Tag Archives: pelvic floor

What comes after the PSA (Prostate-Specific Antigen)? The next steps

I had a conversation with Dr. Harold Frazier ( http://www.gwdocs.com/physicians/hal-frazier ) the other day about some alternative testing when Prostate Cancer is suspect. This would be the next step after the initial screening with the PSA if it shows an elevated level. In the past, a biopsy would be the next step. This however can pose a number of risks to the patient, infection, bleeding, and just being plain unpleasant.

We talked first about a blood test that I had heard about from the Cleveland Clinic called the 4Kscore test. This one combines four prostate-specific results with clinical information into an algorithm that calculates the individual’s risk for aggressive prostate cancer. It has good clinical confirmation behind it.

He also talked about another test that was not a blood test, but a urine test called SelectMDX. It measures the mRNA levels of two biomarkers and helps determine if the possibility of a more aggressive form of cancer is likely and if a biopsy is therefore warranted. Good news if you don’t want to go through another blood draw!

The downside is the expense of the test and the possibility that insurance may not cover the tests. The upside is that there are more options to help detect prostate cancer and the options are simpler and more effective than ever before.

As with all methods of prostate screening, a good dialogue with your doctor, your risk factors, and age should always be taken into consideration before proceeding.

By: Patrick Wenning, PT

Photo Credit: https://pixabay.com/en/what-s-next-yellow-sticker-note-1462747/

New Prostate Screening Recommendations 2018: Rethinking the use of the Prostate-Specific Antigen (PSA) test

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Men need to be proactive about their health. Cardiovascular fitness and blood pressure screening are often part of the regular check ups with their primary care physician. In the last few years, Prostate Cancer screening is becoming part of this proactive approach.

There has been some controversy over the past few years about when and how to screen for prostate cancer. What age do I start? What type of tests are there? Am I more at risk? Do I have to have an “uncomfortable” manual exam?

In the past, there were concerns about “over diagnosing”, “false positive” tests, and unnecessarily scaring men about the threat of prostate cancer; and as a result, the PSA (Prostate-specific antigen)-based test was not part of the proactive strategy. But there are now newer guidelines for men to follow about the PSA-based test to help men determine their risk factor.

The US Preventative Service Task Force (Independent volunteer experts in evidence based and preventative medicine who work to make recommendations about prevention.) https://www.uspreventiveservicestaskforce.org/ have set forth the following guidelines for use of the PSA by men:

Men age 55-69: individual decision on Prostate-specific antigen (PSA) based screening test. Need to discuss potential benefits and harms with their clinician.
Men age 70 – older: No PSA-based screening.
African American Men: Unable to make a recommendation.
Men with family history: Unable to make a recommendation.

There is a similar point of view now from the Prostate Cancer Foundation https://www.pcf.org/ on when to begin screening and if the test is appropriate for you:

40 ➣ If family history
45 ➣ If African American
50 ➣ If no history and not African American
55-69 ➣ Discuss with your Doctor
Over 70 ➣ Not recommended

Often, Men start thinking about how their health is changing somewhere in their early 50s. This is when prostate cancer screening should be considered. Something simple to keep in mind when considering those long term health choices.

By: Patrick Wenning, PT

Photo Credit: https://www.freepik.com/free-vector/person-completing-a-test_1064134.htm

Nina Helms: Yoga Instructor

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Restore Motion is excited to introduce a twice weekly vinyasa yoga class taught by veteran yoga teacher, Nina Helms. Nina has extensive experience practicing yoga since 1994 and was certified to teach at the White Lotus Foundation in Santa Barbara, CA in 2002. She combines her yoga expertise with her knowledge from her own struggles with injury and pelvic pain. Trained by the Yoga industry’s luminaries, Helms takes a non-dogmatic approach and is sensitive to body limitations while focusing on integrating strength, flexibility and balance. Nina’s teaching incorporates knowledge of the anatomy, familiarity with pain and the ability to coach to each practitioner’s ability and experience level. Join her every Tuesday at 11:00am or Wednesday evening at 6:00 to create space, healing and strength in your body and spirit.

