  Magnesium is widely distributed in plant and animal foods and in some beverages. Green leafy vegetables, such as spinach, legumes, nuts, seeds, and whole grains, are good sources. Bottled and mineral waters can also be sources of magnesium.

There are so many other considerations regarding your diet, including inflammatory foods which I will be discussing in my next post.  I encourage you to talk to your doctor and a nutritionist about your diet and what areas may be lacking. Take a look at what you are eating and what you are (or aren't) feeding your pain.

Tuesday, July 15, 2014

Summer Skin Care for Down There

This past weekend, I went to a concert. Outside. In Texas. It was roughly a thousand degrees outside and lets just say I was sitting in a puddle by the end of the night. Oddly enough this got me thinking about my patients. Stay with me. I have many women who have vaginal pain including pain in the vulva or outer genital area and the vestibule which is the area of tissue leading up to your vaginal opening (FYI vestibule means little hallway-this is basically the foyer to your vagina). Before I go further, you should really go read a great article by my colleague Sara Sauder on just what exactly vulvodynia and vestibulodynia are. (Go Here)

Anyway, back to the concert. I was thinking about how hot and irritated that things can get "down there" during the summer. And that's for people who don't have vulvar pain on a daily basis! For many women who already have pain and irritation in that area, adding heat, sweat, sand, chlorine, etc. is a nightmare of biblical proportions. Maybe that's a slight exaggeration, but talk to one of my patients and they might say it's right on target. Many of these women can't even wear underwear and here comes summer with its pool parties, beach vacations and taking your kids to the water park. So what's a girl
to do?

  • First of all if you are going to be in a bathing suit, take a change of dry clothes. Too much moisture is irritating, so no riding home from the pool in a wet bathing suit. This goes for being sweaty after exercising as well.

  • Swimming can be a great form of exercise for people with pelvic pain, but you want to avoid highly chlorinated pools. If you live in Austin, you're lucky that there are lots of spring fed places to swim. 

  • If you do swim in chlorine, rinse off your vulva with cool to lukewarm water as soon as you get out. 

  • Avoid the hot tub! Chlorine + hot, hot water = irritation city.

  • When planning an exercise program, avoid activities that put direct pressure on the vulva such as bicycling and horseback riding.

     
  • Limit intense exercises that create a lot of friction in the vulvar area (try lower intensity exercises such as walking or yoga).
  • Apply a frozen gel pack wrapped in a towel to the area to relieve symptoms.

As a general rule there are things you can also do year-round to decrease your irritation.
  • Use unscented, white toilet paper, white cotton underwear and all cotton tampons and pads - I also recommend organic feminine hygiene products because some others contain chemicals that are irritating to that delicate area. 
  • Do not use bubble bath, feminine hygiene products, or any perfumed creams or soaps down there.
  • Avoid getting shampoo on the vulvar area.
     
Also, talk with your doctor about topical anesthetics that might be helpful to decrease pain in the area. Here's to a more comfortable summer!

Wednesday, May 28, 2014

Why Didn't I Hear About Pelvic PT Before?

This is a very common question that I get from patients and there are a few reasons that this is usually the case.

First of all, most of the topics and diagnoses that I deal with are pretty sensitive subjects. I treat urinary incontinence, fecal incontinence, pain with intercourse, penile and vaginal pain. These aren't usually topics that you're talking to your neighbors and co-workers about, so the word of mouth about this specialty can be pretty limited. I mean, think about it. If you had a shoulder injury or a knee injury and went to see a physical therapist who helped you, you'd be happy to tell anyone about it, right? So many of my patients laugh when I tell them this, because I've called them out. They have no intention of telling anyone about their "vagina therapist." At least not in the beginning, but we'll get back to that.

Another reason that people haven't heard of pelvic PT is that its relatively new. The Section of Women's Health, which is a section of focus through the American Physical Therapy Association (APTA), was founded in 1977. I know that sounds like a long time ago to some, but relatively speaking this specialty is new. Compare that date with the founding of the APTA itself, back in 1921 and you can understand why the exposure for pelvic PT is not as high.

Going off on a tangent here, you may be wondering why the section of the APTA that Pelvic PTs often belong to is called the Section on Women's Health. Time for a little history lesson! This section of the APTA was originally named the Section on Obstetrics and Gynecology and it was
Originally called the Section on Obstetrics and Gynecology - See more at: http://www.womenshealthapta.org/about-us/history/#sthash.Ujl6VMHv.dpuf
Originally called the Section on Obstetrics and Gynecology - See more at: http://www.womenshealthapta.org/about-us/history/#sthash.Ujl6VMHv.dpuf
created to be a resource for physical therapists interested in the healthcare of women before, during, and after pregnancy. As it grew, practice in this area grew to include a variety of health concerns of women including incontinence, pelvic/vaginal pain, prenatal and postpartum issues, osteoporosis, lymphedema, and chronic pain. In 1995 the name was changed to the Section on Women’s Health (SOWH) to mark the specialized education regarding women’s physical therapy needs. But as we treated incontinence and pelvic pain in women, we began to see how these treatment techniques could also benefit men. In 2011, the Mission & Vision statements for the SOWH were changed to recognize specialized Section members who also treat males affected by incontinence and pelvic pain. So despite the name, we do in fact treat men as well. This is often a source of confusion and you can see why!

Back to the topic at hand, another problem with spreading the word about Pelvic PT is that there are relatively few therapists out there doing this. So unfortunately in many areas, there is no education occurring about the options available to patients dealing with these issues, because there is not a PT in the area to speak to the local physicians and let them know what can be done.