Photo Credit: http://www.sheintimatefitness.com/about/

RM Hosts DMV Pelvic Floor Study Group

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Restore Motion hosted the DMV Pelvic Health Study Group Saturday, January 27th. There were over 23 attendees from DC, Maryland, VA and WV! Our guest presenter was Dr. Rachel Rubin a urologist who specializes in sexual health. We were thankful for the chance to discuss scholarly articles and challenging patient care issues with Dr. Rubin.

One sensitive topic discussed was the general outrage about the sexual abuse by USA Gymnastics Team physician, Larry Nassar . His actions put legitimate treatment of the pelvic floor in questionable light for the general public. (See link to article below by a pelvic floor PT and doctor of Physical Therapy.)

This determined group of therapists and physician want to speak out for the necessity of pelvic health and sexual health education for all ages. We also enjoyed catching up with and meeting our colleagues and friends. Always good to put a name with a face!

We plan hold more events that bring our network of colleagues closer together to help our patients. It often takes a team of practitioners to heal pelvic dysfunction and sexual trauma. Physicians (urologists, gynecologists, colorectal, gastroenterologists), physical therapists, mental health therapists, nutritionists and sex therapists refer to each other to promote each patient’s healing and well being.

Written by: Miriam Graham, PT, DPT, MBA

Nassar’s Atrocities Stigmatize A Legitimate Medical Treatment article by Lori Mize, PT, DPT

International Pelvic Pain Conference 2017

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Restore Motion physical therapists Carrie Cothran, Patrick Wenning, and Reshma Rathod attended The International Pelvic Pain Society Conference held in Washington DC October 11-15th. When asked to summarize her “take home discovery” from the IPPS Conference, Carrie Cothran replied, “Pain can be viewed as a neuro-immune response. Structures within the body that aren’t injured may still undergo an inflammatory reaction due to the tissue changes associated with pain. This in turn contributes to long-term protective responses that affect resting muscle tension and ability to do work. The protective responses that occur with pain make the body more vulnerable to injury.”

Patrick Wenning remarked, “At the conference, there was such enthusiasm for better understanding scientific knowledge of the pelvic floor. Most of the time, pelvic floor rehabilitation is new to people and to other PTs mainly because it is an area of the body that people don’t want to talk about. Discussion with fellow participants was frank and enlightening. They made me feel that I had something to contribute and that I made the right decision to pursue this specialty. I still have a lot to learn as the science continues to uncover more useful information!”

Reshma Rathod added, “Opioids don’t work with Fibromyalgia or chronic pain since the endogenous opioid receptors are already occupied due to changes associated with chronic pain. When opioids are given for acute pain, they interfere with mood, sleep patterns and contribute to headaches. Ironically, patients may want to continue on the opioid medication to address their depression, difficulty sleeping and headaches. The body’s dependence opioid medications ‘stick’ with the person making it more difficult to discontinue and cause more problems in the long run.”

RM Friend: Susan Hurson, MD

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Originally from Long Island, Sue Hurson has been a Washington, DC transplant since receiving her undergraduate education from Georgetown University. She worked at the National Cancer Institute for 6 years before attending Georgetown Medical School. While at the Cancer Institute she worked on projects that developed Taxol and Carboplatin for use in the treatment of cancer. She finished her residency at the Washington Hospital Center.

When asked why she chose OB/GYN, she recalls experience during clinical training drew her to gynecology. “I felt I could make a real difference in women’s lives by taking care of women though the continuum of life; I liked the combination of obstetrics, medical and surgical interventions.” Sue was drawn to medicine early in life. Her father was a physician and she volunteered as a candy striper as a teen. Dr. Hurson has practiced in Washington, DC for 25 years, she discontinued obstetrics in 2015 to focus on gynecology.

Sue Hurson’s practice philosophy is to forge a partnership between patient and physician to guide her patient through to optimal health. “Sometimes patients don’t know what to ask. I try to tell women what to expect, real ‘education and empowerment.’ To tell you what you need to know before you need to know—sometimes, as a patient, you don’t even know what to ask.”

She became interested in integrative medicine because of its focus on mind, body, and spirit. She says, “Functional Medicine is putting it all back together so the systems are connected and integrated because they all impact each other ~integrated specialization.” She uses a team approach with other physicians and practitioners such as acupuncturists, physical therapy, nutrition counseling, mental health and health coaching. She guides and encourages her patients, “Be the best you can be at your age, the body will change, knowledge is power.”

What is her most frequent recommendation for women to stay healthy? Sleep! She adds she more fully appreciated the benefits of sleep first hand after she stopped delivering babies to focus exclusively on GYN. “Get enough good quality sleep. It impacts so many areas of health. Prioritize sleep. There is better resilience and improved immune function with proper sleep.”

As told to Miriam Graham, PT, DPT, MBA

MAPP: Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain

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Malassezia spp. Skin Microbiome. https://skinmicrobiome.wordpress.com/tag/malassezia/

MAPP (Multi-Disciplinary Approach to the Study of Chronic Pelvic Pain) Finds That Fungus In Urine Might Be Linked to Urgency and Pain.

One of the most promising lines of research in urology today is the study of the biome, the diverse population of bacteria and fungi that live harmoniously in the human body. In previous MAPP Research Network studies, IC patients were found to have high levels of candida/fungi in their urine during flares (1). Another found that IC patients are deficient in some important bacteria in our bowel while having higher levels of other harmful bacteria (2). This latest MAPP Research Network study now links changes in fungal communities with the symptoms of urinary urgency and pain (3).

Researchers obtained urine specimens from 12 IC patients, 17 Over Active Bladder (OAB) patients and 14 patients without urinary symptoms. DNA was extracted, deep sequenced and compared to multiple fungal sequence databases. They found that patients with more severe symptoms, regardless of the symptom type, had decreased fungal diversity. Individual symptoms were associated with distinctive species of fungi. Patients with severe bladder pain had altered levels of Malassezia spp. composition while patients struggling with incontinence were inversely correlated with Wickerhamomyces spp.

The researchers concluded that the urinary microbiome is altered inpatients struggling with lower urinary tract symptoms, and that the loss of diversity in the microbiome correlated with worsening symptoms. Specific fungal patterns were found in patients with the symptoms of bladder pain and urinary urgency but interestingly this did not correlate with a diagnosis or medical condition. The researchers concluded, “These results suggest the intriguing possibility that particular microbial patterns maybe associated with specific symptoms, not necessarily diagnoses. This could lead to new diagnostic and treatment algorithms for patients struggling with lower urinary tract symptoms.” Clearly, there is a need for greater testing for fungi in urine screening. Bacteria may not be the root problem in some patients. It is time to consider the roll of fungus in bladder dysfunction.

Adapted from Jill Osborne 8/10/17 Interstitial Cystitis Network Blog, Research https://www.ic-network.com/mapp-research-network-study-finds-fungus-urine-might-linked-urinary-urgency-pain/

References:

Osborne J. Could IC Flares Be Caused By Candida – New research study finds higher rates of candida rather than bacteria during IC flares. IC Optimist Winter 2016.
https://www.ic-network.com/could-flares-be-caused-by-candida/
Osborne J. The DIPP Mystery – Why are IC patients deficient in some good bacteria. IC Optimist Summer 2016.
https://www.ic-network.com/dipp-mystery-ic-patients-deficient-bacteria-gut/
Journal of Urology, April 2017 Abstract MP29-10 Alterations in the Urinary Fungal Mycobiome in Patients with Bladder Pain and Urinary Urgency
https://www.ic-network.com/mapp-research-network-study-finds-fungus-urine-might-linked-urinary-urgency-pain/

Postpartum Pelvic Health: Vol. 1.

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During pregnancy and delivery, natural changes occur that impact your pelvic floor and abdominal wall. These changes can cause pain and discomfort for many women during pregnancy and/or after delivery. Childbirth takes a toll on our bodies regardless of the method of delivery.

The toll of postural changes and weight gain on the body can lead to conditions such has back pain, abdominal separation (diastasis recti abdominis), urinary urgency and leakage. It is a misconstrued notion that these symptoms are normal because they are common. Common is not the same as normal. Many women need assistance treating these symptoms so they do not deal with life-long consequences. The good news is therapists at Restore Motion are skilled in treating both pre and postpartum symptoms.