Now, getting back to the topic of your "vagina therapist," (or whatever you may call your Pelvic PT) I have a request. I know this is a big deal and a sensitive area, but please tell someone. It is important to tell your friends and family what you are going through because you need to have a support system, especially if you are dealing with chronic pain. I also think it can be so powerful for someone going through these issues to be able to lead another person down the right path toward finding help. Many of my patients who initially would never have dreamed about talking about why they come to see me, have become more comfortable and confident with talking about these issues as they have seen how therapy has changed their lives. I have a patient who recently told me she overheard someone in the gym locker room talking about how she laughed so hard she had tears running down her legs! I was so proud when she told me that she turned to that woman and said "You need to see a pelvic floor physical therapist, they can help you with that." Just that one comment could change someone's life! Even if you don't feel comfortable discussing your issues, just bringing up the fact that there is such a thing as pelvic PT can be a huge way to lead others to get help!

Monday, April 28, 2014

Pelvic Pain and Dr. Oz

Exciting news! Pelvic floor therapist Amy Stein, will be discussing pelvic pain and physical therapy for this issue on Dr. Oz tomorrow, April 29th! See Amy's blog for more details. This is such a great step for the pelvic physical therapist community and a wonderful opportunity to further educate the public about pelvic pain!

Saturday, April 19, 2014

Interstitial Cystitis

Last month, I posted a Q&A about urogynecology and the topic of Interstitial Cystitis came up. So, many of you may be wondering, "what's that?" or "how can pelvic PT help?"

Interstitial Cystitis (IC) is pain in the bladder in combination with pain in the lower urinary tract system as well, with an absence of infection. Pain can also occur in the urethra, vulva, vagina, testicles, rectum and throughout the pelvis. Upon viewing of the inside of the bladder of those with IC, tiny wounds or ulcers are often found in the bladder wall that are contributing to the pain. In addition to pain, urinary frequency and urgency are found in the majority of patients with IC as they often rush to the restroom to avoid and/or reduce their pain.

Most of the patients that I see who have IC have seen many doctors and it has taken months or years before they received a diagnosis. They have been diagnosed with recurrent bladder infections and may have taken antibiotics for years without success. Unfortunately many health care practitioners are still unaware about IC. From my understanding, medical schools do not provide a lot of education about the specific pelvic pain diagnoses that I encounter on a daily basis, including IC. These are areas of interest that doctors must choose to seek out continuing education. Many doctors are unaware of the treatment options available, but fortunately there is a growing group of specialists and practitioners throughout the U.S. that are working to help those suffering with IC. And things are continuing to move in the right direction! At the 2013 meeting of the American Urological Association, two new courses were offered that trained urologists in the diagnosis of chronic pelvic pain and a very strong emphasis was placed on the examination of the pelvic floor muscles and the use of physical therapy as an important treatment tool.

This is exciting and postive news because I have seen firsthand how much physical therapy can help with the symptoms of IC! Physical therapy will not cure IC, but can help manage the symptoms of pain that these patients suffer from. Because of the pain and irritation in the pelvis that occurs with IC, many have pelvic floor dysfunction, where they develop tight, painful muscles and trigger points. Just like in other areas of the body, our muscles try to guard from the perceived injury associated with pain by tightening. However, when the tension is continuous, painful trigger points and muscle dysfunction occurs. This contributes to a pain cycle that can be broken with manual treatment, stretching and relaxation exercises for key muscle groups.

Physical therapy is key in the management of IC symptoms, but the number one, most important strategy for those with IC is changing your diet. It's also the one thing that people don't want to hear. Often, I have patients who would rather take expensive medications for the rest of their life than modify what they are putting into their bodies in regards to food and drink. But think back to those ulcers in your bladder. When you consume things that are highly acidic and
caffeinated, like sodas, coffee, citrus, and tomatoes it is like pouring acid into those wounds. You know what else is highly acidic? Cranberry juice! The one thing you have always heard is good for your bladder! The thinking behind that is that the cranberry juice makes your urine so acidic that it kills or prevents bacteria that causes a UTI from growing. So for people with IC that acidity is going to seriously irritate your bladder! Would you pour acid into a wound on your arm? Then why are you doing it to your bladder? Water consumption is also very important. When you don't get enough water during the day, your urine becomes more concentrated and acidic which, again, irritates the bladder. In addition to addressing your pelvic floor dysfunction, a pelvic PT who is familiar with IC can help educate you on what you should or shouldn't be eating. For more information about how your diet affects IC click the link below where the IC Network has some great information.

The IC Diet


If you are suffering with IC and need to find a healthcare provider who can help you get on the right path with managing your symptoms, there is some great information, again from the IC Network here. Working with the right doctor and physical therapist can help to keep your bladder happy, which in turn keeps you happy!
 
Happy bladder! I Heart Guts
 
As an aside, I LOVE the line of plush organs from I Heart Guts. The caption for the bladder is "Urine Good Hands," and I hope that you will find the right health care providers so that you will be!



Saturday, April 12, 2014

Blog About Pelvic Pain

I have been on a brief hiatus from writing due to being in charge of a fundraising walk. It's been a busy month for me, but I am going to be back posting soon. In the mean time, I have some new reading material for you! My co-worker and friend Sara Sauder, PT, DPT has recently launched her own blog specifically about pelvic pain. It's going to be a great resource for those dealing with pelvic pain. Go check it out!

Blog About Pelvic Pain