Physical therapy can help pregnant women be strong and fit while decreasing complications during delivery and improving the birth experience. Physical Therapy can also assist postpartum women in regaining their pre-pregnancy body.

Reshma taught Muscle Energy Technique to Women’s Tennis Association Physical Therapists and Miriam taught Sex Therapy U at the Chicago School of Professional Psychology in D.C.

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Reshma and Miriam dedicated time to help others in their professional development in January and February. Reshma taught a nearly full day webinar to physical therapists of the Women’s Tennis Association (WTA) February 4^th. The topic was Muscle Energy Technique (MET), an osteopathic manipulation technique where the action of a muscle is used to improve joint range of motion and the ability of muscle to fire. Reshma and Miriam started their study about and using MET in the 1990’s at Michigan State University School of Osteopathic Medicine CME. Reshma is one of a hand full of primary health providers in the world for the WTA!

Miriam also spent February 4^th teaching for Sex Therapy U at the Chicago School of Professional Psychology in downtown Washington, DC. The topic was Women, Sex and Therapy: Ongoing Sexual Pleasure and Couples Interventions for Healing – Treating Pelvic Floor Issues with PT and Sex Therapy. She presented various issues that affect pelvic floor and sexual function and how physical therapy can help those dysfunctions. The students got to practice breathing into the pelvic floor, and using racquet balls to roll out muscular trigger points in the legs and back and tips to help their patients understand pelvic floor function. They also learned ways to help their clients experience and explore communication through touch.

The staff of Restore Motion is planning to offer a pelvic floor and manual therapy continuing education course for Physical Therapy CEUs in the near future – “watch this space.”

Constipation: What is it and how can physical therapy help?

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According to the National Digestive Diseases Information Clearinghouse, someone is constipated if they have a bowel movement less than 3 times a week. This leaves a large range for what is considered “normal” frequency of defecation, from going three times a day (after every meal) to three times a week.

All of us will likely experience constipation at one time or another in our lives. Constipation just means that our food has spent too long in our colon, so more water than usual has been absorbed from the stool leaving it dry and hard to pass. This can be a frustrating symptom, leading to abdominal bloating, gas, increased pressure on the pelvic floor and surrounding organs and back pain. The best treatment is to be aware of the contributing factors and make daily lifestyle changes as needed.

What can lead to constipation?: Factors that may lead to constipation:

An imbalance in soluble and insoluble fiber intake, or lack of fiber in your diet
Not drinking enough water
Not enough physical activity
Changes in routine (irregular meal intake, traveling, unusual stress)
Ignoring the urge to go to the bathroom
Overuse of laxatives
Pelvic floor muscle dysfunction (we’ll come back to this later in the post)
Sometimes, constipation is a symptom associated with a specific condition such as from suffering a stroke, rectal prolapse, and irritable Bowel Syndrome or IBS. Constipation is common during pregnancy as the abdominal contents must shift and compress to accommodate a growing baby.

Physical therapy for Constipation

Help your pelvic floor muscles relax during defecation

When you go to the bathroom, your pelvic floor muscles should relax to “open the gates” and allow passage of stool and urine. Some people lose this normal coordination if they hold tension in their pelvic floor from life stress, or if they’ve had trauma to the pelvis, back, abdominals, or hips (childbirth and surgery). A pelvic floor physical therapist can help your body re-learn proper pelvic floor muscle coordination with biofeedback, manual therapy, and postural education.

Perform and teach you manual techniques to stimulate movement through your Intestines

In some cases, performing an abdominal massage can stimulate a bowel movement. Your physical therapist can teach you the massage sequence and appropriate amount of pressure. He/she can also perform visceral manipulation, techniques to restore normal movement in your abdominal organs.

Help you become more physically active

Your physical therapist can prescribe exercises to improve your flexibility and strength so that you can be physically active in the community without pain. Establishing a daily exercise routine is an important step in reducing constipation.

Photo: http://static.businessinsider.com/image/550b24a46da8115622cd5ecd/image.jpg

Written by: Claire Agrawal, PT
Edited by: Miriam Graham, PT